by Jessica Pasley
Each year the Vanderbilt Eye Institute (VEI) sponsors a Discovery Grant program to highlight innovative research ideas initiated by its faculty.
This year the number of proposals were not only the most ever submitted, but the committee was able to grant four awards. Typically, only one submission receives funding.
“For this grant year, we directed our call for proposals toward patient-based research related to COVID-19,” said David Calkins, PhD, Denis M. O’Day Professor of Ophthalmology and Visual Sciences. “All of this year’s entries were incredibly creative and forward-thinking. It was very exciting to be able to award four grants, which was only possible through the generosity of our VEI board members.”
Award-winning projects ranged from optimizing telemedicine, new educational formats to infection prevention due to mask wearing and testing tears in COVID-positive patients.
The program was started in 2017 and has awarded $650,000 in Discovery Grants, according to Calkins, vice chair of Ophthalmology and Visual Sciences and director of the Vanderbilt Vision Research Center.
“VEI is very fortunate to have a committed and generous advisory board that provides funds to stimulate innovative research,” said Paul Sternberg Jr., MD, George W. Hale Professor of Ophthalmology and Visual Sciences and chair of the department. “This year was particularly meaningful with our board members wanting the discovery grants to support projects that would catalyze our response to COVID-19.”
VEI Advisory Board gifts have an immediate impact on faculty trainees.
Karla Johns, MD, associate professor of Ophthalmology and Visual Sciences, and Janice Law, MD, assistant professor of Ophthalmology and Visual Sciences, partnered on a project called “Teaching Direct Ophthalmoscopy to Medical Students.” The pair sought to teach medical students how to use a direct ophthalmoscope to examine the retina in patients.
This tool used by most physicians and nurse practitioners requires close proximity between the clinician and patient. Johns and Law wanted to ensure the safety of both parties while instructing students on how best to administer this test. The solution — using funds from the Discovery Grant to purchase Simulation Eyes, on which students could learn the proper technique.
“We needed to find an alternative way to teach medical students how to perform this important examination technique,” said Johns. “Students will be able to apply this skill in the future on patient examinations when the coronavirus pandemic has passed. Additionally, more information will be obtained about how using Simulation Eyes can play a role in the training of health care providers in the future.”
While safety of staff and patients is a primary concern, another group will be studying the impact of masking during the pandemic and how it might affect recovery of patients undergoing ocular procedures.
“Respiratory Flora and Ophthalmologic Procedures,” a project under the direction of Amy Chomsky, MD, professor of Ophthalmology and Visual Sciences, and Law, will explore the unexpected consequences of mask wearing on VEI patients with a focus on non N95 masks.
“The study is aiming to show whether or not respiratory flora growth (infectious agents) is increased near the eyes when a mask is on and if so, whether or not this can be negated with taping across the superior part of the mask,” said Chomsky.
Particularly with non-N95 masks, the airflow upon exhale is directed from predominately forward to either upward and/or downward, she said. The direction of the exhale may impact the direction of respiratory flora toward the eyes during and after ocular procedures.
COVID-19 testing is performed using nasal swabbing, but VEI faculty pondered whether active virus could also be found in the tears of infected patients.
The project “Ocular COVID testing,” developed by Sapna Gangaputra, MD, MPH, assistant professor of Ophthalmology and Visual Sciences, Shriji Patel, MD, assistant professor of Ophthalmology and Visual Sciences, and Stephen Kim, MD, professor of Ophthalmology and Visual Sciences, will examine the tears of COVID-19 positive patients to determine if virus can be detected.
Recent Centers for Disease Control and Prevention requirements state that all health care providers wear eye protection, but there has been a “paucity of data to support the eyes being a form of transmission,” said Gangaputra.
“If COVID-19 is found in the tears of patients we test, then the patients will be tested serially to determine how long tears may remain infective,” she said. “Intraocular fluids are tested for patients that had COVID-19 in their tears to assess if the virus may exist intraocularly. We want to understand the pathophysiology of COVID-19 in tear film.”
Lastly, as COVID-19 limited patients’ ability to be seen in clinic settings, a group of ophthalmologists explored the possibility of providing specific testing kits for in-home use to help in the treatment and diagnosis of some visual impairments.
When the pandemic began and in-person visits were limited, VEI moved to alternative methods of evaluating patients, including telemedicine. But there were still critical pieces of data needed from patients that could not be gained through a phone or video consult including visual acuity, visual field and imaging of optic nerves or retinas.
“We are developing a system to bring the testing home to the patient,” said Sylvia Groth, MD, assistant professor of Clinical Ophthalmology and Visual Sciences. “In order to do this, we are packaging several tools that measure these functions and mailing them directly to patients. Each patient will complete the testing at home and send the package back to VEI for doctors to interpret.
“We are hopeful that this will take the burden off of some patients who struggle to get to VEI due to length of commute, health risks or other concerns.”
“Remote Care in Time of COVID” is being directed by Groth, Patel and Sean Donahue, MD, Sam and Darthea Coleman Professor of Pediatric Ophthalmology.