Lead Researcher: Professor Jonathan Crowston
CERA’s Glaucoma Research program combines basic science and clinical research to translate research in glaucoma from the cell and molecular level through to animal models and clinical trials. Our basic work aims to increase understanding of the role of ageing in glaucoma and from this to develop new therapeutic targets. We have particular interest and expertise in mitochondrial dysfunction, which is where the energy producers in the cells fail to work properly. Our clinical work aims to improve glaucoma diagnosis and optimise patient management by improving the delivery of current treatments and translating new therapies into clinical practice.
- The effect of ageing on the optic nerve
- Glaucoma surgery wound healing
- Clinical research in glaucoma
- Genetic research in glaucoma
The effect of ageing on the optic nerve
We are conducting basic research to discover why ageing predisposes the optic nerve to degeneration in glaucoma. We have recently shown that aged mice show greater optic nerve dysfunction and oxidative stress compared to young mice, after an optic nerve injury. However, if the aged mice are put on calorie restricted diet, the optic nerve dysfunction and oxidative stress are significantly reduced. We are now trying to find ways to mimic calorie restriction and tap into the same biochemical pathways to protect the optic nerve. Our group is also looking at the effects of exercise on these processes.
Our research suggests that the mitochondria – the batteries that supply the cells with energy – play a critical role in the neurodegenerative diseases, including glaucoma. We are trying to find out if optimal mitochondrial function is a common benefit of both restrained diet and increased activity, and whether this can bolster the resistance of older optic nerves to stress.
We are also looking at how the mitochondrial function plays a role in diseases such as Autosomal Dominant Optic Atrophy (ADOA) and Leber’s Hereditary Optic Neuropathy. Mitochondria in these patients work less efficiently and these differences may be related to the severity of vision loss. We hope to better understand how the mitochondria overcome the genetic impairments in some patients so that we can develop novel therapeutics to prevent vision loss in at-risk patients.
Our group is also investigating a protein called Amyloid Precursor Protein (APP) in the ageing retina and glaucoma. We want to determine whether increased age and oxidative stress from intraocular pressure elevation, impair protective functions of APP in retinal ganglion cells. We can then look at ways to increase APP levels as a way to protect the optic nerve.
Glaucoma surgery wound healing
Our surgical researchers are looking at the effect of fluid biomechanics on ocular wound healing. Using an engineering-based approach, we are investigating the impact of mechanical forces on the wound healing response to glaucoma surgery in the rabbit. The aim is to create an engineering model that predicts an “ideal” mechanical environment for limiting postoperative scar formation. This knowledge will be used to develop a new glaucoma drainage device.
Clinical research in glaucoma
In collaboration with the University Of Melbourne School Of Audiology, we are trying to determine if neuronal dysfunction occurs outside the visual system in glaucoma. We think that glaucoma and other neuronal disorders may be associated with increased vulnerability of sensory neurons to oxidative stress.
Our clinical researchers have developed an internet-based assessment tool to determine a practitioner’s ability to diagnose glaucoma, called the Glaucomatous Optic Nerve Evaluation (GONE). This tool will help determine which disc characteristics most influence correct or incorrect glaucoma diagnosis. So far 750 eye care providers from around the world have participated and data will guide a targeted approach to the teaching of optic disc examination.
A study using patient compliance diaries and electronic monitoring devices demonstrated that approximately 30% of glaucoma patients do not adhere to treatment, and surprisingly, approximately 30% of non-compliers do so intentionally. In collaboration with Dr Gwyneth Rees, we are developing methods to address intentional non-adherence.
Genetic research in glaucoma
The Glaucoma Biobank project aims to collect 1000 blood samples and phenotypic data from glaucoma patients for genetic research into glaucoma.
Clinical Genetics at CERA also researches the genetics of glaucoma.