- Email: [email protected]
A meeting of minds
EDITORIALS
A meeting of minds Can J Ophthalmol 2009;44:9–10 doi:10.3129/i08-188
O
n September 26 and 27, 2008, leading research scientists and clinicians gathered at the 3rd Form and Function in Ocular Disease conference at Dalhousie University in Halifax, N.S. The meeting’s main objective is to provide clinicians and scientists from a wide range of expertise with an arena in which to freely discuss and debate matters of mutual interest. The result is the successful translation of research ideas into clinical applications, not only in vision science and ophthalmology, but also in other areas such as drug development, ethics, and the potential of stem cell research in neurological disorders. The Form and Function meetings are targeted to persons involved in any aspect of vision research, ophthalmology, neuroscience, and clinical care. Delegates include ophthalmologists (both general and specialists), clinical and basic science researchers, residents, and fellows. The lecturers, 8 internationally renowned guests and 8 faculty members from Dalhousie University, are expressly informed to present their material such that an audience member outside the speaker’s field of expertise can follow the presentation as easily as a peer of the speaker. This format compels the speakers to position their presentations in a broader context and increases audience participation. The order of lectures is unstructured; for example, a presentation on the epidemiology of blindness might be followed by one on the use of cannabinoids in ocular disease. This format makes for interesting and fruitful discussion. This year the meeting was fortunate to receive support from the Thomas and Alice Morgans Fear Memorial Fund. This endowment, made to the Dalhousie University Faculty of Medicine, provides a forum to encourage the advancement
La rencontre des grands esprits
L
es 26 et 27 septembre 2008, les chefs de file de la recherche scientifique et clinique tenaient leur 3e conférence sur les formes et fonctions en maladie oculaire à l’Université Dalhousie, à Halifax (N.-É.). La rencontre avait pour but principal d’offrir une arène aux cliniciens et aux scientifiques d’une vaste gamme d’expertises pour discuter et débattre librement des questions d’intérêt mutuel. Il en est résulté une fructueuse traduction d’idées en applications cliniques, touchant non seulement la science de la vision et l’ophtalmologie, mais aussi d’autres secteurs comme le développement des médicaments, l’éthique et les possibilités de recherche sur les cellules souches des troubles neurologiques. Ces rencontres s’adressent aux personnes qui s’intéressent de près à tous les aspects de la recherche sur la vision, l’ophtalmologie, la neuroscience et les soins cliniques. Les
of medical knowledge for the benefit of faculty members. Wolfgang Drexler, PhD, of Cardiff University in Cardiff, U.K., was the 2008 Fear Memorial Lecturer, presenting on seeing and probing single cells in the living human retina. Other guest speakers included Keith Martin, MD, Cambridge University, U.K.; Isabelle Brunette, MD, University of Montreal, Montreal, Que.; Michael Walter, PhD, University of Alberta, Edmonton, Alta.; Brian MacVicar, PhD, University of British Columbia, Vancouver, B.C.; Giovanni Staurenghi, MD, University of Milan, Milan, Italy; Joanne Katz, ScD, Johns Hopkins University, Baltimore, Md.; and Brad Fortune, PhD, Devers Eye Institute, Portland, Ore. These lectures were complimented by topics such as frailty and eye disease, advances in robotic neurosurgery, optogenetic strategies to restore vision, and clinical applications of radial deformation acuity from the Dalhousie faculty: Gautam Awatramani, PhD; Paul Artes, PhD; Ryan D’Arcy, PhD; Ivar Mendez, MD, PhD; Lesya Shuba, MD, PhD; Donald Weaver, MD, PhD; Patrice Côté, PhD; and Kenneth Rockwood, MD. A key goal of the Form and Function meetings is to engage trainees, including undergraduates, graduate students, and medical students, and attract them to ophthalmology and visual science. For the next meeting in 2010, initiatives are being planned that will encourage such trainees from across the country to attend the meeting and present their research. It is only by sharing new ideas and crossing the divide between research and clinical practice—and between the many ophthalmology subspecialties—that we can draw fresh and talented minds to our field. Balwantray C. Chauhan, PhD Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, N.S. [email protected]
participants comprenaient des ophtalmologistes (généralistes et spécialistes), des fondamentalistes, des résidents et des fellows. Les conférenciers, en l’occurrence 8 invités de renommée internationale et 8 professeurs de l’Université Dalhousie, sont expressément incités à présenter leur propos de façon à ce que les membres de l’auditoire provenant des autres champs d’expertise que le leur puissent suivre l’exposé aussi facilement que leurs pairs. Le format force les conférenciers à situer leurs exposés dans un contexte élargi et accroît la participation de l’auditoire. Les conférences ne suivent pas d’ordre particulier; par exemple, un exposé sur une épidémiologie de cécité peut suivre un exposé sur les cannabinoïdes des maladies oculaires. Ce format permet des échanges plus intéressants et plus fructueux. Cette année, l’activité a eu la chance de recevoir le soutien du Thomas and Alice Morgans Fear Memorial Fund. Cette dotation, versée à la Faculté de médecine de l’Université Dalhousie, offre un forum qui encourage l’avancement des CAN J OPHTHALMOL—VOL. 44, NO. 1, 2009
9
Editorials sciences médicales au bénéfice des membres de la faculté. Wolfgang Drexler, PhD, de la Cardiff University, à Cardiff (R.-U.) fut le conférencer Fear Memorial 2008; il a traité du visionnement et de l’exploration des cellules individuelles de la rétine humaine vivante. Les autres conférenciers invités furent : Keith Martin, MD, Cambridge University, R.-U.; Isabelle Brunette, MD, Université de Montréal, Montréal, Qué.; Michael Walter, PhD, Université d’Alberta, Edmonton, Alta.; Brian MacVicar, PhD, Université de ColombieBritannique, Vancouver, C.-B.; Giovanni Staurenghi, MD, Université de Milan, Milan, Italie; Joanne Katz, ScD, Université Johns Hopkins, Baltimore, Md.; et Brad Fortune, PhD, Devers Eye Institute, Portland, Ore. À ces conférences s’ajoutèrent des sujets comme la fragilité et la maladie oculaire, les progrès de la neurochirurgie robotisée, les stratégies optogénétiques de restauration de la vision et les applications cliniques de la déformation radiaire de l’acuité, traités par le corps enseignant de Dalhousie : Gautam Awatramani, PhD; Paul Artes, PhD; Ryan D’Arcy, PhD; Ivar Mendez, MD, PhD; Lesya Shuba, MD, PhD;
Polymerase chain reaction or probable contaminated reagin? Can J Ophthalmol 2009;44:10–1 doi:10.3129/i08-186
I
n their excellent narrative review in this issue of the Canadian Journal of Ophthalmology, Yeung et al.1 describe in detail polymerase chain reaction (PCR) methodology and its clinical applicability to ophthalmology. The methodology is based on heat–cool amplifying several cycles of the DNA in question with primers for the suspected DNA in a soup of a thermally stable polymerase enzyme, buffers, and ions. Several variants of this basic reaction are now available and were explained in detail. The authors discuss the potential applicability to detect bacteria, atypical bacteria, viruses, cytokines, and even tumors both inside and outside the eye. When I was a fellow at the University of California San Francisco back in 1995, there was great hope for the applicability of PCR in ophthalmology. So great was the promise that it seemed in a few short months, a few years at most, PCR would be the mainstay of diagnostic testing for infectious ophthalmic conditions. Traditional bacterial and viral cultures would be obsolete sooner than later. But in the year 2008, PCR is still a peripheral test in ophthalmology within our ever-expanding diagnostic armory. Optical coherence tomography, Heidelberg retinal tomography, topography, and ultrasound biomicroscopy have improved with every generation, but PCR has seen no expanded use. Why has this happened? Understanding the fundamentals of diagnostic testing gives us the answer. For a diagnostic test to be useful it must be valid (have high sensitivity and specificity), reliable (be
10
CAN J OPHTHALMOL—VOL. 44, NO. 1, 2009
Donald Weaver, MD, PhD; Patrice Côté, PhD; et Kenneth Rockwood, MD. Les rencontres « forme et fonction » visent essentiellement à recruter des stagiaires, étudiants, diplômés et étudiants en médecine, et à les attirer vers l’ophtalmologie et la science de la vision. En vue de la prochaine conférence, qui aura lieu en 2010, les initiatives auront pour objet d’inciter les stagiaires de partout au pays à participer à la rencontre et à présenter leurs recherches. C’est uniquement en partageant les idées nouvelles et en traversant la ligne de partage entre la recherche et la pratique clinique—et entre les nombreuses surspécialisations de l’ophtalmologie—que nous pourrons attirer des esprits nouveaux, frais et talentueux, dans notre domaine. Balwantray C. Chauhan, PhD Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax (N.-É.) [email protected] Traduction par Claude Gendron
reproduceable by different labs and in the hands of different technicians), responsive (detect change in the condition, not just its existence), convenient, practical, and cost-effective. PCR has fallen short in several of these areas. The most obvious problem is determining when the test is useful. Most surface infections can be easily cultured by traditional means (when culture is even necessary), negating the need for PCR. Similarly, bacteria, when present in ocular infections, are cultured easily and accurately. The best potential clinical use of PCR lies in its ability to detect atypical intraocular organisms, including viruses; the usual methods of culturing these organisms are neither accurate nor reliable. Unfortunately, PCR has been often overlooked even for this purpose. Atypical intraocular infections are rare, making the motivation for public health research in this area (by government or industry) weak. And historically, the test has been characterized by great sensitivity but poor specificity, creating many false-positive assays and the nickname “Probable Contaminated Reagin.” Gold-standard microbes whose DNA and assays have been standardized lab-to-lab have often been elusive. Typically, regional virology labs have standardized specimens derived from serum, not ocular speccimens, making the test’s validity questionable and hampering its reliability. Quantitative PCR has good responsiveness, but still suffers the faults of the binary PCR assays. Given the relatively small number of assays in any given region, the cost of setting up an ocular standardized assay for many atypical organisms is difficult to justify. PCR is still a test with great promise. But until it incorporates assays with high sensitivity and specificity, standardized from ocular specimens that are reliable and cost-effective, it
A meeting of minds Can J Ophthalmol 2009;44:9–10 doi:10.3129/i08-188
O
n September 26 and 27, 2008, leading research scientists and clinicians gathered at the 3rd Form and Function in Ocular Disease conference at Dalhousie University in Halifax, N.S. The meeting’s main objective is to provide clinicians and scientists from a wide range of expertise with an arena in which to freely discuss and debate matters of mutual interest. The result is the successful translation of research ideas into clinical applications, not only in vision science and ophthalmology, but also in other areas such as drug development, ethics, and the potential of stem cell research in neurological disorders. The Form and Function meetings are targeted to persons involved in any aspect of vision research, ophthalmology, neuroscience, and clinical care. Delegates include ophthalmologists (both general and specialists), clinical and basic science researchers, residents, and fellows. The lecturers, 8 internationally renowned guests and 8 faculty members from Dalhousie University, are expressly informed to present their material such that an audience member outside the speaker’s field of expertise can follow the presentation as easily as a peer of the speaker. This format compels the speakers to position their presentations in a broader context and increases audience participation. The order of lectures is unstructured; for example, a presentation on the epidemiology of blindness might be followed by one on the use of cannabinoids in ocular disease. This format makes for interesting and fruitful discussion. This year the meeting was fortunate to receive support from the Thomas and Alice Morgans Fear Memorial Fund. This endowment, made to the Dalhousie University Faculty of Medicine, provides a forum to encourage the advancement
La rencontre des grands esprits
L
es 26 et 27 septembre 2008, les chefs de file de la recherche scientifique et clinique tenaient leur 3e conférence sur les formes et fonctions en maladie oculaire à l’Université Dalhousie, à Halifax (N.-É.). La rencontre avait pour but principal d’offrir une arène aux cliniciens et aux scientifiques d’une vaste gamme d’expertises pour discuter et débattre librement des questions d’intérêt mutuel. Il en est résulté une fructueuse traduction d’idées en applications cliniques, touchant non seulement la science de la vision et l’ophtalmologie, mais aussi d’autres secteurs comme le développement des médicaments, l’éthique et les possibilités de recherche sur les cellules souches des troubles neurologiques. Ces rencontres s’adressent aux personnes qui s’intéressent de près à tous les aspects de la recherche sur la vision, l’ophtalmologie, la neuroscience et les soins cliniques. Les
of medical knowledge for the benefit of faculty members. Wolfgang Drexler, PhD, of Cardiff University in Cardiff, U.K., was the 2008 Fear Memorial Lecturer, presenting on seeing and probing single cells in the living human retina. Other guest speakers included Keith Martin, MD, Cambridge University, U.K.; Isabelle Brunette, MD, University of Montreal, Montreal, Que.; Michael Walter, PhD, University of Alberta, Edmonton, Alta.; Brian MacVicar, PhD, University of British Columbia, Vancouver, B.C.; Giovanni Staurenghi, MD, University of Milan, Milan, Italy; Joanne Katz, ScD, Johns Hopkins University, Baltimore, Md.; and Brad Fortune, PhD, Devers Eye Institute, Portland, Ore. These lectures were complimented by topics such as frailty and eye disease, advances in robotic neurosurgery, optogenetic strategies to restore vision, and clinical applications of radial deformation acuity from the Dalhousie faculty: Gautam Awatramani, PhD; Paul Artes, PhD; Ryan D’Arcy, PhD; Ivar Mendez, MD, PhD; Lesya Shuba, MD, PhD; Donald Weaver, MD, PhD; Patrice Côté, PhD; and Kenneth Rockwood, MD. A key goal of the Form and Function meetings is to engage trainees, including undergraduates, graduate students, and medical students, and attract them to ophthalmology and visual science. For the next meeting in 2010, initiatives are being planned that will encourage such trainees from across the country to attend the meeting and present their research. It is only by sharing new ideas and crossing the divide between research and clinical practice—and between the many ophthalmology subspecialties—that we can draw fresh and talented minds to our field. Balwantray C. Chauhan, PhD Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, N.S. [email protected]
participants comprenaient des ophtalmologistes (généralistes et spécialistes), des fondamentalistes, des résidents et des fellows. Les conférenciers, en l’occurrence 8 invités de renommée internationale et 8 professeurs de l’Université Dalhousie, sont expressément incités à présenter leur propos de façon à ce que les membres de l’auditoire provenant des autres champs d’expertise que le leur puissent suivre l’exposé aussi facilement que leurs pairs. Le format force les conférenciers à situer leurs exposés dans un contexte élargi et accroît la participation de l’auditoire. Les conférences ne suivent pas d’ordre particulier; par exemple, un exposé sur une épidémiologie de cécité peut suivre un exposé sur les cannabinoïdes des maladies oculaires. Ce format permet des échanges plus intéressants et plus fructueux. Cette année, l’activité a eu la chance de recevoir le soutien du Thomas and Alice Morgans Fear Memorial Fund. Cette dotation, versée à la Faculté de médecine de l’Université Dalhousie, offre un forum qui encourage l’avancement des CAN J OPHTHALMOL—VOL. 44, NO. 1, 2009
9
Editorials sciences médicales au bénéfice des membres de la faculté. Wolfgang Drexler, PhD, de la Cardiff University, à Cardiff (R.-U.) fut le conférencer Fear Memorial 2008; il a traité du visionnement et de l’exploration des cellules individuelles de la rétine humaine vivante. Les autres conférenciers invités furent : Keith Martin, MD, Cambridge University, R.-U.; Isabelle Brunette, MD, Université de Montréal, Montréal, Qué.; Michael Walter, PhD, Université d’Alberta, Edmonton, Alta.; Brian MacVicar, PhD, Université de ColombieBritannique, Vancouver, C.-B.; Giovanni Staurenghi, MD, Université de Milan, Milan, Italie; Joanne Katz, ScD, Université Johns Hopkins, Baltimore, Md.; et Brad Fortune, PhD, Devers Eye Institute, Portland, Ore. À ces conférences s’ajoutèrent des sujets comme la fragilité et la maladie oculaire, les progrès de la neurochirurgie robotisée, les stratégies optogénétiques de restauration de la vision et les applications cliniques de la déformation radiaire de l’acuité, traités par le corps enseignant de Dalhousie : Gautam Awatramani, PhD; Paul Artes, PhD; Ryan D’Arcy, PhD; Ivar Mendez, MD, PhD; Lesya Shuba, MD, PhD;
Polymerase chain reaction or probable contaminated reagin? Can J Ophthalmol 2009;44:10–1 doi:10.3129/i08-186
I
n their excellent narrative review in this issue of the Canadian Journal of Ophthalmology, Yeung et al.1 describe in detail polymerase chain reaction (PCR) methodology and its clinical applicability to ophthalmology. The methodology is based on heat–cool amplifying several cycles of the DNA in question with primers for the suspected DNA in a soup of a thermally stable polymerase enzyme, buffers, and ions. Several variants of this basic reaction are now available and were explained in detail. The authors discuss the potential applicability to detect bacteria, atypical bacteria, viruses, cytokines, and even tumors both inside and outside the eye. When I was a fellow at the University of California San Francisco back in 1995, there was great hope for the applicability of PCR in ophthalmology. So great was the promise that it seemed in a few short months, a few years at most, PCR would be the mainstay of diagnostic testing for infectious ophthalmic conditions. Traditional bacterial and viral cultures would be obsolete sooner than later. But in the year 2008, PCR is still a peripheral test in ophthalmology within our ever-expanding diagnostic armory. Optical coherence tomography, Heidelberg retinal tomography, topography, and ultrasound biomicroscopy have improved with every generation, but PCR has seen no expanded use. Why has this happened? Understanding the fundamentals of diagnostic testing gives us the answer. For a diagnostic test to be useful it must be valid (have high sensitivity and specificity), reliable (be
10
CAN J OPHTHALMOL—VOL. 44, NO. 1, 2009
Donald Weaver, MD, PhD; Patrice Côté, PhD; et Kenneth Rockwood, MD. Les rencontres « forme et fonction » visent essentiellement à recruter des stagiaires, étudiants, diplômés et étudiants en médecine, et à les attirer vers l’ophtalmologie et la science de la vision. En vue de la prochaine conférence, qui aura lieu en 2010, les initiatives auront pour objet d’inciter les stagiaires de partout au pays à participer à la rencontre et à présenter leurs recherches. C’est uniquement en partageant les idées nouvelles et en traversant la ligne de partage entre la recherche et la pratique clinique—et entre les nombreuses surspécialisations de l’ophtalmologie—que nous pourrons attirer des esprits nouveaux, frais et talentueux, dans notre domaine. Balwantray C. Chauhan, PhD Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax (N.-É.) [email protected] Traduction par Claude Gendron
reproduceable by different labs and in the hands of different technicians), responsive (detect change in the condition, not just its existence), convenient, practical, and cost-effective. PCR has fallen short in several of these areas. The most obvious problem is determining when the test is useful. Most surface infections can be easily cultured by traditional means (when culture is even necessary), negating the need for PCR. Similarly, bacteria, when present in ocular infections, are cultured easily and accurately. The best potential clinical use of PCR lies in its ability to detect atypical intraocular organisms, including viruses; the usual methods of culturing these organisms are neither accurate nor reliable. Unfortunately, PCR has been often overlooked even for this purpose. Atypical intraocular infections are rare, making the motivation for public health research in this area (by government or industry) weak. And historically, the test has been characterized by great sensitivity but poor specificity, creating many false-positive assays and the nickname “Probable Contaminated Reagin.” Gold-standard microbes whose DNA and assays have been standardized lab-to-lab have often been elusive. Typically, regional virology labs have standardized specimens derived from serum, not ocular speccimens, making the test’s validity questionable and hampering its reliability. Quantitative PCR has good responsiveness, but still suffers the faults of the binary PCR assays. Given the relatively small number of assays in any given region, the cost of setting up an ocular standardized assay for many atypical organisms is difficult to justify. PCR is still a test with great promise. But until it incorporates assays with high sensitivity and specificity, standardized from ocular specimens that are reliable and cost-effective, it