Xerophthalmia and anterior segment blindness

An Accidental Nutritionist

My career as an accidental nutritionist began with my immersion in cholera control, a cyclone disaster, a smallpox epidemic, and formal training in ophthalmology and epidemiology. Interest in blindness prevention inexplicably led me to (re)pioneer the effects, treatment, and prevention of vitamin A deficiency, while faced with intense criticism by many leading scientists in the nutrition community. The resulting efforts by the World Health Organization and UNICEF in support of programs for the global control of vitamin A deficiency still face vocal opposition by some senior scientists, despite having been estimated to have saved tens of millions of children from unnecessary death and blindness. This entire journey was largely an accident!

Measles blindness

Measles remains a major problem in developing countries, where it affects an estimated 30 million children a year and causes up to one million deaths annually. Measles blindness is the single leading cause of blindness among children in low income countries, accounting for an estimated 15,000 to 60,000 cases of blindness per year. There is a close synergism between measles and vitamin A deficiency that can result in xerophthalmia, with corneal ulceration, keratomalacia, and subsequent corneal scarring or phthisis bulbi. High-dose oral vitamin A supplementation is recommended for all children with measles in developing countries. Higher measles immunization coverage to interrupt measles transmission and interventions aimed at improving vitamin A nutriture of children are the main strategies to prevent measles blindness.

Induction of conjunctival transdifferentiation on vascularized corneas by photothrombotic occlusion of corneal neovascularization

Previous studies have established that conjunctival transdifferentiation (transformation into cornea-like morphology) is inhibited by corneal vascularization. Conversely, occlusion of corneal vessels may induce conjunctival transdifferentiation on vascularized corneas. To test this hypothesis, the corneal epithelia of New Zealand albino rabbits were debrided 3 mm beyond the limbus with n-heptanol. Sixteen corneas healed by conjunctival epithelium, with vascularization persisting for 20 months, were used in this study. Photochemically induced occlusion of the corneal vessels was achieved by intravenous administration of rose bengal-saline solution (40 mg/kg body weight) with subsequent argon laser irradiation of the vessels (514.5 nm, 130 mW, 63 micron and 0.2 sec). The treated vessels remained occluded in an 18-week study, as confirmed by corneal fluorescein angiography. Corneal clarity and epithelial integrity were improved after treatment. Goblet cell loss and morphologic transformation into a cornea-like epithelium were verified by flat-mount preparations, histology, impression cytology, and immunofluorescence studies using a mucin-specific monoclonal antibody. These results indicate that conjunctival transdifferentiation can be induced on vascularized corneas after occlusion of corneal vessels by photothrombosis.