Mount Sinai unveils glaucoma imaging method

New York Eye and Ear Infirmary of Mount Sinai researchers reported in August 2022 that a non-invasive imaging approach may detect an early sign of glaucoma before more visible structural damage appears. The work focused on flavoprotein fluorescence, or FPF, a signal linked to mitochondrial stress in the eye. Mount Sinai said the findings were published in the July/August 2022 issue of *Ophthalmology Glaucoma*. The study adds to a broader effort in glaucoma care to identify injury earlier, when treatment decisions may be made before more vision is lost. ### What exactly did the Mount Sinai team measure? The study measured flavoprotein fluorescence in the eye, a signal produced when mitochondria are under stress. Mount Sinai said stressed mitochondria generate higher FPF, and that elevated levels have been seen in people with glaucoma compared with people who have normal eyes. Because mitochondrial dysfunction in the optic nerve can contribute to cell loss and tissue damage, the researchers examined whether that signal could work as an earlier marker of glaucomatous injury. (mountsinai.org) Richard B. Rosen, vice chair and director of ophthalmology research at NYEE and chief of the Retina Service for the Mount Sinai Health System, said the goal was to identify degeneration before irreversible structural injury is obvious. He said in the Mount Sinai release that once structural damage to the optic nerve has occurred, it cannot currently be reversed. (mountsinai.org) ### How did they test it in patients? The researchers used the OcuMet Beacon, a fundus camera with filters designed to isolate the fluorescence signal, to analyze 86 eyes. Mount Sinai said 50 of those eyes had glaucoma, based on thinning of the retinal fiber layer, while 36 had no disease. The team found that FPF was significantly higher in glaucoma eyes than in normal eyes. (mountsinai.org) Mount Sinai and Ophthalmology Times both said the difference was especially notable in early-stage glaucoma, where conventional damage can be harder to detect. The researchers also reported that FPF levels correlated with established glaucoma measures, including visual field mean deviation, visual field pattern deviation, and retinal nerve fiber layer thickness. ### Why are early-stage cases the focus here? Glaucoma is often difficult to diagnose in its earliest stages, according to Rosen’s statement in the Mount Sinai release. He said physicians also struggle to confirm subtle progression in more advanced disease. That is why an objective signal tied to metabolic stress, rather than waiting for clearer structural damage, is the central claim in this study. (mountsinai.org) Rosen said the study showed FPF “may be useful” as an objective measure for predicting glaucoma progression earlier than structural measurements, with sensitivity similar to visual field changes but with easier and potentially more consistent use. That wording is important: Mount Sinai described the method as a possible biomarker, not as a replacement that is already standard in routine care. (mountsinai.org) ### Does this mean the test is ready for broad clinical use? The available reports describe preliminary clinical testing, not a completed rollout into standard glaucoma screening. The evidence cited by Mount Sinai comes from a study of 86 eyes, and the institution said the results suggest FPF could be used clinically to detect metabolic evidence of glaucoma-related injury and potentially reduce the need for frequent visual field testing. (mountsinai.org) Mount Sinai’s wording points to the next step: further validation in clinical practice. The published study in *Ophthalmology Glaucoma* and the named device, the OcuMet Beacon developed by OcuSciences, provide the main public trail for how the work would be assessed and followed from here. (mountsinai.org)