Seeing the solution: Dry eyes and the bacteria that live there

Annual treatment costs to individuals and the Norwegian health system likely exceed 100 million NOK and dry eyes reduce productivity and lower quality of life. Despite this, very little progress has been made toward better care.

But what if that’s because we have been looking at the problem the wrong way? PhD candidate Maria Naqvi in OsloMet’s pharmacy department may have found a better method for diagnosing, and possibly treating, dry eyes: the ecosystem of bacteria that live in your eyes, the eye microbiome.

Eye would you do that?

Naqvi can usually be found in her lab in the Disease and Environmental Exposures research group trying to grow the bacteria she swabs from the eyes of volunteers at the Norwegian Dry Eye Clinic.

“It’s tough to do,” she says.

“Your tears have antimicrobial properties so there is much less to sample than, for example, the gut.”

Once she has collected the bacteria and avoided contamination, there’s no guarantee the samples will survive and multiply. She needs to try several different combinations of foods and temperatures to encourage them to grow. After a week of bacteria wrangling, Naqvi usually has enough to begin studying their properties.

She also sends some of the bacteria sample off to a commercial lab for DNA sequencing. “It’s an easy way to get a lot of data quickly and inexpensively,” she remarks.

The results she gets from the lab contain a wealth of information about which kinds of bacteria are present and some of their abilities.

With this data, Naqvi can start on the more difficult step: using artificial intelligence to compare bacterial DNA sequences and figure out if they relate to dry eyes. Fortunately, she can get help from AI experts within the Intelligent Health network.

A cornea-copia of data

The main focus of Naqvi’s research is figuring out whether the bacteria in the eye have an impact on dry eyes or play some part in protecting the eye’s surface. She reasons that since our eyes are in constant contact with the environment – weather, air pollution, and even if we wear makeup – maybe the tear film in our eyes changes in response to those conditions.

One thing that makes her research challenging is just how little is known about the cause of dry eyes. The condition was only officially defined in 1995 and then was re-defined in 2006.

It’s so understudied – we don’t know much for sure about the ocular microbiome. There are some older studies on the subject but it’s still quite limited.

Contributing to the lack of information on dry eyes is the fact that people, especially men, rarely go to the doctor to get treatment. The multi-billion NOK over-the-counter dry eye treatment industry doesn’t help either.

What Naqvi does know is that dry eyes are painful and expensive.

“Especially in places like the United States where this is most studied, the cost to the individual to go to the doctor and get treatment is massive. There’s also an economic burden from loss of productivity, and it definitely lowers quality of life.”

Analysing the results

The bacteria’s characteristics and specific traits might be the key to finding new ways to diagnose or even treat dry eyes.

Supporting Naqvi’s research on the biology side are professors Colin Charnock, a microbiologist, and Tor Utheim, an ophthalmologist. She also has the help of professor Anis Yazidi, an expert in AI.

Having three supervisors with different backgrounds contributing their expertise has been an advantage.

Her research is still in its early stages, but Naqvi suspects that some particular bacteria might be overrepresented in people with dry eyes. If this is the case, future doctors could target those bacteria for treatment.

She is also testing her cultured bacteria to see if they are resistant to certain antibiotics, which could inform best practices for prescribing antibiotics.

Answering these questions will require combing through a great deal of data.

Statistics and artificial intelligence have become an important component of biology research and play a major role in Naqvi’s work. She is one of the first people in the world to use artificial intelligence on the eye biome to diagnose dry eye.

It’s hard work, but she has the resources of Intelligent Health at OsloMet to help her acquire a deeper understanding of the disease.

Looking forward

“If I find that the microbiome has an enormous impact, we could find new therapeutics for dry eye and doctors might change how they prescribe antibiotics,” Naqvi says.

Collecting eye bacteria and analysing DNA is hard work. Dry eyes and the ocular microbiome are poorly understood. Naqvi will continue expanding our knowledge of biology and disease over the next few years of her PhD project and her intended career in the microbiology field.

Researching this new method in a field that is so poorly understood is both frustrating and rewarding but, as she says, “the research I’m doing will contribute to discovery about the eyes, even if it’s not dry eye.”