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Prof Paul Foster
Division of Epidemiology and Genetics, UCL Institute of Opht
11-43 Bath Street
  • Professor of Ophthalmic Epidemiology & Galucoma Studies
  • Institute of Ophthalmology
  • Faculty of Brain Sciences
Research Groups
Research Themes
Research Summary
My research career began at UCL in1995 when I carried out a population-based study of glaucoma prevalence and risk factors in Mongolia. This is now widely recognised as an important and ground-breaking piece of research. It identified a high prevalence of primary angle-closure glaucoma (PACG) in this East Asian population at a time when data from China and Japan suggested that PACG was relatively rare. It also highlighted the poor prognosis for vision among those who suffer from PACG and do not have access to adequate ophthalmic care. These findings were consolidated during a 3 year research fellowship in Singapore, which demonstrated again the poor prognosis for sight among people with undetected PACG. It became apparent that the contemporary approaches to diagnosis and classification of glaucoma (and in particular of PACG) in epidemiological research were anachronistic and did not specifically identify people with a poor visual prognosis, or those who had established, significant visual loss. This issue was addressed in a meeting of ophthalmic epidemiologists interested in glaucoma in 1997, for which I was raporteur. I proposed a modified approach to classifying angle-closure glaucoma based on staging of the natural history of disease. This, together with a parallel classification of angle-closure based on mechanism responsible for closure (Ritch), and a standardised approach to defining glaucomatous optic neuropathy (Quigley) is now a widely accepted international research standard. The principles developed have now been adopted by many regional and global representative organisations and societies. Subsequent detailed definitional studies have helped to provide an evidence-based approach for the diagnosis and classification of angle-closure glaucoma both in research and clinical practice. However, most ophthalmic textbooks have yet to be updated with the revised classification system. Hence, I have traveled extensively over the last decade presenting at UK, European and international meetings, and conducted many instructional courses based on my research into the epidemiology of primary angle-closure glaucoma. At the same time as studying the distribution and burden of PACG, we investigated the potential of different screening tools to allow early detection of this condition, and studied the potential role of laser iridotomy (the standard treatment for established disease) as a prophylactic measure. This has culminated in a series of large-scale, randomised controlled trials in Mongolia, Singapore and China. We expect that laser iridotomy will prove to be a viable prophylactic measure, and that ocular biometry will be an appropriate method of screening populations. I am confident that this body of work offers the best foreseeable prospect of making a significant reduction in the prevalence of blindness worldwide. My research into the diagnosis and management of angle-closure glaucoma is already providing practical benefits to patients in the UK in my angle-closure glaucoma clinic at Moorfields Eye Hospital, which provides approximately 2,000 patient visits as well as 600 laser and surgical procedures per year. My future research into the epidemiology of glaucoma will involve collaborative work with colleagues at Cambridge University working on the EPIC Norfolk cohort, which will encompass primary open angle glaucoma, and involve assessment of the impact of diet, lifestyle and environment on glaucoma. Ongoing research into the molecular genetics of glaucoma and refractive error offers further exciting prospects for identifying aetiological mechanisms and possible novel therapeutic options.
Academic Background
1995 PhD Doctor of Philosophy – Ophthalmic Epidemiology University College London
1989 MBBS Bachelor of Medicine/Bachelor of Surgery – Medicine/Surgery University of Nottingham
1987 BMEDSCI Bachelor of Medical Science – Medical Science University of Nottingham
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