Researchers study Brillouin spectroscopy to provide additional treatment options for patients with keratoconus.
Cleveland Clinic’s Cole Eye Institute has been awarded a four-year, $1.5 million grant from the National Eye Institute at the National Institutes of Health to research a non-invasive, all optical technique for imaging corneal biomechanics, or the shape and strength of the cornea.
Led by J. Bradley Randleman, MD, this study will further examine the standard protocol for using Brillouin spectroscopy, an emerging imaging tool for corneal biomechanics. This technology uses light to map corneal stiffness in three dimensions, which will ultimately lead to helping create personalized treatment plans for patients.
Keratoconus is a naturally occurring form of corneal weakness. This weakness leads to cornea thinning, protruding and warping. Corrective measures like glasses and contact lenses aren’t an option for people with this condition. Cross-linking, a process used to stiffen the cornea and improve vision, is usually prescribed in the progressive phase of the disease, so as to catch the keratoconus early and prevent further development.
Despite cross-linking being used clinically for two decades, there are still many fundamental aspects that are misunderstood. And, outside the U.S., there are numerous protocols being applied to patients despite a poor understanding of how one protocol compares to another.
“In the U.S., any patient with any form of progressive keratoconus receives the same corneal cross-linking protocol, regardless of the stage of their disease,” says Dr. Randleman. “That’s different than any other branch of medicine, where treatments are tailored to disease severity. We’re limited in that cross-linking simply stiffens the cornea; it doesn’t do anything else in a predictable fashion.”
The ultimate goal of the team’s work is to develop customized cross-linking protocols, fit for the individual patient. To achieve this, different cross-linking models will be treated and then tested at varying stages throughout the four years to understand what Brillouin data looks like at each time point. They will then compare this data to that of different protocols to understand where cross-linking may be combined with other procedures for the most effective treatment. With this information, researchers will use the finite element analysis process to combine the Brillouin data with predictive modeling to discover possible outcomes in terms of changes in the cornea shape.
“We feel our work is timely because, while there is plenty of data in the world for this condition, we lack data on combined treatments,” says Dr. Randleman. “If we can find success in combination treatments, the hope and desire is to reduce a patient’s astigmatism or irregularity, giving them a better chance to see well with glasses.”
Dr. Randleman will be joined by William Dupps Jr., MD, PhD, Professor of Ophthalmology at the Cleveland Clinic Lerner College of Medicine and Professor of Biomedical Engineering at Case Western Reserve University, and Giuliano Scarcelli, PhD, Associate Professor at Fischell Department of Bioengineering at University of Maryland.
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