Course: Advances in Eyecare: Developments in screening

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In this edition of Advances in Eyecare we hear from three experts about developments in neurological and retinal health assessment and management. The speakers also discuss their research relating to optometric practice.

Prof Francesca Cordeiro discusses the use of fluorescent dye markers in early detection of glaucoma and the detection of apoptosing retinal cells or DARC technique.

Dr Rebekka Heitmar offers an insight into the developments in retinal vascular assessment that are useful in monitoring vascular diseases via retinal analysis.

Dr Doina Gherghel looks at the influence of Alzheimer's disease upon eye health and appropriate management options.

Last published: May 2018

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Learning objectives

1.1.2 Understand the latest techniques for the detection of neurological and vascular changes that may be indicative of underlying conditions such as retinal ganglion cell apoptosis in glaucoma and neurodegenerative disorders such as Alzheimer's disease and understand their likely influence upon earlier intervention in treatment.
2.5.3 Understand the latest techniques in the assessment of early glaucoma and neurodegenerative disease so to be better able to inform patients and adapt practice as they impact in future.
3.1.3 Understand the latest techniques in imaging the retina and its vasculature and understand their likely future impact upon general optometric practice.
6.1.8 Understand the technique of DARC in early detection of glaucoma and its likely impact on future practice.
6.1.14 Understand the ocular implications of Alzheimer's disease and how best to manage them.

Unit 1 - Detection of apoptosing retinal cells (DARC) (~17 mins)

FileDetection of apoptosing retinal cells (DARC) File
Professor Francesca Cordeiro interviewed by Serge Miodragovic

Glaucoma affects 60 million people in the world. Earlier detection and medical intervention is important to improve the long-term prognosis for the patient. A new technique has recently been developed at University College London (UCL) which claims to detect changes in cellular structure that may indicate potential glaucoma at a much earlier stage than might be possible with more traditional approaches. Professor Francesca Cordeiro leads the Glaucoma and Retinal Neurodegenerative Disease Research Group at UCL. This is the team behind the latest developments in using the detection of apoptosing retinal cells technique, or DARC, to identify the earliest signs of glaucoma. She discusses this innovative test with our interviewer, Serge Miodragovic.
References

Cordeiro M F (2016) Eyeing the brain. Acta Neuropathologica, 132(6), 765-766
Jutley G et al. (2017) Management of glaucoma as a neurodegenerative disease. Neurodegenerative Disease Management, 7(2), 157-172
URLCordeiro M F et al. (2017) Real-time imaging of single neuronal cell apoptosis in patients with glaucoma. Brain. Volume 140. Issue 6. Pages 1757–1767 [Accessed Nov 2017] URL Opens in a new window.

Unit 2 – Developments in retinal screening (~ 19 mins)

FileDevelopments in retinal screening File
Dr Rebekka Heitmar interviewed by Dr Robert Cubbidge

Alzheimer’s disease is the most common cause of dementia, currently affecting more than 520,000 people in the UK. Recent research has shown how changes in the central nervous system related to Alzheimer’s disease may be visualised at the retina. This has implications for the possible use of eye assessments in the screening, and management, of this disease. Aston University has a track record in research into novel approaches in imaging and assessing the retina. Dr Robert Cubbidge and Dr Rebekka Heitmar from Aston University discuss these techniques and the recent developments in retinal screening of Alzheimer’s disease.
References
Blair N (2017) Retinal oximetry and vessel diameter measurements with a commercially available scanning laser ophthalmoscope in diabetic retinopathy. Investigative Opthalmology & Visual Science, 58(12), 5556
Mwanza J, Budenz D (2017) New developments in optical coherence tomography imaging for glaucoma. Current Opinion in Ophthalmology
Seshadri S et al. (2015) Ageing effect on flicker-induced diameter changes in retinal microvessels of healthy individuals. Acta Ophthalmologica, 94(1), 35-42
URLKoronyo Y et al. (2017) Retinal amyloid pathology and proof-of-concept imaging of trial in Alzheimer’s disease. JCI Insight. 2(16):e93621. [Accessed Nov 2017] URL Opens in a new window.

Unit 3 – Eyecare in Alzheimer’s management (~17 mins)

FileEyecare in Alzheimer’s management File
Dr Doina Gherghel interviewed by Dr Robert Cubbidge

Alzheimer’s disease is well known to cause a range of cognitive and behavioural concerns. Perhaps less well known is the significant impact the disease has upon the health of the eyes and vision. Understanding this may well help in earlier diagnosis, improve optometric management, and benefit the ongoing care for the patient. Here, Dr Robert Cubbidge discusses the role of the clinician in dementia management with Dr Doina Gherghel from the Vascular Research Laboratory at Aston University.
References
Bowen M et al. (2016) The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of 60-89 year old people with dementia and qualitative exploration of individual, carer and professional perspectives. Health Services and Delivery Research, 4(21)
Mroczkowska, S et al. (2014) Retinal Vascular Dysfunction Relates to Cognitive Impairment in Alzheimer Disease. Alzheimer Disease & Associated Disorders, 28(4), 366-367
URLCollege of Optometrists. Guidance for professional practice – Examining patients with dementia or other acquired cognitive impairment. [Accessed Nov 2017] URL Opens in a new window.
URLGhergel D. Alzheimer’s Disease. Optician [Accessed Nov 2017] URL Opens in a new window.
URLVISION 2020 UK Dementia and Sight Loss Committee. Dementia & Low Vision Factsheets. [Accessed Nov 2017] URL Opens in a new window.
URLVISION 2020 UK Dementia and Sight Loss Committee. Eye examinations for people with dementia. [Accessed Nov 2017] URL Opens in a new window.
URLVISION 2020 UK Dementia and Sight Loss Committee. Wearing spectacles with dementia. [Accessed Nov 2017] URL Opens in a new window.

More information

DOCET would like to thank the following for their contribution to this programme:
Prof Francesca Cordiero, MBBS, PhD, MRCP, FRCOPhth Professor of Ophthalmology at Imperial College and Professor at UCL
Dr Rebekka Heitmar Dipl.Ing.(FH) AO, PhD Fitness to Practice Officer for the School of Life and Health Sciences
Dr Doina Gherghel MD, PhD, FHEA, Dipl. OB (ABS) Co-ordinator of the Vascular Research Laboratory at Aston University