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Emily Gower Seeks to Prevent Blindness from the US to Ethiopia and Tanzania

May 17, 2018
Institute for Global Health and Infectious Diseases

Emily Gower is an associate professor in epidemiology and ophthalmology at the University of North Carolina at Chapel Hill. Her international research focus involves improving trichiasis surgery outcomes for people with trachoma, the leading infectious cause of blindness worldwide. In the United States, she researches diabetic retinopathy, which also causes blindness but is 99 percent preventable.

Q. What attracted you to the ocular epidemiology field?

A. During graduate school, I received a pre-doctoral training grant from the National Eye Institute. I took a course about the epidemiology of eye disease. Each day was about a different eye disease, such as glaucoma and cataract. I found the day about trachoma really interesting. We had to develop a study for our final project, and I chose trachoma. The lead instructor approached me after I turned in my project and said she may have some funding for my dissertation based on my idea, and here we are many years later!

Q. What is trachoma?

A. Trachoma is not common in the United States. I work mostly in Ethiopia and Tanzania. Trachoma is a bacterial infection of the eye. In areas where trachoma is a problem, children can be repeatedly infected. Repeated infection causes scarring of the eyelid. This scarring eventually leads to the eyelid turning in, causing the eyelashes to rub against the eye in a condition called trichiasis. The lashes cause abrasions on the eye, which ultimately lead to the cornea becoming opaque. It is the leading infectious cause of blindness worldwide.

Q. Explain your research into trachoma and trichiasis.

A. My research investigates ways to improve surgical outcomes for trichiasis. One problem trachoma-endemic countries face is a lack of ophthalmologists. When I started working on trachoma, Tanzania only had eight ophthalmologists in the entire country. The trachoma community developed a surgical training program for lower-skilled workers. These are people with a high school diploma and one year of nursing school. Traditional trichiasis surgery training typically includes a weeklong class followed by a few weeks of surgical practice. When I started working on trichiasis, surgical outcomes were typically poor, with up to 40-50 percent of people needing repeat surgery due to poor outcomes. So, the bulk of my research has focused on trying to make those outcomes better.

My team developed and tested a surgical simulator to bridge the gap between classroom training and surgical practice. The simulator is now standard practice in most-trachoma endemic countries. My team is also looking at other ways to improve surgical outcomes by modifying the procedure and increasing the frequency and quality of supervision.

Q. Describe your domestic research.

A. My research in the United States focuses on diabetic retinopathy and other common ocular conditions. Diabetic retinopathy occurs when blood vessels in the back of the eye become weak and leak. This causes swelling of the retina, and eventually, blindness.

But 99 percent of blindness from diabetic retinopathy is preventable and that is why education is so important. A focus group we conducted of people living with diabetes and found that many did not understand the retina’s role in their eyesight and that diabetes can impact the retina. Someone with diabetic retinopathy can have no symptoms or mild vision problems, so they do not realize that something really serious is going on.

Educating them about the importance of maintaining their blood sugar levels and having regular eye screenings can help prevent diabetic retinopathy. My research focuses on how to get people living with diabetes into treatment. Less than 50 percent go for regular eye screenings. We are currently exploring putting cameras in pharmacies where patients go to fill their diabetes medication prescriptions. If they get their eyes screened there, they can then get help accessing eye care.

Q. What do you enjoy the most about your job?

 A. I am an oddity in the Department of Epidemiology as there are not many ocular epidemiologists. And I have a global health side to my research, too. I have to say going to Africa and seeing the patients who have benefited from the trichiasis surgery is the most rewarding part of my job. One day, you can see 50 people waiting for surgery who are in pain. Then two weeks later, you visit with them and they are happy and their quality of life has greatly improved.

Q. What other research questions would you like to answer?

A. Ninety percent of trichiasis affects the upper eyelid. But in 10 percent of cases, the bottom lid is also affected. Current approaches to treating lower eyelid disease are ineffective. I am working to obtain funding to test a new surgical procedure with colleagues at Johns Hopkins to address this. Our initial findings are quite promising!

We are also exploring ways for eye surgeons in these resource-limited settings to maintain their surgical skills between patients, and as the number of trichiasis patients is reduced. We are interested in testing whether our surgical simulator can help to maintain skills in areas where there are fewer patients, so they are ready to operate when a patient arrives.

Q. What do you like to do when you are not working?

A. I have 10-year-old twins who keep me busy and who are actively involved in my work. I have brought them with me before to Africa, and really enjoy traveling with them and my husband. I also enjoy cooking, painting and outdoor activities.

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