Zhang et al., 2020. Violet Light Suppression of Thermogenesis By Opsin 5 Hypothalamic Neurons. Nature, 585, pages 420-425

In this study, the Lang lab showed that a small population of neurons within the hypothalamus of the brain can sense violet light, and in doing so, suppresses body temperature. The light sensing protein that mediates this effect in Opsin 5, a member of the opsin family of G-protein coupled receptors. This action of Opsin 5 means that Opn5 null mice have a constitutively high body temperature, eat more, drink more, and expend more energy. This finding fundamentally changes our understanding of how energy metabolism is regulated in mammals and may have interesting implications for our understanding of metabolic disease in humans. The experimental work in this study was led by Kevin Zhang, a former student in the Medical Scientist Training program who defended his thesis in 2020 based on this work.

Michael Gray, MD

Gray serves as the principal investigator for PEDIG (Pediatric Eye Disease Investigator Group) studies at Cincinnati Children’s Hospital Medical Center. PEDIG is a nationwide network that facilitates multicenter clinical research in strabismus, amblyopia, and other eye disorders in children. Gray serves as the protocol co-chair for ATS22 (Amblyopia Treatment Study 22). Many pediatric eye care providers currently treat amblyopia first with glasses alone, followed by part-time patching if there is residual amblyopia with glasses. Other providers advocate a simultaneous approach prescribing glasses and patching at the beginning of treatment. ATS22 will help answer which approach is better by randomizing children to either a sequential vs. simultaneous approach for amblyopia treatment. This study could potentially change clinical practice for pediatric eye care providers worldwide. Recruitment began in 2021 and will continue for approximately two years.

In another PEDIG study, Gray was a recruiter for IXT5 – A Randomized Clinical Trial of Overminus Spectacle Therapy for Intermittent exotropia. Intermittent exotropia is a common form of childhood-onset exotropia, and many providers use overminus lens therapy of additional minus power in glasses to help the control of a child’s exodeviation with this condition. JAMA Ophthalmology published the results in 2021, with Gray serving as co-author. This paper reported a benefit for overminus glasses for intermittent exotropia, however, results were not sustained after tapering off the treatment with an associated myopic shift in certain patients treated with overminus. Investigation continues for additional long-term data.

Melissa L. Rice, OD, FAAO

Rice serves as the medical director for the CLEAR Clinic, providing functional vision exams with occupational therapists for children with cerebral visual impairment and cerebral palsy in a monthly clinic at the Aaron W. Perlman Center. This clinic is part of the Cincinnati Children's Pediatric Low Vision Program developed by Terry Schwartz, MD, utilizing a multi-disciplinary approach to better serve children with low vision from cerebral visual impairment and ocular disease. Rice and Schwartz engage actively in collaborative cerebral visual impairment research with the Divisions of Occupational Therapy and Physical Therapy (Karen Harpster, PhD, OTR/L) and Neonatology. They present their research regionally, nationally and internationally as well as serving as invited expert panelists at meetings. The Cincinnati Children's Pediatric Low Vision Program has a partnership with Clovernook and raised over $225,000 funding for the program in fiscal year 2021. The Low Vision Program team members include Sarah Lopper, OD, FAAO, low vision; Fred Neurohr, program coordinator; Melody Klayer, ophthalmic technician; Kelly Lusk, teacher of visually impaired; and occupational therapists Harpster, Patricia Gribben, OTR/L, Kihmberly Hymore, MOT, OTR/L, ATP, Jessica McCoy, MOT, OTR/L, Amy Klein, MPP, MS, OTR/L, Elsie Bush, MS, OTR/L, and Katherine Clark, MOT, OTR/L, ATP.

The Association of Adrenal Insufficiency and Pseudotumor Celebri Syndrome

Pediatric neuro-ophthalmologist and faculty researcher Veeral S. Shah, MD, identified a link between adrenal insufficiency and pediatric pseudotumor cerebri syndrome (PTCS), also known as idiopathic intracranial hypertension (IIH). In this collaborative work between pediatric neuro-ophthalmology / endocrine services, he and his collaborators were the first to identify a prevalence of adrenal dysfunction in a large pediatric PTCS/IIH cohort in a retrospective study (PMID: 33110007). They further demonstrated clinical evidence in a JAMA Ophthalmology publication (PMID: 32940641) that 1) Substantiates a neuro-endocrine model for prepubertal PCTS, 2) Reports the first evidence of physiologic and anatomical finding associated with AI and PCTS, 3) Supports a new diagnostic work-up, as well as 4) Describes a new etiologic target for PCTS/IIH.

Their work highlights a global unawareness among pediatricians and subspecialties (endocrine, ophthalmology, neurology, and pulmonary) of the consequences of topical / inhaler steroid and inhaler use that can induce AI in young children and cause episodic AI and PTCS/IIH. The general incognizant among all pediatrics services warrant this as a major public health concern.

Eniolami O. Dosunmu, MD

Dosunmu serves as the ophthalmologist for the Cincinnati Children's CHARGE (Colobomas – an incomplete closure of structures of the eye, Heart defects, Atresia of the nasal choanae, Restriction of development, Genitourinary abnormalities, Ear and hearing anomalies) Center. Colobomas are typically the diagnostic ophthalmic finding of CHARGE syndrome. Dosunmu recently conducted a retrospective analysis of all patients clinically diagnosed with CHARGE syndrome, with confirmed CHD7 positive genetic testing seen in the Division of Ophthalmology from January 1, 2008, through September 25, 2018. The analysis was specific to the ophthalmic findings of patients with CHARGE syndrome WITHOUT a finding of coloboma in either eye. This analysis was a first, as previous research on CHARGE patients with ophthalmic findings, focused on the coloboma findings. Research determined those in the cohort without colobomas was 19.4%. Strabismus (69.2%) and a refractive error needing correction (76.9%) were the most common findings. There were also findings of amblyopia (23.1%), nasolacrimal duct obstruction (38.5%), dry eye syndrome and exposure keratopathy (30.8%). Other less common findings in this cohort were ptosis, blepharitis, cortical visual impairment, optic nerve drusen, and Marcus Gunn jaw winking. The study demonstrated that there are numerous ophthalmic findings in CHARGE patient without colobomas. It also highlighted the need to assess and treat these findings to ensure optimal vision in the CHARGE patient.