Glaucoma is a progressive optic neuropathy characterised by the neurodegeneration of the retinal ganglion cells (RGCs) resulting in irreversible visual impairment and eventual blindness if untreated. In glaucoma, damage and degeneration of RGCs and their axons result in characteristic changes in the appearance of the optic nerve head and patterns of visual field loss.
Glaucoma is the leading cause of irreversible blindness worldwide and is estimated to affect over 60 million people globally; a number which is predicted to 118.8 million by 2040. Primary open angle glaucoma (POAG) is the commonest subtype of glaucoma and pseudo-exfoliation glaucoma (PXFG) is the most prevalent type of secondary open angle glaucoma. The pathogenesis of POAG is multifactorial and complex but currently lowering intra-ocular pressure (IOP) medically or surgically is the only modifiable risk factor. Our research is multidisciplinary and is centred on two main themes:
1. Molecular therapies for ocular disease targeting the underlying genetics and molecular disturbances resulting in ocular pathology. We have established an ex vivo anterior segment perfusion model to study glaucoma, develop new therapies and evaluate drug delivery. We have several RNA and molecular therapies in pre-clinical evaluation for glaucoma. This includes a novel bispecific antibody developed within Ulster University to target neuro-inflammation in glaucoma. These therapeutic approaches may also be relevant to other common eye diseases including age-related macular degeneration and diabetic retinopathy.
2. Personalised or stratified medicine for eye disease. Using genetic information to determine disease risk, disease stratification and to predict treatment response/pharmacogenetics. We have an active multicentre study investigating the genetic basis of steroid glaucoma and improve the clinical surveillance and treatment of patients. With collaborators in Liverpool and Lancaster we are developing AI tools to better detect glaucoma in the developing world and UK/Ireland.