Trainee's Background

• MD with 3-year residency in ophthalmology and 1-year residency in primary care
• Courses in clinical epidemiology
• Staff member for Doctors Without Borders in Bangladesh; participated in several village-level trachoma interventions

Career Goals

• The design and conduct of randomized trials for the treatment of trachoma in the developing world. To attain that goal, the trainee realizes the need for more extensive training in clinical epidemiology as provided by the BCSDP.

Expected Program Duration and Stages

• Four years
• Year 1: Courses, seminars, scientific meetings, and research project development
• Year 2: Courses, seminars, scientific meetings, and research project data collection
• Year 3: Completion of data collection and analysis of data; preparation for trainee's own R01 or clinical trial grant application to NIH
• Year 4: Manuscript preparation and submission; discussion of results with village leaders in community meetings; review and final submission of trainee's NIH grant application

Proposed Courses, Seminars, and Meetings

• Required Core Courses and Seminars
• Courses in Intermediate and Advanced Epidemiologic Methods; Biostatistics: Introduction to Biostatistics, Statistical/Computer Analysis using S-PLUS, Biostatistical/Epidemiologic Data Applications, and Introduction to Multivariate Statistics; Epidemiology: Intervention Trial Design; Practical Applications of Epidemiologic Methods in Developing Countries.
• Seminars: Translational Vision Research; Epidemiology; Biostatistics
• Meetings: Attend two scientific meetings each year, such as the annual meetings of the Association for Research in Vision and Ophthalmology (ARVO) and the American Academy of Ophthalmology

Proposed Research Project

• "Community-level Treatment for Trachoma"
• Hypothesis: Mass, prophylactic treatment with single dose oral azithromycin in villages with high (>5% prevalence) of trachoma will reduce the prevalence of trachoma by at least 50% after two years.
• Aims: (1) Identify 20 villages in India with current trachoma prevalence in the population greater than 5% of the population; (2) Conduct a cluster-randomized trial with 10 active and 10 control villages (matched by baseline prevalence) to evaluate the effectiveness and durability after 24 months of a single oral dose of azithromycin delivered to an entire village; and (3) Analyze the results with proper biostatistical methods to account for the clustered randomization and submit for peer-reviewed publication.
• Design and Methods: Cluster-randomized trial to be conducted in 20 villages (10 active; 10 control) in India over two summers. The villages will be matched at baseline with respect to current prevalence of active trachoma. All identified active cases of trachoma discovered during enrollment or follow-up will be treated with tetracycline eye ointment. All participants in the active villages will receive one dose of oral azithromycin after an eye examination. All participants in the control villages will receive an eye exam and no prophylactic therapy (treatment is provided for active trachoma). At 6, 18, and 24 months, the prevalence of trachoma in each of the 20 villages will be measured again. If successful in maintaining a reduced prevalence of trachoma throughout the study, this trial could have a major impact on national trachoma control programs.

Proposed Mentors

• Principal Mentor: Faculty in Epidemiology—infectious diseases and intervention trial design
• Associate Mentors: Three other faculty in (1) Epidemiology—infectious diseases and developing country studies; (2) Biostatistics—cluster randomized analysis methods; and (3) Optometry & Vision Science—clinical trials

Trainee's Background

• OD in vision science

Career Goals

• To become an independent researcher investigating the locus and neural mechanisms underlying amblyopia and other vision disorders.

Expected Program Duration and Stages

• Five years
• Year 1: Courses, seminars, scientific meetings, and research lab rotations; attend vision science semniars and Society for Neuroscience meeting
• Year 2: Courses, seminars, scientific meetings; develop research plan; begin setting up psychophysical and VEP experiments and recruiting subjects; attend vision science semniars and Society for Neuroscience meeting
• Year 3: Complete psychophysical studies, and continue VEP data collection and analysis; write psychophysical results for publication; attend vision science semniars and Society for Neuroscience meeting; present BCSDP seminar; give papers at scientific meetings
• Year 4: Complete VEP studies and begin fMRI study; complete writing R01 or Clinical Trial Grant and submit within first 6 months of Yr 3; attend vision science semniars and Society for Neuroscience meeting; present BCSDP seminar; give papers at scientific meetings
• Year 5: Complete fMRI study and write papers for publication; write R01 or Clinical Trial Grant and submit during first 6 mos of Yr 5; attend vision science semniars and Society for Neuroscience meeting; present BCSDP seminar; give papers at scientific meetings

Proposed Courses, Seminars, and Meetings

• Required Core Courses and Seminars
• Courses in Introductory, Intermediate, or Advanced Teaching Methods in Vision Science; Epidemiology and Human Disease; Ethics in Scientific Research; Application of Vision Psychophysics to Clinical Disorders; Instrumentation and Methodology in Vision Research,;Cognitive and Biological Development, Systems/Computational Neurobiology; Functional MRI Methods; Linear Systems Theory
• Meetings: All seminars in Vision Science and Translational Research; annual for Neuroscience meetings

Proposed Research Project

• "The functional role of striate and extrastriate loss in amblyopia"
• Hypothesis:The proposed experiments will distinguish among the following hypotheses for losses in amblyopia and strabismic suppression. To simplify, we will refer to the suppressed eye as the non-dominant eye (NDE): (a) The NDE loss is found approximately equally in all visual areas; (b) The V1 response is suppressed by feedback from extra-striate areas, or positive feedback to V1 is lacking under NDE stimulation. Evidence for this hypothesis would be the finding that the early V1 response from NDE stimulation was relatively normal, with the later responses being attenuated; (c) V1 has a relatively normal response to the NDE, with responses in later visual areas attenuated.
• Aims: The aim of these experiments is to use fMRI, VEP and psychophysics to identify the functional role of striate and extrastriate loss in amblyopia, with stimuli and tasks that differentially activate striate and extrastriate areas in normal observers. The fMRI studies, combined with novel stimuli, offer a powerful method to localize the deficits in amblyopia.
• Design and Methods: All VEP experiments will be done in a haploscope so that even the eyes of strabismics can be lined up to fixate in a stable manner. These experiments test three hypotheses regarding where the amblyopic or strabismic suppression loss occurs (before or after V1, early or late portions of the V1 temporal response function, after occipital cortex). Then fMRI retinotopy will be carried out on all the subjects who participated in the ER study, using both conventional rotating-wedge and expanding ring stimuli

Proposed Mentors

• Principal Mentor: Faculty in Optometry-VEP and Psychophysics
• Associate Mentors: Two other faculty in Psychology-Neuroscience