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Solving vision problems: Where ophthalmologists and neuroscientists converge

Erik van Kuijk, M.D., Ph.D., marks his first anniversary as head of the newly named Department of Ophthalmology and Visual Neurosciences. (Photo: Scott Streble)

Consider the mind-bending truth about the human eye: with an estimated 2 million working parts that allow us to absorb images of the world around us in fractions of a second, the intricate mechanism is second only to the brain itself in complexity.

When things go wrong, however, the impact on a human life can range from annoying to devastating, with total blindness the ultimate insult. But scientists in the University of Minnesota’s recently renamed Department of Ophthalmology and Visual Neurosciences (OVNS) take up the fight daily, battling their way from questions and problems to answers and treatments.

At the forefront of the effort is the department’s new chair, Erik van Kuijk, M.D., Ph.D., who came to the University last October with a clear charge: continue to improve the department’s clinical and education programs and raise the national and international profile of its already outstanding research program.

“I really came here because of the talented faculty that had been recruited by my predecessor [Jay Krachmer, M.D.],” explains van Kuijk. “We have an electrical engineer, an internationally recognized ocular pathologist, one of the country’s preeminent neuro-ophthalmologists… We truly have an impressive roster of talented individuals.”

The clinical experience

That “preeminent neuro-ophthamologist” is Michael S. Lee, M.D., a nationally recognized clinician who is also working on multiple research projects with department colleagues and who recently cofounded the new Center for Thyroid Eye Disease with pediatric ophthalmologist Erick Bothun, M.D., and oculoplastics and orbital specialist Andrew Harrison, M.D.

According to Lee, patients afflicted with thyroid conditions like Graves’ disease often suffer disabling eye symptoms that disfigure and, worse, threaten vision loss.

“Many times in the past, these patients had to see multiple specialists within ophthalmology to finally enjoy some improvement and restoration,” says Lee. “At the center, the three of us assess patients together, which significantly reduces the number of clinic visits for these folks.”

This new center is just one of the many improvements under way, all geared toward improving the experience for the 70,000- plus patients who are seen annually at the University’s six specialty treatment centers. Phase-one renovations on the East Bank clinic, which is now devoted exclusively to adult patients, have just been completed, and van Kuijk hopes to complete a second phase in 2013. The pediatric clinic has moved across the river, near the new University of Minnesota Amplatz Children’s Hospital.

Neuro-ophthalmologist Michael S. Lee, M.D., is codirector of the University's newest clinic, the Center for Thyroid Eye Disease. (Photo: Scott Streble)

Critical work in the labs

As van Kuijk notes, the University’s OVNS department has long had top-notch researchers. If there was any complaint at all, he says, it was that his outstanding team has been reluctant to toot its own horn—something University President Eric Kaler, Ph.D., has encouraged faculty to do since his arrival over a year ago.

Van Kuijk notes that many recent findings by University faculty members have significant potential for treating debilitating and blinding diseases. Work by Linda McLoon, Ph.D., for instance, has shown that strabismus—a condition often called “lazy eye” in which the eyes are improperly aligned—can be treated in animals with sustained-release insulin-like growth factor-1. This is the first pharmacologic agent, says van Kuijk, shown to increase force and size in strabismic muscles and improve eye alignment.

In addition to letting the public know about important successes in his department, van Kuijk is also connecting researchers across traditional specialty lines to address some of the thorniest problems that affect vision—a mission that’s well reflected in the department’s new, more descriptive name.

Case in point: When Robert Miller, M.D., a professor in the Department of Neuroscience, was stalled on a research project, van Kuijk connected him with Lee and pediatric ophthalmologist C. Gail Summers, M.D.

“Together, they’ve discovered some retinal abnormalities in patients with schizophrenia,” says van Kuijk, “and they may have refined a test that can be used to diagnose the problem.”

Eric Newman, Ph.D., another neuroscience professor, is collaborating with van Kuijk’s team on diabetic retinopathy research that deals with blood flow—or lack of it—to the retina.

“If the retina is deprived of blood flow,” Newman explains, “it ultimately leads to blindness.”

But working with diabetic animals, Newman’s team has discovered that by inhibiting a key enzyme, they can reverse the lack of blood flow. Now they’d like to find out whether they can use this chemical intervention to restore blood flow in diabetic humans.

Lee sees the recent changes in the OVNS department as a boon to research.

“Prior to the change,” he says, “we were in silos of ophthalmology and neuroscience. Now Dr. van Kuijk has opened up more collaborative opportunities, connecting us with our neurosciences colleagues. That enables both sides to bring an important new perspective to the research.”

Lee frequently collaborates with McLoon, a professor in both ophthalmology and neuroscience, on a range of research projects. One current project aims to extend the effect of onabotulinumtoxinA, or Botox, which is administered to patients who suffer from conditions like blepharospasm, which results in excessive, spastic blinking.

“It’s a disabling condition,” Lee explains, “but you can paralyze the excessive blinking with Botox injections. Unfortunately, they’re quite painful and only last about three months. If we can extend the duration of the treatments, it would be important relief for those patients.”

Looking ahead

With significant improvements to clinics already under way and exciting new teaching tools in place—the department has recently added a simulator that helps train residents to do cataract surgery—van Kuijk is focusing on breaking down those specialty “silos” and making better use of the resources on hand.

“A lot of what I do now is look for opportunities and make connections,” he says. “One of the University’s five corridors of discovery is neuroscience, and by bringing the words ‘visual neurosciences’ into our department name, we remind people that ophthalmology at the University of Minnesota is about a lot more than just seeing patients.

“We’re very proud that this is the first ophthalmology department in the country to have this name, which reflects the depth and range of the work we do.”

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