Vikas Gulati M.D. is applying for a patient oriented research career development award to obtain training in the techniques involved in the assessment of human and vertebrate aqueous humor dynamics. He additionally plans to complete a doctorate in Clinical and Translational Research during the award period. Both these components build upon Dr. Gulati's prior training and experience with aqueous humor dynamics research and clinical trials involving glaucoma diagnostics and therapeutics. The aqueous humor dynamics training will be obtained at the University of Nebraska Medical Center (UNMC) under the mentorship of Dr. Carol B. Toris, who is an established, well published expert in the field. Supplemental and complementary training will be obtained at Mayo Clinic, the only other center in United States with published work in the field in the past 5 years and Ocumetrics Inc., a leader in fluorophotometer development and design. Didactic and practical training towards above mentioned doctorate will be pursued under the multi-college Center for Clinical and Translational Research at UNMC. Training in responsible of conduct of research will be undertaken both in formal classroom forum and through interactions with mentor and colleagues. Training in aqueous humor dynamics will be obtained through a research project involving a study of the aqueous humor dynamics in a pediatric population aged 15 -18 years, the youngest age range approved by the Institutional Review Board at UNMC at this time. Adults, preferably biological parents, also will be enrolled in the study as controls. Supplemental animal work will evaluate the effects of puberty on the aqueous humor dynamics of rabbits by longitudinally measuring the same in study animals during different stages of their growth and development. Training in ex-vivo techniques of outflow facility measurement also will be obtained during the award period. Data obtained from the study will reveal any pertinent differences in the aqueous humor dynamics physiology in the pediatric population as compared to adults. This will help tailor the pharmacologic and surgical management of elevated intraocular pressure and glaucoma in younger patients. The study also will provide safety data for use in subsequent studies in children younger than 15 years. The rabbit data will evaluate the significant changes induced in aqueous humor dynamics by puberty. The long term goal of this research is to understand why children respond differently to IOP-lowering treatments than adults. Our findings could help improve treatments for pediatric glaucoma. By the end of the proposed training the candidate will have the necessary expertise to independently conduct aqueous humor dynamics studies in humans and vertebrate animals. The candidate also will have obtained the required training to function as an independent investigator for comparative clinical outcomes trials, to help advance cost effective, evidence based care of glaucoma patients.

Public Health Relevance

The goal of this application is the career development of the candidate to be an independent investigator in the field of aqueous humor dynamics. This field is critical to the understanding of pathophysiology of glaucoma and mechanism of action of interventions used to treat the same. The candidate will also develop skills towards managing clinical trials and outcomes studies with a goal to provide cost effective evidence based care to glaucoma patients. The research project described herein will explore the flow of aqueous in the pediatric eye with a potential to develop new management strategies in younger glaucoma patients.

National Institute of Health (NIH)
National Eye Institute (NEI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZEY1-VSN (04))
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Agarwal, Neeraj
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University of Nebraska Medical Center
Schools of Medicine
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Hays, Cassandra L; Gulati, Vikas; Fan, Shan et al. (2014) Improvement in outflow facility by two novel microinvasive glaucoma surgery implants. Invest Ophthalmol Vis Sci 55:1893-900