An interdisciplinary team of scientists at the University of Iowa has been awarded a five-year, $2.8 million grant from the National Eye Institute (NEI) to improve how doctors manage treatment for patients with the wet form of age-related macular degeneration (AMD). Collectively, the different forms of AMD are the primary cause of blindness in the United States.

The study focuses on making better use of three-dimensional imaging and analysis to allow physicians to know when a treatment is being effective and thus not overuse it.

The team is jointly led by two UI principal investigators:

• Michael Abramoff, MD, PhD, associate professor of ophthalmology and visual sciences, and electrical and computer engineering.
• Milan Sonka, PhD, professor and chair of electrical and computer engineering and professor of ophthalmology and visual sciences.

"Effective treatments involving injections into the eye have recently become available to restore vision for people with the wet form of AMD," Abramoff said. "These treatments have benefits, but they are costly and the risk of serious side effects to the eye increases with repeated injections. Our study goal is to learn how to tailor dosing for each patient so that the minimal necessary number of injections is used."

Anti-VEGF

The treatments being studied include the drugs Lucentis (ranibizumab) and Avastin (bevacizumab). These drugs prevent a protein called vascular endothelial growth factor (VEGF) from causing blood vessels to overgrow and damage the eye. The "anti-VEGF" activity of the drugs can slow down or stop vision loss, but the drugs must be carefully used.

"Current use of these treatments suggest some patients may need injections every four weeks, while other patients may need them only once every six months." Abramoff said. "The more accurately we can predict how often each patient needs injections, the more beneficial and cost-effective the treatment."

The study will examine how advanced imaging—known as three-dimensional optical coherence tomography—and related image analysis can be used to assess changes in the macula and retina of patients' eyes. These changes can reveal how well a person is responding to anti-VEGF treatment and thus help doctors provide proper treatment timing and care.

Because the imaging provides so much data, computers are needed to help interpret the information. The imaging approach also builds on two decades of collaborative research at the UI, said Sonka, who also is co-director of the Iowa Institute for Biomedical Imaging.

Three-dimensional Data

"We have learned a great deal by working with UI cardiologists and radiologists about how to manage three-dimensional data," Sonka said. "We can now apply this experience efficiently to other areas, including ophthalmology. The physicians cannot do their work without the engineers, and the engineers cannot do their work without the physicians. It's an important collaboration that makes research possible.

"We hope this study will bring improved image-guided treatment of the most prevalent cause of blindness in the United States," Sonka added.

Sonka noted that scientific work by Mona Garvin, PhD, UI assistant professor of electrical and computer engineering, contributed significantly to the design of the study.

Other researchers on the team include members of the Iowa Institute for Biomedical Imaging, including faculty and staff from the UI Carver College of Medicine, College of Engineering and College of Public Health.

The diverse team includes the UI Health Care retinal specialists Stephen Russell, MD, and James Folk, MD, as well as Trudy Burns, PhD, in epidemiology at the UI College of Public Health.

Michael Abramoff, MD, PhD

Milan Sonka, PhD

Mona Garvin, PhD

Stephen Russell, MD

James Folk, MD

Trudy Burns, PhD

Biomedical Imaging