Medical Student Research Projects

Projects with Ophthalmology Faculty

Throughout the year, Department of Ophthalmology faculty members welcome medical student involvement in research projects. Medical students interested in pursuing research in the Department of Ophthalmology should review the topics below and contact the faculty member directly.

Identification of the subcellular localization of wild-type and mutant fibulin-3

Mentor: John D. Hulleman, Ph.D.

The rare retinal dystrophy, Malattia Leventinese, is caused by a mutation of an arginine residue at the 345th position in a protein called fibulin-3. Instead of incorporating an arginine residue, a change in the DNA code results in the insertion of a large, bulky tryptophan residue, thus the mutation is called Arg345Trp (R345W). This mutation site occurs in a specific region of the protein called an epidermal growth factor (EGF) domain.

The presence of this large tryptophan residue causes problems with fibulin-3 protein folding and its eventual secretion from cells. As a result, the disease-causing mutant protein is poorly secreted and has a tendency to activate the cell’s stress responsive signaling pathways.

In healthy individuals, misfolded proteins are normally recognized by the cellular quality control machinery and targeted for degradation, effectively removing them from the cell. However, an interesting aspect of this R345W mutation is that it is not effectively degraded within the cell. This observation begs the question: Where is mutant fibulin-3 located within the cell that renders it resistant to degradation? Is it localized in vesicles? Is it trapped in the Golgi apparatus? Can we identify ways to target mutant, disease-causing fibulin-3 for degradation?

The overall goal of this project is to determine the intracellular localization of wild-type (normal) and R345W (mutant) fibulin-3 in human retinal pigmented epithelial cells.

The student who undertakes this study will develop a skill set enriched in molecular biology and cell biology techniques including: aseptic cell culturing, mammalian cell transduction, immunohistochemistry, epifluorescence microscopy, and confocal microscopy.

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Generation of high-throughput-capable fusion proteins for identifying new drugs to treat retinal diseases

Mentor: John D. Hulleman, Ph.D.

A number of retinal disorders are caused by genetic mutations in genes encoding for secreted proteins. Many of these mutations compromise protein folding, and thus cause a defect in the protein’s secretion efficiency. Identifying compounds which rescue the mutant protein’s secretion defect is of substantial interest to my lab. However, since a cell at any given time secretes tens of thousands of proteins, it is difficult to specifically monitor the secretion of the one protein.

Researchers have therefore developed reporter assays to follow a single protein by modifying it and making it unique compared to the rest of the cell’s proteome. One such reporter assay strategy is to fuse is a light-generating enzyme (luciferase) to the protein of interest. Then, using an assay to detect the amount light given off in a sample, researchers can infer how much protein of interest is present. Such an approach can be useful for identifying new potential drugs which rescue the secretion defects using unbiased screening techniques in a high-throughput manner.

The goal of this project will be to use the Gaussia luciferase or Nano luciferase as a way to follow the secretion of retinal disease-associated proteins. Following the successful establishment and validation of this assay, the student will perform small-scale high-throughput screening experiments to identify drugs which may rescue the secretion of the mutant protein.

The student who is assigned to this project will develop skills associated with molecular biology, cell biology, and high-throughput screening. Specifically, s/he will be taught molecular cloning, luciferase assay development, cell culture, high-throughput screening, secondary assay verification, and quantitative PCR.

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Unilateral hereditary retinal dystrophy?

Mentor: Chan Nguyen, M.D., Ph.D.

Retinal dystrophies are almost by definition bilateral. However, there is a young Parkland patient with a unilateral lesion who claims that three of her brothers also suffered vision loss in only one eye at a young age. Project involves contacting the patient and bringing family members in to see if the case is reportable.

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True access to care

Mentor: Chan Nguyen, M.D., Ph.D.

There are various figures normally quoted for the percentage of physicians who accept Medicaid, but these figures may not represent the true access to care for these patients. This project involves calling various local physician offices to try to obtain a regular appointment or an urgent appointment for a vision-threatening condition that requires surgery. Results will be published in a report put forth by the Dallas County Medical Society's Access to Care and Vulnerable Populations Committee.

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Autologous serum tears for the treatment of dry eye

Mentor: Chan Nguyen, M.D., Ph.D.

Serum tears have been shown to be effective for various corneal surface disorders related to autoimmune disease. While these conditions are rare, dry eye disease is not, and studies of the effectiveness of serum tears for the treatment of dry eye have been limited in scope and in size. This project would involve drawing subjects' blood, centrifuging it to produce the serum, and then assessing subjects' ocular surface health after use of the drops for two weeks.

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Comparison of the Effectiveness of Lucentis versus Eylea for Avastin Failures

Mentor: Chan Nguyen, M.D., Ph.D.

Anti-VEGF agents have revolutionized the way macular edema from diabetes and retinal vein occlusions is treated. Avastin is the least expensive anti-VEGF agent available, with the cost of a single injection being ~$25. Lucentis and Eylea cost ~$1,500 per injection. As a result, Avastin is frequently the first-line anti-VEGF agent. However, many patients fail Avastin therapy, and there are no prospective studies that address which second-line therapy is better.

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Driving practices of visually impaired patients in a large county hospital eye clinic

Mentor: Chan Nguyen, M.D., Ph.D.

Most states have laws requiring physicians to report patients with seizures to the Department of Motor Vehicles. However, no such laws exist for visually impaired patients. In this prospective questionnaire-based IRB-approved study, Parkland patients not meeting the Texas vision standard for an unrestricted driver’s license will be questioned about their driving habits and license status. This will help determine the potential scope of the problem of unreported visually impaired drivers.

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Projects with Ophthalmology Residents

Medical students are invited to assist the residents with their projects listed below:

Noy Ashkenazy, MD (PGY2) –

Project: Investigating the incidence of Remicade “rescue” in patients failing Humira for ocular inflammatory disease (uveitis). While some studies look at switching from one anti-TNF agent to another, there have not yet been studies looking at Remicade, specifically, after failure of achieving steroid-free remission with Humira.
Responsibilities: Reviewing databases at two or three different hospitals (i.e. Children’s and Aston) in order to identify the cases to present in this case series. Although I will be writing the majority of the paper, I would like assistance with literature review and developing the story for the manuscript
Faculty Advisor: Jennifer Cao, MD

Keerthana Bolisetty, MD (PGY2) –

Project: Resident complications of intravitreal injections in a large county hospital; a retrospective chart review
Responsibilities: Understand and be familiar with the procedure of performing intravitreal injections; you can shadow and/or help me out in clinic at your convenience! Understand common vs. rate complications of intravitreal injections. Chart review of patients that have had intravitreal injections to determine complications and outcomes – not just busy work as it will require comprehending the entire case and clinical course via which you will gain significant ophthalmic knowledge (especially retina).
Faculty Advisor: Zachary Roberston, MD

Sylvia Casas de Leon, MD (PGY2) –

Project: Yield of buccal mucosal biopsy in the diagnosis of ocular cicatricial pemphigoid
Responsibilities: Chart review under supervision of resident
Faculty Advisor: Jennifer Cao, MD

Ankur Gupta, MD (PGY2) –

Project: Video Consent for intravitreal injections and Panretinal - The project will look at using a standardized video consent process for patients undergoing intravitreal injection in the resident clinic. Parameters such as time saved / expended and patient understanding of the proposed procedure will be analyzed. Data will be collected in the resident clinic prospectively.
Responsibilities: helping with the actual data collection (timing of consent process, administering of surveys to residents and patients). The student would need some dedicated research time, as this would take place during the weekday and likely conflict with any concurrent clinical responsibilities (also can be flexible eg if student wants to come in only on the afternoons). The student would also have the potential to help with data analysis / writing of the manuscript. Dr. Blomquist does want to eventually publish this study, and I would be happy to have the student be first author on the paper/poster if submitted/published.
Faculty Advisor: Preston Blomquist, MD

Brian Heiniger, MD (PGY2) –

Project: Pterygia (fleshy, wing-shaped growths of the conjunctiva extending onto the cornea) are a very common problem in North Texas. However, recurrence after primary excision is a major concern. This study is intended to examine the rates of recurrence stratified by different excision techniques at Parkland Eye Clinic, the North Texas VA, and the Aston Eye Clinic at UTSW.
Responsibilities: Chart review and data collection, assistance with manuscript preparation, possible opportunities for presentation at local and national conferences.
Faculty Advisor: Steven Verity, MD

Emma McDonnell, MD (PGY2) –

Project: My project is a retrospective review of patients who have had combined CE/IOL and endocyclophotocoagulation (ECP) procedures at Parkland from 2008-2016. We will look at the patient demographics, eye pressure, number of glaucoma drops, visual acuity, complications, etc.
Responsibilities: Med student can help with the chart review...and if they have any statistics knowledge that would be fabulous!
Faculty Advisor: Jess Whitson, MD

Lilian Nguyen, MD (PGY3) -

Project: The purpose of my research project is to describe various outcomes of implementing diabetic teleretina screening in a low-income inner-city population. Diabetic retinopathy is the leading cause of blindness among adults aged 20-64 years in the United States, so there needs to be an effective and efficient method of screening, and that is what this project aims to investigate. The study design will be a retrospective chart review of all patients who underwent diabetic teleretina screening within the Parkland Hospital system. Overall we will be looking at the numbers screened, the efficacy of photography for determining pathology, and costs. This is an already established project that I have been working on for the past year, but we are trying to make this a very large and publishable study so there is still a lot of data collection and analysis to be done.
Responsibilities: The medical student's main responsibilities will be assisting me with chart review. If they would like, they can also assist with writing up the project, but that is not necessary. I already have one medical student helping me on the project, so the students would need to be willing and able to work together.
Faculty Advisor: Preston Blomquist, MD

Mohamed Guenena, MD (PGY4) –

Project: My project is acanthamoeba keratitis in parkland and Aston.
We are looking into natural history of corneal ulcers, complications, their response to treatment and final vision outcome.
Responsibilities: Medical student help would be reviewing the charts and filling in the data base. We will start as soon as we get IRB approval.
Faculty Advisor: H. Dwight Cavanagh, MD, PhD

Andrew Siegel, MD (PGY4) –

Project: The purpose of this study is to describe the difference in outcomes between phacoemulsification with endoscopic cyclophotocoagulation, versus trabeculectomy filtration surgery alone in a low-income inner-city population when performed by beginning surgeons. Glaucoma is a multifactorial disease, with both medical and surgical treatment modalities. One of the newer surgical techniques is endoscopic cyclophotocoagulation, or ECP. ECP is a cyclodestructive procedure developed by Martin Uram in 1992, that uses an image guide, a light source, and the semiconductor diode laser to ablate the ciliary body epithelium. This procedure is less destructive than transscleral cyclophotocoagulation, albeit more precise, thus limiting damage to the underlying ciliary body and surrounding tissue. Trabeculectomy is a filtering surgery where an ostium is created into the anterior chamber from underneath a partial thickness scleral flap to allow for aqueous flow out of the eye. It has been considered the gold standard surgical technique for which other surgical therapies are compared. This study will compare the two surgical techniques with regard to several outcomes, namely complication rate, intraocular pressure (IOP) reduction, and number of glaucoma medications required after surgery.
Responsibilities: Chart review and data collection.
Faculty Advisor: Chan Nguyen, MD, PhD

William Waldrop, MD (PGY4) –

Project: Corneal power and refractive changes after DMEK and DSAEK (endothelial transplants)
Responsibilities: Chart review, contacting patients to ensure they return to clinic for measurements
Faculty Advisor: Vinod Mootha, MD

Linda Yang, MD (PGY4) –

Project: Review the surgical outcomes of patients with posterior intraocular foreign bodies at UTSW, Parkland, JPS and Children’s.
Responsibilities: chart review and compile database
Faculty Advisor: Zachary Robertson, MD

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