Research program based in Springfield puts eye repair in sight
Department of Defense awards $4.8 million to St. John’s to deliver solutions for eye-injured soldiers
October 26, 2010
Weapons of war in Iraq have inflicted serious eye injuries to soldiers on the battlefront. The military’s search for new and better ways to treat eye traumas has led it to a Springfield, Mo. doctor and his high-tech work.
Dr. Shachar Tauber and the research team at St. John’s Medical Research Institute, have received a $4.8 million Department of Defense grant to develop front-line use products that can save damaged corneas and preserve eyesight after blast and chemical injuries.
Dr. Tauber is principal investigator on the research and product development initiative, in collaboration with the leaders and scientists of the research and development division at the institute. The initiative is in partnership with the United States Army, Walter Reed Army Medical Center, Missouri State University and The University of Colorado.
How it began:
Dr. Tauber began making trips to Walter Reed Army Medical Center in Washington, D.C. in 2007, where he and other eye specialists showed Walter Reed doctors a technology they believed promising to greatly improve eye injury treatment, and could one day revolutionize the prompt and successful treatment of eye lacerations and burns suffered on the battlefield.
The military was so impressed, it launched a research project with St. John’s to test it further.
Technology initially discussed was electrospun polymer fibers, a Nobel-prize winning breakthrough, that Dr. Tauber believed could be successfully applied to the world of ophthalmology. It’s the use of this technology in both a contact lens and corneal glue that interests the military for its applicability in the field.
“We will be able to impregnate the electrospun fibers with medication or other agents that will inhibit infection, improve wound healing and limit scarring so that visual loss is minimized,” he explained.
Sustained drug delivery has been difficult to accomplish because of the time period required and the eyes’ draining system attempting to rapidly eliminate foreign materials. This unique system will easily allow more than one therapeutic entity to be delivered at a time for a more comprehensive and concurrent approach to stabilization, treatment, and healing.
Retired Army Colonel Kraig Scot Bower, M.D., was the director of refractive surgery at The Walter Reed Army Medical Center and served as the Army’s refractive surgery subject matter expert, when Dr. Tauber first started discussions about corneal wound repair.
“Corneal injuries are relatively common in soldiers who sustain combat-related blast trauma,” Dr. Bower said. “Unfortunately, despite our best efforts, corneal wound healing often leads to scarring that limits vision and abnormal blood vessel growth that makes rehabilitation of vision with current treatments such as corneal transplant prone to failure.”
“Dr. Tauber and the St. John’s team’s strategies that aim to augment or modulate the corneal healing process will hopefully result in improved treatment options and better vision for our injured soldiers.”
Knowing that St. Johns’ work could benefit Iraq War troops, “It almost became an obligation,” Dr. Tauber said.
“Between our work with St. John’s clinical research and our research with Missouri State University and (Jordan Valley Innovation Center), we’ve found ourselves understanding eye injuries and becoming more expert than before,” Dr. Tauber said.
The Problem:
The incidence of eye trauma due to improvised explosive devices (IEDs) and other weapons is of growing concern to the military. Nearly 40% of all war injuries are eye injuries, yet often these injuries are deemed secondary to life-threatening wounds. Ophthalmologic treatment can be delayed by as much as one to three days.
“The development of solutions that can be readily administered by a medic to treat the cornea until the patient reaches a hospital where surgery is available, can change that,” Dr. Tauber says.
“Time is of the essence in saving a damaged a cornea and we are working on solutions that include the development of a new technology that will make it possible to provide immediate corneal repair, stabilize the traumatized cornea and aid wound healing.”
The gold standard of corneal wound healing is the use of amniotic membrane. It is applied over the wound to provide a “scaffolding” on which healthy tissue on the edges of the wound can adhere. It eliminates the need for sutures, which causes the scarring that distorts eyesight.
The problem with this treatment is that amniotic membrane if very sensitive to temperature and not very conducive to use in the field of battle.
The Solution:
The two types of eye injuries – chemical and laceration, can be addressed with the proposed research solutions.
Two different contact lenses can be used in the event of chemical and other surface injuries – one as a first aid lens applied to an eye directly following an injury to protect and stabilize to provide drug delivery for 1-3 days and another applied to an eye to modulate the healing process, designed to protect and speed healing and recovery and provide drug delivery for 1-3 months.
Another treatment product – an ophthalmic glue would be used by doctors in forward medical bases in forward medical bases to seal the wound quickly and disperse the medication or other agents.
“A laceration injury, such as a piece of metal going into the eye – that is usually sewn up with sutures and requires a significant amount of time and creates a lot of scarring and irregularity. The glue would allow for the wound to be closed within minutes, while delivering drugs to jumpstart healing,” Tauber said.
“In first aid situations, this would allow front line surgeons to close the wound and then send the patient for more definitive treatment. We believe that once this glue is shown to work in the rigors of military, it will have huge applicability commercially for other incisional surgeries such as cataract surgery.”
In addition to these new treatment options, Dr. Tauber and team have found a way to make the use of amniotic membrane in the field a possibility. Their proposal? A passive thermal device for transport of the membrane to the injured soldiers. The device is capable of maintaining the necessary temperature of 2-8° C for 48-72 hours.
Five Products/deliverables the grant supports:
- First Aid Lens applied to an eye directly following an injury to protect and stabilize, provide drug delivery for 1-3 days, reduce risk of infection and improve visual outcomes.
- Healing Lens applied to an eye to modulate the healing process, designed to protect and speed healing and recovery, provide drug delivery for 1-3 months and improve visual outcomes.
- Corneal Adhesive to be applied to corneal lacerations to aid in stabilization of injury, provide drug delivery, reduce risk of infection and improve visual outcomes.
- Passive Thermal Device for transport of amniotic membrane to injured soldiers.
- Tear Proteomics Research to determine proteins found in a tear that are involved in the wounding and healing processes of the eye and allow for future drug development and tear diagnosis.
Southwest Missouri Congressman Roy Blunt initially requested funding for the projects in 2008 as part of the Defense Department’s Appropriations bill for the 2009 fiscal year. The bill passed the full House as part of a larger spending package, went on to Senate approval thanks in part to support from Senator Kit Bond.
“From advancing medical treatment for our wounded soldiers to funding technology that will improve the effectiveness of our intelligence community, these projects highlight the innovative technology and hard work being done right here in Missouri,” Blunt said.
St. John’s Medical Research Institute partnered with Roy Blunt Jordan Valley Innovation Center (JVIC), a Missouri State University research center, in 2006 to create products and technologies to meet the needs of patients. St. John’s has lab facilities in the center as one of JVIC’s corporate affiliates.
Currently, St. John’s Medical Research Institute (R&D Division) is working on more than 26 projects, most of which are ideas of their physicians about products that will improve ways they treat, care for, and serve their patients. It is anticipated that two to four additional products will be commercialized this year by the institute and partner company Inveno Health.
ACKNOWLEDGEMENT CITATION:
“This research and development project/program/initiative was conducted by St. John’s Medical Research Institute and is made possible by a cooperative agreement that was awarded and administered by the U.S. Army Medical Research & Materiel Command (USAMRMC) and the Telemedicine & Advanced Technology Research Center (TATRC), at Fort Detrick, MD under Contract Number: W81XWH-10-2-0070.
Non-Endorsement Disclaimer:
“The views, opinions and/or findings contained in this research/presentation/publication are those of the author(s)/company and do not necessarily reflect the views of the Department of Defense and should not be construed as an official DoD/Army position, policy or decision unless so designated by other documentation. No official endorsement should be made.”
St. John’s is part of Mercy, the eighth largest Catholic health care system in the U.S. and includes 30 hospitals and more than 1,300 integrated physicians in Arkansas, Kansas, Missouri and Oklahoma.
