The cornea is the front part of the eye that acts as the physical and biological protective layer to the more sensitive areas like the iris, and retina in the back of the eye. The cornea is comprised of a perfectly transparent tissue that focuses perceived light and redirects it to the light-sensitive tissue in the posterior part of the eye. Corneal blindness is a type of blindness, or visual disruption, that occurs when this perfectly transparent tissue either becomes cloudy, scratched, or otherwise damaged.
The Department of Ophthalmology does a lot of work on the cornea, including dry eye, keratoconus, and cornea regeneration.
A healthy ocular surface, consisting of the cornea, conjunctiva and the tear film, is essential for normal vision. Ocular surface disorders account for the bulk of the primary eye care services in the U.S, with dry eye alone affecting about six million women and three million men with moderate to severe symptoms and an additional 20 to 30 million people with mild symptoms.
The Swamynathan Laboratory, also known as the Ocular Surface Development Laboratory, is interested in understanding the molecular mechanisms that regulate the formation and function of the ocular surface, to generate new opportunities for diagnosis, prevention and therapy of ocular surface disorders such as dry eye. The cornea is somewhat analogous to a vehicle’s windshield. Just as we use the windshield wipers and windshield washer liquid to keep an automobile’s windshield clean, our eyelids spread the tear fluid to keep the cornea healthy. In dry eye disease, the quality and/or quantity of the tear produced is affected, resulting in a dry and itchy sensation that further leads to inflammation.
The Swamynathan Laboratory discovered that the transcription factors KLF4 and KLF5 are required for proper maturation and maintenance of a healthy ocular surface. It also found that a protein called SLURP1 (one of many KF4-target genes) helps maintain low level of inflammation in healthy corneas. Ongoing research in the Swamynathan Laboratory is supported by federal grants from the NIH.
Keratoconus is a corneal degenerative condition with corneal thinning and protrusion, which results in blurred vision and visual loss. Dr. Yiqin Du‘s lab, Cell Biology and Glaucoma, aims to develop stem cell-based and stem cell-free therapies using stem cell derived exosomes or secretomes to promote corneal regeneration and treat keratoconus. They have shown that corneal stromal cells and the stem cell-derived secretomes were able to promote scarless corneal wound healing and prevent corneal thinning.
Vital work is also being done on cornea regeneration. The late Dr. Jim Funderburgh worked with his wife Martha on corneal scarring. As part of the Funderburgh Corneal Regeneration Project, his pioneering work with collaborators in the Department of Ophthalmology, including Yiqin Du, MD, PhD, was discovering stem cells in the corneal stroma and applying them translationally to treat corneal scarring. With colleagues at the University of Pittsburgh, Dr. Funderburgh first reported these therapies in mice. Colleagues in India then applied the Funderburgh Laboratory’s approach in clinical trials to successfully treat over 100 patients with blinding corneal scars.
After Dr. Funderburgh’s passing in late November 2019, the Department of Ophthalmology created the Cornea Task Force. Composed of scientists (Drs. Yiqin Du, and Gary Yam) and clinicians (Drs. Deepinder Dhaliwal and Vishal Jhanji), the goal is to bring the clinical treatment of corneal stromal stem cells for corneal scarring to the United States, continuing Dr. Funderburgh’s legacy so that more patients have access to this innovative treatment. FDA approval will require significant time and resources, but the reality is within our grasp.
Dr. Gary Yam, Research Associate Professor, is also continuing Dr. Funderburgh’s corneal regeneration research with Yam Lab. Also known as the Corneal Regeneration Laboratory, the focus is on the biological processes that produce and maintain the unique tissue of corneal stroma as well as the pathological changes that occur during injury, wound healing, scarring and diseases. The lab is exploring new designs to reverse the scarring process or replace the scarred cornea with bioengineered corneal tissue.
With continued support from generous donors to the Eye & Ear Foundation, we can provide a non-surgical regenerative therapy for corneal scarring that will reduce the need for invasive transplant surgery and the costs and complications associated with it, with a convenience and accessibility that will revolutionize the field.
For more information on Dr. Yam’s work, visit the Corneal Regeneration Laboratory.