When my 2 1/2-year-old son asks, “Why are trees green? Why did Mama sneeze? Why did baby Alex spit up?” I smile. I smile because I am amazed at how inquisitive human beings are, even at such a young age. I smile because others once had these questions and, through their perseverance and hard work, gifted us with the knowledge to help answer them. I smile because that little word why is what enticed me into academic medicine and continues to challenge me to look for answers to a few of the many questions still unsolved.
As a clinician, I take great pleasure in telling my patients that their IOP is well controlled, their optic nerve examination is stable, and their visual fields have not progressed. Yet, when Mrs. Johnson asks, “I'm glad that my exam and tests look great, but why does my vision seem worse?” I do not have a clear answer for her, and I realize how much we have yet to learn about glaucoma. Does vision tested in the clinic reflect vision at home? Are contrast sensitivity and glare affected earlier in glaucoma, and should they be routinely tested? Would an improvement in home lighting enhance a patient's visual function in his or her home? At what stage of glaucoma does visual impairment begin? These are a few questions that have motivated my involvement in clinical research.
RESEARCH
For the past several years, I have been fortunate to have funding to pursue my research questions from a National Institutes of Health career development award, Pfizer Inc. (New York, NY), the American Glaucoma Society, and the Center for Aging at Washington University in St. Louis. My colleagues and I recently completed a study in which we measured bilateral vision (visual acuity, contrast sensitivity, and glare) and lighting levels in the homes of 138 individuals with glaucoma and 52 normal participants. We then compared the results to those of the same tests conducted in the clinic. In addition, we administered multiple performancebased measures and self-reported questionnaires to assess which aspects of visual function are most affected by glaucoma and at what stage of the disease visual impairment begins. The unique experience of observing patients in their home environment provided me with greater insight into the daily function of glaucoma patients than any current clinical examination. Our preliminary findings1,2 led to our current studies, which involve customized home-lighting interventions for glaucoma patients and an on-road driving test to assess the driving performance of patients with moderate and advanced glaucoma.
I am extremely grateful for the guidance, knowledge, and inspiration provided by my mentors and colleagues throughout my training and in my current position at Washington University. My fellow investigators and I are at an exciting stage of our research and look forward to contributing our findings to the growing body of knowledge.
CONCLUSION
Why do I perform research? I perform research so that, when Mrs. Johnson asks me why she cannot read and what can be done to help, I may be able to provide her with an answer. That will make me smile and, I hope, her as well.
Section editor Tony Realini, MD, MPH, is an associate professor of ophthalmology at West Virginia University Eye Institute in Morgantown. Dr. Realini may be reached at (304) 598-6884; realinia@wvuh.com.
Anjali Bhorade, MD, MSCI, is an assistant professor of ophthalmology at Washington University School of Medicine in St. Louis. Dr. Bhorade may be reached at bhorade@vision.wustl.edu.
