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Glaucoma and Hyperspectral Imaging Research

 Lead Researcher:  Professor Andrew McNaught, Consultant Ophthalmic Surgeon

 Current studies:
 1.      Spectral imaging: NIHR portfolio study of retinal oximetry

Winner: ‘Best Translational Research’ - 2008 UK ‘Medical Futures’ Innovation Awards

rof Andrew McNaught: Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (Visiting Professor, Cranfield University), and Prof Andy Harvey, Department of Physics and Astronomy, Glasgow University, Glasgow.         

Professors Andy McNaught and Andy Harvey have devised a novel spectral imaging camera that has been used to estimate the oxygen saturation in retinal blood vessels. Prof McNaught, who is a consultant surgeon in Cheltenham General Hospital's award-winning eye department, came up with the invention following a chance meeting with Prof Andy Harvey, who was at that time, a military scientist, then working with Cranfield University. 

Funding sources for the retinal oximetry research have included £200,000 from the Department for Trade and Industry, and also funding from the NIHR, and the Gloucestershire Eye therapy Trust. Prof McNaught, Prof Harvey and their colleagues are undertaking ongoing research to develop a commercial version of the camera.

The initial research consortium included the UK Department of Trade and Industry, the company Qinetiq, as well as a UK manufacturer of conventional retinal cameras.

This is an imaging device, and analysis software, that can quantify the oxygen saturation in blood vessels in the retina at back of the eye. The new technique uses hyperspectral imaging, and may help in the detection, and management of eye disease such as diabetic retinopathy, glaucoma and macular degeneration.  The ‘snapshot’ spectral imaging technology employed (‘IRIS’) was originally developed by Prof Harvey for defence applications in association with Qinetiq.  The new technology is non-invasive and is an improvement over current methods to estimate retinal blood supply which involve an injection of dye into the blood vessels. It could potentially be used as a screening tool in diabetic retinopathy, and also to determine the extent of nerve damage in glaucoma.  

The team is looking to commercialise the product. 

Retinal oximetry, current work: 

Non-invasive detection of poor retinal circulation in diabetics, and other patients with impaired retinal circulation eg retinal vein occlusion.Better understanding of glaucoma nerve damage: estimation of inner retinal function in response to treatment.Possible application to the diagnosis of malaria (collaborative project based in Malawi).Measurement of cerebral blood vessel oxygen saturation in animal model of MS (with UCL and

NHNDQS: Prof Kenneth Smith. 2.      Glaucoma NIHR portfolio trial: 

‘UK glaucoma treatment study’ (UKGTS) and follow-on study ‘UK glaucoma risk factors study’ (UKGRIFS) 

The UKGTS which closed in October 2011 recruited 24 patients at CGH between January 2008 and February 2010.  

The UKGTS, the world’s only multi-centre, double-masked, placebo-controlled medical treatment trial in glaucoma, was designed for the primary objective to quantify the effect of intraocular pressure (IOP) lowering treatment (Does treatment with Latanoprost reduce the incidence of visual field progression events by 50% within a 24-month period?) and for the secondary objective to identify the major risk factors and biomarkers for glaucoma progression.

The extended follow-up study provided by the UKGRiFS will provide additional power to identify risk factors for progressive glaucoma. The study is a prospective observational study designed to elucidate the risk factors for glaucoma progression (deterioration) and continues the follow-up of the UK Glaucoma Treatment Study (UKGTS) cohort. The study comprises patients randomized to treatment with Xalatan alone or no treatment. Valuable data on the natural history of glaucoma progression will, therefore, be available.

There are 174 patients enrolled in UKGRiFS across 8 sites; 14 enrolled at CGH. 

3.         Commercial trial: PRM151:  

Novel anti-scarring treatment to augment trabeculectomy: European multicentre trial 

This is a multicentre, randomized, double-masked, placebo-controlled 120-day study of PRM-151 administered as a sub-conjunctival injection to patients undergoing primary trabeculectomy followed by an investigator-masked, 240-day extension.  Each subject will receive PRM-151 2 mg or placebo administered as a sub-conjunctival injection at the end of surgery followed by additional injections of PRM-151 2 mg or placebo on days 2, 3, 5 and 9 post-surgery.

Three patients have been recruited to the study at CGH since August 2010.  The primary objective is to assess the effects of PRM-151 compared to placebo on the success of trabeculectomy by reducing post-surgical scarring in glaucoma patients who have undergone primary trabeculectomy, evaluated at day 120.

The secondary objective is to assess the safety and tolerability of PRM-151 administered as a sub-conjunctival injection in glaucoma patients who have undergone primary trabeculectomy.

Recent related publications: 

‘Validation of human whole blood oximetry, using a hyperspectral fundus camera with a model eye’ Mordant DJ, Al-Abboud I, Muyo G, Gorman

A, Sallam A, Rodmell P, Crowe J, Morgan S, Ritchie P, Harvey AR, McNaught AI.  Invest Ophthalmol Vis Sci. 2011 Apr 27;52(5):2851-9.
 ‘Spectral imaging of the retina’. Mordant DJ, Al-Abboud I, Muyo G, Gorman A, Sallam A, Ritchie P, Harvey AR, McNaught AI.  Eye (Lond). 2011 Mar;25(3):309-20.

 ‘Transcleral Cyclodiode Laser Photocoagulation in the Treatment of Aqueous Misdirection Sydrome’.  Stumpf TH, Austin M, Bloom PA, McNaught A, Morgan JE. Ophthalmology. 2008 Nov; 115 (11): 2058-61. Epub 2008 Jul 31.
‘New Spectral Imaging Techniques for Blood Oximetry in the Retina’. I. Alabboud, G. Muyo, A. Gorman, D. Mordant, A. McNaught, C. Petres, Y. R. Petillot, A. R. Harvey, Novel Optical Instrumentation for Biomedical Applications III, Proceedings of SPIE – Vol. 6631, 2007.

‘The Effects of Intraocular Pressure Reduction on Perimetric Variability in Glaucomatous Eyes’. Fogagnolo P, McNaught A, Centofanti M, Rossetti L, Orzalesi N. IOVS 2007 Oct; 48 (10): 4557-63.

‘Caring for the patient with glaucoma’. McNaught AI. Practitioner. 2006 Jul; 250 (1684): 18, 20-23.

‘Spectral Imaging of the Retina’ Harvey AR, Alabboud I, Gorman A, McNaught A, Ramachandran S, Theofanidou, E. Proc. SPIE 6047 (2006)

‘Loss of Vision after Phacotrabeculectomy’. McNaught AI. J Glaucoma. 2005 Aug; 14 (4): 299-301.

 ‘Interobserver agreement on visual field progression in glaucoma: a comparison of methods’ .Viswanathan, A.C., Crabb, D.P., McNaught, A.I., Westcott, M.C., Garway-Heath, D.F., Kamal, D.S., Hitchings, R.A. and Fitzke, F.W. (2003).    Br J Ophthalmol 87: 726-730.

'Evidence for genetic heterogeneity within eight glaucoma families, with the GLC1A Gln368STOP mutation being an important phenotypic modifier’ Craig JE, Baird PN, Healey DL, McNaught AI, McCartney PJ, Rait JL, Dickinson JL, Roe L, Fingert JH, Stone EM, Mackey DA.  . Ophthalmology. 2001 Sep;108(9):1607-20.

‘Accuracy and implications of a reported family history of glaucoma: experience from the Glaucoma Inheritance Study in Tasmania’  McNaught AI, Allen JG, Healey DL, McCartney PJ, Coote MA, Wong TL, Craig JE, Green CM, Rait JL, Mackey DA.  Arch Ophthalmol. 2000 Jul;118(7):900-4.

Jan 2013