With life expectancy on the rise, age-related ailments are a significant strain on the welfare of individuals and the economy. Progress is being made towards combating the leading cause of unavoidable blindness, age-related macular degeneration (AMD). AMD affects ten million Americans and costs the world economy $343 billion annually. Retinal implants promise to restore sight by replacing the eye's damaged photoreceptors with electronic photodiodes. Clinical trials succeed at restoring some vision, but are limited by the stimulating electrodes. We study the electrode-neuron interface with a focus on the geometrical dependence of the electrode. The functionality of neurons is intimately connected to their branching and curving shape, described by fractal geometry. We examine the morphology of neurons using fractal analysis. The results inform our electrode designs, which are fabricated using top-down lithographic and bottom-up self-assembly techniques. A novel technique for fabricating a fractal electrode is presented. Heating and cooling a film of poly(methyl methacrylate) on a SiO2 substrate causes fractal structures to form on the surface. The geometry of the structures is temperature dependent, producing crystalline branches at lower temperatures and diffusion-limited aggregates at higher temperatures. Subsequent deposition of antimony nanoclusters shows preferred diffusion to the fractal surface features. The dependence of a photodiode's performance on its top contact geometry is explored using modified nodal analysis. The results reinforce the need to balance a low mean semiconductor-metal separation distance with an adequate contact width for low resistance, all while maximizing light input. Future designs will benefit from the spatial voltage maps produced by the simulation. The electric field emanating from an electrode is also dependent on the geometry of the electrode. The Faraday cage effect is exploited to achieve similar electric field responses to traditional electrode shapes. A preliminary study of neural adhesion to SU-8 fractal electrodes is promising. The neuron grows along the electrode even at 90° turns. The role the fractal geometry plays in neuron and electrode functionality is shown to be significant. Continued study of, and experimentation with, new electrode designs is sure to produce exciting possibilities in the future. This dissertation includes previously unpublished co-authored material.

M.Phil. (Optometry) / Despite many years of research, diabetic retinopathy (DR), and diabetic macular edema (DME) remain difficult to diagnose, prevent, and treat. The complicated nature of the disease, the limited information on DR and DME and the increasing prevalence of diabetes mellitus (DM) in South Africa, provided motivation for this study. To the best of my knowledge, this is the first study in our country to identify demographic, medical and visual aspects ofDR and DME collectively. A further incentive was the availability in optometry of recently developed computer software based upon multivariate statistics, which provided a unique opportunity to analyze, for example, tri-variate contrast sensitivity acuities using stereo-pair scatter plots. All refractive status measurements were also analyzed and compared with the same method. Together, the results from this study provide a broader clinical and research perceptive on DR and DME. In this cross-sectional study, 202 diabetic patients at the Helen Joseph Hospital in Johannesburg were recruited. Demographic variables included age, gender, race, age of diagnosis, duration of DM, and social habits. Medical variables included systemic conditions present, blood pressures, body mass index (BMI), lipid profiles, glycerated haemoglobin (HbAlc), and other available biochemical data (for example cholesterol, urea and creatinine levels). Visual variables included, distance, pinhole and near visual acuities, contrast sensitivity acuities, refractive status measured with autorefraction, colour vision, Amsler grid, intraocular pressures (lOP), and fundus photography. Administration of the Impact of Visuallmpainnent (IVI) questionnaire provided new information concerning the restrictions in daily living participation caused by DR or DME. The predominant characteristics of the study population consisted of Type 1DM among female Coloured subjects. Approximately 66% of all subjects had also been diagnosed with hypertension. The mean age ofthe subjects was 52 (± 14) years, age of diagnosis 41 (± 13) years, and duration ofDM 10.8 (± 9.7) years. Mean blood pressures (136/81 ± 20.5/11 mmHg) and glycated haemoglobin (HbAlc, 9.9 ± 3.4%) values were slightly higher than the recommended control levels (BP= 120/80 mmHg and HbAlc = 6 to 7%).

Indiana University-Purdue University Indianapolis (IUPUI) / Transforming growth factor β-activated kinase 1 (TAK1), a hub kinase at the convergence of multiple signaling pathways, is critical to the development of the central nervous system and has been found to play a role in cell death and apoptosis. TAK1 may have the potential to elucidate mechanisms of cell cycle and neurodegeneration. The Belecky-Adams laboratory has aimed to study TAK1 and its potential roles in cell cycle by studying its role in chick retinal development as well as its possible implication in the progression of diabetic retinopathy (DR). Chapter 3 includes studies that explore TAK1 in a study in chick retinal development and TAK1 in in vitro studies in retinal microglia. Using the embryonic chick, immunohistochemistry for the activated form of TAK1 (pTAK1) showed localization of pTAK1 in differentiated and progenitor cells of the retina. Using an inhibitor or TAK1 activite, (5Z)-7-Oxozeaenol, in chick eye development showed an increase in progenitor cells and a decrease in differentiated cells. This study in chick suggests TAK1 may be a critical player in the regulation of the cell cycle during retinal development. Results from experimentation in chick led to studying the potential role of TAK1 in inflammation and neurodegeneration. TAK1 has previously been implicated in cell death and apoptosis suggesting that TAK1 may be a critical player in inflammatory pathways. TAK1 has been implicated in the regulation of inflammatory factors in different parts of the CNS but has not yet been studied specifically in retina or in specific retinal cells. Chapter 2 includes studies from the Belecky-Adams laboratory of in vitro work with retinal microglia. Retinal microglia were treated with activators and the translocation to the nucleus of a downstream factor of TAK1 was determined: NF-kB. Treatment of retinal microglia in the presence of activators with TAKinib, an inhibitor of TAK1 activation, revealed that TAK1 inhibition reduces the activation of downstream NF-kB. Together this data suggests that TAK1 may be implicated in various systems of the body and further studies on its mechanisms may help elucidate potential therapeutic roles of the kinase.

Indiana University-Purdue University Indianapolis (IUPUI) / Elaborate vascularization of the retina is crucial for the development and functioning of the eye. The proper patterning of astrocytes is a key event preceding retinal angiogenesis by providing guidance cues for endothelial cells, yet how this is regulated still remains obscure. The dual function of proteoglycans in both extracellular matrix (ECM) composition and cell signal transduction suggests their potential in the regulation of astrocyte migration. The current study demonstrated that non-cell-autonomous regulation by neuroretina cell surface proteoglycan is crucial for PDGF-A regulated astrocyte migration. Ablation of glycosaminoglycan side chains of proteoglycans in neuroretina led to impaired astrocyte migration, incomplete retinal angiogenesis, and hyaloid vessel persistence. This is followed by severe photoreceptor degeneration as a result of reactive gliosis, which cannot be rescued by constitutively activated Kras signaling. Notably, inner limiting membrane (ILM), the basement membrane of the retina, was breached in proteoglycan-deficient retinae prior to the formation of astrocytic network. Herein we propose that cell surface proteoglycans are essential for the initial assembly of ILM, and this cannot be compensated by secreted ECM proteoglycans. In support of this, after removal of ILM in retinal explant by Collagenase digestion, establishment of a new ILM can be achieved by incubation with exogenous laminin-supplemented Matrigel. This basement membrane reconstitution failed, however, in proteoglycan-deficient retinae or in wild type samples digested with a combination of Heparinase and ChABC in addition to Collagenase. Taken together, our study reveals a novel function of neuroretinal cell surface proteoglycans in the initial assembly of basement membrane which subsequently serves as a permissive substratum necessary for astrocyte migration.

Indiana University-Purdue University Indianapolis (IUPUI) / In glaucoma, the connection between the eye and the brain is severed leading to the degeneration of retinal ganglion cells (RGCs) and eventual blindness. A need exists to better understand the maturation of human RGCs as well as their degeneration, with the goal of developing new therapeutics diseases like glaucoma. Human pluripotent stem cells (hPSCs) provide an advantageous model for the study of RGC development and disease as they can be differentiated into RGCs in large, reproducible quantities. Efforts of the current studies initially focused on the development and maturation of RGCs from hPSCs. RGCs derived from hPSCs were a diverse population of cells and matured in a temporal fashion, yielding morphological and functional characteristics similar to their in vivo counterpart. CRISPR/Cas9 gene editing was then utilized to insert the OPTN(E50K) glaucomatous mutation into hPSCs to model RGC degeneration. RGCs harboring this mutation exhibited numerous degenerative phenotypes including neurite retraction an autophagy dysfunction. Within the retina, many cell types contribute to the health and maturation of RGCs including astrocytes. As such, a co-culture system of hPSC-derived RGCs and astrocytes was developed to better understand the interaction between these two cell types. When grown in co-culture with astrocytes, hPSC-derived RGCs demonstrated significantly enhanced and accelerated morphological and functional maturation, indicating an important relationship between these cells in a healthy state. Astrocytes have also been shown to encompass neurodegenerative phenotypes in other diseases of the CNS, with these deficits profoundly effecting the health of surrounding neurons. hPSC-derived astrocytes grown from OPTN(E50K)-hPSCs demonstrated cell autonomous deficits and exhibited significant effects on the degeneration of RGCs. Taken together, results of this study demonstrated the utilization of hPSCs to model RGC maturation and degeneration in glaucoma. More so, these results are one of the first to characterize astrocyte deficits caused by the OPTN(E50K) mutation and could provide a new therapeutic target for pharmacological screenings and cell replacement therapies to reverse blindness in optic neuropathies.

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Yes / Identification of glaucomatous damage and progression by perimetry are limited by measurement and response variability. This study tested the hypothesis that the glaucoma damage signal/noise ratio is greater with stimuli varying in area, either solely, or simultaneously with contrast, than with conventional stimuli varying in contrast only (Goldmann III, GIII). Thirty glaucoma patients and 20 age-similar healthy controls were tested with the Method of Constant Stimuli (MOCS). One stimulus modulated in area (A), one modulated in contrast within Ricco’s area (CR), one modulated in both area and contrast simultaneously (AC), and the reference stimulus was a GIII, modulating in contrast. Stimuli were presented on a common platform with a common scale (energy). A three-stage protocol minimised artefactual MOCS slope bias that can occur due to differences in psychometric function sampling between conditions. Threshold difference from age-matched normal (total deviation), response variability, and signal/noise ratio were compared between stimuli. Total deviation was greater with, and response variability less dependent on defect depth with A, AC, and CR stimuli, compared with GIII. Both A and AC stimuli showed a significantly greater signal/noise ratio than the GIII, indicating that area-modulated stimuli offer benefits over the GIII for identifying early glaucoma and measuring progression.

Retina is a unique site in the human body where the microcirculation can be imaged directly and non-invasively, allowing us to study in vivo the structure and pathology of the human microcirculation. Retinal images can be quantitatively assessed with computerized imaging techniques, enabling us to measure several different quantitative traits derived from the retinal vasculature. Arterial and venular calibres are the most extensively studied traits of the retinal microvasculature and numerous epidemiological studies demonstrated promising associations with systemic and ocular diseases as well as with disease markers. However, there has been a lack of research into pathophysiological processes leading to retinal vascular signs, and how they link retinal microcirculation with coronary and cerebral microvasculature change. Information about genetic determinants underlying retinal vascular structure is therefore important for understanding the processes leading to microvascular pathophysiology. Two genome wide association studies have been published so far revealing four loci associated with retinal venular calibre and one locus with arteriolar calibre. Here the results from the genome-wide association analysis of 10 different retinal vessel traits in two population based cohorts are presented. Retinal images were measured in non-mydriatic fundus images from 808 subjects in the Orkney Complex Disease Study (ORCADES) and 390 subjects from the Croatian island of Korcula, using the semi-automated retinal vasculature measurement programme SIVA and VAMPIRE. Using pairwise estimates of kinship based on genomic sharing, heritability was calculated for each trait. Estimates of tortuosity measure and fractal dimensions present first published reports of heritability estimates for those traits. In addition correlation analysis with systemic risk factor was also completed, confirming already published results as well as revealing some new associations. A genome wide association analysis of retinal arteriolar width revealed a genome wide significant hit (1.8x10-7) in a region of chromosome 2q32 (within TTN gene). Replication was sought in a further independent Scottish population (LBC) and additional 400 retinal images were graded. The result did not replicate, however the direction of the effect was consistent and a larger sample size is required. Analysis of the remaining traits did not yield genome wide significant result,s and will also require larger sample sizes. Genetic analysis of a binary retinal trait was also explored in a case control study of retinal detachment, which is an important cause of vision loss. A two-stage genetic association discovery phase followed by a replication phase in a combined total of 2,833 RRD cases and 7,871 controls was carried out. None of the SNPs tested in the discovery phase reached the threshold for association. Further testing was carried out in independent case-control series from London (846 cases) and Croatia (120 cases). The combined meta-analysis identified one association reaching genome-wide significance for rs267738 (OR=1.29, p=2.11x10-8), a missense coding SNP and eQTL for CERS2 encoding the protein ceramide synthase 2. Additional genetic risk score, pathway analysis and genetic liability analysis were also carried out.