DARC: From Bench to Bedside

Tracing the path of an exploratory retinal biomarker.

Francesca M. Cordeiro, MD, PhD, MRCP, FRCOphth

Glaucoma Today

The management of chronic neurodegenerative diseases such as glaucoma, age-related macular degeneration (AMD), Alzheimer disease, Parkinson disease, and stroke is complicated by a similar set of challenges. These diseases cause significant disability, owing in part to their late diagnosis, the absence of appropriate screening tests, ineffective monitoring, and a lack of early clinical endpoints. Patients with neurodegenerative diseases progress slowly and are followed over long periods of time. Reliable indicators are therefore needed to measure disease progression and efficacy of treatment. In glaucoma, the gold standard for diagnosis is visual field testing. Visual field defects, however, can take years to develop, by which point at least 30% of the eye’s retinal ganglion cells (RGCs) may be lost. This inability to identify early disease is estimated to translate to about a 10-year delay in the diagnosis of glaucoma.1 Diagnostic delays affect patients with other neurodegenerative diseases as well. Parkinson disease is diagnosed only once a patient presents with symptoms, by which point 70% of dopaminergic receptors have typically been lost.2 With Alzheimer disease, the time between the start of the disease process and the development of memory loss is reported to be about 20 years.3 The detection of apoptosis and cell stress is a promising strategy for detecting neurodegenerative disease before irreversible damage occurs and for monitoring treatment response ahead of existing endpoints. This article reviews a novel retinal biomarker—the Detection of Apoptosing Retinal Cells (DARC)—and the potential for this to function as a surrogate endpoint in glaucoma and other conditions. BIOMARKERS AND ENDPOINTS A biomarker is a characteristic that can be objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic response to a therapeutic intervention.

Papilledema Associated With Meningioma

Even if you suspect idiopathic intracranial hypertension, it’s important to order appropriate imaging and workup to rule out more serious causes of papilledema.

Christopher J. Borgman, OD, FAAO, and Rick Savoy, OD, MPH

Modern Optometry

A 45-year-old Black female was referred to us for a second opinion on possible edematous optic nerves after being seen 1 week earlier. The patient reported having headaches that worsened over the past year. She denied trauma and changes to her vision; her ocular history was unremarkable. She also denied systemic medical issues and allergies and was taking only a daily multivitamin. EXAMINATION FINDINGS The patient’s entering VA was 20/20 OU. Her pupils were equal, round, and reactive to light, without afferent pupil defect. Extraocular motilities showed full range of motion OU, and the patient denied experiencing diplopia. Confrontation visual fields were full to counting fingers OU. Color vision was normal with Hardy-Rand-Rittler testing OU. The patient’s anterior segment was also normal for her age OU.

A Global Community

Callan Navitsky, Editor-in-Chief

Glaucoma Today

Working in proximity to many trainees through YoungMD Connect, BMC’s platform for young and aspiring ophthalmologists, I regularly hear that one of the most appealing aspects of ophthalmology is its community feel. People in the field are perceived as welcoming, connected, and collegial. Although community may seem synonymous with closeness, the concept itself may be broader than that. For some, community is not defined solely by shared geography, nationality, or other social or cultural ties. In this issue of GT, ophthalmologists recount experiences in which they traveled abroad to serve and support others from different backgrounds, in different settings, and with different resources—but with a common goal to combat blindness. The anecdotes and photographs they share are snapshots of comprehensive initiatives and continuous collaborations. For example, after observing unmet needs in trabeculectomy care in Bali, Oluwatosin Smith, MD, is now working to establish a program within her home practice to address this obstacle. Annette L. Giangiacomo, MD, communicates regularly with providers she has met on past trips to remain an active part of their support team. Shawn Gulati, MD, MPH, is participating in a dedicated global ophthalmology fellowship.