Glaucoma Research
Chat Highlights
June 26, 2002

Norma Devine, Editor

On Wednesday, June 26, 2002, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Glaucoma Research."

Moderator:  Dr. Rick, is there a particular aspect of glaucoma research that interests you the most?    

Dr. Rick Wilson:  I'm still a big proponent of stem cell research as the future to be able to restore sight, not just try to prevent loss.  The other area that has great potential is neuroprotection, i.e., treatment to increase the optic nerve's resistance to pressure rather than trying to lower it.  Doing both would be the best approach.

P:  Would regeneration of nerve damage help an aniridic eye?

Dr. Rick Wilson:  It should help any eye that has nerve damage.  In aniridia, the fovea, the center part of vision, has been absent since birth.  Perhaps the stem cells could be given normal genes to help a fovea develop. 

P:  I live in the U.K. and will be the first patient to receive stem cells to the nerve in my blind eye.  How would those cells be delivered to the optic nerve? 

Dr. Rick Wilson:  Probably a tiny needle, one much smaller than you have seen before, would be used in the retina or just in front of it.

Moderator:  What is a stem cell?  

Dr. Rick Wilson:  When sperm meets the egg, it forms a cell that divides into two, then into four cells, etc.  All the original cells can become anything they want, depending upon the stimuli they are exposed to.  As the organism continues to grow, it starts to differentiate, with different cells becoming more of one type of tissue, such as muscle or bone.  The early cells are stem cells. 

P:  Isn't it more difficult to get stem cells from bone marrow? 

Dr. Rick Wilson:  Cells from the bone marrow may be coaxed into becoming less specialized and then re-specialized.  But it is much more difficult than taking four- or eight-cell embryos left over from fertilization clinics.  If those cells are not used, they will be destroyed.

P:  Isn't stem-cell research controversial?

Dr. Rick Wilson:  The greatest hindrance to stem cell research in the U.S. is our government.  I respect anyone's feeling about abortion, but I cannot understand sacrificing lifesaving advances to save four- and eight-celled organisms that will be destroyed anyway.  Wouldn't it be great, for instance, for diabetics who are allergic to all insulin to be able to get a new pancreas made from stem cells from their own body?

P:  Isn't the U.S. lagging behind other nations in stem-cell research?

Dr. Rick Wilson:  England recently recruited one of our best researchers in stem-cell research.  The research climate in England is more conducive to advancement.  Europe, Israel, and Singapore will probably lead the science of stem cells.  Sorry to get on my soapbox, but the issue drives me to distraction.

P:  How much research is sponsored by drug companies versus other sources, such as universities, charities, the government and the public? 

Dr. Rick Wilson:  As you know, our government will not fund any research on stem cells except from existent lines.  That is slowing down the pace of research, since science is expensive.  Some venture capital companies are funding research without government assistance.  All pharmaceutical companies are looking at stem cells for a variety of uses. 

P:  Are researchers trying to turn stem cells into nerve cells? 

Dr. Rick Wilson:  That has already been done at Johns Hopkins and many other centers.  Now research is trying to make sure the cells differentiate into the correct nerve cells and do not grow tumors or show other unwanted side effects.

P:  I have stem-cell deterioration in my left eye.  I'm reluctant to undergo a cornea transplant because of my severe glaucoma.  How is stem-cell research proceeding in that area?  

Dr. Rick Wilson:  Recent research has shown that stem cells injected into animal retinas with nerves that have been damaged can grow back to the brain, developing into nerve cells.  The amazing thing was that these cells found the correct paths to grow back to the brain,  rather than just growing.  Developing that for human beings will take a while, but probably will become commonplace in our lifetimes.

P:  Cyclosporin is used to stop rejection of stem cell grafts.    Cyclosporin is an awful drug.  Is research being done to find something else?  

Dr. Rick Wilson:  Yes, researchers are looking for drugs that are more effective, as well as drugs that may be as effective as the ones we have now, but are more benign. 

P:  Is Copaxone going to be available any time soon for optic nerve protection?

Dr. Rick Wilson:  I'm sorry, but I am not familiar with the drug. 

P:  Copaxone is a vaccination being developed in Israel.  

Dr. Rick Wilson:  I had never heard it called that, but know the research you speak of.  It seems promising, but is too early to be sure if it would be neuroprotective of a chronic debilitating stimulus like high pressure for years.

(Editor's note: Professor Michal Schwartz of the Weizmann Institute’s Neurobiology Department in Rehovot, Israel, conducted a study that found vaccination with Copaxone may be neuroprotective.  Since the FDA has already approved the use of Copaxone for multiple sclerosis, scientists hope human trials can begin soon.)

P:  Are you interested in researching any particular drugs?

Dr. Rick Wilson:  Most of the drugs we are looking at come from the neurological, especially the stroke, literature. One of the problems with drops is that not much of the drop makes it to the back of the eye.  Nevertheless, it seems that some of the glaucoma drops may improve circulation slightly, and in that sense may be neuroprotective.

P:  Are you aware of any research being done on ICE (Iridocorneal endothelial) syndrome that involves the cornea?  

Dr. Rick Wilson:  The cornea is the cause of ICE syndrome. Diseased cells from the lining of the cornea grow over the drain in the eye, blocking it with a clear membrane, and pulling the iris up over the drain and, in many cases, pulling the iris apart.

P:  Is the cause of ICE syndrome known? 

Dr. Rick Wilson:  Since there is a higher prevalence of  herpes in corneas of patients with ICE syndrome, compared to the general population, it is thought that a fetal, or early childhood ocular infection, with herpes might be the cause of ICE syndrome.

P:  What limits are placed on a doctor's remuneration from drug companies when the doctor participates in research involving drugs?

Dr. Rick Wilson:  If the patient is being treated as part of a study, the patient should not be charged.  Most drug companies pay for staff and doctors' time, but not at the level that would be made if the doctor was seeing paying patients.  Research is not a well-paid field compared to patient care or business.

P:  Are researchers trying to solve the problem of glaucoma directly?  For example, are they asking (or have they ever asked) exactly what went wrong with an eye that developed open-angle glaucoma?  Have they tried to restore the original through discoveries in that direction -- as, for example, a doctor might set a broken bone?  I'm thinking along mechanical lines.

Dr. Rick Wilson:  They are asking those questions all the time. We're getting closer but the clues are not easy to come by.

P:  Little research involves the effect of drugs on children.  Labels state the drugs are not recommended for children.  Is anything being done about that?  

Dr. Rick Wilson:  Yes, the FDA has asked all companies to research the safety and effectiveness of their current medications on infants and children.  The FDA is giving inducements, I think, in terms of patent extension,  to prove that. 

Moderator:  Thank you, Dr. Rick.

Dr. Rick Wilson:  You're welcome.  Have a happy Fourth of July.  There will be no doctor here on the Fourth.  See you in two weeks.

End of highlights for June 26, 2002.

On July 10, Dr. Wilson discussed "Shunt Surgery" in the Chat room. Click here for highlights of that meeting.

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