Researcher in the Spotlight April 2015

Professor Irene Gottlob is a Professor of Ophthalmology at the University of Leicester.

What is your research about?

My research is mainly about the connection between the eye and the brain. Visual input occurs through the innermost layer of the eye (the retina) and the optic nerve carrying the signal to the brain. Messages also leave the brain to coordinate eye muscles to focus gaze to objects of attention. If the inward/outward loop does not work, vision and eye movements can be disturbed. I am looking into abnormal childhood development of the visual system as well as degeneration in later life.

One condition I study is “lazy eyes”, known as amblyopia. It is caused by lack of stimulation of one eye in early childhood. The brain suppresses the amblyopic eye for example because this eye turns inwards or outwards (squint) or is not corrected with glasses. Due to plasticity of the brain, this can be reversed by wearing correct glasses and a patch on the healthy eye in order to activate the amblyopic eye and to improve its vision. In Leicester, we are researching how to improve patching in terms of its acceptability to children and the optimal patching regimen for each individual child.

Another problem of visual development in early childhood is faulty development of the centre of the retina (fovea), the area of sharpest vision. For example in genetic diseases such as albinism or retinal degeneration, the retina is underdeveloped. Insight into the exact shape of the fovea can be seen with an instrument called optical coherence tomography (OCT). OCT enables early diagnosis of such diseases.

Nystagmus is a key area of my research, which can also be caused by foveal underdevelopment leading to gaze instability. Patients with nystagmus have continuous to and fro eye movements. My research is about genetic causes, and possible drug and surgical treatment.

OCT also allows us to look at the retina as a potential biomarker in degenerative diseases, such as Alzheimer’s disease, Parkinson’s and schizophrenia.

How did you come to be working in this field and was this something you always wanted to do?

The first time I came across this field was a fascinating lecture in sensory physiology in my second year of medical school at the University of Vienna (Austria). This inspired me to become an ophthalmologist. After graduating from Medical School, I worked in physiology on a project involving pharmacological properties of the isolated retina. This further fuelled my interest in Neuro-ophthalmology. Later fellowships at Wills Eye Hospital in Philadelphia and in Kiel in Germany allowed me to specialise in nystagmus.

Why is your work important?

The work we do is of direct clinical significance to patients. Nystagmus is a rare disease and we established a specialist centre in Leicester for clinical research into this. Our research spans from genetics to treatment and provides patients with greater insight into their disease as well as the potential amelioration of symptoms. Research into patching techniques and regimens not only optimises an amblyopic child’s treatment, but also aims to reduce the stigma around patching and may improve the quality of life of children and their families. This has a large impact, with amblyopia unlike nystagmus being a common childhood disease. The work we do with adults can also be of benefit; for example the investigations into problems with reading may help design improved methods for adults with visual problems.

A new development in our research is the hand-held OCT. Until recently, it was not possible to examine children with OCT because they could not stay still for long enough! The hand-held scanner is much more suitable for children and means that we can even look at the retinas of newborns. Currently, we have only little knowledge about what constitutes a ‘normal’ retina in a child and of course, things are also changing as they grow and develop. At the University of Leicester Ulverscroft Eye Unit, we are investigating normal and abnormal development of the retina and optic nerve as an aid to future diagnosis. This has been made possible by being able to look at the retinas of such young children.

We have found that the retina is immature at birth. For example, the photoreceptors, the sensors in the retina which detect light, are very small at birth, but elongate by about 30 times, until 6 years of age. We can also follow the development and formation of the fovea (this is the central region of sharpest vision) and this shows that retinal and optic nerve development is not completed before young adulthood.

Do you think your work can make a difference?

Yes! As mentioned before, my research is of direct clinical relevance and has the potential to benefit patients’ lives. Furthermore, my work contributes towards the knowledge we have about certain diseases. For example, I have been able to pinpoint certain genes and syndromes that can cause nystagmus. This can aid with the genetic diagnosis and counselling of the siblings and children of the affected sufferers. The recent development of the handheld OCT has given great insight into the development of the retina and early diagnosis of conditions, such as e.g. albinism, can help to avoid unnecessary investigations under anaesthesia.

What does a typical day involve?

My time is split approximately into a fifty/fifty divide between clinical work and research. On some days I see patients in clinic, and on others, I perform surgery. I have seven postgraduate research students so much of my job involves overseeing their projects.

What do you enjoy most in your job?

I mainly enjoy the contact with patients and students. As well as this, making progress with my research and discovering new things provides great satisfaction.

What do enjoy the least?

The paperwork.

What advice would you give to students/early career researchers?

Research is not easy. I think that one should not be easily discouraged. Throughout their studies, students may have always been successful, and this expectation may be carried through when they begin research. Unfortunately, experiments may go wrong and papers and grants may be rejected. This should not be viewed as a failure, but as the reality of working in such a challenging environment. With enough perseverance and hard work, success will eventually come.

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