Text on bright blue background promoting research to prevent blindness.

Celebrating Research to Prevent Blindness

Research to Prevent Blindness (RPB) is celebrating 30 years of its highly impactful Career Development Awards, which jump-start research early in the careers of outstanding scientists.

 

Sixteen UCSF vision scientists have received Career Development Awards over the years, advancing new knowledge, insights, and solutions — building blocks in the future of vision. UCSF vision research continues to benefit from these and other RPB awards, including three this year.

 

Portrait of a woman in a dark suit with short hair against a blue background.Nurturing Novel Approaches

Thuy Doan, MD, PhD, applied her 2016 RPB Career Development Award to help launch pioneering genomic studies of the ocular micro-environment (biome) in search of pathogens underlying uveitis inflammations.

Dr. Doan’s international work at the Proctor Foundation involves investigation of the intestinal microbiome for an antibiotics study of 190,000 children in sub-Saharan Africa. Dr. Doan is lead author of a new Proctor publication in Nature Medicine,* which posits that reductions in two diarrhea-related bacteria may be a factor in higher child survival rates.

“Those of us who study… child survival in sub-Saharan Africa haven’t seen well-done trials showing such a striking mortality benefit in a really long time, so it’s very exciting,” says Patricia Pavlinac, MD, a University of Washington epidemiologist.

 

A woman smiling with long dark hair in a patterned blue blouse.

Preventing AMD

Retinal cell biologist Aparna Lakkaraju, PhD, won RPB’s 2019 Catalyst Award for Innovative Approaches to Age-Related Macular Degeneration (AMD). Her team uses innovative microscopy, genome editing, and stem cell technologies to pinpoint genetic and cellular mechanisms responsible for initiating AMD, and identify promising therapies to target the earliest disease stages to preserve central vision. The research builds on earlier successes made possible by her Career Development Award in 2010.

 

Understanding Epidemics

RPB collaborates with the American Academy of Ophthalmology to grant awards for big data research. Michael Deiner, PhD; Thomas Lietman, MD; and Travis Porco, PhD, won this 2019 award to use the exceptional IRIS Registry to study infectious eye epidemics in the United States.

 

Strategic Flexibility

The Department of Ophthalmology was awarded an RPB unrestricted grant this year as well. The five-year grant extends decades of institutional support from the foundation. “We’re extremely grateful,” says Department Chair Stephen D. McLeod, MD. “These awards allow us to build high potential research from the ground up.”

 

*T Doan, A Hinterwirth, L Worden, AM Arzika, R Maliki, A Abdou, S Kane, L Zhong, SL Cummings, S Sakar, C Chen, C Cook, E Lebas, ED Chow, I Nachamkin, TC Porco, JD Keenan, TM Lietman. “Gut microbiome alteration in MORDOR I: a community randomized trial of mass azithromycin distribution.” Nature Medicine. 2019 Aug 12.

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A caregiver giving medication to a child.

The Proctor Foundation Saving Sight and Lives

Committed to reducing blindness worldwide, UCSF’s Francis I. Proctor Foundation for Research in Ophthalmology has worked in sub-Saharan Africa since 2000.

A major investigation led by the Proctor Foundation is rocking the public health firmament. “The study shows we can prevent young children in sub-Saharan Africa from dying with a simple intervention,” says Jeremy Keenan, MD, MPH, director of International Programs.

This team previously established that the same intervention saves children’s sight. The UCSF team and international partners investigated whether giving two doses a year of a common antibiotic to infants and toddlers in Malawi, Tanzania, and Niger would reduce child deaths. The work was funded with $14.8 million from the Bill & Melinda Gates Foundation.

According to principal investigator Thomas Lietman, MD, the biggest effects were seen in Niger, where 10 percent of newborns do not survive to their fifth birthday. A continuation of the Niger study will examine the impact of a four-year course of treatment, with the support of a $2.4 million Gates Foundation award.

Tens of Thousands of Lives Saved

With 190,000 children participating, the treatments prevented one in four deaths among 1- to 5-month-olds and slashed death rates by nearly 14 percent overall. The New England Journal of Medicine published the results in April, with Dr. Keenan as lead author. The news was covered everywhere from CNN to the Wall Street Journal and NPR.

The New York Times reported that these results are influencing the World Health Organization to decide whether to advise routinely giving antibiotics to newborns. Such a recommendation could speed progress toward the United Nations’ goal of ending preventable child deaths by 2030. Concerns about antibiotic resistance are central to this discussion. In fact, Proctor scientists monitored resistance bacteria in the respiratory tract and the stool, and they will continue to do so for the next two years.

Saving Sight Increased Survival

The Proctor Foundation’s meticulous studies on community-wide administration of the antibiotic azithromycin have played a leading role in arresting the epidemic spread of trachoma.

Early studies also showed that the vision-saving treatment increased survival rates for young children. Researchers believe the antibiotics could possibly help children fight off pneumonia, malaria parasites, and diarrhea, the biggest causes of death for this group.

Group of smiling children in a village setting.
Lack of basic medicines and good sanitation leaves infants and children vulnerable to disease.

 

Next Study to Support Newborns

The UCSF team is taking another leap forward, supported by a new $13.5 million award from the Gates Foundation. A three-year study of at least 50,000 young children in Burkina Faso is being planned. Drs. Lietman and Keenan share principal
investigator honors with colleagues Catie Oldenburg, PhD, and Thuy Doan, MD, PhD. In the first study, most babies were not treated in their earliest months, when they are most vulnerable. “In Burkina Faso, we are partnering with local health workers to provide azithromycin to infants at 4-6 weeks, during vaccine visits,” explains Dr. Oldenburg. The study will explore whether treatment in the first weeks of life helps infants survive.

Biosamples to Yield Answers

Biosamples gathered from the infants and toddlers are critical to understand precisely why more children survive,” says Dr. Doan. Using conventional and advanced genetic sequencing techniques, she will analyze samples from the back of the throat and the gut to determine which pathogens are being killed. She’ll also monitor for antibiotic-resistant genes and characterize the microbial environment in these children’s digestive systems.

“ Thanks to the Bill & Melinda Gates Foundation, we are able to test our strategies at scale.” – Dr. Thomas Lietman

 

Research Benefits Sight, Too

“As we determine how best to use antibiotics to help vulnerable children survive, we also see benefit for the overall trachoma eradication program,” says Dr. Lietman. Seed funds from That Man May See helped launch this work many years ago, with pilot funding from John Debs and others. “Small well-designed studies allowed us to establish evidence that led to increased support from the Bernard Osher Foundation, the National Institutes of Health, and most notably the Gates Foundation.” says Dr. Lietman.

 

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A diverse group of healthcare professionals posing together in a clinical setting.

Serving the City’s Homeless

A volunteer-run clinic helps shelter residents keep their sight.

”Whether crossing the street or trying to avoid trouble, poor vision intensifies the vulnerability of an already vulnerable population,” says ophthalmology resident Lauren Hennein, MD. When Dr. Hennein floated the idea for a shelter-based vision clinic two years ago, Alejandra de Alba Campomanes, MD, MPH, became an enthusiastic faculty sponsor. Dr. Hennein and medical student Ogonna Nnamani dug in to make it happen.

Training to Care

With The California Endowment’s $20,000 equipment gift to That Man May See, the monthly clinic opened in fall 2017. It joins other UCSF services at Division Circle Navigational Center, a shelter run by the St. Vincent de Paul Society in San Francisco’s South of Market area.

The clinic has no paid staff. A handful of medical and premedical students are led by Dr. Hennein and Mrs. Nnamani. Volunteers provide care under the supervision of ophthalmology residents, fellows, and faculty. Project Homeless Connect pays to have glasses made. Students learn to do intake, collect histories, perform comprehensive exams, coach patients on their conditions, and document next steps.

Dr. de Alba is thrilled. “Providing care at the shelter allows us to serve those in the most unstable circumstances,” she says. “Aspiring doctors are learning the value of community service as well as patient care and the tools of ophthalmology.”

Sarah Menchaca, Dr. Neeti Parikh
Volunteer Sarah Menchaca learns from attending faculty ophthalmologist Dr. Neeti Parikh

Connecting to County

The clinic is a bridge to sight-saving treatments at Zuckerberg San Francisco General Hospital and Trauma Center. Jay Stewart, MD, chief of ophthalmology there, saves appointments for patients referred from the shelter.

“Those already experiencing sight loss are the most motivated to follow up,” says Dr. Stewart. “We want to make it easy.”

Momentum and Hope

“Even though we want to serve more people, our first goal is to make the clinic sustainable,” says Dr. Hennein. “Eventually, we’d like to open our doors twice each month.” Right now, leaders hope to acquire a portable slit lamp to provide more comprehensive services.

Volunteering at the clinic is extremely popular. “It is inspiring to see young students’ eagerness to learn and their enthusiastic commitment to help in such a respectful, compassionate way,” says Dr. de Alba. “It gives me so much hope.”

Shelter Clinic Volunteers pictured above:
Back row, from left: Ana Marija Sola, Joseph Atangan, Ermin Dzihic, Charlie Kersten, Dr. Murtaza Saifee. Front row, from left: Sarah Menchaca, Kiki Spaulding, Dr. Lauren Hennein, Tianyi Zhang, Heer Purewal

Thanks to The California Endowment, That Man May See, and Akorn Pharmaceuticals for donations; additional faculty sponsors Drs. Stewart and McLeod; premedical student clinic director Kiki Spaulding, Project Homeless Connect’s Alison Van Nort, MSW, and faculty and student volunteers.

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Three individuals examining a model in a classroom.

Improving Vision Care in China

UCSF ophthalmologists are improving quality of care for vision patients by teaching and consulting at vision clinics across China.

It isn’t every day that ophthalmologists see their names dancing across a Jumbotron. This bold welcome met two UCSF clinician scientists last fall at the equivalent of a county hospital in Changchun, China. Vitreoretinal specialist Jay Stewart, MD, and oculofacial plastics specialist M. Reza Vagefi, MD, were the honored guests at a three-day teaching event.

Advancing Training, Care, and Understanding

Drs. Stewart and Vagefi spent one day consulting on how to help patients with complex vision disorders, and another day in surgery, teaching advanced methods. “I was able to share a method for approaching the orbit that avoids leaving a scar on the skin,” says Dr. Vagefi. A third day was devoted to theory and clinical application.

An eye doctor examining a patient's eyes with an ophthalmic device.
Dr. McLeod offers expertise on a difficult case.

“This was our second trip,” says Dr. Vagefi, “and each has offered a unique learning experience. In China, patients are in charge of their own medical charts and carry them from doctor to doctor. For the most part, only senior ophthalmologists perform eye surgeries.”

“After our first visit, we recommended a video system be installed in the operating room as a teaching tool,” adds Dr. Stewart. “This will help advance the skills of younger ophthalmologists.”

 

Initiative to Improve Quality

These trips are part of a larger initiative to lift the quality of care for Chinese vision patients. In China, ophthalmologists often lack access to training on par with the best available in the United States and Europe, with only a handful of outstanding vision centers providing comprehensive training.

Organized by the nonprofit Lifeline Express, Western specialists help fill gaps in professional knowledge at interested hospitals and clinics and recommend improvements. Pediatric specialist Creig Hoyt, MD, was the first UCSF ophthalmologist to participate in the program, and he soon interested others.

A group of four people closely observing a screen together.
Chinese ophthalmologists consult with Dr. Hoyt.

This year Dr. Hoyt will teach at a clinic on the Tibetan plateau. Glaucoma specialist Ying Han, MD, pediatric ophthalmologist Alexandra de Alba Campomanes, MD, and Stephen D. McLeod, MD (cornea, external disease, and refractive surgery), have also led professional development missions.

 

Inspiring Deeper Learning

“The impact of this work continues to unfold,” says Dr. Vagefi. “After our first visit, a junior ophthalmologist traveled to Shanghai, inspired to seek additional training in orbital surgery.”

These UCSF ambassadors are establishing ties to vision institutions across China and offering invitations for ophthalmologists to apprentice as international fellows at UCSF. This year Drs. de Alba and Hoyt will host visiting Chinese scholars whom they met while working for Lifeline Express.

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