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Getting Involved in Research

Responding to feedback received from viewers, Innovation Journal Club dedicated an episode to getting involved in research. Dr. Singh invites Sila Bal, MD, MPH, currently a cornea fellow at Mass Eye and Ear transitioning to private practice, to discuss how she got started in research and what advice she could offer to peers interested in getting involved. They discuss a paper published by Dr. Bal as a case example of how a research study moves from concept all the way through to publication.

How Dr. Bal Got Involved in Research

While in her undergraduate studies, Dr. Bal had the opportunity to participate in bench research. And, she says, it was never something she felt passionate about. But then she was asked to participate in a clinical research study by an influential mentor, Gil Binenbaum, MD, who helped demonstrate the possibility for research to impact the practice of medicine and improve the lives of patients. Suddenly, everything changed for Dr. Bal.

“That’s one thing you want to discover early on, whether you really love the basic science research, or whether you’re like me, and you prefer clinical research,” Dr. Bal offered.

From there, Dr. Bal followed her passion, initially focusing on research in pediatric patients, which eventually evolved into an interest in international public health.1-4 Those studies may not have landed in the highest of impact journals in ophthalmology; however, she said, they looked at issues such as access to care and disparity in displaced populations, “and that is what is most special to me.”

Dr. Bal is pointed in crediting her mentors for introducing her to research, as well as for teaching her the nuances of how clinical trials are run. Early on she had to do the “grunt work” involved in research, but as she proved herself, opportunities became more readily accessible.

Tune into the episode for the full discussion between Drs. Bal and Singh, in which they discussed the role of the Institutional Review Board, the advent of big data and how consortium efforts like Intelligent Research in Sight (IRIS) can impact eye care, and the pros and cons of conducting research in private practice versus academic settings.

Studying RD Rates in Ocular Coloboma

At the suggestion of Dr. Binenbaum, and because she was interested in pediatric work at the time, Dr. Bal led a study to understand the risk of retinal detachment (RD) in children with ocular coloboma.5 Prophylactic retinopexy is often used in this setting to mitigate the risk of RD but comes at the expense of damaging retinal tissue. Underlying the study was the question of whether retinopexy was necessary for patients with ocular colobomas. For the study, a retrospective chart review was performed among patients with optic nerve (ONC) or chorioretinal coloboma (CNC); data were collected on 387 eyes of 258 children (ONC = 288 eyes; CNC = 236; both = 137). The median age was 2.1 years at the time of the first/only exam, and patients were 7.4 years old at the latest follow-up.

Somewhat surprisingly, the team found dramatically lower rates of acquired RD than expected: 0.52% per eye and 0.78% per patient compared to a range of 4% to 18% in previous studies.6-8 Based on their findings, the team suggested that screening exams are warranted, but the role of prophylactic retinopexy is uncertain. The difference may be that historical studies were largely single-center series, whereas the current study was broader in scope.

“Our dataset was multinational where we had more patients, a more diverse group of patients, so we’re probably seeing a more representative population of patients,” Dr. Bal explained. “I don’t know that it has completely changed practice patterns just yet. We need bigger data studies to really answer those questions about the role of prophylactic retinopexy. But it’s a good starting point where we can say the rate [of acquired RD] is lower than what we previously thought.”

1. Bal S, Marjane S, Gonzalez C, et al. Pterygium in rural Andean Ecuador: epidemiology, risk factors, and barriers to care. Pan Am J Ophthalmol. 2021;3(1):38. 

2. Bal S, Gonzalez C, Marjane S. Prevalence of cataracts and barriers to cataract-related Care in Ecuador. Pan Am J Ophthalmol. 2019;1(1):7.

3. Bal S, Duckles A, Buttenheim A. Visual health and visual healthcare access in refugees and displaced persons: a systematic review. J Immigr Minor Health. 2019;21(1):161-174.

4. Bal S. Vision-related quality of life and access to eye care among recently resettled Syrian refugees in Philadelphia. J Glob Health. 2018;2:e2018013.

5. Bal S, Mills M, Tomlinson L, et al. Risk of retinal detachment in children with ocular coloboma. Ophthalmology. 2022;129(1):117-118. 

6. Daufenbach DR, Ruttum MS, Pulido JS, Keech RV. Chorioretinal colobomas in a pediatric population. Ophthalmology. 1998;105(8):1455-8. 

7. Maumenee IH, Mitchell TN. Colobomatous malformations of the eye. Trans Am Ophthalmol Soc. 1990;88:123-132

8. Morrison DA, Fleck B. Prevalence of retinal detachments in children with chorioretinal colobomas. Ophthalmology. 1999;106(4):645-6.

Sila Bal, MD, MPH
  • Cornea Fellow, Massachusetts Eye and Ear, Boston
  • alislab24@gmail.com; Instagram @dr.eyebal
  • Financial disclosure: None