Transforming Eye Care Locally and Globally

“In 1909, if you had a cataract, there was a good chance that you’d be blind,” says Russell Van Gelder, the chair of UW Medicine’s Department of Ophthalmology and holder of the Boyd K. Bucey Memorial Endowed Chair in Ophthalmology.

Today, 100 years later, surgery is a successful and often-used clinical intervention for cataracts. Van Gelder estimates that 3 million cataract surgeries will be performed in the United States this year. In fact, the procedure is so prevalent that it has become almost routine. “It is rare that this isn’t the best option for patients today,” says Van Gelder.

We are the sole academic ophthalmology program for the 11.5 million people living in the five WWAMI states.

- Dr. Russell Van Gelder

The UW Medicine Eye Institute: Transformative Potential

Advances like cataract surgery have revolutionized ophthalmology, and Van Gelder sees the potential for more progress in the coming years. The UW Medicine Eye Institute will be an essential part of that progress.Since its founding, the UW Medicine Department of Ophthalmology has been a leader in eye care and research. For example, Carl Kupfer, the Department of Ophthalmology’s inaugural chair, was appointed the first director of the National Eye Institute (NEI), a position he held for 30 years. And the NEI funds 25 scientists at the University of Washington. With the launch of the new Eye Institute at Harborview Medical Center, UW Medicine will continue to build its regional reach and national reputation.

The institute includes most of the Department of Ophthalmology’s faculty, and it also will serve as an umbrella, bringing together multi-disciplinary research faculty from nine departments and three schools at the UW. Although not everyone will be housed at Harborview, the institute will help to better coordinate and focus many of the University’s vision-related projects, says Thomas Reh, professor in the Department of Biological Structure. The institute will “move vision research forward faster,” he says.

The fact that the institute will be “an integrated part of a larger enterprise” is one of its greatest strengths, says Van Gelder, the institute’s director. He notes that cross-fertilization of ideas often leads to innovation in clinical practice, research, and training.

“I believe in the transformative potential of what we’ve started,” Van Gelder says.

Tueng Shen, associate professor of ophthalmology, Brian Otis, assistant professor in electrical engineering, and Babak Parviz, associate professor in electrical engineering, designed an artificial cornea embedded with microelectronics. This half-millimeter eye chip, equipped with radiofrequency antenna, is designed to measure intraocular pressure — critical to eye health — and achieve continuous wireless transmission, allowing it to communicate with an ophthalmologist in the next room or on another continent. Still in development, their collaboration was recognized by Time magazine as one of the top 50 inventions of 2008. Illustration by Tueng Shen.

Tom Reh, a professor of biological structure affiliated with the eye institute, has been looking at ways to treat retinal diseases using stem cells. Recently, a graduate student in his laboratory developed a technique for transplanting photoreceptors developed from stem cells into mice. This image shows photoreceptors before transplantation. Photo courtesy of Tom Reh.

“It works! Now what?”

Among the institute’s primary activities will be vision research, and among those research projects will be the gene therapy work of husband-and-wife team Maureen and Jay Neitz, professors of ophthalmology, who began their collaboration 23 years ago.

“We thought that if we could better understand how the visual system works, we could help people who can’t see,” says Jay Neitz.

The Neitzes began investigating color blindness, which involves a genetic mutation that results in missing or damaged photoreceptors in the retina — those cells that distinguish red, green, and blue. The Neitzes theorized that replacing these defective genes with healthy ones might lead to normal vision. In 2007, they cured color blindness in squirrel monkeys using gene therapy.

Recognizing that the photoreceptors of the eye responsible for color are the same cells that we rely on to see in regular light, the Neitzes are also looking at gene therapy as a treatment for other vision-related conditions.

Curing color blindness served as a proof of principle. “It’s an issue of simply understanding the mechanism,” says Maureen Neitz. Now, adds Jay Neitz, “we’re at a place where this understanding can be applied.” Some of their work has suggested that it might be possible to slow down degenerative processes that lead to blindness and nearsightedness.

In addition to replacing defective genes in photoreceptors, UW Medicine Eye Institute researchers are also attempting to replace the photoreceptors themselves to restore vision to people with retinal degeneration. Tom Reh, for example, has been looking at ways to treat retinal diseases using stem cells. Recently, a graduate student in his laboratory developed a technique for transplanting photoreceptors developed from stem cells into mice. This confirmation of a lifetime of hypotheses is gratifying, says Reh, but knowing that it works is not enough. These discoveries need to be applied to benefit patients.

And therapies for patients are in the works. Reh, Van Gelder, and their colleagues at the UW Institute for Stem Cell and Regenerative Medicine are planning for the first clinical trials using stem cells to restore vision.

Successful research like Reh’s depends, in large part, on funding — on obtaining the resources to recruit expert faculty members who can compete for grants. Large eye centers in Boston, California, London, and Wisconsin are involved in similar work, says Reh, and the creation of the eye institute will make UW Medicine more competitive in the field of eye-related research and care.

“It’s a matter of who’s going to do it first,” Reh says. “If Seattle wants to be competitive in this field, the eye institute is critical.”

Helping people see, here and abroad

In addition to making UW Medicine more competitive on the research scene, the eye institute will make life better for patients. After surgery, patients will receive post-operative care at one site, rather than needing to visit different sites in the UW system. It’s a function of having all the subspecialties under one roof.

Deborah Lam, Res. ’06, acting instructor of ophthalmology, is delighted with the change. “This will improve continuity of care,” she says.

Comprehensive patient care also extends to trauma and injury. Housed at Harborview, the region’s only level I trauma center, the eye institute has a dedicated ophthalmological trauma service. For instance, Lam, the first director of Trauma Services, is on call five nights a week.

In addition to trauma care, the institute offers a number of other clinical services — including those provided by Tueng Shen, associate professor of ophthalmology, director of the Refractive Surgery Center, and the Northwest Lions Foundation Professor in Cornea and External Disease.

Shen performs refractive surgery, cataract surgery, and corneal transplant surgery using donor tissue. In addition, she performs special corneal surgery using an artificial cornea called the Boston Keratoprosthesis, developed by Claes Dohlman, her mentor at Harvard Medical School. Shen, who established the artificial cornea program at UW Medicine in 2004, is one of the few surgeons trained to perform the transplant of this artificial cornea.

Most of Shen’s patients are from Washington, Wyoming, Alaska, Montana, or Idaho (the region served by the UW School of Medicine), but she hopes, one day, to cast a wider net — to help more of the estimated 12 million people who have some form of corneal blindness, many in the developing world, where the health-care infrastructure makes corneal surgeries and post-operative care all but impossible. For those patients, says Shen, “the current model does not cut it.”

In an attempt to address these limitations, Shen’s research group is developing the next generation of artificial corneas for the global market. With her background in medical engineering, she and her colleagues in bioengineering and electrical engineering are designing biopolymer and wireless microelectronic systems that are customized for controlled medication release and post-operative monitoring. “Our goal is to create high-tech and low-cost solutions to treat blindness worldwide,” she says.

It’s an issue of simply understanding the mechanism. We’re at a place where this understanding can be applied.

- Maureen and Jay Neitz

Putting a value on vision

In the Department of Ophthalmology, there is palpable excitement surrounding the UW Medicine Eye Institute. “We have the opportunity to contribute at a high level across our mission,” says Russell Van Gelder.

Not only will the new facilities expand patient-care options and research collaborations, but they also will benefit training. Currently, the Department of Ophthalmology admits 12 trainees to its three-year residency program, with almost 400 applicants for four incoming resident slots. Van Gelder anticipates that the institute will make an already strong program even more competitive, and hopes to increase the number of resident positions — an important step forward, given the School of Medicine’s extensive service area. “We are the sole academic ophthalmology program for the 11.5 million people living in the five WWAMI states,” says Van Gelder.

The institute also provides an opportunity to recruit more faculty members. Faculty are attracted to programs where there are opportunities to take part in world-class research and clinical innovations, says Van Gelder. They will have access to both in the new 27,000-square-foot institute.

Of course, the eye institute’s primary beneficiaries will be its patients. Over the next 10 years, researchers anticipate a 50-percent increase in the incidence of the four leading eye diseases, ones largely associated with aging: cataracts, macular degeneration, diabetic retinopathy, and glaucoma.

In these circumstances, a resource like the UW Medicine Eye Institute is important not only for restoring sight, but also for maintaining or restoring quality of life for our aging population.

The benefits provided by the institute will be virtually incalculable, says Van Gelder. “You can’t assign a value to being able to drive or cook a meal, or the joy of watching your grandchild’s first baseball game,” he says. “Sight is simply part of the joy of being alive.”

By Sarah Park