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Supporting the future of eye care research in Ireland

Now in its fifth consecutive year, the annual bursary is an unrestricted educational grant awarded to a doctor who wishes to undertake a research project or specific training in the field of ophthalmology.

The bursary has been instrumental in facilitating ophthalmologists in Ireland to undertake pioneering research into potential cures and treatments for sight-threatening conditions.

Commenting on the importance of the bursary, Mr William Power, President of the ICO and Consultant Vitreoretinal Surgeon at the Royal Victoria Eye and Ear Hospital, Dublin, said: “The ICO is delighted to confirm this fantastic opportunity for eye doctors to continue to be involved in cutting-edge ophthalmic research and we thank Novartis for their support. Eye research in Ireland is at an exceptionally high level so it is wonderful to support this work on future therapies and treatments for patients with eye conditions.”

Ms Loretto Callaghan, Managing Director, Novartis Ireland, said: “Novartis is delighted to partner with the ICO again in 2016 to support the Research Bursary. As a company, Novartis is committed to ophthalmology and to research in Ireland and we are delighted to continue our support in this area.”

At this year’s conference in Killarney, the two winners of the awarded funding for the ICO/Novartis Eye Research Bursary in 2015 presented an update on their projects.

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Dr Ghaleb Farouki (left) and Dr Khalid Kamel (third left), recipients of the ICO/Novartis Eye Research Bursary 2015, pictured with Miss Marie Hickey-Dwyer, ICO; and Dr Oliver McCrohan, Novartis, at the ICO Annual Conference 2016

Glaucoma

Joint 2015 bursary winner Dr Khalid Kamel was awarded funding for his clinical project examining a genetic weakness that may predispose certain glaucoma patients to accelerated optic nerve damage.

Affecting an estimated 67 million people worldwide, glaucoma is the second-leading cause of irreversible blindness. Dr Kamel’s study aims to find out whether patients with pseudoexfoliation glaucoma (PXFG) (a severe sub-type of glaucoma) have a genetic weakness in the mitochondria, and whether this genetic weakness predisposes their cells to be incapable of getting rid of toxic waste products that can lead to optic nerve damage.

To date, the study has recruited 40 PXFG patients, and Dr Kamel has completed training in skin biopsy techniques and isolation of skin cells, which will be used in mitochondrial function assessment. Training in mitochondrial function assays is ongoing in University College Cork labs and data collection will start in July 2016, followed by data analysis and results six months later, Dr Kamel said.

“If the study demonstrates that glaucoma patients with a mitochondrial gene defect are unable to clear away toxic waste products from cells, then we would propose that these patients would benefit from ‘across-the-counter’ medications (such as co-enzyme Q10) that enhance mitochondrial function to help control their glaucoma disease mechanism,” he explained. “This can eventually help in reducing the morbidity of glaucoma by decelerating visual loss.”

Dr Kamel encouraged trainees to put themselves forward for the bursary this year. “Of course the bursary was very helpful in funding the project, to go ahead with the steps in the lab, training and so on. That was very helpful. I would definitely advise other trainees to try to do such research, as it broadens your knowledge, gets you into different aspects of knowledge rather than just the clinical side. It helps to get into the basics; the basic science behind glaucoma, and the lab, and it introduces you more to the literature and the critical appraisal, to look into the studies in a critical way. It is very helpful and all adds to your experience.”

Wet AMD

Dr Ghaleb Farouki also presented an update on his joint winning project from 2015 at this year’s ICO Annual Conference, which is aimed at identifying patients at an increased risk of developing wet age-related macular degeneration (AMD). The animal-based project is investigating the potential protective role of neutralising interleukin-18 binding protein on the development of laser-induced choroidal neovascularisation in a mouse model.

AMD is the leading cause of central vision loss worldwide. The estimated prevalence of AMD in Ireland is 7 per cent and currently, AMD accounts for a third of the total cost of vision loss in the Republic, which is estimated to cost €400 million annually and predicted to rise to €2.7 billion by 2020. Current treatment for wet AMD is based on blockage of the action of vascular endothelial growth factor (VEGF) in the retina.

The research by Dr Farouki is taking place at the Ocular Genetic Lab at the Smurfit Institute at Trinity College Dublin under the supervision of Mr Mark Cahill, Dr Sarah Doyle and Dr Matthew Campbell.

Explaining the background to the study, Dr Farouki said inflammation plays a significant role in the development of AMD and in disease progression. “We are trying to develop new treatments that will target the inflammation and immune system that are part of macular degeneration. Interleukin-18 (Il-18) is a cytokine that has been highlighted as having useful anti-angiogenic (against the development of new abnormal blood vessels) effects, with promising results in animal studies, including the use of exogenous interleukin-18 as a therapy on its own and in combination with established treatments.”

He added that the results to date of the work “seem promising”.

“We are very excited about the real promise in terms of improved medium and long-term outcomes, in finding ways for earlier detection and treatment of that proportion of AMD patients who develop wet/neovascular AMD.”

Dr Farouki praised his research colleagues and supervisors and expressed gratitude for the opportunity afforded by the bursary.

“The work couldn’t have happened without the bursary. So I think it is amazing that the ICO and Novartis recognise the importance of supporting biomedical research in this area of ophthalmology. The hope is it will have effects in the real world, on patients’ outcomes and quality of life down the line.

“I would definitely encourage colleagues to explore opportunities that allow them to do useful and meaningful research and to explore areas of ophthalmology that they are interested in. Without this kind of high-quality research, there wouldn’t really be any potential for improving treatments and outcomes for people with such conditions.”

Negative regulators

The 2014 bursary winner Dr Maedbh Rhatigan also gave a presentation at this year’s ICO Annual Conference.

Dr Rhatigan was awarded the bursary for her project, titled ‘Negative regulators of inflammation and AMD in a cohort of the Irish Longitudinal Study on Ageing (TILDA)’. 

Explaining the project rationale, Dr Rhatigan said inflammation is known to play a role in the development of AMD, however the exact mechanisms remain unresolved. In collaboration with TILDA, Dr Rhatigan and the study team have looked at levels of negative regulators of three key inflammatory mediators, elevated in the blood of people with AMD.

 “It is our understanding these pathways may aid in identification of patients at increased risk of progression to more severe forms of AMD and may provide novel targets for therapeutic intervention.” 

To date, the research has found that the examined regulators are altered in patients with AMD.

“The ultimate aim is to have a panel of biomarkers to use, along with risk factors and clinical history and exam to identify people that might follow that ‘steeper curve’ so we can follow up and treat and have a disease risk algorithm for them,” Dr Rhatigan said.

 Commenting on the how the bursary aided her project, she said: “It allowed the screening of the off-regulators in an unbiased manner using cutting-edge technology, without which we would have been more restricted in our project design.”

Dr Rhatigan said the bursary had been a “very positive experience” overall and also encouraged colleagues to apply for the next round of funding under the bursary.

Anterior uveitis

Another winner of the bursary is Dr Michéal O’Rourke, who won in 2013 for his project on anterior uveitis.

“My research project had both clinical and experimental arms — from a clinical point of view, I developed a referral algorithm for ophthalmologists to refer patients presenting with anterior uveitis who may have underlying spondyloarthritis to rheumatologists, as well as assessing the impact of disease on the patient’s quality of life,” he explained.

 “In the lab, I showed aberrantly expressed micro-RNAs in anterior uveitis, assessed function of these microRNAs and identified novel gene targets for these micro-RNAs. I also examined the role of dendritic cells in circulation, as well as in the local inflamed micro-environment and downstream functional effects of these activated cells on T cells.”

 Dr O’Rourke said the bursary provided him with significant funding towards his three years of full-time research, from which he recently graduated with a PhD from UCD. “This time in research was invaluable to me, in that it allowed me to understand the role of evidence-based care in managing patients. It also gave me a fuller understanding into the global impact of the disease on patients, rather than just measuring clinical indices available in the outpatient setting. As a clinician-scientist, I understand fully the role of lab-based research and the importance of clinicians and scientists collaborating for better treatment options and novel treatment for patients. My research gave me a huge insight into the importance of knowing disease pathogenesis.”

 Dr O’Rourke is currently on the higher ophthalmology surgical training scheme and intends developing his research interests based on collaborations he developed during his PhD.

Opportunity

The ICO is now inviting interested medical practitioners to submit their applications for the ICO/Novartis 2016 Eye Research Bursary to the College by Monday, 5 September 2016.

The prize is not restricted to eye doctors in training and those in practice are encouraged to consider making a suitable application. Further details are available at www.eyedoctors.ie.

                           IE02/LUC16-CNF046

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