Professor James E Morgan
Professor in Ophthalmology, Consultant Ophthalmologist, School of Optometry & Vision Sciences
My research is aimed at understanding the structural and cellular changes occurring at the level of the optic nerve in glaucoma using clinical and laboratory based techniques. Glaucoma is one of the most common causes of vision loss in the UK population, affecting up to 2% of the population as a whole. Classically, it is associated with increased intraocular pressure, which causes the death of retinal ganglion cells and results in a slow and, if untreated, progressive loss of vision. In most cases, peripheral vision is lost first and is usually asymptomatic. By the time a patient notices restriction of visual field, advanced damage may have occurred to the optic nerve that is usually irreversible. Treatment is aimed at the reduction of eye pressure (intraocular pressure) to prevent this vision loss. Usually, this is achieved using eye drops although, in some cases, surgery or even laser treatment may be required. One of the key problems is in identifying the disease in its earliest stages and in detecting the first signs of retinal (optic nerve) damage.
As a consultant ophthalmologist, I run a glaucoma service at the University Hospital of Wales. I currently chair the Expert Working Group for the development of shared care glaucoma in Wales where we are working to develop the role of virtual clinics for the community care of patients with diagnosed glaucoma.
These are based at the Retinal Imaging Laboratory and are directed at the quantification of structural optic nerve changes in the early stages of glaucoma. Since these precede the development of visual field changes as detected using clinical perimetric techniques, their detection should enable early disease diagnosis and improve the long-term prognosis for the patient. We are currently assessing the value of digital stereoviewing in the quantification of these nerve head changes. In addition, we are assessing the value of other imaging modalities such as OCT in the determination of optic nerve head changes that occur in early glaucoma.
Using a variety of in vivo and in vitro models of glaucoma, my group is investigating the mechanisms of retinal ganglion cell death in glaucoma. There is good evidence that these cells undergo a prolonged period of atrophy and remodelling prior to cell death, which is manifest as shrinkage and pruning in the cell body and dendritic processes. These changes will reduce the efficiency with which these cells can detect visual signals but also suggests that this damage could be reversed. We use techniques such as biolistics transfection to see if the overexpression of genes that might be beneficial for retinal neurons can result in cell rescue.
We are collaborating with Bruce Caterson in the School of Biosciences to determine the role of extracellular matrix and the perineuronal net in limiting the extent to which retinal ganglion cells can recover from injury.
We are developing techniques for the early detection of these changes using imaging techniques such as OCT. We are currently investigating the possibility that OCT can detect optical signal associated with sub-cellular changes that are the earliest changes that occur prior to cell death. These studies are being undertaken with Wolfgang Drexler and Boris Povazay in the Biomedical Imaging Group.
Honours and awards
- Senior Whitby Scholarship (Downing College, Cambridge 1982)
- College Prize in Medicine (Downing College, Cambridge 1982)
- Medical Research Council Scholarship 1982-1985
- Medical Research Council Travelling Fellow 1994-1995
- IGA Research Award 1995
- Chair Expert Working Group Shared Care in Glaucoma (Welsh Assembly) 2006-2008
- Chair UK and Eire Glaucoma Society 2007
- RCO Informatics Committee
- CCIO Open Eyes Moorfields Eye Hospital
- National Eye Research Centre (Bristol) Grants Committee
- Fight for Sight Grants Committee
- Association for Research in Vision and Ophthalmology
- European Glaucoma Society
2000 Bury St Edmunds Ophthalmology Symposium 2000
Horizons in Glaucoma, Devers Eye Institute, Portland Oregon 2000
London (Institute of Physics)
2003 Western Ophthalmic Hospital (Imperial), London
Cambridge Ophthalmic Symposium, Cambridge
Oxford Eye Hospital,Oxford
2004 Aberdeen 2004
Keynote speaker: Imaging in glaucoma: Finnish Ophthalmological Society, Lahti, FInland Jan
Keynote speaker: Glaucoma in the 21st century: UK Glaucoma Society, London
St Thomas Hospital
Moorfields Eye Hospital
2006 Glaucoma Summit meeting: Topic; Retinal plasticity in glaucoma. Beijing
Neuroplasticity in glaucoma: International Neurophthalmology Society, Tokyo
Plasticity and repair in glaucoma; Japanese Glaucoma Society, Tokyo
2007 Imaging in glaucoma; Harcourt Symposium
Neuroplasticity in glaucoma Bristol Vision Symposium
Retinal ganglion cell degeneration in glaucoma: (symposium) ARVO, FL, USA
Shared care in glaucoma European Glaucoma Society, Mallorca
School of Medicine, Cardiff University
MOSS (medical specialties) Ophthalmology, Cardiff University
School of Optometry
Year 3 Abnormal Ocular Conditions
Medical Student and postgraduate teaching at University Hospital of Wales
Fellowship in Glaucoma
I run a fellowship in Glaucoma which is usually advertised September October in the year before it is taken up. The post is for one year; details can be obtained from my NHS secretary (029 20743222)
Mechanisms of retinal ganglion cell death in glaucoma
My research has focussed on understanding the early changes that characterise retinal ganglion cell degeneration in retinal disease. I have concentrated on glaucoma in which retinal ganglion cells are selectively damaged resulting in loss of visual sensitivity. The changes are manifest by atrophy and pruning of the retinal ganglion cell dendritic trees with preservation of the cell some and retinal ganglion cell axon. These cells are a potential source for the recovery of vision in glaucoma since they maintain central connections to the brain at the time of degeneration.
We use a range of experimental models of glaucoma in which the pressure is elevated for several weeks, resulting in the selective loss of retinal ganglion cells. We then use particulate gene and Dye delivery (Gene Gun) to determine changes in retinal connectivity.
In glaucoma, dendrites are pruned resulting in a left shift in the Scholl Distribution. Since the sensitivity of a retinal ganglion cell is critically dependent on dendritic structure this provides important information on one of the ways in which vision is lost in glaucoma. We have observed this as a general feature of retinal degeneration, with similar changes seen in optic neuropathy as a result of mitochondrial mutation (OPA1). We have used these models to try and understand the important of mitochondrial energy production in the maintenance of dendritic structure. Recently we have shown that dendritic atrophy is a feature of experimental Alzehimer's, raising the possibility that its detection could be used to detect Alzheimer's degeneration at an early stage.
In the context of retinal disorders neuronal degeneration, in the absence of cell loss is important since it raises the prospect that this damage can be reversed – possibly resulting in the recovery of lost vision. We are currently exploring methods to make this possible.
We have developed high resolution imaging techniques to quantify neuronal health. From the outset we have tried to do this without the use of neuronal labels such as fluorescent probes since this would limit the use of this approach in the clinical domain. Using high resolution OCT we have recently shown that it is possible to detect the optical correlates of early neuronal degeneration raising the prospect that this can be used to detect early retinal damage. Using retinal explants as a model of neuronal degeneration we were able to show that the sub cellular scattering characteristics of degeneration neurons changed rapidly following optic nerve transections.
Our findings are not dependent on the imaging of sub cellular structures- rather that we can detect the optical scattering which is generated by these structures. We know that the cell undergo considerable degeneration during this time frame, providing compelling evidence that this could be used to provide a quantitative index of neuronal health. We are currently exploring the possibility that high resolution OCT can be used for the detection of neuronal activity.
The translational of laboratory-based research can be challenging and the paucity of robust informatic support in the NHS can be a significant barrier. To overcome this I have encouraged the uptake of electronic patient management systems for eye care, with a focus on the OpenEyes EMR. I am currently the CCIO for the OpenEyes development (based at Moorfields Eye Hospital, London) and a member of the Informatics Committee at the Royal College of Ophthalmologists. Our goal is to provide the best electronic patient record for eye care.
We were successful in procuring the support of Welsh Government for OpenEyes to connect primary and secondary care throughout Wales. For the first time patients with eye disease can be managed using a common informatic system to provide seamless care- whether in the primary and secondary sector.
As part of our goal to develop innovative solutions in Health care we organised the first NHS Hack day in Wales in 2014. This brought together clinicians, software developers, scientists and engineers to collaborate over a weekend and pilot solutions to discrete clinical problems. Several projects sparked collaborations with potential for translation into clinical care.
Dr Anne Cunningham School of Medicine, Cardiff
Dr Sian Armstrong School of Engineering, Cardiff.
Albon J, North RV, Morgan JE. £52,688, The use of 1050nm OCT to identify changes of optic nerve head pathophysiology in glaucoma, College of Optometrists, 2011-2014.
Albon J, North RV, Drexler W, Morgan JE,£15,000, Optic nerve head changes in the progression of glaucomatous optic neuropathy using 1mm OCT, Hirsch and Fight for Sight Award, 2010-11.
Morgan JE, Tudor D, Albon J, £49,918, Perineuronal net (PNN) digestion as a therapy for the restoration of retinal ganglion cell structure in glaucoma. National Eye Research Centre, 2010-11.
Morgan JE, Albon J, £49,911, Characterisation of the perineuronal net (PNN) in the glaucomatous human retina: the identification of targets for PNN digestion as a potential therapy for the restoration of retinal ganglion cell structure in glaucoma, International Glaucoma Association, 2010-11.
Wride MA, Morgan JE, Albon J, £49,918, The role of inhibitors of apoptosis (IAPs) and caspases in retinal ganglion cell death and dendrite remodelling. National Eye Research Centre, 2007-10.
Dr Siene Ng (WCAT fellow)
Kate Binley Graduate student
James Tribble Graduate student
Asta Vasalauskaite Graduate Student
Dr Gek Ong (Research Manager)
Professor John Morrison, Oregon Health Sciences University, Portland Oregon, USA
Professor Wolfgang Drexler, Center for Medical Physics and Biomedical Engineering, Medical University Vienna.
Professor Mike Fautsch, Department of Ophthalmology, Mayo Graduate School of Medicine, Rochester, USA.
Professor Simon John Jackson Laboratories, Bar Harbor Maine, USA
Dr Gareth Howell Jackson Laboratories, Bar Harbor, Maine, USA
Dr Richard Foxton, Institute of Ophthalmology, UCL
Dr Lindsay Nicholson, School of Medicine (Ophthalmology) University of Bristol
Dr Alin Achim, Faculty of Engineering, University of Bristol