Ronald Silverman, MD: Preeclampsia & The Eye

Investigators from ophthalmology, engineering, and obstetrics and gynecology departments collaborated on a study looking at the choroid of patients who had recently given birth. Some patients had experienced preeclampsia while others were healthy controls.

The research team hoped to gain insight into the effects that preeclampsia might exert on the eye. Results from the ongoing study was presented at the 2019 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) in Vancouver, BC.

Ronald Silverman, PhD, Professor of Ophthalmic Science, Columbia University Irving Medical Center, New York, spoke with MD Magazine® about the reasons for the collaboration.

“Now the rationale for this is that preeclampsia is a systemic disease, but also the placenta plays a major role in it. The placenta is very difficult to access for imaging—for obvious reasons—but it bears some anatomic similarity to the choroid,” Silverman explained.

What is the rationale for examining the eye in patients with preeclampsia?

How did you conduct this study?

Now the rationale for this is that preeclampsia is a systemic disease, but also the placenta plays a major role in it. The placenta is very difficult to access for imaging—for obvious reasons—but it bears some anatomic similarity to the choroid, which is the part of the eye that is a vascular layer underneath the retina and that actually provides much of its oxygen and nutrients. For this reason we thought—or I should say Dr. Bearelly and Dr. Wapner thought—that it would be very interesting if we could characterize what's going on in the choroid in patients who have had preeclampsia versus controls. So, that was the basic structure of the study.We looked at women within 72 hours of childbirth, some of whom had preeclampsia and some of whom were just normal controls. We used a special ultrasound technique that we've been developing ourselves in my laboratory and this is called ultra-fast plane wave imaging. So, this is somewhat different from the standard ultrasound in that it provides extremely high rates of imaging—many thousands of images per second—and it also produces less ultrasound intensity which makes it safe for the eye and this is always a concern. So, we are imaging many thousands of images per second. We do the exam—usually the patient is in a wheelchair, that they're just transported from the OB/GYN facility to the ophthalmology department and we just scan them while they're sitting there. The eye is closed. We put the probe on the eyelid with just a little bit of gel and we take images of the optic nerve head and of the choroid itself in a plane just north or superior to the optic nerve head.