Sven-Erik Bursell, Ph.D.
Dr. Bursell is an Investigator in the Section on Eye Research and the Director of the Joslin Vision Network, as well as Associate Professor of Ophthalmology at Harvard Medical School. After receiving his doctoral degree in Biophysics from Boston University, he began biomedical and biophysical research at Joslin Diabetes Center, focusing on diabetic complications in the eye. Dr. Bursell studies molecular and biochemical events and mechanisms leading to the development of pathological changes and subsequent vision impairment. He has also developed diagnostic and therapeutic instrumentation for assessing ocular physiology. Dr. Bursell is a reviewer for a number of prestigious journals in ophthalmology and diabetes and has been a scientific reviewer for National Eye Institute study sections of the National Institutes of Health. He pioneered the development of the Joslin Vision Network eye care program and the Joslin Vision Network Comprehensive Diabetes Management program.
Diabetic retinopathy (a disorder of the retina that can lead to vision loss and/or blindness) will at some point affect everyone with diabetes. However, 50 percent of people with diabetes do not receive appropriate eye care in time to prevent vision problems or preserve vision. Dr. Bursell is combating diabetic eye disease on two fronts: early detection and accessibility to treatment.
The retina is the neurosensory “brain” of the eye and becomes compromised with insufficient blood flow. Dr. Bursell and his colleagues pioneered physiological diagnostic tests and were the first to show that blood flow to the retina is reduced in patients with poorly controlled early-stage diabetes—even before they have developed eye disease.
In collaboration with George L. King, M.D., and Lloyd P. Aiello, M.D., Ph.D., Dr. Bursell also found that this reduced blood flow follows activation of protein kinase C-beta (PKC-beta). During the past decade, Drs. Bursell, King and Aiello developed and tested several novel therapies—including a PKC-beta inhibitor that may halt damaging proliferation of blood vessels in the retinas of people with diabetes. The results from these trials have demonstrated the efficacy of the PKC-beta inhibitor for reducing the risk of moderate vision loss, and have supported an application to the Food and Drug Administration, which has deemed the drug “Approvable” pending additional study data.
Drawing on his background in theoretical physics, biophysics and bioengineering, Dr. Bursell was instrumental in developing noninvasive systems for measuring retinal blood flow, useful not only for early diagnosis but also for rapid evaluation of the effectiveness of therapeutic agents. Working with Lloyd M. Aiello, M.D., Dr. Bursell developed the Joslin Vision Network (JVN), which uses Joslin’s advanced diagnostic technology to evaluate patients for diabetic eye disease in ambulatory and primary care settings at more than 60 sites around the United States. The tests take about 10 minutes, do not require dilation of the pupil and can be administered by non-physicians. The images are then transmitted through a telemedicine network to Joslin specialists, who analyze them, prescribe treatments or referrals as necessary and transmit the information back to the site--in the case of emergent conditions, before the patient leaves. Additionally, as part of the JVN TeleHealth Program, the integration of eye care into our diabetes management platform allows a robust clinical coordination for appropriate eye care that takes into account all available medically related information about the patient.
Studies have shown that these examinations through the nondilated pupil have diagnostic accuracy comparable to a dilated exam and at a much lower cost. To date, some 40,000 patients have been evaluated in sites that include Native American Health Services and Veterans Administration clinics. Dr. Bursell predicts that in the next decade, Joslin will be able to offer not only diagnosis in remote locations, but also corrective treatment with robotic lasers operated through remote-control telemedicine networks using surgical simulation technologies.
The JVN increases access to appropriate eye care, reduces patient costs and, through the use of participating Centers of Excellence, provides patients with the best eye care regardless of geographic or cultural barriers.
Selected References
Aiello LP, Clermont A, Arora V, Davis MD, Sheetz MJ, Bursell SE. Inhibition of PKC beta by oral administration of ruboxistaurin is well tolerated and ameliorates diabetes-induced retinal hemodynamic abnormalities in patients. Invest Ophthalmol Vis Sci 47:86-92, 2006.
Whited JD, Datta SK, Aiello LM, Aiello LP, Cavallerano JD, Conlin PR, Horton MB, Vigersky RA, Poropatich RK, Challa P, Darkins AW, Bursell SE. A modeled economic analysis of a digital tele-ophthalmology system as used by three federal health care agencies for detecting proliferative diabetic retinopathy. Telemed J E Health 11:641-651, 2005.
Abiko T, Abiko A, Clermont AC, Shoelson B, Horio N, Takahashi J, Miyamoto K, Adamis AP, King GL, Bursell SE. Characterization of retinal leukostasis and hemodynamics in insulin resistance and diabetes: role of oxidants and protein kinase-C activation. Diabetes 52:829-837, 2003.
Bursell SE, Cavallerano JD, Cavallerano AA, Clermont AC, Birkmire-Peters D, Aiello LP, Aiello LM; Joslin Vision Network Research Team. Stereo nonmydriatic digital-video color retinal imaging compared to Early Treatment Diabetic Retinopathy Study seven standard field 35-mm stereo color photos for determining level of diabetic retinopathy. Ophthalmology 108:572-585, 2001.
Ishii H, Jirousek MR, Koya D, Takagi C, Xia P, Clermont AC, Bursell SE, Kern TS, Ballas M, Heath WF, Stramm LE, Feener EP, King GL. Amelioration of vascular dysfunctions in diabetic rats by an oral PKC ß inhibitor. Science 272:728-731, 1996.
