XVI. LABORATORIES FOR CLINICAL RESEARCH

The Laboratory to Study Retina and Optic Nerve Circulation

This laboratory is using two new instruments: the Laser Doppler Flowmeter (LDF) and the optic nerve flowmeter, both developed by Gilbert Feke, Ph.D., who is one of our research scientists.  A pilot model of the LDF was made by Canon Inc. of Tokyo.  We now have one of very few models existing in the Western world.  It permits the most accurate measurement of the blood flow through the retina in a painless and non-invasive way (Fig.33).  This measurement helps patients suffering from vascular diseases of the retina, particularly certain types of glaucoma.  The optic nerve flowmeter helps in making a precise diagnosis and delivering an effective treatment of optic nerve diseases.  This laboratory is directed by Wallace J. McMeel, President of the SRA Foundation.

Fig. 33

Gilbert Feke, Ph.D. with the Laser Doppler Flowmeter measures the flow of blood in the retina precisely.

Laboratory for Scanning Laser Ophthalmoscopy (SLO)

Invented by Dr. Oleg Pomerantzeff (deceased), also a co-worker of the Schepens Retina Associates, the SLO instrument was made commercially by Rodenstock of Germany.  It enables the ophthalmologist to see and photograph the back of the eye without dilating the pupil or exposing the patient to unpleasantly bright light (Fig.34).  It has proved invaluable in measuring the damage done to the retina by macular degeneration, and in guiding the laser treatment when treating wet macular degeneration.  Further research with the SLO will lead to additional improvements in the management of macular degeneration.  This laboratory is directed by Dr. Frans Van de Velde.

Fig.34.  Frans Van de Velde, M.D., examines the retina of a patient with the SLO.

Electrophysiology Laboratory

For many years, the functioning of the retina has been tested electrically, in a way similar to that used for an electrocardiogram.  It was called electroretinography (ERG).  A special method called topographical electroretinography (ERG) records the electrical reaction of the retina in many locations simultaneously.  It gives new information about the functioning of the individual layers of the retina as well as the whole retina.  This technique sheds new light on many obscure diseases of the retina.  Other tests carried out in this laboratory are: 1) the Pattern Visual Evoked Response (PVER) which helps detect fine disturbances in the macula or optic nerve; 2) glare tests to improve the glare suffered by a number of patients.

Laboratory for Vitreous Studies

The vitreous is the transparent jelly-like tissue which fills 80 percent of the eye and is situated between the crystalline lens and the retina.  Its transparency has made the study of the vitreous difficult.  For more than 20 years, the  director of the laboratory, and young doctors who have been fellows-in-training have used new techniques they devised to record changes in the vitreous.  Examples of conditions that have been helped by this special vitreous examination include macular hole, diabetic retinopathy, retinal detachment and occlusion of retina vessels.  The results of their work were summarized recently in an Atlas that is distributed worldwide.

Laboratory for Optical Coherence Tomography (OCT)

In this laboratory we study, non-invasively, cross-sectioning of the retina.  Using this technique, it is easy to study the position of the transparent vitreous in relation to the retina.  We also use the OCT to study cases of normal pressure glaucoma, cases of early neurodegenerative diseases, and cases of macular degeneration. 

(INSERT FIG.36 HERE)

Fig.36  Marcel Menke, M.D., examining a patient’s eye with the OCT.  He is a clinical research fellow.

Laboratory for Photographic Study of the Macula