Paul R. Lichter, M.D.
Research Projects
Treatment and Genetic Studies of Glaucoma
Newly diagnosed primary open-angle glaucoma is conventionally treated with medications. Only after a series of medical regimens has failed to control intraocular pressure or if there has been glaucomatous damage is incisional or laser surgery performed. The Collaborative Initial Glaucoma Treatment Study, of which Dr. Paul R. Lichter is Study Chairman, is a randomized, controlled clinical trial being conducted to determine whether patients are best managed by a medical approach first or immediate filtration surgery. There are 14 clinical centers around the country that are comparing outcomes of these two initial therapies. The study was supported by the National Eye Institute for 10 years and now is being supported for the collection of follow-up data by an unrestricted grant from Allergan, Inc.
Although the primary outcome variable is visual function, intraocular pressure differences between the two treatments will also be evaluated. The final variable to be measured is quality of life for the patients who are undergoing the treatments. Because there can be significant side effects from the various treatments for glaucoma, the Collaborative Initial Glaucoma Treatment Study hopes to provide definitive data on specific quality of life issues for patients and their ophthalmologists as treatment options are considered for those who are undergoing these interventions. A genetics component of the Study, supported by the Glaucoma Research Foundation, hopes to learn more about the genetic aspects of glaucoma among the study's patients.
As part of another national collaborative clinical trial sponsored by VisionCare, Inc., Dr. Lichter heads one of 28 clinical centers evaluating the safety and effectiveness of a miniature telescope that is surgically implanted at the time of cataract surgery in lieu of an intraocular lens into the eyes of study participants who have lost their central vision from macular degeneration.
In collaboration with Julia Richards, Ph.D., and Michael Boehnke, Ph.D., Dr. Lichter is conducting studies on families with inherited glaucoma to determine the genetic defects that cause various forms of glaucoma. Their focus has been to use positional cloning strategies to map and clone glaucoma-causing genes not yet identified and to investigate the mechanisms by which genetic mutations lead to glaucoma. In addition, Dr. Lichter and colleagues discovered that open-angle glaucoma can be a significant clinical feature of a systemic disease called the Nail-Patella Syndrome (NPS). Along with collaborators, they have found mutations in the NPS gene (LMX1B) that cause NPS with associated glaucoma. When more of the genes that are the direct cause of glaucoma have been identified, it may be possible to develop directed treatments and genetic screening for patients at risk.
Dr. Lichter is also investigating new forms of laser surgery for glaucoma. In collaboration with faculty colleagues Maya Eibschitz, M.D., Victor M. Elner, M.D., Ph.D., and Tibor Juhasz, Ph.D., along with Distinguished University Professor Gerard Mourou, Director of the famed U-M Center for Ultrafast Optical Science, Dr. Lichter is helping to develop clinical applications for femtosecond laser technology to treat glaucoma.
