Research
 

"Security is mostly a superstition. It does not exist in nature, nor do the children of men as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is a daring adventure or nothing at all." - Helen Keller

Saving Sight, Speech and Hearing

The Helen Keller Foundation for Research and Education (HKFRE) targets three vision research areas:

The Child's Eye

  • Retinopathy of Prematurity
  • Strabismus
  • Eye Tumor

The Injured Eye

  • Prevention
  • Treatment

The Aging Eye

  • Retinal Detachment
  • Macular Degeneration
  • Cataract
  • Glaucoma
  • Diabetic Retinopathy


The Child's Eye

In the United States, children lose vision from retinopathy of prematurity, strabismus (crossing of the eyes), and retinoblastoma, ocular tumor. Internationally, children are afflicted by these disorders, as well as by infections, such as onchocerciasis and toxocariasis, which can lead to blindness, and nutritional deficiencies. Major advances have been made in each of these areas.

Retinopathy of Prematurity
Today, we examine premature babies soon after birth, and watch for signs of the development of abnormal blood vessels. Laser treatment is applied promptly after these blood vessels appear, and most children maintain useful vision. Unfortunately, some eyes still progress to develop scar tissue and become blind despite laser treatment. Screening, optimal timing of laser treatment, and preventative treatment of scarring and retinal detachment are important areas for further research.

Strabismus
If unrecognized, strabismus, or crossing of the eyes, can result in amblyopia, commonly known as lazy eye. Eyes with amblyopia have reduced vision not correctable by glasses or contact lenses. The brain, for reasons not yet known, does not fully acknowledge the images seen by the amblyopic eye. This almost always affects only one eye but may manifest with reduction of vision in both eyes. It is estimated that three percent of children under six have some form of amblyopia. Other causes of amblyopia include anisometropia (different optical prescriptions in each eye), trauma, and droopy eyelid. Screening of infants and surgical and sensory techniques for treatment are important areas of research.

Eye Tumor
While uncommon, children can get intraocular tumors. Perhaps the most devastating is retinoblastoma, the most common intraocular cancer of childhood which afflicts approximately 300 children in the United States each year. Untreated, this is a fatal disease; but, if detected in time, more than 90% of children can be cured. Unfortunately, some children can have both eyes affected, which can lead to total blindness. Fortunately, recent advances in oncology and genetics have helped to limit some of the impact of retinoblastoma.

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The Injured Eye

Prevention
Over 2 million eye injuries occur annually in the United States, with 60-100,000 of these having serious visual consequences, including loss of the eye from a retinal detachment, macular hole, ocular rupture, and infection. Ocular injuries are the most preventable form of sight loss and affect all age groups. The causes are numerous, from shaken baby syndrome to sports injuries. Injuries can occur at both the workplace and home. One third of eye injuries occur in children. Adult eyes are injured at home, work, in automobile accidents, and recreational activities. Elderly patients are particularly susceptible to falls at home, which often leads to craniofacial and globe injury. Prevention strategies must be based on a better knowledge of how, where, to whom, and why eye injuries occur. The World Eye Injury Registry (WEIR) is beginning to gather this data.

Treatment
Treatment of the injured eye continues to be the most challenging of all types of eye surgery. But injuries usually occur in young, healthy eyes, so that a successful operation can often restore as much as a half century of eyesight.

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The Aging Eye

Retinal Detachment and Macular Pucker
Ocular structures change with age. The vitreous gel, which acts as a shock absorber in young eyes, becomes liquefied and separates from the retina. In some patients, this normal aging process can result in a hemorrhage, and/or a retinal tear or detachment. Retinal detachment repair is sometimes complicated by the formation of scar tissue, which if severe, can limit visual recovery. Scar tissue over the center of vision, or macula, can occur after a retinal injury, or sometimes for reasons that aren't known. Macular pucker, as this scar tissue is called, can be quite visually debilitating, making reading and activities of daily living difficult.

Macular Degeneration
Age-related macular degeneration (AMD) is a leading cause of severe vision loss in people 60 years of age and over. About 1.7 million Americans over age 65 have been diagnosed with AMD. About one to two percent have severe vision loss. Millions of others have milder AMD, but don't know it. AMD irreversibly disrupts the architecture of the retina and surrounding structures. Although AMD causes legal blindness by destroying central vision, it almost never causes total blindness. Most people with AMD continue to live independently, often using devices termed low-vision aids. AMD will become a far more serious health problem as a higher percentage of Americans reach age 60. The number of older Americans will double in the next 30 years. While some laser and medical treatment is available, “success” is generally measured in limiting loss instead of increasing visual recovery.

Cataract
Cataract progression is another normal consequence of aging. Most people develop some clouding of the lens after the age of 60. The incidence of visually significant cataract ranges from 50 percent of Americans ages 65 to 74 to about 70 percent of those age 75. Most people with cataract have similar changes in both eyes, although one eye may be worse than the other. Many people with cataract have only minimal visual changes and are not aware of their cataracts. Factors that may contribute to cataract development are low serum calcium levels, diabetes, long-term use of corticosteroids, and various inflammatory and metabolic disorders. Environmental causes include trauma, radiation exposure, and excessive exposure to ultraviolet light (sunlight). The only treatment for a symptomatic cataract is surgery. While cataract surgery is one of the most frequently performed and safest operations, still the risk of post-operative infection and a poor visual outcome exists.

Glaucoma
Several types of glaucoma exist, all of which, if untreated, will permanently damage critical optic nerve fibers, resulting in blindness. It was once thought that high intraocular pressure (IOP) was the main cause of this optic nerve damage. Although IOP is clearly a risk factor, we now know that other factors must also be involved because even people with "normal" IOP can experience vision loss from glaucoma. Some forms of glaucoma steal vision away silently, without warning signs of pain or blurry vision. For that reason, screening and early recognition of glaucoma are particularly critical.

Diabetic Retinopathy
Diabetic retinopathy is the leading cause of blindness in working age Americans. People with both non-insulin-dependent diabetes mellitus and insulin-dependent diabetes mellitus are at risk for developing diabetic retinopathy. The incidence and severity of the retinopathy increases with the duration of diabetes and is likely to be worse if control of the diabetes is poor. Almost all people who have had diabetes for more than 30 years will show signs of diabetic retinopathy. The disease is caused by damage to blood vessels of the retina, which eventually robs the retina of oxygen (ischemia). In the earlier and less severe type (non-proliferative diabetic retinopathy) the existing blood vessels become porous and leak fluid into the retina, causing blurred vision. In the more advanced and severe type (proliferative retinopathy) new growth of blood vessels occurs within the eye. These new vessels are fragile and can hemorrhage causing loss of vision. Retinal detachments can form, leading to blindness.

Other Retinal Vascular Diseases
Besides diabetes, patients can suffer from other diseases which affect the blood vessels in the eye. Patients with high blood pressure are at a higher risk for developing a clot in one of the veins in the eye, called a branch or central retinal vein occlusion (BRVO or CRVO, respectively). Often these patients develop fluid in their macula, which causes vision loss, or develop new weak-walled blood vessels which tend to bleed easily. These diseases also tend to affect those over 50 years old, and can be partially prevented with tight control