Dr. Terry Smith and Dr. Raymond Douglas, specialists in Graves’ eye disease, are Kellogg’s newest faculty members.
New faculty join Kellogg colleagues in planning a unique research and treatment center Graves’ eye disease, also called thyroid-associated ophthalmopathy, remains poorly understood, according to the two newest faculty members at the U-M Kellogg Eye Center. They are shedding new light on the disorder through their research and an initiative to standardize the evaluation of treatment. These advances should one day help patients, chiefly women, who experience its painful manifestations — bulging eyes, double vision, and, in severe cases, vision loss. Even before settling into their new laboratory, Terry J. Smith, M.D., and Raymond S. Douglas, M.D., Ph.D., are discussing several promising therapeutic agents that may soon be ready for clinical trials. And they are keen to join forces with other U-M specialists in developing a major research and treatment program for Graves’ eye disease and other autoimmune conditions. Dr. Smith, the Frederick G.L. Huetwell Professor of Ophthalmology and Visual Sciences, is a renowned endocrinologist who has studied Graves’ disease, its 4
university of michigan kellogg eye center
eye manifestations, and related autoimmune diseases for over 20 years. His laboratory was first to describe the unique molecular attributes of tissue surrounding the eye that make it susceptible to inflammation in Graves’ disease. The discovery came as he questioned why a systemic disease associated with thyroid overactivity would single out the orbit as a site of involvement. From these findings, Dr. Smith went on to identify a receptor that binds to antibodies and sets off a series of events resulting in inflammation and fibrosis — excessive scar-like tissue that pushes the eye outward and disrupts its function. Currently, he is mapping a signaling pathway where “cross talk” between cells and small molecules may provide a therapeutic target that allows interruption of the immune system’s assault on orbital tissue. As he notes these successes, Dr. Smith observes that the biggest impediment in understanding Graves’ disease is lack of access to tissue early in the process. “It is generally later, when surgery is indicated, that we can access and analyze the tissue. But by then we may be looking at secondary reactions that are entirely different from those initiating the pathology,” he says. “It’s like looking at a scar that has formed over a wound. The scar is the reaction to the injury, not the cause of it.”