As ever, the latest high-quality Irish ophthalmological research featured heavily during the 2019 ICO Annual Conference, with outgoing President Dr Alison Blake praising the breadth and innovation of the submitted projects.
During the conference, recipient of the ICO/Novartis Eye Research Bursary 2018-2019 Dr Emily Greenan presented an update on her study ‘Multiomic Profiling of Ocular Inflammation in Dry Eye Disease and Targeted Therapy Using Novel Micro-RNA Based Therapeutics’.
Dr Greenan’s study is aimed at researching inflammation of the ocular surface, seen to be the main driving factor underlying the pathogenesis of dry eye disease, a key feature of primary Sjogren’s syndrome (pSS) and ocular graft versus host disease (GVHD) after allogeneic haematopoietic stem cell transplant (HSCT).
Ocular manifestations of GVHD develop in 40-to-60 per cent of patients following allogeneic HSCT, with keratoconjunctivitis sicca (dry eye) being the most common finding, present in 90 per cent of cases. For HSCT patients, severe dry eye persists after the remission of acute GVHD and normal tear function is rarely noted after four years of follow-up. Treatment options are reactive and several complications may follow such as punctate keratitis, corneal filaments, persistent epithelial defects, corneal keratinisation, ulceration and even perforation, in spite of adequate tear substitutes. Considering 25,000 HSCT are undertaken annually worldwide and that this figure will double in the next five years, it is critical that diagnosis and disease management strategies are improved, Dr Greenan told he Medical Independent (MI).
By identifying the dysregulated panel of microRNA, short sequences of mRNA that normally control the production or inhibition of inflammatory proteins, in her study, the hope is to offer new therapeutic targets for the disease. This knowledge will be combined with recently-developed nanoparticle drug delivery systems to provide a more effective and targeted treatment option for patient use in the future.
The research is being carried out between the Royal Victoria Eye and Ear Hospital (RVEEH), Dublin, and the RCSI as part of Dr Greenan’s PhD under the supervision of Prof Conor Murphy, Chair and Professor of Ophthalmology at the RCSI and Dr Joan Ní Gabhann at the Department of Ophthalmology and Molecular and Cellular Therapeutics, RCSI.
Meanwhile, the winner of the inaugural John Blake Research Medal at this year’s conference was Dr Alan Hopkins, Smurfit Institute of Genetics, Trinity College Dublin. He was presented with his medal by Prof Conor Murphy and Dr Alison Blake. The objectives of Dr Hopkins’s study titled ‘Fundus Fluorescein Angiography in Human Subjects Displays Circadian Variation’ was to examine the relationship between the circadian clock, retinal inner blood-retina barrier permeability and their possible role in retinal pathology.
As previously reported by MI, the new research paper medal is in honour of Dr John Blake (1932-2011), father of Dr Blake, for his tireless campaigning and lobbying of the Government in the 1980s to have toughened glass banned in favour of laminate windscreens and to ensure compulsory seat-belt legislation was properly enforced in order to prevent horrific eye injuries as a result of car crashes. The enforcement of these measures ultimately led to the virtual elimination of perforating eye injuries from road traffic accidents.
The winner of this year’s Barbara Knox Medal for Best Paper at the conference was Dr Clare McCloskey, SpR, University Hospital Waterford, for her paper titled ‘Audit of Acute Acquired Esotropia in Adults with Myopia’. The paper described the clinical characteristics of adult-onset esotropia in association with myopia in eight patients that recently presented to University Hospital Waterford.
All patients underwent bilateral medial rectus recessions with an adjustable suture following prism adaptation, and, following surgery, all patients were symptom-free of diplopia. This is possibly an increasing presentation ophthalmologists will see in clinic with rising rates of myopia worldwide, as well as advancing technologies mounting near work usage.
The winner of the William Wilde Medal for best poster at the conference was Dr Brian Woods, SHO, Mater Misericordiae University Hospital, Dublin, for his paper titled ‘A Retinal Rarity’. Retinal metastases are exceedingly rare, with only a few case reports in the literature and therefore represent a diagnostic challenge.
The case presented highlighted the importance of considering malignancy in a non-resolving retinal lesion, despite treatment. Data continues to be limited on how to best manage retinal metastases and what role screening has.