Devers Research Programs

Devers Research — Discoveries in Sight Research Laboratories

Research studies and programs currently in process at Devers Research — Discoveries in Sight Research Laboratories include:

 

Special facilities available through Devers Research — Discoveries in Sight Research Laboratories include:

Research Studies

Ocular Hypertension Treatment Study (OHTS)

Devers Eye Institute is the Portland site for the Ocular Hypertension Treatment Study (OHTS). The first five-year period of the study showed eye drops used to treat elevated pressure inside the eye are effective in delaying the onset of glaucoma. This clinical trial, sponsored by the National Eye Institute and the National Center on Minority Health and Health Disparities, then entered a second five-year phase to determine whether eye drops to lower pressure are as effective when started later compared to earlier treatment. 

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Visual Field Reading Center

Under the direction of Shaban Demirel, OD, PhD, the Discoveries in Sight Visual Field Reading Center (VFRC) serves as a global resource center for compilation, analysis and verification of visual field information. The VFRC is responsible for: 

  • Developing study specific reading center protocols for the collection and interpretation of visual field data.
  • Designing computer systems that allow quality control assessment and processing of visual field data.
  • Receiving, analyzing and interpreting visual field data, including statistical analysis of data transferred from national and international sites.
  • Certifying study sites and their staff involved in collecting visual field data, overseeing and managing the performance of quality control, patient recruitment and data collection.
  • Determining whether or not a visual field event or outcome has been reached, per study protocols

The VFRC has collaborative projects with government and private industry, including the National Eye Institute and National Institutes of Health clinical trials. There are currently 40 sites worldwide sending visual field data to our center.

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Epidemiology and Biostatistics

Under the direction of Stuart Gardiner, PhD and Steven Mansberger, MD, MPH, the Devers Eye Institute Ocular Epidemiology and Biostatistics Center (OEBC) serves to study the determinants of health-related conditions or events and their distribution within specific populations (epidemiology) as well as in the application of statistical methodology towards the description, analysis, modeling and interpretation of health-related data (biostatistics). Overall, the goal of epidemiology is to decrease the burden of disease in specified populations. This lies in contrast to the typical medical model of decreasing the burden of disease on an individual level.

The OEBC conducts multiple epidemiological and clinical trial studies. Some of our more recent studies include the determination of the prevalence of eye diseases in American Indian/Alaska Natives (AI/AN), an exploration of the determinants of compliance with glaucoma medications, an examination of the gains in vision-related quality of life after the provision of eyeglasses in AI/AN, the use of telemedicine to track progression of diabetic eye disease, and various clinical trials to determine the efficacy and tolerability of assorted eye medications and surgical procedures.

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Ocular Blood Flow Laboratory

Under the direction of Lin Wang, MD, PhD, the Ocular Blood Flow Laboratory focuses on the pathological role of blood flow in the mechanisms of glaucoma. By using different techniques, this lab has investigated vascular anatomy and physiology of microcirculation in the eye under normal and experimental conditions. Current projects include:

  1. To test the hypothesis that blood flow autoregulation dysfunction is a principle contributing mechanism to blood flow deficiency in the optic nerve and to visual system damage in an experimental model of glaucoma.
  2. To explore and advance different techniques for blood flow measurement and assessment of autoregulatory capacity in the optic nerve, which may translate for clinical application.
  3. In cooperation with Dow Neurobiology Laboratories, to investigate the neuropeptide processing system in the retina and its potential roles in the pathology of ischemic retina injury.
  4. In collaboration with Dr. Brad Fortune to develop techniques to investigate the angioarchitecture of the optic nerve head with a cutting-edge technology; and to advance, validate and compare several diagnostic tools that are used clinically to evaluate the nerve fiber layer in experimental models of glaucoma.

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Optic Nerve Head Research Laboratory

Under the direction of Claude Burgoyne, MD, the Devers Eye Institute Optic Nerve Head Research Laboratory (ONHRL) is funded by the National Institutes of Health along with private and corporate funding agencies to study the neural and connective tissues of the optic nerve head. To do so, this laboratory utilizes state of the art in-vivo and in-vitro three-dimensional (3D) imaging techniques to build high-resolution digital reconstructions of the optic nerve head tissues of normal and glaucomatous eyes. The laboratory is particularly interested in early glaucomatous damage and in the alterations in susceptibility which may be associated with optic nerve head aging. Ongoing collaborations with biomedical engineers, clinical ocular imaging researchers and cell and molecular biologists are adding to the laboratory’s ability to describe the basic mechanisms by which the neural and connective tissues of the optic nerve head are damaged in glaucoma. The long-term goal of the ONHRL is to translate optic nerve head basic science into clinical tools that will help predict an individual eye’s risk for developing glaucomatous vision loss.

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Axonopathy in Glaucoma

Under the direction of Brad Fortune, OD, PhD, studies are being conducted to evaluate progressive changes within the axons of the retinal nerve fiber layer (RNFL). These axons each project from a single retinal ganglion cell carrying information about the visual world to a specific target within the brain; they course along just beneath the retinal surface in bundles within the RNFL and join together to become the optic nerve as it leaves the eye to ultimately connect the eye to brain centers. Glaucoma is the most common optic neuropathy, indeed one of the leading causes of incurable blindness throughout the world. Damage and loss of these axons is what underlies loss of vision in glaucoma. We are interested in combining clinical and experimental studies to determine whether we can detect the earliest stages of abnormalities within these axons. We are also using the same techniques to probe hypotheses about the course of disease-related changes within the axons of the RNFL, that is, to study pathophysiological sequences in glaucoma and experimental disease models.

Our studies were supported at their earliest stages by pilot grants from the Legacy Good Samaritan Foundation, Legacy Research Institute, the Glaucoma Research Foundation and the American Health Assistance Foundation to Dr. Fortune as Principal Investigator and are currently supported by two NIH grants from the NEI: R01-EY019327 and R21-EY021311, both with Dr. Fortune serving as Principal Investigator.

Electrophysiology

Under the direction of Brad Fortune, OD, PhD, the Devers Eye Institute Electrodiagnostic Services and electrophysiology laboratory apply an array of electrodiagnostic and ocular imaging techniques to study both normal and abnormal aspects of the visual system. These techniques can reveal interesting aspects of normal visual system function or anatomy and also serve as important diagnostic tools for diseases of the visual system, the eye and brain. The goal of some portion of research in the Devers electrophysiology laboratory is to better understand the fundamentals and the intricacies of these electrodiagnostic techniques, while other projects aim to improve diagnostic capabilities or to gain insight into the process of eye diseases such as glaucoma.

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Perimetry and Psychophysics

The Perimetry and Psychophysics Laboratory, under the joint direction of Shaban Demirel, OD, PhDBrad Fortune, OD, PhD and Stuart Gardiner, PhD, is currently conducting the Longitudinal Study of Ocular Hypertension and Glaucoma. In this study, which is in its 15th year, people at risk of significant vision loss from glaucoma undergo a series of tests at regular intervals. The overarching aim is to better understand how glaucoma progresses over time. For example, how quickly does it worsen on average? Perhaps more importantly, we would like to identify individual patient features that predict who is most at risk for rapid worsening.

Results from this study are used to improve the clinical tests used by physicians to manage their patients with glaucoma. This type of ongoing study is quite rare (there are probably only a handful like it anywhere in the world), due to the large labor commitment and great cost involved in conducting such a study. Perhaps even more important to the success of the study is the enduring commitment of the patients being tested. Even though this type of study is difficult to conduct, there are certain questions about glaucoma that can only be answered by this approach, e.g., determining which clinical tests will identify the disease earliest. It is also important for describing the natural history and staging of this disease.

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Northwest Tribal Vision Project

American Indians and Alaska Natives (AI/AN) suffer from higher rates of systemic diseases, such as diabetes and cardiovascular disease. However, little information exists regarding eye disease in AI/AN. Under the direction of 
Steven Mansberger, MD, MPH, Devers Eye Institute designed the Northwest Tribal Vision Project (NWTVP) to provide preliminary information regarding the prevalence of eye diseases in Northwest AI/AN communities, to measure the quality of life benefits of providing eyeglasses, and to measure the impact of non-mydriatic cameras and telemedicine on preventing blindness from diabetic retinopathy.

Our current project, The Comparative Effectiveness of Telemedicine to Detect Diabetic Retinopathy, expands upon the NWTVP by evaluating the comparative effectiveness of telemedicine to traditional surveillance methods (annual eye exams in eye care provider's office) for detecting diabetic retinopathy. It aims to address three critical gaps in knowledge:  1) the efficacy for detecting diabetic retinopathy with telemedicine and traditional surveillance methods; 2) the health behavior factors related to receiving annual diabetic eye examinations; and 3) the cost-effectiveness of telemedicine when compared to traditional surveillance methods.

The Centers for Disease Control and Prevention funds this joint venture between Devers Eye Institute, Oregon Health and Science University's Prevention Research Center, the Northwest Portland Area Indian Health Board, and participating tribes both locally and abroad.

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Age-Related Eye Disease Study (AREDS)

This major clinical trial is sponsored by the National Eye Institute and is designed to assess the clinical course, prognosis and risk factors of age-related macular degeneration (AMD) and cataract, and to evaluate the effects of pharmacologic doses of (1) antioxidants and zinc on the progression of AMD and (2) antioxidants on the development and progression of cataract. Results from the Age-Related Eye Disease Study (AREDS) showed that high levels of antioxidants and zinc significantly reduce the risk of advanced age-related macular degeneration and its associated vision loss. These same nutrients had no significant effect on the development or progression of cataract. See http://www.nei.nih.gov/amd for more information.

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Age-Related Eye Disease Study 2 (AREDS2)

The Portland center for the Age-Related Eye Disease Study 2 (AREDS2) is under the direction of Michael Klein, M.D., Principal Investigator and Patty McCollum, Clinical Research Coordinator. AREDS2 is trying to determine whether the nutritional supplements, Lutein and Zeaxanthin, and two nutrients found in fish oil, DHA and EPA, will slow the development of advanced age-related macular degeneration (AMD). Lutein and Zeaxanthin are found in many yellow and orange fruits and vegetables, and in dark, leafy greens. The study will also look at whether reducing or eliminating certain vitamins and minerals from a previous nutritional supplement that slowed macular degeneration in people at risk for the advanced stages of the disease will work as well as the original supplement did.

There are approximately 90 medical centers in the United States participating in this study. Recruitment for the study ended June 30, 2008, and more than 4,000 patients have been enrolled. The study is sponsored by the National Eye Institute, one of the federal government’s National Institutes of Health. Results from this study are anticipated in 2013. See http://www.nei.nih.gov/areds2 for more information.

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Community Screening with the Frequency Doubling Technology

Since 1999, Devers Eye Institute has provided free glaucoma/visual field screenings to more than 17,000 individuals in Portland and surrounding communities using frequency-doubling technology. Devers Eye Institute recognizes the value of these screenings in their commitment to the prevention of blindness. Early diagnosis and intervention is key to successful treatment of glaucoma. Changes in visual field can also be a sign of stroke, retinal degenerations, diabetic retinopathy or brain disease along the visual pathway. The screening venues range from large health fair settings to small community events.

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Uveitis

The Uveitis research unit will be under the direction of Devers Eye Institute’s Chief of Ophthalmology, James Rosenbaum, M.D. He and his colleagues have studied the pathogenesis of intraocular inflammation (uveitis) for more than 30 years. This research involves animal models as well as clinical trials. A major portion of the current investigation into the origin and development of uveitis involves the interaction between bacteria in the intestine and the immune system. Dr. Rosenbaum’s work has been honored most recently with the International Uveitis Study Group Eye Foundation’s Gold Medal in 2012 and the Friedenwald Award from the Association for Research in Vision and Ophthalmology (ARVO) in 2011.