The Hartwell Foundation


2012 Biomedical Research Collaboration Award

Memphis, TN, November 05, 2012 -- The Hartwell Foundation officially announced a Biomedical Research Collaboration Award to Cynthia A. Toth, MD, 2008 Hartwell Investigator and Professor, Departments of Ophthalmology and Biomedical Engineering, Duke University and Boris I. Gramatikov, Ph.D., 2009 Hartwell Investigator and Assistant Professor, Department of Ophthalmology, The Johns Hopkins University for their proposal “Diagnosis and Management of Infant Retinal Disease: Fast Swept Source Optical Coherence Tomography Synchronized with Central Fixation”. The researchers will receive $629,957 in combined direct cost over three years. Both Duke University and The Johns Hopkins University are named to the Foundation’s 2012 Top Ten Centers of Biomedical Research.

Each year in the United States, more than 50,000 children are reported as legally blind, with nearly a half million reported as having subnormal vision. The statutory definition of “legally blind” is that central visual acuity must be 20/200 or less in the better eye with the best possible correction, or that the visual field be 20 degrees or less. During the first several years of life, even temporary interruption in the vision of one eye can produce severe vision loss, which becomes less reversible with increasing age. The most common form of permanent visual impairment originates in the retina (photosensitive layer at the back of each eye), which can be caused directly by medications, such as those for seizures or chemotherapy; in response to elevated oxygen in treatment of premature birth; the presence of tumors; and by physical trauma. Because these disorders of the retina may lead to visual deficits, it is critical to properly identify and treat evolving disease prior to permanent damage.

Today, when a retinal condition is suspected in an infant or toddler, the challenge to the medical professional is having the child achieve and maintain visual fixation during an eye exam. This may necessitate placing the child under general anesthesia to obtain a precise retinal examination. While undesirable, the alternatives are to perform a limited examination or worse, wait until the child grows older to identify what is wrong. For adults, where visual fixation and cooperation are usually not an issue, a technology known as spectral domain optical coherence tomography (OCT) is available to provide high speed, 3-dimensional, and magnified images of the retina. This standard of care for outpatient diagnosis and management of retinal disease in adults is well-tolerated in older children. Unfortunately, the size of a conventional OCT device is too large for deployment in an infant care setting or for squirming toddlers.

Cynthia Toth is an ophthalmologist and clinical research scientist at the Duke Eye Center who is a specialist in the evaluation and surgical treatment of retinal diseases in children and adults. She is widely recognized as an expert in retinal imaging with optical coherence tomography (OCT). As a 2008 Hartwell Investigator she pioneered the first use of a research hand-held OCT system for infant examination. While the imaging device has now been shown to be valuable in the assessment of premature and newborn infants, the apparatus must be held less than one inch from the eye to achieve proper ocular alignment. Infants, active toddlers and young children will not cooperate for such imaging without special intervention and thus a more suitable version of the hand-held OCT instrument that provides for a more comfortable working distance is desperately needed.

Boris Gramatikov is a research scientist at The Johns Hopkins Wilmer Eye Institute. He is a biomedical engineer with expertise in medical optics, electronic hardware, computer software and signal processing. His current research interest is to identify children who have misaligned eyes and/or unequal refractive error (amblyopia or “lazy eye”), an otherwise treatable condition that can cause irreversible blindness. As a 2009 Hartwell Investigator, he developed a noninvasive, automated vision screening instrument that rapidly and accurately detects focus and alignment of both eyes simultaneously, enabling early identification and treatment of children at risk for amblyopia. His device is designed to operate conveniently from a distance 12 inches from the eyes by scanning the retina with a spot of polarized near-infrared light, which takes advantage of an optical property of the eye known as retinal birefringence.

It is distressing that treatable visual conditions in infants and young children are frequently missed because of a lack of appropriate instrumentation. To meet this unmet clinical need, Toth and Gramatikov will embark on a unique collaboration to overcome the limitations of existing technology. They propose to improve upon the Toth state-of-the-art handheld OCT imaging device by developing a swept-source optical coherence tomography (SSOCT) retinal imaging system that is 10 times faster. The proposed hand-held SSOCT system will operate within a comfortable viewing distance from the eyes of the child and based upon technology offered by Gramatikov, will automatically detect central fixation (focus and alignment of both eyes). This new system will have the unsuspecting infant or child view an “eye-catching” picture or cartoon on a small LCD computer screen, with no distracting apparatus between the child and the screen. The examiner will be able to retain optical alignment of the SSOCT device with the child’s eye because invisible polarized light will simultaneously and automatically detect when the eye is looking at specific targets on the computer screen.

If Toth and Gramatikov are successful, their technology will allow for the first time the ability to readily follow the dynamics of eye development in infants and toddlers. The availability of such technology will enable the discovery of critical new diagnostic information while monitoring longitudinal drug therapy, which could improve the management of pediatric retinal disease to eliminate its consequences.

Fostering collaborations between investigators of complementary scientific strengths is one of the objectives of The Hartwell Foundation Mission to fund innovative, early-stage applied biomedical research with the potential to benefit children.


2008 Hartwell Investigator Cynthia A. Toth, MD, Duke University

2009 Hartwell Investigator Boris I. Gramatikov, Ph.D., The Johns Hopkins University

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