App assisting ophthalmologists

iPad app allows ophthalmologists to view what their patients see Despite the prevalence of Alzheimer’s, there are still no treat-

The practice of medicine relating to sight has been around for more than 2,500 years. But for the first time, ophthalmologists are now able to see what their glaucoma patients see through an iPad tablet application.

“This represents the first time we have been able to understand what glaucoma patients see. We’ve never really known. It’s startling,” said Deepta Ghate, MD, an associate professor in the University of Nebraska Medical Center’s Department of Ophthalmology and Visual Sciences at the Truhlsen Eye Institute. “This is critical to improve patient understanding of the disease and for future rehabilitative efforts.”

Dr. Ghate collaborated with students from the University of Nebraska at Omaha’s College of Information Science and Technology to develop the app, then studied it in 12 glaucoma patients.

Glaucoma is a disease of the optic nerve that causes loss of peripheral vision. No one was quite sure exactly what glaucoma patients saw in their “blind spots.” Dr Ghate decided to design an app so the patients could answer the question themselves.

In the study, participants used the app on the iPad to modify “blur” or “dimness” to match their perception of a two-by-two-meter wall-mounted poster at one meter distance. They looked at various scenes and recorded what they saw.

Patients could modify the scenes so ophthalmologists could see what the patient sees and compare and validate the patient’s vision. The experiment finished when the patient looked at the iPad re-creation and said, “This is exactly what I see.”

One of the problems with glaucoma is patients don’t know they’re losing their vision. Their central vision is perfect, often 20/20, but the glaucoma is continuously causing a loss of peripheral vision so slowly that normally it isn’t noticeable.

“This is preventable, and prevention is everything,” Dr. Ghate said. “Glaucoma causes irreversible vision loss and blindness if not diagnosed early. A lack of peripheral vision causes patients to bump into things, fall more, have more vehicle crashes, and affects their quality of life in a dramatic way.”

The app can show patients they have lost vision even when they think their vision is fine. It also can reinforce the importance of taking their medications to slow the disease and prevent blindness, she said.

The study was funded by a grant from the National Institutes of Health funded Great Plains Institutional Development Award Program Infrastructure for Clinical and Translational Research. (UNMC provided this information.)

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• Florence Home Healthcare • Royale Oaks Assisted Living • House of Hope Assisted Living • House of Hope Memory Care • Gerimed & Unimed Pharmacies ments, in part because it has been challenging to study how the disease develops. Now, scientists at the Salk Institute in California have uncovered new insights into what goes awry during Alzheimer’s by growing neurons that resemble – more accurately than ever before – brain cells in older patients. Like the patients themselves, the afflicted neurons appear to lose their cellular identity. The findings showed these brain cells are characterized by markers of stress as well as changes in which the cells become less specialized. Interestingly, many of the alterations seen in these cells are similar to what’s been observed in cancer cells—another disease linked to aging. “We know the risk of Alzheimer’s increases exponentially with age, but due to an incomplete understanding of age-dependent pathogenesis, it’s been difficult to develop effective treatments,” says Professor and Salk President Rusty Gage, the paper’s senior author. “Better models of the disease are vital for getting at the underlying drivers of this relationship.” In an earlier study, the Gage lab had shown a new way that skin samples can be used to create brain cells. These induced neurons more accurately reflect the age of the person they came from (unlike neurons made from the more commonly used induced pluripotent stem cells). The new study builds on that finding and is the first to use skin cells from people with Alzheimer’s to create induced neurons that have the characteristics of neurons found in patients’ brains.

“The vast majority of Alzheimer’s cases occur sporadically and have no known genetic cause,” says Jerome Mertens, an assistant adjunct professor at Salk and the first author of the paper, who was also involved in that earlier work. “Our goal here was to see if induced neurons we generated from Alzheimer’s patients could teach us anything new about the changes that take place in these cells when the disease develops.”

In the recent research, the investigators collected skin cells from 13 patients with sporadic, age-related Alzheimer’s. They also used cells from three people who have the more rare, inherited form of the disease. As a control, they collected skin cells from 19 people who were matched for age but did not have Alzheimer’s. Using a specialized type of skin cells called fibroblasts, they generated induced neurons from each of the cell donors. They then compared the molecular differences in the cells among those who had Alzheimer’s to the cells of those who did not.

The investigators found the induced neurons made from the cells of people with Alzheimer’s had distinct characteristics that were different from the healthy control subjects’ cells. For one thing, the Alzheimer’s cells had a lack of synaptic structures, which are important for sending signals to each other. They also had changes in their signaling pathways which control cell function, indicating the cells were stressed.

Additionally, when the researchers analyzed the cells’ transcriptomes – a type of analysis that shows what proteins the cells are making – they found the induced Alzheimer’s neurons had very similar molecular signatures to immature nerve cells found in the developing brain.

According to Mertens, the neurons seem to have lost their mature identity, and this de-differentiation, in which cells lose their specialized characteristics, has also been described in cancer cells. He suggests the finding opens up the door for new studies. (The Salk Institute provided this information.)