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Vision Research Meeting Battlefield Needs: Corneal Wound Sealing/Healing and Protection

Left to right: AEVR Executive Director James Jorkasky with Irene Kochevar, Ph.D. (Massachusetts General Hospital and Colonel Donald Gagliano, M.D., M.H.A., Director of the DOD/VA Vision Center of Excellence (VCE)
Left to right: AEVR Executive Director James Jorkasky with Irene Kochevar, Ph.D. (Massachusetts General Hospital) and Colonel Donald Gagliano, M.D., M.H.A., Director of the DOD/VA Vision Center of Excellence (VCE)
On February 18, the Alliance for Eye and Vision Researchís (AEVR) Decade of Vision 2010-2020 Initiative sponsored a Congressional briefing to educate about vision research that is addressing the devastating nature of traumatic eye injuries being experienced by the nationís troops in Iraq and Afghanistan, which account for about 16 percent of injuries in those wounded on/evacuated from the battlefield. These include both penetrating eye injuries and visual dysfunction as a result of Traumatic Brain Injury (TBI).

Colonel Donald Gagliano, M.D., M.H.A., who commanded troops in the early years of Operation Iraqi Freedom, provided an initial description of how traumatic eye injuries are diagnosed and treated in battlefield conditions. Col. Gagliano serves as the Director of the Vision Center of Excellence (VCE), a joint Department of Defense (DOD) and Department of Veterans Affairs (VA) initiative with the primary goal of coordinating the implementation of the Defense and Veterans Eye Injury and Vision Registry (DVEIVR). Short-term, with more complete data on eye injuries, the VCE can update in-theater vision protocols to ensure early intervention to avoid ocular cell death. Long-term, the Registry can identify the most significant future research needs. The VCE is coordinating with an already existing civilian eye injury registry to ensure that what is learned from treatment and research is shared broadly.

Featured speaker Irene Kochevar, Ph.D., (Wellman Center for Photomedicine, Massachusetts General Hospital), who is a photochemist, described herself as a basic researcher who has focused on the light activation of tissue sealing agents. After consulting with clinical ophthalmologist Colonel Anthony Johnson, M.D. (Ophthalmology/Cornea Service, Brooke Army Medical Center, San Antonio, Texas), the pair decided to combine their skills and submitted and subsequently received jointly an Advanced Technology/Therapeutic Development Award from the DODís Deployment Related Medical Research Program (DRMRP) to study the sealing of penetrating eye injuries using photo-activated bonding, as well as a joint DOD Peer Reviewed Medical Research Program (PRMRP) Translational Research Award to study corneal protection in burn patients.

Dr. Kochevar, who has studied photochemical tissue bonding on skin and peripheral nerves, tendons, and blood vessels in animal research, emphasized its benefits for wound sealing and healing in that it is sutureless, thereby reducing inflammation and scarring; creates a water-tight seal, which guards against fluid loss and infection; and is simple and rapid, with potential direct battlefield application. In summary, a non-toxic, non-inflammatory Rose Bengal dye is applied to lacerated or damaged tissue, a light source is applied (green laser or LED), and the tissue is sealed. The activation of the dye, which is already Food and Drug Administration (FDA)-approved for diagnostic purpopses, promotes linking of the collagen fibers, which she describes as "nanosutures."

In the DRMRP awards, Dr. Kochevar and Col. Johnson are directly applying this technology to the sealing and healing of wounds to the cornea, especially to ensure its continued transparency, as well as to the sclera, the white part of the eye, and eyelid lacerations. For more complex, penetrating eye wounds, Dr. Kochevar seals amniotic membrane over the cornea, similar to a patch on a tire. The membrane, which is the innermost layer of the placenta, has numerous benefits in that it has a high collagen content that promotes nanosuture cross-linking, it is already used in corneal surgery, and it contains healing properties.

Building on the initial research into the membrane patch, in the PRMRP awards, the researchers are studying how it can be made stronger to create a long-lasting protective eye covering in patients who cannot blink due to scarring after burns and grafts that cause skin contraction around the eyes. Current treatments include eye drops and an amniotic membrane ring, but the latter is often degraded by enzymes in the eye within a day or two. The researchers are studying how to fortify the membrane patch by photo-bonding multiple layers of the amnion together to create a highly cross-linked structure which is more resistive to degrading enzymes.

In both sets of these animal studies, the researchers are looking at multiple variables, such as amount of dye and efficacy of light source, to determine optimal sealing and healing conditions and their relationship to a battlefield application. Dr, Kochevar estimates that the research could be ready for human clinical trials within a year, but that separate, additional funding would be necessary.

In closing, AEVR Executive Director James Jorkasky reminded the attendees that the Fiscal Year (FY) 2008 DRMRP and PRMRP translational research awards that Dr. Kochevar and Col. Johnson received were among the most prestigious, and that the researchers competed against a very large pool of grants from multiple disciplines. He added that, in FY2009, Congress created a dedicated Peer Reviewed Medical Research-Vision (PRMR-Vision) line item in defense appropriations for extramural research and funded it at $4 million. FY2010 funding was at $3.75 million. He noted that the National Alliance for Eye and Vision Research (NAEVR), through its advocacy, is urging Congress to fund the PRMR-Vision at $10 million in FY2011 appropriations, especially since Defense Secretary Robert Gates has identified research into Restoration of Sight and Eye-Care as one of the four top priorities for defense funding, in addition to Post Traumatic Stress Disorder (PTSD), TBI, and Prosthetics. Seven Veterans Service Organizations (VSOs) have written to Congress urging PRMR-Vision funding at $10 million, and The Independent Budget of FY2011 funding recommendations to Congress by VSOs also supports that request.

Left to right:  NAEVR Advocacy Manager David Epstein with Chris Gaspar from the office of Cong. James Moran (D-VA) and Colonel Gagliano. Cong. Moran, a defense appropriator, was a lead champion for the creation of the dedicated Peer Reviewed Medical Research-Vision line item in Fiscal Year 2009 appropriations, funded at $4 million.
Left to right: NAEVR Advocacy Manager David Epstein with Chris Gaspar from the office of Cong. James Moran (D-VA) and Colonel Gagliano. Cong. Moran, a defense appropriator, was a lead champion for the creation of the dedicated PRMR-Vision line item.
Left to right:  Colonel Gagliano with Tom Zampieri, Ph.D., of Blinded Veterans Association (BVA) and Kathleen Terlizzese of TBI/Tissue Banks International.  BVA, which has been an ardent voice for the creation of the VCE and the dedicated PRMR-Vision line item, has coordinated support for these initiatives with the Veterans Service Organizations (VSOs).
Left to right: Colonel Gagliano with Tom Zampieri, Ph.D., of Blinded Veterans Association (BVA) and Kathleen Terlizzese of TBI/Tissue Banks International. BVA has coordinated support for these vision research with the Veterans Service Organizations (VSOs).
Prior to speaking, Dr. Kochevar met with Mariana Osorio (left) from the office of Cong. Stephen Lynch (D-MA), a strong supporter of defense-related vision research
Prior to speaking, Dr. Kochevar met with Mariana Osorio (left) from the office of Cong. Stephen Lynch (D-MA), a strong supporter of defense-related vision research
Dr. Kochevar also met with Heather Gasper (left) and Chief of Staff Robert Primus in the office of Cong. Michael Capuano (D-MA), also a strong supporter of defense-related vision research
Dr. Kochevar also met with Heather Gasper (left) and Chief of Staff Robert Primus in the office of Cong. Michael Capuano (D-MA), also a strong supporter of defense-related vision research