Eye Opening Interviews
We visited the Wilmer Eye Institute of the Johns Hopkins University to learn about the current conditions of macular degeneration, its symptoms and treatments.
Baltimore, Maryland
We met with a researcher who studies, among many things, macular degeneration.
The first visit was to Wilmer Eye Institute in Baltimore where we spoke to Dr. Noriko Esumi, who studies retinal pigment epithelium (RPE) and how it relates to AMD. After giving her an explanation of what iGEM is and why we were choosing to study lutein production, she told us that, while her experience with lutein itself is limited, she would be more than willing to answer all of our questions. All we had to do was ask what her research involved and it sparked a long, information-rich conversation.
From the meeting with Dr. Esumi, We learned the following:
RPE is a cell type that nourishes retinal visual cells. They provide the nutrients since photoreceptors are avascular, they have no blood vessels for direct nutrient uptake. RPE also collects waste from photoreceptor cells and excretes them into the circulatory system to be filtered out. The RPE acts as a mediator for nutrient and waste transfer.
RPE is significant because there are two types of AMD, the wet-type and the dry type. The wet type involves the overgrowth of blood vessels, structurally impairing the eyes. This is easier to treat with medication and injections of antibody to help stop cell growth. Dry type, where RPE cells begin to die, is far more common and there is no treatment.
Macular Degeneration has been attributed to a few factors: smoking, immune responses based on bacterial infections, genetics, and, most commonly by far, aging. It has been dubbed an age-related disease, hence why it is known most commonly as AMD instead of simply macular degeneration.
Dr. Esumi works on studying the RPE and its specialization. She studies the genes unique to the RPE and the transcription factors associated to help answer the question of why are these unique genes only expressed in the RPE and nowhere else in the body?
She also focuses mainly on the aging process of cells. Without aging AMD will not develop, she argued.
However, she also shared that she agrees that lutein is an effective vitamin supplement to help maintain and improve ocular health.
She shared with us a study where a group of scientists tested a variety of cells in hope of finding a common gene that could be attributed to aging. While this gene was not found, the did find a common sequence in the promoter region of these cells, NFkappaB. A certain transcription factor related to inflammation loves this sequence as a binding site.
Drawing from this study, Dr. Esumi experiments with mice. She allows transgenic mice, and naturally-aging mice to age for two years and studies AMD development in them. She also uses these mice to study inflammation patterns and whether exposure to oxidative stress (smoking) increases risk of AMD.
All in all, we learned a lot about the potential to eradicate AMD as an affliction, the importance of RPE, and that lutein is a useful supplement for maintaining healthy eyes.
Columbia, Maryland
We also interviewed an ophthalmologist from a branch of the Wilmer Eye Institute.
Our next interview was with Dr. Nosheen Ahmed. While Dr. Esumi had more experience with the tissue cells that cause AMD when dysfunctional, Dr. Ahmed had more experience with the disease itself, its symptoms, its common treatments, how it affects the lives of patients, etc.
From the interview with Dr. Ahmed, we learned:
AMD often results from waste products building up in the eyes with age. This correlates with RPE malfunction.
A trend noticed in AMD patients, is that they tend to be more affected or more susceptible to the condition the lesser pigmentation they have in the eyes, it correlates with UV exposure.
Dr. Ahmed discussed a series of two studies known as AREDS (age related eye disease study) I and II. The second set of studies actually discussed lutein and zeaxanthin as feasible vitamin supplements to apply to AMD especially in the case of dry type.
In accordance with the information provided by Dr. Esumi, Dr. Ahmed also explained the dry type has no significant treatment. She also added that it develops more slowly than wet type.
Wet type AMD can be treated with cancer drugs to reduce tissue cell proliferation. Originally these drugs were specific to colon cancer but drugs have been more recently developed to specialize in treatment for the RPE.
However, this aforementioned treatment is stressful as it requires injections into the eye every 4-8 weeks.
The average age of risk is 50-60 years.
AMD had various stages, it can jump from Stage I (minor) dry directly to wet type in some severe cases.
A good prevention for those who have risk factors for AMD is a change in lifestyle habits, ex. quitting smoking or less computer use (blue light does damage), and eating a healthier diet. Optometrists recommend a lot of leafy greens and dark vegetables, which do contain lutein.
The AREDS study found a formulation of vitamins that prevent AMD progression from Stage III to wet type, this included lutein in the mix.
Dr. Ahmed concluded that not many studies has been done with lutein but there is a consensus it has a positive effect on AMD.
She also discussed that many patients will not recognize AMD as it develops. As the vision decreases or spotting occurs, they think they may only need glasses. More research is needed for the disease and potential treatments as well as vitamins like lutein which can help.
*Put pictures heere*
