Center for the Prevention and Treatment of Visual Loss

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The Iowa City VA Center for the Prevention and Treatment of Visual Loss (CPTVL) focuses on the early detection of potentially blinding disorders of the Veteran and general population caused by disorders of the eye and nervous system that mediate visual perception, light sensitivity, eye movements, blinking, pupil movements, ocular sensation, and pain. The Center tests new ways of determining the earliest sign of disease, its progression and response to treatment. New treatment innovations are discovered by a dedicated group of VA scientists and clinicians who study the cellular mechanisms of disease. Key discoveries utilize machine learning and artificial intelligence in combination with advanced ocular imaging to elucidate structure and function of the eye and central nervous system. Resulting discoveries provides important, clinically relevant biomarkers of eye and neurologic disorders. These include reflex movements of the eyes, pupils, eyelids and facial muscles of expression in three dimensions for objective diagnosis and monitoring of treatment. Many diseases of the nervous system, cardiovascular system and immune system are manifested in the eye, making it an ideal platform to detect, monitor and develop new treatments for ocular and systemic disorders affecting Veterans. The Center's mission of prevention and treatment of visual loss is carried out in 3 main spheres of research: Telemedicine, Cellular Mechanisms of Disease, and Novel Therapeutics. Telemedicine: Advanced technology is developed for automated telemedical assessment of ocular structure and function to facilitate diagnosis, staging, and monitoring of treatment of visual disorders and related central nervous system diseases. This includes an innovative effort to enable smartphone devices for assessing vision and neurologic reflexes which are important readouts of many disorders affecting the eye and nervous system. The CPTVL partners with manufacturers of eye imaging devices and pharmaceutical companies to provide a translational framework for clinical implementation, with rapid dissemination of benefits to Veterans. Cellular Mechanisms of Disease: Therapeutic discoveries along a translational framework are built upon the identification of cellular mechanisms of disease. Traumatic brain injury is being emphasized because of its significant sensory, psychiatric and neurologic morbidity in Veterans. Novel Therapeutics: The discovery of new treatments for disabling conditions involving the visual system is a major focus of CPTVL rehabilitation for improving vision and quality of life of Veterans. Current therapeutic targets of high priority include glaucoma, diabetic peripheral neuropathy, multiple sclerosis, traumatic brain injury, migraine, and light sensitivity. An important new initiative of the CPTVL is to link readouts of vision and neurologic function to quality of life metrics in Veterans. By doing so, we intend to discover which readouts have the largest impact on quality of life and quality of vision. This will provide much needed insight into which visual functions hold the greatest importance as outcome measures. The linking of readouts of vision to quality of life can be individualized for personalized medicine initiatives. Key Words: telemedicine, glaucoma, macular degeneration, diabetic retinopathy, diabetic peripheral neuropathy, traumatic brain injury, multiple sclerosis, light sensitivity, migraine, ocular imaging.