DIT Optometry Research

Research activities currently underway within the Department of Optometry are summarised here.  For more detailed information concerning each of these projects, please follow the link to the researcher's personal page.  For information on Graduate Studies in DIT please click here.

Research Activities

There many aspects of vision which are only partly understood, but there is a large volume of international research which is steadily improving our knowledge of how we see. Staff of the D.I.T. Department of Optometry conduct research into a range of vision science topics of both a clinical optometric and applied science nature. There are currently nine postgraduate researchers registered and undertaking research in the Optometry Department.

Research is active in the following areas at present:

MOZAMBIQUE EYECARE PROJECT RESEARCH

Dr. James Loughman, Ms Aoife Phelan, Ms. Eva Doyle, Ms Patricia Mordaunt & Dr Peter Davison (Full Departmental Staff Participation)

This proposal successfully secured Irish Aid funding of €1.5 million, in 2008, to develop and implement a sustainable model for optometric education and eyecare service delivery initially in Mozambique and subsequently across developing nations in a five-year project. The dearth of eyecare services, infrastructure and human resource capacity in developing nations is a significant barrier to basic human rights. Approximately 670 million people in the world today are visually impaired because they do not have access to an eye exam and a pair of spectacles or low vision aids.

Poor vision is an indicator of vulnerability, a constraint to sustainable livelihood development and education and more generally implicated in health and poverty complexes.  The likelihood of adequately addressing this problem in the immediate future is bleak since the number of optometrists and ophthalmologists produced in sub-Saharan Africa is drastically deficient.

The project involves the collaboration of Optometry staff from Dublin Institute of Technology, with support from the University of Ulster, Coleraine, in association with the Brien Holden Vision Institute (BHVI) and Lurio University in Mozambique.

Lurio University has educated nine optometrists who graduated in December 2012 with 80 students enrolled in the Optometry Degree course; further cohorts are due to graduate each December. This co-ordinated programme of deployment on graduation will provide a sustainable solution to eliminating avoidable blindness and, consistent with the thematic priorities of Irish Aid, addresses issues of poverty and disadvantage, education, gender equality, health, HIV/AIDs, livelihood and security and pro-poor economic growth. Research activities will focus specifically on epidemiological, pedagogical and impact analyses.

 

1: An Economic Evaluation of the Impact of Refractive Error in Nampula, Mozambique

Dr. Stephen Thompson – PhD Completed (email)
Dr. James Loughman - Supervisor

Introduction

Poverty is both a cause and a consequence of blindness and visual impairment. As part of the Mozambique Eyecare Project, undergraduates in Optometry will be trained at Universidade Lúrio, Nampula. Once qualified, one of their core functions of the optometrists will be to correct refractive errors within the population, complementing the Vision 2020 initiative. If left uncorrected, refractive error has a negative impact on education, employment opportunities and every day function. This research project aims to measure the socioeconomic impact of the Mozambique Eyecare Project, and in particular the development of the optometry profession to address the burden of uncorrected refractive error within Mozambique.


Methods

An economic evaluation will be conducted using standard Cost Benefit Analysis methodology and other standard economic methodologies, to quantify the impact of the Mozambique Eyecare Project.


Expected Outcomes

The impact of the Mozambique Eyecare Project will be expressed in economic terms through analysis of the costs and benefits of the project.


Collaborators: Partners of the Mozambique Eyecare Project in association with University KwaZulu Natal

 

2: Development of a Child Eye Health Programme for Nampula, Mozambique

Aoife Phelan – MPhil Complete
Dr Veronica O'Dwyer - Supervisor

Introduction

There is no plan for a national child eye care programme or existing human resource infrastructure to address the immediate challenge of child eye health in Mozambique. Furthermore, the prevalence and incidence of refractive error, visual impairment (VI) and child blindness (CB) in Mozambique is unknown. VI and CB have devastating personal, developmental, economic and other implications for the child, the family, the community and indeed, the nation. This study aims to design, implement and evaluate a school based paediatric vision screening service, to identify those in need of eye health services, among Mozambique’s 11,561,000 children.


Methods

Literature Review of Screening Methods in Developing and Developed Countries

Three school eye health screening campaigns in Nampula

Implementation, Monitoring and Evaluating of a Pilot Teacher Training Programme

Interviewing child eye health stakeholders to understand the considerations in the design of a Child Eye Health Programme


Expected Outcomes

Strategic Document on the Development of a Child Eye Health Programme for Nampula. This Policy Document will be translational across health care sectors and internationally.


Collaborators: Partners of the Mozambique Eyecare Project in association with the Mozambique Eyecare Coalition

 

3: Evaluation of Students in a V2020 Optometry Program in Mozambique

Kajal Shah – PhD Candidate (email)
Dr. James Loughman – Supervisor

Introduction

My research as part of the Mozambique Eyecare Project with the Dublin Institute Of Technology (DIT) has two strands. The first evaluates the student experience and their competencies as they progress through the Optometry course at Unilurio in Nampula, Mozambique. The second evaluates the existing skills and knowledge in refraction of ophthalmic technicians in Mozambique.


Evaluation of Optometry Students

There are currently 16 students enrolled in the first year group and 26 in the second year group who will graduate as the first professional optometrists in the country. This research will inform the course coordinators on how to better structure and develop the module and course.


Expected Outcomes

The research will benchmark a novel training scheme against international optometric standards for clinical competency that can revolutionise training for refractive error service delivery in developing nations.


Evaluation of Ophthalmic Technicians

There are currently only 34 ophthalmic technicians in Mozambique. They along with 13 Ophthalmologists are the only providers of refraction services however their knowledge and level of refraction is unknown. The aim of the research is to evaluate their skills and knowledge in refraction.

Expected Outcomes

This strand will provide the Mozambique Eye Care Coalition (The Ministry of Health and NGO’s involved in eye care)  with valuable information for the National Eye Care Strategy. By identifying strengths and weaknesses of the ophthalmic technicians refraction knowledge and skills, mentoring and continuing education can be tailored accordingly.

Collaborators: Partners of the Mozambique Eyecare Project in association with the Mozambique Eyecare Coalition

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4: An Evaluation of the Regional School of Optometry in Mozambique: the Implementation Phase

Vanessa Moodley – PhD Candidate
Dr. James Loughman – Supervisor

Introduction

The Mozambique Eyecare Programme has been designed with the aim of facilitating the development, implementation and evaluation of a regional optometry model for Lusophone Africa which includes the countries Angola, Guinea Bissau, Sao Tome e Principe and Cape Verde.  This project serves to contribute to the overall aim of the programme by implementing a two-phased strategy, the first of which is the development of a model for the recruitment and retention of students for this programme. The criteria for entry recruitment will be assessed and the likelihood of retention and success in the programme evaluated within the context of the applicant’s background education and exposure.
In addition to being appropriately recruited and retained in the programme, graduates will need to return and contribute to the ultimate development of the eye health services in their respective countries. Phase two of this project hence involves interacting with the relevant government departments within respective countries to contribute to the creation of a legislative framework that will support the graduates throughout the programme as well as on return to their respective countries. The legislative framework will assist the region and specific country in ensuring that the services and education of eye care personnel are sustainable, thus over the years, creating successively greater access to quality eye care services for the millions of people in the Lusophone African region.

Collaborators: Partners of the Mozambique Eyecare Project in association with the Mozambique Eyecare Coalition

 

5: An evaluation of a multi-partner development initiative in the establishment of an undergraduate optometry training program for Lusophone Africa: the Mozambique Eye Care Project Implementation Lessons

Diane Wallace – PhD Candidate (email)
Dr. James Loughman – Supervisor

Introduction

The research will evaluate three main aspects of the Mozambique Eye Care Project, a multi-partner development initiative in the establishment of an undergraduate optometry training program for Lusophone Africa.  The aim of the study is to review the relevance of, approach to and implementation of the project; and identify key learnings for the successful implementation of a quality, sustainable and appropriate optometric training program for the developing world.


The research will undertake:

  • Critical evaluation of the Multiple Entry Exit Model initially planned for this project and its suitability for a Mozambican / Lusophone Africa context.
  • Review of regional developmental and legislative frameworks for such an initiative, and critical success factors to multi-partner cross-sectoral collaborations.
  • Review programmatic challenges in the implementation of the project.


Methods

This descriptive study will employ both qualitative and quantitative research methods. The qualitative aspect will be facilitated primarily through key informant interviews, focus groups and direct observation. Quantitative data will arise from semi-structured interviews as well as project documentation, reports and desktop studies.


Expected Outcomes

Since there were no benchmarks to implementing a multi-partner, non-English language regional optometry training program in the developing world, key lessons can be learned from this project, which can be taken into consideration for the development of future initiatives or emerging programs in this regard.   Projected outcomes of the research will be identifying appropriate contextual models and factors that influence these, as well as understanding processes and approaches that have an impact on the success and sustainability of multi-partner development projects in higher education and health systems development.

Collaborators: Partners of the Mozambique Eyecare Project in association with the Mozambique Eyecare Coalition

 

6: Baseline & Clinical Mozambique Eyecare Project Research

(a) Rapid Assessment of Refractive Error (RARE)

Rapid assessment methods are a means to undertake a comprehensive assessment of a public health issue, in this case Refractive Errors and Presbyopia, using minimum resources within a limited amount of time. Such methods help plan, develop and implement interventions and monitor service delivery.

RARE is a simple examination protocol that can be administrated by personnel with minimal training, using simple equipment has been developed to detect vision loss from refractive errors.  Find out more here.
The Mozambique Eyecare Project plan to carry out a RARE in the province of Nampula. The protocol has been submitted to the National Bioethics Committee.

Collaborators: Partners of the Mozambique Eyecare Project

(b) Situational Analysis

The Mozambique Eyecare Project partners are working with the Mozambique Eye Care Coalition (Mozambiques Eyecare NGO’s and the Ministry of Health) to support the Ministry of Health in conducting a Situational Analysis of eye care services in Mozambique. A situational analysis is  performed to develop a statistical picture of the current status of services, human resources, and infrastructure for Eyecare in Mozambique. This is based on currently available information, gathered by members of the Mozambique Eyecare Coalition. This data will be used to identify and describe trends in Eyecare provision in Mozambique so that the next National Eyecare Strategy can address the challenges highlighted by this research. The data will also be used to compare Mozambique’s service provision with other countries. Stephen Thompson, Project Manager, MEP has travelled to several under-served provinces to collect data from eye departments in provincial hospitals. Final figures are not in yet, but the situation in most provinces is less than ideal. In Nampula (highlighted in green) and Capo Delgado (approx population 5.5 million) there are only two ophthalmologists and a few refractionists.

(c) Clinical AMD & Glaucoma Research

These projects include:

  • An evaluation of a novel visual field device for glaucoma screening in community environments developed by Moorfields Eye Hospital
  • An evaluation of macular pigment levels in Mozambique

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OPHTHALMIC INSTRUMENTATION: DARK ADAPTOMETRY

Dr. David O'Brien & Dr Peter Davison

Researchers from the School of Physics researched and developed a number of awarding winning diagnostic ophthalmic instruments.  The Automatic Dark Adaptometer is a patented instrument designed to investigate human dark adaptation (night vision). It is used as an aid in the diagnosis of specific eye diseases , such as retinal and choroidal diseases, retinitis pigmentosa. The instrument was intended for use as a screening device for vitamin A deficiency in developing countries as night blindness is an early symptom of this condition. Estimates indicate over one million children lose their sight each year as a consequence of this deficiency; associated morbidity and mortality rates are high.

 

MACULAR PIGMENT RESEARCH

Dr. James Loughman, Dr. Peter Davison, Dr. Veronica O' Dwyer

Macular Pigment (MP) is composed of the dietary carotenoids, lutein (L) and zeaxanthin (Z) which accumulate, to the exclusion of all other carotenoids, in the central retina. MP is a blue light filter and possesses powerful antioxidant properties. While there is a growing body of evidence that MP may protect against cataract and age-related macular degeneration (AMD), which is the commonest cause of age-related blindness in the Western World, the visual and physiological role of MP has yet to be explored.

A series of collaborative macular pigment studies are underway, and bring together complementary areas of expertise to assess, for the first time, whether MP has an effect, beneficial or otherwise, on visual function.  The implications of a finding that MP is important for central visual function would include the possibility that appropriate dietary supplements could enhance visual performance. In the long term, visual performance deteriorates with advancing age even in the absence of established disease such as AMD and cataract. The ultimate goal includes protection against eye disease and also preservation of visual performance into older years in the absence of eye disease.

The COMPASS project recently completed, and demonstrated a benefit of MP supplementation on vision in normal healthy observers. Current studies are building on these findings and include:

1: Macular Pigment & Glare Disability in Glaucoma

Dr. James Loughman, Prof Colm O’ Brien, Dr. John Nolan, Prof. Stephen Beatty

This project aims to elucidate whether the glare symptoms often experienced in advanced glaucoma relate to MP levels, and whether they can be alleviated through MP supplementation. Data collection is ongoing by Dr. Estera Igraz and Mr. Matthew Ratzlaff at the Mater Hospital in Dublin.

2: Macular Pigment and Glare Disability in Post-Laser Refractive Surgery Patients

Dr. James Loughman, Dr. Arthur Cummings, Dr. John Nolan, Prof Stephen Beatty

This project aims to elucidate whether the glare symptoms experienced by some post-laser refractive surgery patients relate to MP levels, and whether they can be alleviated through MP supplementation.

3: Macular Pigment in an African Population

Dr. James Loughman, Prof. Bill Wooten, Dr. John Nolan, Prof. Stephen Beatty

This project aims, for the first time, to evaluate macular pigment levels in an African population. This project will determine the effect of dietary variation, sunlight exposure and a variety of additional population factors on MP optical density in this population, where AMD levels are beginning to rise.

4: Macular Pigment in AMD

Dr. James Loughman, Dr Sarah Pickett, Dr. John Nolan, Prof. Stephen Beatty

There are currently a number of active research projects evaluating the potential role of MP in AMD. These are collaborative DIT/WIT projects and include:

Functional, morphological and biochemical responses to supplementation with three different macular carotenoid formulations, in patients with early AMD.
Dr. Sarah Pickett – PhD Completed
Dr. James Loughman - Supervisor

This study is designed to compare three different carotenoid-based products, in a single-blind, randomised fashion, with respect to changes in MP optical density and serum concentrations of MZ, L and Z in patients with early AMD. This study will also investigate whether MP augmentation enhances visual function and/or reduces AMD severity in patients with early AMD, and in addition, whether such changes relate to product formulation.

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LASER REFRACTIVE SURGERY RESEARCH

Dr. Aoife Lloyd McKernan, Dr. Veronica O’ Dwyer, Dr. Linda Moore, Dr. James Loughman

1: The impact of modern soft contact lens wear on corneal curvature and thickness and on the outcomes of refractive Laser surgery

Dr. Aoife Lloyd McKernan – PhD Complete
Dr. Luisa Simo, Dr. Veronica O’ Dwyer, Dr. Linda Moore – Supervisors

The research will evaluate the impact of modern soft contact lens (SCL) wear on corneal curvature and thickness parameters. The stability of these measurements following SCL cessation for a two week period will be examined. Through comparison of curvature and thickness scans between a group of SCL wearers and a non-lens wearing control group, the influence of SCL on corneal measurements will be analysed.
The accuracy of pre-operative measurements of corneal curvature and thickness is crucial in order to assess patient suitability for corneal refractive surgery (CRS) and rule out potential risk factors for developing post-operative corneal ectasia. SCL wear may impact on the stability of these measurements and result in poorer CRS outcomes. This study will assess the stability of measurements taken prior to CRS and the possible influence of SCL wear on refractive outcomes.

2: Macular Pigment and Glare Disability in Post-Laser Refractive Surgery Patients

Dr. James Loughman, Dr. Arthur Cummings, Dr. John Nolan, Prof Stephen Beatty

This project aims to elucidate whether the glare symptoms experienced by some post-laser refractive surgery patients relate to MP levels, and whether they can be alleviated through MP supplementation.

NEOVASCULAR AMD TREATMENT RESEARCH

Dr. Sarah Pickett, Dr. James Loughman

Prognostic indicators and outcome measures for patients with neovascular age-related macular degeneration undergoing treatment with intravitreal ranibizumab.
Dr. Sarah Pickett – PhD Completed
Dr. James Loughman – Supervisor

In this study, we are investigating visual performance, and its response to treatment, in patients with neovascular age-related macular degneration (nv-AMD) by performing an array of psychophysical tests in patients undergoing a course of intravitreal ranibizumab injections for their condition. The purpose of this study is to explore whether alternative psychophysical testing is more appropriate than, or complimentary to, corrected distance visual acuity (CDVA) (the standard and most commonly utilised method for assessing vision) in reflecting the patient’s visual experience, and if so, whether such alternative parameters are more sensitive to changes in retinal thickness than is CDVA.

GLAUCOMA RESEARCH

Catriona Barrett, Dr. James Loughman, Prof. Colm O Brien

1: Glaucoma Care in the Community

Catriona Barrett – PhD Candidate (email)
Dr. James Loughman - Supervisor

Glaucoma is the second leading cause of blindness in Ireland. As our population ages and life expectancy increases glaucoma prevalence is also increasing. Community optometry has the capacity to expand on its current role and do even more to relieve pressure on hospital eye services. This research will assess the feasibility of a new care pathway for glaucoma suspects. Optometrist, Catriona Barrett, will work with Dr. James Loughman and Prof. Colm O’ Brien to complete a research masters in glaucoma shared care over a two year period. Following a period of specialist training at the Mater hospital, a pilot scheme will be launched, inviting optometrists to send their glaucoma referrals to the National Optometry Centre. The scheme will seek to:

  • Reduce patient waiting times for initial assessment
  • Reduce glaucoma referrals to hospital
  • Improve the clinical information accompanying referral
  • Evaluate any cost-benefit generated
  • Analyse patient satisfaction

2: Glaucoma Screening using a Novel Visual Field Device (Moorfields Motion Displacement Test) in African Communities

Ms Vivien Ocampo, Dr. James Loughman, Prof Roger Anderson, Dr. Gay Verdon Roe, Prof Kovin Naidoo

This project seeks to evaluate a novel visual field device developed in Moorfields Eye Hospital specifically for community glaucoma screening. The use of the device in an African, developing nation context, is of central importance, and this series of projects will determine the clinical applicability of the device in very different community environments in South Africa and Mozambique. Of particular interest is patient understanding and tolerability of the device, and the suitability of different suprathresholding algorithms.  

3: Development of a Novel Adjunct Therapy for the Management of Glaucoma

Ms. Ekaterina Loskutova - PhD Candidate
Dr. James Loughman - Supervisor

Glaucoma, which is a progressive optic neuropathy, is the second leading cause of global blindness. In glaucoma, as the retinal nerve cells die, the connection between the eye and the brain is gradually diminished. Current therapeutic options are limited, and typically fail to arrest disease progression for the majority of glaucoma patients.

Recent evidence indicates that three dietary carotenoids which accumulate in the retina (lutein, zeaxanthin and meso-zeaxanthin) may be involved in glaucoma pathogenesis. These carotenoid levels are low in glaucoma subjects, and the lack thereof is associated with more severe visual loss and structural damage particularly affecting central vision.

This study is a randomised, placebo controlled and double masked clinical trial designed to investigate the effects of dietary macular carotenoids supplementation on disease progression, visual function and quality of life in glaucoma patients. This study will ultimately determine, for the first time, whether macular carotenoid enrichment can provide an effective adjunct therapy that alters disease progression and quality-of-life impact of glaucoma in affected individuals

 

ATROPINE FOR THE TREATMENT OF MYOPIA IN CHILDREN

Saoirse McCrann – PhD Candidate (email)
Dr. James Loughman & Prof. Ian Flitcroft - Supervisors

There is no current therapeutic approach to the control and prevention of myopia, which is expected to affect one in three people worldwide by 2020, and represents the only major cause of blindness that is untreatable.

The aim of the research is to investigate new ways to prevent, treat and control myopia progression in children and to deepen our understanding of myopia and its risks.

Optometrist, Saoirse McCrann, will work with Dr. James Loughman and Prof. Ian Flitcroft to complete a four-year PhD, which will evaluate, for the first time in Europe or the USA, the safety, efficacy and acceptability of atropine, a pharmacological intervention currently used in the treatment of amblyopia in childrenand which has shown potential for effective myopia control in Asia.

A randomised, placebo-controlled two-year clinical trial will be conducted to investigate the capacity of atropine to control the progression of myopia among eligible Irish children.

 

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