Diabetic retinopathy is the leading cause of vision loss in the working-age population worldwide. Despite recommendations for annual eye examinations, many diabetic patients do not receive timely ophthalmic examinations. The teleretinal imaging program utilizes ophthalmic imaging in the primary care setting to assist in early detection of diabetic retinal disease and referral for treatment to prevent vision loss. The teleretinal imaging program is being expanded within the Mount Sinai Health System. Through this program, patients with other undiagnosed eye diseases including macular degeneration, retinal vascular occlusive disease, and glaucoma have also been identified. Our research focuses on the development and implementation of teleretinal imaging in the primary care setting, as well as the development and implementation of AI technology to detect ocular disease.

AI/teleophthalmology researchers include:

• Meenakashi Gupta, MD

Our researchers have developed a tele-consult protocol for rapid diagnosis of Central Retinal Artery Occlusion (CRAO), which is an embolic stroke in the eye. This new paradigm is a collaborative effort between the New York Eye and Ear Infirmary of Mount Sinai’s Retina Service, the Mount Sinai Stroke Centers, and the Stroke Endovascular Service at the Mount Sinai Health System. Using optical coherence tomography, images of the retina in patients with painless unilateral vision loss are acquired by the stroke team at the point of care and transmitted to the retina team electronically. The retina team interprets the images and communicates the findings to the stroke team. If a diagnosis of CRAO is confirmed, and the patient can be treated within 12 hours of symptom onset, the stroke team will intervene with an injection of tissue plasminogen activator directly into the arteries that carry blood to the eye, dissolving the blockage. (As with a stroke, timing is critical to save vision.) This protocol has allowed our researchers to decrease the time to diagnosis by over 100 minutes, treat more patients, and improve our outcomes for treating eye strokes.

Retinal vascular occlusion researchers include:

• Alexander Barash, MD
• Robin Ginsburg, MD
• Gareth Lema, MD, PhD
• Richard Rosen, MD

Glaucoma is a multifactorial disease characterized by progressive optic nerve damage and permanent vision loss. The leading cause of irreversible blindness in African Americans, the disease is one of the most heritable, with first-degree relatives having a nearly 10-fold higher risk over their lifespan. Researchers at Icahn Mount Sinai use novel, noninvasive imaging platforms to identify and characterize biomarkers of ocular blood flow and metabolism, in combination with tissue structure and physiological function. They model how intraocular pressure, age, high or low blood pressure, ischemia, genetics, female gender, lifestyle behaviors, and/or a combination of factors alter the risk of glaucoma onset and progression over a lifetime. In previous and current National Institutes of Health- and National Science Foundation-funded grants, our researchers are describing retinal tissue/function/hemodynamic connectivity in glaucoma and utilizing artificial intelligence (AI) approaches to identify specific groups of patients with similar characteristics and translate complex physiology into simple outcomes for improved disease management.

Our researchers are also heading a unique research project to determine if a blood test based on genetic makeup could be used to screen for glaucoma. The investigators first assigned everyone in two biobanks—one at Mount Sinai, the other at Mass General Brigham—a glaucoma genetic predisposition score, then invited individuals with the highest and lowest genetic risk scores for a face-to-face exam that determines glaucoma status. They also take extensive histories regarding diet, dental health, and female reproductive health, because these factors may modify the relation between genetic predisposition to glaucoma and the actual development of the disease.

Glaucoma researchers include:

• Masako Chen, MD
• Alon Harris, MS, PhD, FARVO
• Varun Kumar, PhD
• Gareth Lema, MD, PhD
• Kira Manusis, MD
• Louis Pasquale, MD, FARVO
• Richard Rosen, MD
• Paul Sidoti, MD
• Tania Tai, MD
• James Tsai, MD, MBA

Icahn Mount Sinai researchers are using photobiomodulation, a type of infrared light therapy, to enhance mitochondrial function in the retina and successfully demonstrate vision improvement during a 24-month multicenter study in subjects with dry age-related macular degeneration. Notably, the treated group also experienced a reduced risk of progression to geographic atrophy. Members of the New York Eye and Ear Infirmary of Mount Sinai’s Retina Services contributed to the trial. The treatment is expected to be available and offered in early 2024.

Our researchers are also using optical coherence tomography scans of the retina and AI predictive modeling to show that poor ocular circulation of blood is an important marker for systemic vascular disease (cardiac or neurovascular disease), and that there is an association between age-related macular degeneration (AMD), cardiovascular disease, and stroke. If the optical coherence tomography scan shows a patient has subretinal drusenoid deposits, which occur in about half of AMD cases, they are at a much higher risk for life-threatening cardiovascular disease and stroke. At the same time, if cardiac imaging shows an irregularity, the patient is a much stronger candidate for AMD, and should also be screened for that condition. These findings set the stage for establishing large-scale screening programs that could involve cross-departmental collaboration among ophthalmologists, cardiologists, and primary care physicians testing patients for potentially life-threatening disease.

Macular degeneration researchers include:

• Richard Rosen, MD
• Theodore Smith, MD, PhD