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.

The Good Life

Selina R. McGee, OD, FAAO; Justin Schweitzer, OD, FAAO; and Walter O. Whitley, OD, MBA, FAAO

Modern Optometry

What makes a good life? How does one truly define happiness? If you could choose only one investment to focus on for your future self, what would it be? Would you save more for retirement? Travel more? Learn a new language? Take a cooking class? Learn to fit scleral lenses (finally)? What would you do so that when you look back on your life, you truly feel as though you lived it well? As we move into our adult years and away from optometry school, it’s easy to put our heads down, get into the daily grind, and move through the days while time just ….

Changing the Perception of the Retail Optometrist

It’s time we broaden our perspectives on the possibilities of providing care in this setting.

Harmin Chima, OD, and John Womack, OD

Modern Optometry

Picture a familiar scene in a busy eye care clinic: An optometrist assures a relieved patient they don’t have glaucoma while reviewing their OCT results in the exam lane. The OD swiftly walks to the room next door to begin expressing the meibomian glands of another patient who is undergoing treatment for dry eye disease. Ten minutes and 25 questions about dry eye later, and the optometrist is heading back to the first exam lane to check on an 11-year-old boy who has been in a myopia control treatment program for 6 months. On the way there, a patient in the optical asks whether the red or tortoiseshell frame looks better on her. Add in 10 to 15 comprehensive examinations, several of which also require a contact lens fitting, and what you end up with is a typical day at work for many optometrists. As you were reading the above, were you imagining a retail optometric setting? If not, then you’re not alone—and that’s the purpose of this article—to let our private practice and academic colleagues know that our concept of retail optometry may be outdated. RECOGNIZING OUR PATIENTS’ NEEDS We practice at a franchise group that owns and operates 88 Pearle Vision locations across the country. One of us (JW) serves as the chief medical officer, and the other (HC) as vice president of Professional Services. Our roles come with many responsibilities, one of which, fortunately, is seeing patients so that we can remain clinically relevant.