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Melinda Duncan (seated) and research team members (from left)
Mahbubul Shihan, Yan Wang and Samuel Novo look at a section through an
eye showing a cataractous lens.
cataract surgery is often described as a marvel of modern medicine, a
one-hour outpatient procedure that has spared millions from blindness,
especially in developed countries.
But nothing is perfect.
“Modern cataract surgery is one of the most miraculous human health
innovations,” said Melinda Duncan, professor of biological sciences at
the University of Delaware. “It has completely revolutionized eye care
and has greatly reduced the incidence of blindness around the world.
“As with any surgery, there are side effects.”
Duncan conducts research into those side effects — both short term
and long term — and is seeking ways to prevent what is called “secondary
cataract” that can occur years after a successful surgery. Her research
also explores the makeup of cells in the lens of the eye and the way
surgery affects them.
Cataracts occur when the lens of the eye becomes cloudy, a process
that develops over time and is commonly related to aging. Eventually,
individuals with a cataract in one or both eyes feel as if they are
looking at the world through a dirty window.
The surgical procedure removes that
clouded natural lens through a tiny incision and replaces it with a
clear, flexible plastic lens. The surgery and the artificial lenses have
been steadily improving, Duncan said, leading to better and better
vision for patients.
“But some lens cells always remain behind after surgery,” she said. “And that can form scar tissue, which isn’t transparent.”
Some 40-to-70 percent of patients will develop this scarring in the
eye, which will often interfere with their vision. Occurring as long as
10 years after the original surgery, the condition is known as posterior
capsular opacification (PCO), sometimes termed “secondary cataract.”
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These images from Melinda Duncan’s lab show the clear lens of a healthy eye and one clouded by a cataract.
“Most people who develop PCO are fine with a further treatment, but
others are at risk for additional problems,” including damage to their
retinas, Duncan said. “It’s much better to prevent PCO in the first
Her research on this issue has been continuously funded by the National Eye Institute (NEI), a division of the National Institutes of Health
(NIH), since 2004, and the institute recently awarded her a four-year
grant renewal for the project of $1.37 million. Duncan said her research
team has already discovered several molecules that are critical for the
formation of PCO scar tissue.
“We hope to identify clinical interventions to block this potentially
blinding condition,” she said. “That’s what we’re working on now — a
drug that would shut this process down.”
In another active research project, initiated with support from both a
Shovel-Ready Pilot Grant from the Delaware Center for Translational
Research and a dual core access award from Delaware INBRE
(the IDeA Network for Biomedical Research Excellence), Duncan is
investigating the mechanisms that operate immediately after cataract
surgery to trigger PCO.
In researching that process, Duncan made a novel discovery, finding
that the lens cells left behind after surgery produce molecules that may
be the primary triggers for post-surgical eye inflammation.
This was important because doctors prescribe general
anti-inflammatory eye drops to be used in the days after cataract
surgery to prevent pain and damage to the retina. The finding also
relates to PCO, as inflammation is known to drive scar tissue formation
in other organs. This work opens up the possibility that the exact cause
of inflammation could be determined, allowing for a more targeted
therapy to be used in the future, Duncan said.
“Normally in the eye, lens cells
are completely walled off from the immune system and have no resemblance
to immune cells,” she said. “But it turns out that an injury to the
lens, such as surgery, changes that. The data really surprised us
because this was completely unknown before.”
These findings are the focus of a recent paper published by Duncan’s group in the journal Investigative Ophthalmology and Visual Sciences.
The recently published research on injured lens cells as mediators of
inflammation led this work to be supported by both a second recent
grant from the NEI, a four-year award of $1.53 million, as well as
$46,800 in additional funding to expand the scope of the work to
investigate how age affects this process.
Duncan is a professor of biological sciences at UD, as well as
director of the Education and Professional Development Core of Delaware
INBRE and associate director of the Center for Biomedical Research
Excellence (COBRE) in Discovery of Chemical Probes and Therapeutic
She is an editorial board member of Investigative Ophthalmology and
Visual Sciences and a trustee of the Association for Research in Vision
Duncan earned her doctorate at the University of Medicine and
Dentistry of New Jersey, Robert Wood Johnson Medical School and Rutgers
University. She conducted postdoctoral research at the National Eye
Article by Ann Manser; photos by Evan Krape and courtesy of Melinda Duncan