UC Davis study has important implications for improving balance and preventing falls.

UC Davis Health System Eye Center research has found that visually impaired individuals and those with uncorrected refractive error — those who could benefit from glasses to achieve normal vision but don’t wear glasses — have a significantly greater risk of diminished balance with their eyes closed on a compliant, foam surface than individuals with normal vision.

The research, published in today’s (June 6) issue of JAMA Ophthalmology, suggests that vision may play an important role in calibrating the vestibular system, which includes the bones and soft tissue of the inner ear, to help optimize physical balance. The work provides direction for more targeted studies on how poor vision impacts vestibular balance, and how to better develop fall prevention strategies for those with poor vision.

“We know that vision and balance are highly integrated in the brain, but we don’t fully understand the relative contributions of the visual, proprioceptive, and vestibular systems in maintaining balance and preventing falls, especially among the visually impaired,” said Jeffrey R. Willis, an ophthalmology resident at UC Davis Health System Eye Center and lead author of the study.

“Our research is the first large scale population study to compare objective measures of physical balance across individuals with normal vision, uncorrected refractive error, and the visually impaired, and the first to link poor vision with diminished vestibular balance,” he said. “These results have important implications for improving balance and mobility in the U.S. population and preventing falls.”

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Mark Mannis named to University of Florida medical college’s Walk of Fame.

Mark Mannis, UC Davis

Mark J. Mannis, director of the UC Davis Eye Center, has been named to the University of Florida College of Medicine’s Wall of Fame.

Mannis is professor and chair of ophthalmology and vision science and a 1975 graduate of the University of Florida medical college. He joins 24 fellow alumni who have been recognized for outstanding contributions since 1991 when the award was established.

Mannis was honored for his leadership and scientific contributions in the field of corneal transplantation as well as for his commitment to ophthalmic education in the United States and throughout the world. He has published more than 125 papers and is the author of five books on topics relating to corneal surgery and disease.

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Farsighted engineer invents bionic eye to help the blind.

For UCLA bioengineering professor Wentai Liu, more than two decades of visionary research burst into the headlines last month when the FDA approved what it called “the first bionic eye for the blind.”

The Argus II Retinal Prosthesis System — developed by a team of physicians and engineers from around the country, including from Lawrence Livermore National Laboratory and UC Santa Cruz — aids adults who have lost their eyesight due to retinitis pigmentosa (RP), age-related macular degeneration or other eye diseases that destroy the retina’s light-sensitive photoreceptors.

At the heart of the device is a tiny yet powerful computer chip developed by Liu that, when implanted in the retina, effectively sidesteps the damaged photoreceptors to “trick” the eye into seeing. The Argus II operates with a miniature video camera mounted on a pair of eyeglasses that sends information about images it detects to a microprocessor worn on the user’s waistband. The microprocessor wirelessly transmits electronic signals to the computer chip, a fingernail-size grid made up of 60 circuits. These chips stimulate the retina’s nerve cells with electronic impulses which head up the optic nerve to the brain’s visual cortex. There, the brain assembles them into a composite image.

Recipients of the retinal implant can read oversized letters of the alphabet, discern objects and movement, and even see the outlines and some details of faces. And while the picture is far from perfect — the healthy human eye sees at a much higher resolution — it’s a breakthrough for people like the first patient, a man in his 70s who was blinded at age 20 by RP, to receive the implant in clinical trials. “It was the first time he’d seen light in a half-century,” said Liu, adding that “it feels good as the engineer” to have helped make this possible.

Liu joined the Artificial Retina Project in 1988 as a professor of computer and electrical engineering at North Carolina State University. The multidisciplinary research project was funded by the U.S. Department of Energy’s Office of Science because it envisioned a potential pandemic of eyesight loss in America’s aging population. Leading the project was Duke University ophthalmologist and neurosurgeon Dr. Mark Humayun, now on faculty at USC. He tapped Liu to engineer the artificial retina.

“I thought it was a great idea,” Liu said. “But I asked, ‘What can I do?’ because I didn’t know much about biology.” Humayun handed him a six-inch-thick medical manual on the retina. “The learning curve was very steep,” Liu recalled with a laugh.

However, Liu’s fellow engineers questioned his sanity. “I was working on integrated chip design and had just gotten tenure when I signed on to this project. They said, ‘You’re crazy!’ But I’m glad I made that choice, getting into this new field.”

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Artificial retina can partially restore sight of blind individuals after surgical implantation.

Argus II: A retinal prosthesis contains a small implantable chip with electrodes.These electrodes stimulate the retina and help people regain limited vision.

The U.S. Department of Energy announced Thursday that its support for a decade of revolutionary research has contributed to the creation of the first ever retinal prothesis — or bionic eye — to be approved in the United States by the U.S. Food and Drug Administration for blind individuals with end-stage retinitis pigmentosa.

LLNL engineers played a key role in the project by developing the microelectrode array for the epiretinal prosthesis.

The artificial retina, dubbed the Argus II Retinal Prosthesis System (developed and manufactured by Second Sight Medical Products Inc. of Sylmar), may prove to be an aid to those blinded by the disease retinitis pigmentosa, which can run in families and is estimated by the National Institutes of Health to affect about 1 in 4,000 people in the United States. Over the 10-year lifetime of the project, the department provided $75.2 million for the development of technologies aimed at advancing artificial retinas like the Argus II, which was based on work by a consortium of scientists using advanced technologies developed by several of the department’s national laboratories.

“The team was very passionate about this project because there is such a need for a device like this,” said Satinderpall Pannu, the engineer who led the Livermore team. “While we were developing the technology, we received a lot of plaintive e-mails from people around the world who wanted to be a part of the clinical trials or who were just looking for a ray of hope for themselves or their children. It is most gratifying to see this device finally become available to the people who need it and provide them with the hope of a better tomorrow.”

The Argus II can partially restore the sight of blind individuals after surgical implantation. Clinical trials demonstrated that totally blind individuals could safely use the device to successfully identify the position and approximate size of objects and detect movement of nearby objects and people.

Expertise in biomedical microsystems at Lawrence Livermore’s Center for Micro and Nano Technology was tapped to develop a “flexible microelectrode array,” able to conform to the curved shape of the retina, without damaging the delicate retinal tissue, and to integrate electronics developed by UC Santa Cruz. The device serves as the interface between an electronic imaging system and the human eye, directly stimulating neurons via thin film conducting traces and electroplated electrodes.

The multi-institutional team that developed the artificial retina received a Popular Mechanics Breakthrough Award in 2010. In 2009, the team also received an R&D 100 Award from R&D Magazine. The Livermore team was led by Satinderpall Pannu and included: Phillipe Tabada, Courtney Davidson, Terri Delima, Sarah Felix, Julie Hamilton, William Benett, Kedar Shah, Maxim Shusteff, Vanessa Tolosa and Angela Tooker.

The LLNL team contributed three major components to the artificial retina program: the thin-film electrode array that contains the neural electrodes; the biocompatible electronics package that contains the electronics for stimulating the retina and wireless power and communications; and an ocular surgical tool that will enable the replacement of the thin-film electrode array. In addition, Lawrence Livermore was responsible for the system integration and assembly of the next generation artificial retina system.

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Beckman Foundation funding will be used explore blindness-prevention therapies.

The first-floor Gavin Herbert Eye Institute clinical center will be named the Arnold & Mabel Beckman Foundation Center for Vision Care in honor of the late inventor and his wife.

The Gavin Herbert Eye Institute, which is part of UC Irvine Health, has been awarded a $3 million grant from the Arnold and Mabel Beckman Foundation for fellowships and instruments that advance research to prevent blindness caused by such diseases as age-related macular degeneration and retinitis pigmentosa.

“We are grateful to the Arnold and Mabel Beckman Foundation for demonstrating confidence in the quality of scientific discovery taking place at the Gavin Herbert Eye Institute,” said Dr. Roger Steinert, professor and chair of ophthalmology and director of the Gavin Herbert Eye Institute. “Researchers here share the late Dr. Beckman’s commitment to excellence and will use this grant to strategically support our bold goal of eradicating blindness by 2020.”

The Beckman Foundation grant includes $1 million for state-of-the-art instruments designed to perform promising medical procedures such as stem cell transplantation for retinal degeneration.

Dr. Henry Klassen, associate professor of ophthalmology, and his Gavin Herbert Eye Institute team have shown that stem cells can repair damaged retinal cells in retinitis pigmentosa, the most common form of inherited retinal degeneration. If proven effective in humans, this treatment could change what it means to be diagnosed with age-related macular degeneration, a disease that affects the vision of 1 in 27 Americans.

The other $2 million from the Beckman Foundation grant establishes fellowships for young researchers to contribute to stem cell studies and other exciting new avenues of eye research. Working alongside some of the nation’s leading ophthalmologists, these fellows will participate in the discovery process and learn the latest clinical procedures in vision care.

An earlier grant from the Beckman Foundation provided $2 million to support construction of a new center for the Gavin Herbert Eye Institute on the UC Irvine campus. The 70,000-square-foot medical facility, which is slated to open for patients in September, includes design features recommended by the Braille Institute that will make it easier for low-vision patients to navigate within the building. The first-floor clinical center will be named the Arnold and Mabel Beckman Foundation Center for Vision Care in honor of the late inventor and his wife. The building, which is funded entirely through local private philanthropy, will be Orange County’s first university eye center.

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UCLA eye surgeon Leonard Apt dead at age 90.

Leonard Apt

Internationally respected UCLA eye surgeon Dr. Leonard Apt, who co-developed an inexpensive antiseptic eye drop that substantially reduced the incidence of blindness in children in developing countries, died Feb. 1 at UCLA Medical Center, Santa Monica, after a brief illness. He was 90.

A founding member of the Jules Stein Eye Institute at UCLA and an emeritus professor of ophthalmology, Apt was the first physician in the world to become board-certified in both pediatrics and ophthalmology. He devoted his career to preventing blindness in children.

Together with longtime collaborator Dr. Sherwin Isenberg, Apt identified povidone–iodine as a safe topical antimicrobial agent. Prior to their research, no previous studies provided a standard for sterilizing the surface of the eye before surgery. Known commercially as Betadine, the eye drop is now used throughout the world to prepare patients for eye surgery and prevent infection. Apt and Isenberg also demonstrated that Betadine was safer, cheaper and more effective than silver nitrate or antibiotics in preventing eye disease in newborns.

“Leonard described himself as ‘a man of firsts,’ and he really was,” said Isenberg, UCLA’s Laraine and David Gerber Professor of Ophthalmology and chief of ophthalmology at Los Angeles County Harbor–UCLA Medical Center. ”He had very clever ideas and constantly looked for meaningful ways to improve patient care on a large scale. His prolific research resulted in innovations in pediatrics and ophthalmology that are now used all over the world.”

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Potential to restore retinal function after injury or disease.

Alexander Sher, UC Santa Cruz

Alexander Sher, assistant professor of physics, has received a grant totaling $2.5 million over five years from the National Eye Institute, part of the National Institutes of Health (NIH). The grant supports Sher’s research on how the retina heals itself after laser surgery.

Sher uses custom-designed arrays of microscopic electrodes to study the activity of retinal neurons. He contributed to recent research showing that light-sensitive photoreceptors can migrate into retinal lesions caused by selective laser photocoagulation and reconnect with retinal neurons to fill in blind spots. Last year, he received funding as a Pew Scholar in the Biomedical Sciences for a project to further explore how the retina responds to this laser treatment. The new NIH grant provides major funding for Sher’s ongoing investigation of the potential to restore retinal function after injury or disease.

“Our earlier findings demonstrated that the retina has the potential for constructive plasticity that was never observed or even suspected before,” Sher said. “Our goal is to establish the mechanism and the limits of this new and exciting phenomenon.”

Laser photocoagulation is widely used to treat retinal diseases, but side effects of the current standard method include retinal scarring and blind spots. A new approach, using shorter pulses of laser light, destroys photoreceptor cells but leaves underlying retinal neurons intact. Sher has documented the migration of photoreceptor cells into the lesion, where they establish new connections with inner-retinal neurons.

“The newly discovered phenomenon of photoreceptor migration and rewiring may enable restoration of visual function in retinal lesions,” Sher said.

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UCLA finding provides new insights into heat shock proteins.

Zhe Jing, UCLA

UCLA researchers, in a finding that runs counter to conventional wisdom, have discovered for the first time that a gene thought to express a stress-response protein in all cells that come under stress instead expresses the protein only in specific cell types.

The research team, from the Jules Stein Eye Institute at UCLA and the UCLA Division of Pulmonary and Critical Care Medicine, focused on αB-Crystallin, one of a class of molecules known as heat shock proteins, which are involved in the folding and unfolding of other proteins, helping them recover from stress so they can do their job.

The expression of heat shock proteins is increased when cells are exposed to taxing environmental conditions, such as infection, inflammation, exercise, exposure to toxins and other stressors.

The heat shock protein αB-Crystallin may be associated with certain cancers and could be developed into a biomarker to monitor for diseases such as multiple sclerosis, age-related macular degeneration, heart-muscle degeneration and clouding of the eye lens. Any discoveries about how this protein is regulated and its molecular biology may reveal potential targets for novel therapies, said the study’s first author, Zhe Jing, a research associate in the UCLA Division of Pulmonary and Critical Care Medicine.

“If you use a certain cell type, this protein can be induced when the cells are stressed, but that doesn’t happen in a different cell type,” Jing said. “This novel finding does conflict with what has been thought — that this protein could be induced in any cell type.”

The findings of the two-year study are published in the current issue of the journal Cell Stress and Chaperones, a peer-reviewed journal for research on cell stress response.

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$16M from Gates Foundation supports international projects.

UCSF's Thomas Lietman treats a young boy in Ethiopia, where communities that received mass doses of azithromycin to treat trachoma experienced an overall reduction in childhood mortality from all causes.

Two UC San Francisco teams have received a total of $16 million from the Bill & Melinda Gates Foundation to study new ways to significantly reduce childhood mortality and disease in developing nations.

An international team led by Thomas M. Lietman, MD, associate director of the UCSF Francis I. Proctor Foundation for Research in Ophthalmology, received $12 million for a multiyear trial to study the effectiveness of mass oral administration of the antibiotic azithromycin in reducing childhood mortality in Niger, Tanzania and Malawi – three nations with severe childhood mortality rates.

A second team, led by James H. McKerrow, M.D., PhD, professor of pathology and pharmaceutical chemistry, received $4.3 million to identify and develop a drug that kills the parasitic roundworms known as filiariae that cause river blindness, the leading cause of blindness in parts of West Africa.

If successfully developed, the same drug will have a high probability of killing the closely related parasite that causes lymphatic filariasis, or elephantiasis, a crippling and disfiguring disease that affects millions of people in Africa, Asia, the Indian subcontinent and South America.

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Preschoolers to receive vision services.

UCLA Mobile Eye Clinic

Young children in Los Angeles County who are in need of vision services will soon be seeing things a lot clearer, thanks to a new collaboration between the Jules Stein Eye Institute at UCLA and First 5 LA, the child advocacy and grant-making organization.

The UCLA Mobile Eye Clinic, an outreach program of the Stein Institute, has received an allocation of $4.1 million from the First 5 LA commission that will be used to screen more than 90,000 children between the ages of 3 and 5 from underserved populations in the county over the next five years.

Under the collaboration, the UCLA Mobile Eye Clinic will provide services to preschoolers, including initial vision screenings at preschool locations; full-eye exams conducted by ophthalmologists and optometrists for children who fail the initial exam; referrals to partner specialists for visually impaired children who need special medical or surgical treatment; and free eyeglasses for those with refractive errors.

Additionally, the mobile clinic has an automated scheduling, coordination and data-registration program that makes it easy for parents to schedule appointments, and the clinic’s staff will work hand-in-hand with preschool teachers and parents to ensure follow-up care and compliance.

UC Davis finding could help lead to new treatments for visual deficits.

Scanning electron micrograph of rod photoreceptors lining the surface of a mouse retina.

On the road at night or on a tennis court at dusk, the eye can be deceived. Vision is not as sharp as in the light of day, and detecting a bicyclist on the road or a careening tennis ball can be tough.

New research reveals the key chemical process that corrects for potential visual errors in low-light conditions. Understanding this fundamental step could lead to new treatments for visual deficits, or might one day boost normal night vision to new levels.

Like the mirror of a telescope pointed toward the night sky, the eye’s rod cells capture the energy of photons ― the individual particles that make up light. The interaction triggers a series of chemical signals that ultimately translate the photons into the light we see.

The key light receptor in rod cells is a protein called rhodopsin. Each rod cell has about 100 million rhodopsin receptors, and each one can detect a single photon at a time.

Scientists had thought that the strength of rhodopsin’s signal determines how well we see in dim light. But UC Davis scientists have found instead that a second step acts as a gatekeeper to correct for rhodopsin errors. The result is a more accurate reading of light under dim conditions.

A report on their research appears in the October issue of the journal Neuron in a study entitled “Calcium feedback to cGMP synthesis strongly attenuates single photon responses driven by long rhodopsin lifetimes.”

Individual rhodopsin errors are relatively small in magnitude ― on the order of a few hundredths of a second ― but even this much biological noise can affect how well the signal gets transmitted to the rest of the brain, the researchers said.

The gatekeeper protects us from “seeing” more light than is actually there ― a misreading that would have endangered an ice-age hunter, as it would a driver at dusk today. The correction may prevent the photon receptor from swamping the intricate chemical apparatus that leads to accurate light perception.

“The rhodopsin receptor is the site where physics meets biology ― where a photon of light from the physical world must get interpreted for the nervous system,” said Marie Burns, professor of ophthalmology and vision science at UC Davis School of Medicine and lead author of the study. “Biology is messy. Rhodopsin does a remarkable but not perfect job.”

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