Dr. Gardiner has been working for almost two decades to improve clinical diagnostic tools for glaucoma. This consists of assessing current techniques, developing new techniques for making measurements, and improving methods of analyzing the results. The aims are to detect the presence of disease, and accurately measure its rate of change, so that appropriate treatment can be assigned.
He has gained a growing international reputation for this work, leading to invited talks and a place on the editorial board of the premiere ophthalmology research journal, IOVS, and as a reviewer on NIH study sections.
His background is in medical statistics, and he uses this expertise to help other researchers with designing and analyzing experiments at Devers, for other Legacy Health departments, and externally at other institutions both nationally and internationally.
Detection of Functional Change Using Cluster Trend Analysis in Glaucoma.
Gardiner SK, Mansberger SL, Demirel S. Invest Ophthalmol Vis Sci. 2017 May 1;58(6):BIO180-BIO190.
Localized Changes in Retinal Nerve Fiber Layer Thickness as a Predictor of Localized Functional Change in Glaucoma.
Gardiner SK, Fortune B, Demirel S.
Am J Ophthalmol 2016; 170: 75-82.
Assessment of the reliability of standard automated perimetry in regions of glaucomatous damage.
Gardiner SK, Swanson WH, Goren D, Mansberger SL, Demirel S.
Ophthalmology 2014; 121: 1359-69. https://www.ncbi.nlm.nih.gov/pubmed/24629617
A method to estimate the amount of neuroretinal rim tissue in glaucoma: comparison with current methods for measuring rim area.
Gardiner SK, Ren R, Yang H, Fortune B, Burgoyne CF, Demirel S.
Am J Ophthalmol 2014; 157 (3): 540-549.
The main focus of Dr. Gardiner’s research is on improving diagnostic techniques for glaucoma.
Currently, when patients visit the glaucoma clinic, they may undergo one or more different tests. Functional testing, called “perimetry”, typically consists of looking at a white screen, and pressing a button when a brighter light appears. The aim is to measure how bright this light has to be for it to be visible, at different locations, in order to produce a map showing how much damage there has been across the eye. These tests are long and frustrating for the patient, and the results can vary from day to day, especially in eyes with glaucoma. Dr. Gardiner is working to improve this testing, making it more accurate and reliable. This will provide better quality information to the doctors, while also improving the experience for the patient.
Structural testing consists of taking images of structures at the back of the eye. Of particular interest is OCT (optical coherence tomography), which can be used to measure the thickness of different layers as much as 2mm deep within the retina. These structures change in glaucoma as cells are damaged, and vision is lost. Dr. Gardiner is working with others, including Drs. Burgoyne and Fortune within Legacy Health, to improve the understanding and interpretation of these measurements.
With all diagnostic testing, the doctor needs to be able to see not only how much damage there has been, but also how quickly it is getting worse. A rapidly progressing eye needs to be treated aggressively to prevent or delay severe vision loss, and so it is essential to identify those eyes as early as possible. Dr. Gardiner is working with others to improve methods for determining the rate of change, and to predict the likely subsequent rate of change based on testing that can be performed now.
Blood flow within the eye is known to be altered in glaucoma. Dr. Gardiner is using longitudinal testing to help us work out whether this is the result of damage to other cells in the eye, or is actually a root cause of damage.
Dr. Gardiner also uses his experience and training to help other researchers, both internally within Legacy Health and externally at other institutions, with designing and analyzing experiments. This has encompassed a diverse range of medical fields, including studies in breast cancer, neonatal intensive care, trauma, and mental health.
Functional Testing for Glaucoma
R01EY020922 (PI: Stuart Gardiner)
Major Goals: This project aims to explain and reduce the variability observed in functional testing of the visual field in patients with glaucoma. This will allow earlier and more accurate assessment of a patient's current status and response to treatment. It will improve the ability to design an appropriate and cost-efficient personalized management strategy to preserve vision, with the aim of maintaining a patient's quality of life.
Blood Flow And Hemodynamics in Glaucoma
R01EY031686 (PI: Stuart Gardiner)
Major Goals: This project will provide important new information about the role of blood flow in glaucoma. It is known that blood flow in the retina is altered during the disease; this project aims to determine whether that is the result of retinal ganglion cell loss, or a factor that contributes to cell loss, or both. This will be achieved by longitudinal testing of blood flow in the optic nerve head and retina in human participants with glaucoma, and comparison against other clinical testing modalities. It will reveal new targets both for diagnostic testing and for treatment, and elucidate the processes by which glaucoma progresses and ultimately leads to blindness.
Optic Nerve Head Glymphatics and Debris Clearance
R01EY029087 (PI: Nick Marsh-Armstrong)
Major Goals: We will test the hypotheses that: 1) ONH debris is removed either by astrocytes using glymphatic channels for waste disposal, or, alternatively, by CNS myeloid cells, 2) and the balance of these pathways differs in the ONH relative to elsewhere in the Optic ¬Nerve (ON), and 3) is highly perturbed within the ONH early in glaucomatous optic neuropathy. If we are correct, then either increasing ONH astrocytes’ phagocytosis or capacity to flush waste, or inhibiting recruitment of discrete CNS myeloid cells into ONH parenchyma will be rational therapeutic strategies for glaucoma.
80 Years and Older Vision & Hearing Important Persons Project (80VIP)
R34EY031427 (PI: Steve Mansberger)
Major Goals: This proposal will develop the infrastructure to evaluate neurosensory loss in community-dwelling adults aged 80 years and older, a key age group that will increase 600% in the next 30 years, an increase faster than any other age strata or minority group. This age group is rarely included in population-based research because of special concerns in this age groups such as health problems, transportation issues, and impaired capacity to provide informed consent. Information from this proposal will develop the infrastructure for a future multicenter study to forecast health care costs, develop novel interventions, and augment healthy living and prevent morbidity such as institutionalized care.