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EGRET-Plus Report Summary

Project ID: 675033
Funded under: H2020-EU.1.3.1.

Periodic Reporting for period 1 - EGRET-Plus (European Glaucoma Research Training Program-Plus)

Reporting period: 2016-01-01 to 2017-12-31

Summary of the context and overall objectives of the project

Glaucoma is the most common age-related neurodegenerative and a major blinding eye-disease in western society. If untreated or detected too late, glaucoma ends in blindness, yielding a profound loss of quality of life for the individual and major costs to society. Given the vast complexity of glaucoma, and to advance assessment and therapy beyond the current state-of-the-art, our overall objective is to train a new generation of researchers on how to study functional, structural and genetic aspects of the visual system of patients and age-matched controls to provide essential information for improving clinical diagnostics. Finally, we will teach fellows how to improve on current rehabilitation techniques.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

EGRET-plus has organised three training events on topics covering visual system pathophysiology, sensory biophysics, diagnostics and genetics of glaucoma (see Attachment 1).
ESRs have successfully started their projects and made considerable progression. Meta-analysis and literature reviews have been performed, pilot studies have been conducted, METC approvals have been obtained, secondments have started, manuscripts have been drafted, and results have been disseminated. Below a short report on each of the ESR's progress.
Giorgia Demaria [UMCG] evaluated a battery of perimetry tests by comparing it to the gold standard (Humphrey Field Analyser) based on its user friendliness and discriminative power. Three tests were newly developed by EGRET partners. Subject recruitment has started and actual measurements will follow.
Iris Tigchelaar [OCU] tests Ocusweep’s vision, visual field and neurological tests in a patient group and compares it to methods established to measure fitness to drive. She is currently piloting in patients with mild cognitive impairment and glaucoma. She developed, tested and validated a new reaction time test that will become available to Ocusweep users.
Daniel Asfaw [CITY] assesses whether visual system’s dysfunction is reflected in person's gaze. Using eye tracking, he determined suitable methods to study eye movements in glaucoma patients with asymmetric visual field loss. He found that the worse eye's movements were restricted in spatial extent with more frequent back-and-forth movements compared to the better one.
Sang-Yee Go [UMCG] reviewed literature on motion sensitivity in glaucoma, and obtained METC permission to use motion localisers, (f)MRI and behavioral measures to examine structure-function relationships at the level of the brain. She conducted a pilot study in healthy subjects to examine the relationship between various existing motion paradigms.
Stephen Kelly [CITY] examines the measurement variability of more than 1,000,000 visual field measures, by assessing the effect of order of testing, age and frequency of examinations. Further research is done on glaucoma progression, considering co-pathologies and adherence to testing regime.
Shereif Haykal [UMCG] ​carries out the world’s first longitudinal study on structural brain changes in glaucoma by diffusion MRI. He is now recruiting and rescanning participants from previous studies (4-10 years interval).
Khaldoon Al-Nosairy [OVGU] ​optimises non-invasive retinal electrophysiology, reflecting retinal ganglion cell function, with a potential for glaucoma assessment. He is currently optimising parameters for multifocal photopic negative response recordings and for simultaneous recordings of multifocal pattern ERG and cortical responses.
Gokulraj Prabhakaran’s [OVGU] focusses on mapping out the deafferented visual cortex in glaucoma patients and investigating its task-related functional activity. Using an existing paradigm, he performed a pilot fMRI study on a retinitis pigmentosa patient. Population receptive field mapping showed good correspondence between subjective and fMRI related visual field coverage. Comparisons of different one-back-tasks resulted in stimulus set-up for a fMRI study on glaucoma patients.
Jeferson Jhone da Silva [ECHO] works on improving intracranial pressure (ICP) measurement techniques using otoacoustic emissions. A new method of signal recording with improved stability has been developed, validated, and will be implemented in two devices used by fellow ESRs. Furthermore, he works on a better understanding of inter-subject variation in signal strength and stability.
Sandra Gonzalez Torrecilla [UDA] compares outcomes of several tests of ICP through the ear in subjects whom ICP changes in a controlled manner. By wideband absorbancemetry, absolute ICP from the air pressure in the external ear canal is read from 40 normal subjects submitted to body tilt. Absorbancemetry showed to be a consistent and

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

Kelly will produce maps of the UK, illustrating late diagnosis of glaucoma in relationship to socioeconomic status; we plan to make these publically available.
Work on eye movements and VR by Asfaw will be showcased at meetings illustrating vision loss in people with glaucoma.
Haykal collected data for what we believe is the world’s first longitudinal study into brain changes in glaucoma patients, providing unique data and information on degeneration and plasticity related to this disease.
Wagstaff constructed a functional glaucoma-model-in-a-dish from stem cells that can be used to test new glaucoma genes identified in the glaucoma GWAS and family studies, as well as potential new glaucoma treatment targets.
Gonzalez Torrecilla developed and currently evaluates a non-invasive ICP measurement technique that has the potential to change a wide range of clinical care substantially.

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