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Mount Sinai study shows flavoprotein fluorescence could serve as new biomarker

A new, noninvasive eye imaging method may be able to detect an early indicator of glaucoma in time to prevent disease progression and vision loss, according to a new study from the New York Eye and Ear Infirmary of Mount Sinai (NYEE). The study was published in the July/August issue of Ophthalmology Glaucoma. Read also : 4 locations were upgraded to CDC ‘high’ risk for immigration.

The study focused on measuring flavoprotein fluorescence (FPF) in the eye. Mitochondria, which are responsible for generating energy in cells, produce FPF when under stress, and FPF levels are elevated in people with glaucoma compared to people with normal eyes. Mitochondrial dysfunction in the optic nerve, which sends light signals to the brain and is critical for vision, can eventually lead to cell loss and tissue damage, leading to several eye diseases such as glaucoma and macular degeneration, as well as other retinal damage. This is the first comprehensive study to examine FPF changes in optic nerves from patients with different degrees of glaucoma compared to healthy eyes.

“Glaucoma is difficult to diagnose in the early stages and often doctors find it difficult to confirm subtle signs of progression in the advanced stages. Once structural damage to the optic nerve occurs, it is currently irreversible. The better we can become at identifying early or ongoing degeneration, the more proactive we can be in implementing protective therapy,” says principal investigator Richard B. Rosen, Ph.D. MD, Vice President and Director of Ophthalmic Research at NYEE and Chief of the Retina Service for the Mount Sinai Health System. “Our study suggests that FPF may be useful as an objective measure to predict glaucoma progression earlier than measuring structural damage, with similar sensitivity to visual field changes, but easier and potentially more consistent.”

The team of researchers used the OcuMet Beacon – a fundus camera with special filters that specifically isolate fluorescence, developed by OcuSciences Inc. – for the analysis of 86 eyes. Fifty eyes had glaucoma based on thinning of the retinal fiber layer, and 36 had no disease. They found that FPF, an indicator of mitochondrial oxidative stress, was significantly higher in glaucomatous eyes compared to normal eyes, especially in early-stage glaucoma cases where the damage is difficult to detect. FPF levels were correlated with other glaucoma detection methods, including mean visual field deviation, visual field pattern deviation, and retinal nerve fiber layer thickness.

These results suggest that FPF could be used clinically to reliably and objectively detect metabolic markers of glaucomatous damage, limiting the need for frequent visual field testing, which is the gold standard for measuring visual function. In fact, the researchers say, FPF may be a more accurate measurement, as visual fields have a number of weaknesses — they are subjective, they fluctuate with the patient’s attention, and patients can lose concentration during this assessment.

“Previous studies have shown that flavoprotein fluorescence levels decrease when mitochondrial oxidative stress is alleviated by drugs or surgery. This makes the technique very attractive as a sensitive way to monitor response to therapy,” explains Dr. Rosen. “This measurement could potentially be used as a first-line indicator for monitoring glaucoma progression for the patient and the physician.”

The researchers say their next step is to determine whether FPF can reliably monitor the effect of therapy in glaucoma patients, to determine when treatment has flattened the progression risk curve in advanced cases, and to identify patients in need of early glaucoma intervention.

OcuSciences, Inc., is a clinical-stage biotech company developing a retinal imaging device, OcuMet Beacon, to identify metabolic dysfunction occurring in the retina for early disease detection. For more information, visit

About Mount Sinai Health System

Mount Sinai Health System is one of the largest academic health systems in metro New York, with more than 43,000 employees working in eight hospitals, more than 400 outpatient clinics, nearly 300 laboratories, a school of nursing, and a leading medical school and graduate school. Mount Sinai promotes health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific knowledge and insights; developing safer and more effective treatments; educating the next generation of healthcare leaders and innovators; and supporting local communities by providing high-quality care to all who need it.

By integrating its hospitals, laboratories and schools, Mount Sinai offers comprehensive health care solutions from birth to geriatrics, leveraging innovative approaches such as artificial intelligence and informatics, while keeping patients’ medical and emotional needs at the center of all treatment. The health system includes approximately 7,300 primary care physicians and specialists; 13 shared ambulatory surgery centers in the five boroughs of New York City, Westchester, Long Island and Florida; and more than 30 affiliated community health centers. U.S. News & World Report’s top hospitals that receive high “Honor List” status and are highly ranked: no. 1 in Geriatrics and Top 20 in Cardiology/Cardiac Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation and Urology. New York’s Mount Sinai Eye and Ear Clinic is ranked #12 in ophthalmology. US News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children’s Hospital among the nation’s best in 4 out of 10 pediatric specialties. The Icahn School of Medicine at Mount Sinai is one of three medical schools to earn recognition across multiple indicators: U.S. News & U.S. News & World Report’s “Best Medical Schools,” aligned with US News & World Report “Honor Roll” hospital and top 20 in the nation for National Institutes of Health funding and top 5 in the nation for many areas of basic and clinical research. Newsweek’s “World’s Best Smart Hospitals” ranks Mount Sinai Hospital #1 in New York and top five in the world, and Mount Sinai Morningside in the top 20 in the world.

For more information, visit or find Mount Sinai on Facebook, Twitter and YouTube.

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