Neuro-ophthalmology research

• Dr Clare Fraser
• Dr Jenny Hepschke
• Dr Chris Hodge
• Dr Mitchell Lawlor

Local collaborators

• Associate Professor Michael Buckland
• Associate Professor Fabienne Brilot
• Dr Yael Barnett
• Dr Ann McCormack
• Dr Rowena Mobbs
• Dr Sudarshini Ramanathan
• Dr Anthony Sammel
• Dr Paul Sowman

International Collaborators

• Associate Professor Steffen Hamann
• Dr Patria Hume
• Dr Doug King
• Dr Axel Petzold

Optic disc drusen

Save Sight Institute is part of the International Optic Disc Drusen Consortium, being coordinated through Denmark. We now have several papers published formalising disc drusen diagnosis with OCT. These papers will be the benchmark for large prospective studies and treatment trials. We have started a project to examine the link between optic disc drusen and presentation of NAION in young patients.

Pituitary tumors

We're studying the effects of optic nerve and chiasmal compression from pituitary tumors, in collaboration with the pituitary tumor team at St Vincent’s Hospital. We're evaluating MRI diffusion tensor imaging changes, coupled with:

• visual measures of acuity and visual fields
• structural measures from optical coherence tomography of the optic nerves 
• electrophysiological changes of pattern ERG and visual evoked potentials.

Our aim is to define a biomarker for those patients at most risk of permanent visual loss from compressive pituitary tumors. This will allow us to identify patients who need to have expedited surgery compared to those at low risk of visual loss who can try medical management.

Concussion

We are extending our work on the ophthalmic assessment of concussion. The University of Sydney is part of a large international study looking at health in past rugby players being run in conjunction with the Sports Performance Research Institute of New Zealand.  We have held three weekend clinics for people who have had past concussion injuries. With this project we aim to look for ophthalmic biomarkers of chronic traumatic encephalopathy. Working with us on this project are Dr Chris Hodge and Dr Julian Kelman (masters student). Our team continues to work with UTS Orthoptics and collaborate on studies looking at eye movement changes in children and adults post-concussion. We are also excited to collaborate with the Sports Brain Bank team of Dr Rowena Mobbs and Prof Michael Buckland.

We're working with the neuro-inflammation group at the Brain and Mind Centre, to provide visual assessment and input into research on diseases of neuro-inflammation.

Patients may present to Save Sight Institute with optic neuritis as the first manifestation of a more generalised neuro-inflammatory condition such as multiple sclerosis, neuromyelitis optica or anti-MOG disease. We provide visual information and collect required blood samples. We also contribute work on multifocal visual evoked potentials and MRI changes.

Optic Neuritis 

The dedicated Optic Neuritis clinic continues to study patients with Optic Neuritis (inflammation of the optic nerve). Optic neuritis can be associated with Multiple Sclerosis (MS) and other neurological inflammatory diseases. We are now working in conjunction with Dr Sudarshi Ramanathan and Prof Fabienne Brilot, looking at the rates of anti-MOG antibodies in clinically isolated syndrome and uveitis.

Giant Cell Arteritis 

Our team continues to work on Giant Cell Arteritis continues with a simple new test using chewing gum to help in the diagnosis of this condition to be published soon. We have been assisting Dr Anthony Sammel (PhD) in his study on PET scanning in GCA in collaboration with the rheumatology team at Royal North Shore Hospital.  This is to be expanded to include other vascular imaging modilities including MRI, ultrasound and OCT-A.  More of our GCA data is now being reviewed by Dr Julian Quigley.

IIH EVOLVE

This is a multi-center study evaluating Presendin, a slow release exenatide, in the management of patients with Idiopathic Intracranial Hypertension.

Visual snow

In March 2018, our team including Dr Jenny Hepscke, won the North American Neuro-ophthalmology Pilot Grant to continue our work on visual snow. We have been working with Prof Paul Martin and Prof Paul Sowman (Macquarie University) to test the visual stimuli that trigger/alleviate visual snow, and testing whether changes in cortical excitability can be detected on magneto-encephalography. Results will be analyzed later this year.

Idiopathic intracranial hypertension

We have started a new research focus on idiopathic intracranial hypertension (IIH).  Dr Juan Ang Lyn is working on an audit of clinical response to weight loss. Formalised clinical trials with dedicated dieticians and intensive calorie restrictions have been shown to treat IIH.  However, these resources are not available in a standard ophthalmic clinic. We are thus assessing simple, patient-driven weight loss efforts, to see if IIH can be managed and reversed. We will be collaborating with the neuro-ophthalmology team in Birmingham on future IIH studies.

In 2019 we started a collaboration with NeuroNode, to see if ocular-derived electrical signals can be used to assist communication in patients with motor neuron disease and other forms of locked-in syndrome. The early results are very promising, and the EOG device has been used in several patients, allowing them to communicate via computer.  Further research into patient Quality of Life with this communication device are planned.