Elevating optometry by advocating for dry eye patients

Biomarkers—biological molecules found in body fluids—provide valuable patient health insights. But current diagnostic lab tests of blood and urine samples offer a limited snapshot. What if there was a simple, noninvasive way to continuously monitor the biomarkers found in tears? 

That’s the aim of the Ocular Laboratory for Analysis of Biomarkers (OCULAB), a program of the Advanced Research Projects Agency for Health (ARPA-H), which accelerates scalable solutions to society’s most challenging health problems. The goal of OCULAB is to create a puncta-based biomarker sensory system that can collect high volumes of data to facilitate disease monitoring and ultra-precise delivery of hormones, proteins, small RNA or pharmaceuticals. 

“This program has the potential to have the greatest impact of anything I’ve participated in so far in my optometric career,” says Nora Lee Cothran, O.D., who was tapped to serve as the clinical expert at OCULAB Proposer’s Day last year. “The first target of this project is dry eye disease, which impacts some 20 million Americans. But if the framework is created correctly, the platform has the potential to identify biomarkers and deliver therapeutics for non-ocular diseases as well.” 

Dr. Cothran, who practices at the Eye Institute of West Florida and is a member of the AOA’s Coding & Reimbursement Committee, was an intelligence officer in the U.S. Air Force and an analyst for the Department of Defense before pivoting to a career in health care. She explains how she got involved with ARPA-H OCULAB—and why doctors of optometry should embrace opportunities to showcase their subject matter expertise. 

How did you connect with the OCULAB project? 

A colleague contacted me because of my current role as a glaucoma specialist and also my reputation as a patient advocate. She was also aware of my unique background in military intelligence and inherent understanding of how agencies, such as the Defense Advanced Research Projects Agency, can create life-changing technologies. I was absolutely ecstatic at this incredible opportunity and immediately, without hesitation, said “yes.”  

What was your role with OCULAB? 

I was a panelist for OCULAB Proposer’s Day held last December in Tampa, Florida, and moderated by Calvin Roberts, M.D., OCULAB project manager. I was the sole doctor providing a clinical perspective on dry eye disease to the audience of scientists, engineers and industry experts from across the nation. 

Explaining the multi-factorial nature and natural history of dry eye disease was the easy part. Conveying the tremendous disease burden that patients, especially women and those with autoimmune diseases, bear seemed especially compelling. I used examples of my own patients and discussed how meeting the goals of this project would fundamentally change the world’s understanding of the information that can be gleaned from our eyes. No longer relegated to the poetic “window to the soul,” our eyes could serve as both a tangible roadmap and modifiable highway for the identification and treatment of ocular and systemic diseases. 

ARPHA-H solutions are all merit-based with an emphasis on data and scalability. OCULAB proposals will be selected this summer, and the program kicks off this fall. 

What does it mean to you to be part of OCULAB? 

There are no words to adequately articulate my enthusiasm. Providing the clinical perspective on the insidious and debilitating nature of dry eye disease, as a physician expert, was truly a privilege. I was proud to be a voice, not only for the optometric and ophthalmological community, but for the patients who entrust us with their care. 

How did your background prepare you for this role? 

A decade of clinical practice as an optometrist exposed me to the significant role that untreated disease can have on a patient’s life. The real-world feasibility of an incredible project like OCULAB ties into coding and reimbursement because every optometrist in America is capable of placing the punctal plug-type device and a billable procedure (CPT) code already exists. 

Why is it important for doctors of optometry to engage with opportunities like this? 

Every optometric physician has their niche, and we are all equally important to keep our profession viable and progressing. There is real inherent value in what we know and the experiences we’ve had. When you’re recognized as a subject matter expert, it’s not just for you. It elevates optometry. Projects such as this have the ability to impact millions of American lives, and your unique clinical perspective may be the one that inspires paradigm-altering action.