Guest blog: Dr Omar Mahroo discusses how funding enabled him to further his research
I am an ophthalmologist with a special interest in retinal conditions. Diseases of the retina are a major cause of blindness worldwide and in the UK. There has been a revolution over the last 10-15 years in our ability to generate high-resolution images of the retina rapidly in clinic, so that we are better able to understand, diagnose and monitor retinal disease. However, although these images allow us to view the structure of the retina, they do not tell us whether the cells in the retina are working properly or not. The cells in the retina generate electrical signals in response to light, which are processed and then sent to the brain, enabling us to see. Recording these electrical signals from patients is possible (a bit like an ECG of the eye), and can give us direct information on how the cells of the retina are working. These recording techniques are not available in every clinic, and have not developed as rapidly as the developments in retinal imaging. Before my ophthalmology training, I completed a PhD at Cambridge, and post-doctoral work in Australia, developing newer ways of understanding retinal function through recording these electrical signals in healthy volunteers. Towards the end of my ophthalmology training, I was successful in obtaining an Academic Clinical Lectureship at King’s College London, and I set up a laboratory at St Thomas’ Hospital, so we could start to use these techniques in patients. I was fortunate to be awarded a new lecturer’s grant from Fight for Sight in 2012, which allowed me to purchase the necessary equipment, and, through subsequent small grants from Fight for Sight in 2014 and 2016 (jointly awarded by the Birdshot Uveitis Society and the Thomas Pocklington Trust), I was able to take this research even further.
So far, we have recorded electrical responses from over 1000 patients and healthy volunteers. We have been able to quantify the relative effects of the genetic and environmental factors on the variation in retinal responses (published in Ophthalmology earlier this year: http://www.aaojournal.org/article/S0161-6420(16)32318-1/pdf ). We have applied mathematical modelling techniques to the electrical waveforms to understand the mechanisms of some genetic retinal diseases. We have identified some aspects of retinal electrical function that may be important in understanding how myopia develops (this was designated a “hot topic” at the international The Association of Research in Vision and Ophthalmology meeting this year), and why some people are more susceptible than others. We have trialled the use of hand-held portable devices that could potentially be used in every clinic. We have recorded from patients with some neuropsychiatric conditions, to explore whether these recordings may give us an idea of the mechanisms of disease in the brain. Also, we have even used these recordings to demonstrate that viewing a smartphone with one eye in the dark can reduce retinal sensitivity for several minutes afterwards, and this explains the phenomenon of “Transient Smartphone Blindness”, which is completely benign. This was published as a research letter in the New England Journal of Medicine, and generated a great deal of media interest (it was number 23 of the 100 most discussed articles of 2016: https://www.altmetric.com/top100/2016/).
I was successful this year in obtaining a Wellcome Trust Clinical Research Career Development Fellowship Stage 2 (an award of £1.1 million over 5 years) to take the above research further still. The research will be based at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, and also at St Thomas’ Hospital (King’s College London). One goal will be to develop newer techniques for assessing retinal function that can be used in every clinic. Also we want to better understand retinal and neurological disease. As experimental treatments are developed for previously untreatable diseases, the methods developed in this project could allow us to more precisely determine whether the new treatments are effective. I am very grateful to Fight for Sight for funding my initial studies, and allowing me, based on my preliminary findings, to secure more substantial funding.
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