Prof. Dua discovered a new layer in the human cornea, the clear window in the front of the eye, in 2013, termed the Dua’s Layer (Also called the “pre-Descemet’s layer, as it lies above the Descemet’s membrane of the cornea). It has been endorsed by the American Association of Ophthalmic oncologists and pathologists and has appeared in several text-books and journal articles.
It has had a major impact on the understanding of corneal transplant surgery, making the procedures easier to perform and safer. It has also improved our understanding of diseases of the cornea, highlighting new mechanisms.
Based on this layer, three new surgical procedures have been developed. (a) Pre-Descemet’s endothelial keratoplasty (PDEK), (b) Combined deep anterior lamellar keratoplasty and cataract surgery (DALK-Triple), both innovated by Prof. Dua himself and (c) Treatment of ‘Acute hydrops in keratoconus’ by stitching the torn layer together, developed by a French group of researchers. Prof. Dua has also invented the PDEK clamp, an instrument designed to make the operation easier and consistently obtain the desired tissue for transplantation.
The Dua’s layer also has potential implications for the understanding of glaucoma (raised eye pressure with damage to the optic nerve), a blinding disease that affects millions of patients globally. Research on the impact of the layer in the maintenance of eye pressure and refinement of operations for control of glaucoma, especially one called deep sclerectomy, is ongoing.
This work was awarded the Times Higher Education Award as ‘Research project of the year’ in 2014, in competition against submissions from all UK universities across all fields of research.
In 2006 Prof. Dua developed the application of the operation called ‘Alcohol Delamination of the corneal epithelium’ in the management of recurrent corneal erosion syndrome. This is a very painful condition that affects people all over the world. The technique provides effective cure in over 85% of patients and has been validated by Australian researchers who, in a randomised controlled trial, demonstrated that it is a simpler and better option than the expensive alternative of Laser treatment. Prof. Dua has elaborated further diagnostic and therapeutic applications, and has been adopted worldwide. This work is now the recommended first technique for management of this very painful condition.
In 2001 Prof. Dua published a classification of chemical burns of the ocular surface (Dua’s Classification). This has been independently validated as a best prognostic classification and used as the standard classification in many centres across the world.
In 2000 Prof. Dua invented and developed a technique to close blood vessels that grow in to the cornea as part of many disease processes. These cause scarring, leak fatty material in to the cornea, reduce vision and increase the risk of rejection of corneal transplants. The technique called Fine Needle Diathermy occlusion of corneal vessels, is today regarded as a standard for occlusion of established and mature corneal vessels and is commonly practised.
New drugs have come along to treat new blood vessels but they only affect young active vessels. Administration of drops or injections of these drugs is now combined with FND to control established and young vessels.
In the 1980s Prof. Dua established the fundamental rules of corneal epithelial wound healing that determine the surgical approach to ocular surface reconstruction after severe chemical and thermal injury and diseases. On the basis of this he innovated two novel procedures called (a) Sequential Sector Conjunctival Epitheliectomy and (b) Amnion assisted conjunctival epithelial re-direction (ACER). His team developed the vacuum dried version of the amniotic membrane called Omnigen, for use in a variety of diseases. He holds a joint patent with Dr Andrew Hopkinson for this innovation. Prof. Dua discovered and established the limbal epithelial crypts as a specialised niche for limbal stem cells.
He and his team were also the first to demonstrate presence of antimicrobial peptides (AMPs) also called Human defence peptides (HDPs) at the human ocular surface. These are antibiotic like molecules and are being developed to treat a number of infections caused by bacteria and fungi. He has recently shown that HDPs enhance the efficacy of known antibiotics several fold. HDPs may hold the answer to treat resistant strains of microbes.
Clinical Research [the symbols , ♦ and ♠ relate to scientific papers in the full list of publications, corresponding to the respective themes]
This centres around restoring sight in eyes with severe scarring on the eye as a result of chemical burns, Stevens Johnson syndrome and chronic infections. This includes characterisation of corneal stem cells and stem cell transplants, use of amniotic membrane and different types of anti-rejection medication. A substantial part of this research is focused on Dry Eye Disease.
This is primarily focused on Dua’s layer and its surgical implications and applications. The research is refining the operation of pre-Descemet’s keratoplasty, Deep anterior lamellar keratoplasty and Glaucoma, to improve outcomes for patients.
The research is also exploring the role played by Dua’s layer in Keratoconus, Acute hydrops (where the corneal suddenly get totally waterlogged), Descemet’s membrane and Dua’s layer detachments and Descemetoceles and pre-descemetoceles where in the respective layers bulge out singly or in combination and lead to perforation of the eye.
The work concentrates on ascertaining the profile of microbes that cause sight threatening infections.
On the use of the technique of Alcohol delamination for other conditions for both treatment and diagnosis.
Treatment of corneal blood vessels and corneal erosions and non-healing epithelial defects.
Alcohol delamination of the corneal epithelium in the management of recurrent corneal erosion syndrome, and the technique or find needle diathermy for occlusion of corneal blood vessels are two examples of widely used innovations arising from this research.
Basic Research [the symbols ♥ and ♣, relate to scientific papers in the full list of publications, corresponding to the respective themes]
Starting in 1998 as the first group to demonstrate these molecules in the eye, the research has profiled the full range of HDPs in different infections, vial, bacterial, fungal and acanthamoeba, of the eye. Current work is focused on using part of these molecules to assemble a very potent molecule that will be effective against a range of microbes. This is also being studied in combination with known antibiotics, to some of which the bacteria have developed resistance.
This work has been ongoing for several years and has led to several new discoveries of corneal nerve architecture and function and the effect of diseases on the corneal nerves. This work has informed the ways in which treatments can be developed to treat nerve damage related eye conditions.
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For more information about treatments offered by Prof. Harminder Dua, consultant eye doctor in Nottingham, United Kingdom, visit our treatments page.
Prof. Dua’s team of researchers who have been part of the research effort and made valuable contributions are all named in the over 400 publications listed
“I am writing to add to what I am sure has been a tremendous response to your Duke Elder Lecture last week. I have rarely sat through a lecture without drifting off but yours was most definitely an exception” “…It was a wonderful combination of superb clinical acumen and brilliant scientific thought” “Thank you for an inspirational lecture”.
“I would like to thank you very much for your excellent talk to the Society on Wednesday. Many members remarked to me that this was perhaps the best MedChi meeting they had attended. Some of the compliments were from past presidents of the society who have been member for over 40 years.” “…to me personally, you are a star. I knew it would be the highlight of my year in office and you surpassed my expectations. I too am proud of your achievements and admire your skills of communication and respect your authority on your subject.”
“Prof., it’s been lovely and a privilege working with/for you. Thanks for making it so enjoyable and I shall miss your wit and sense of humour!”
“I want to thank you personally for your wonderful lecture. You need to know that you have succeeded in inspiring a whole generation of ophthalmologists. We are very proud of you.”
“I found guidance, friendship and love, everything in one person and that person is you. You have a special way of making the world a better place, just because you are you. Thank you for everything.”
“….the conference in Nottingham and I felt like your lecture was the highlight of my whole weekend there.”
“I have no words to express my gratefulness for all what you have done so far. Your patience kindness and commitment would always be remembered by me in life.”
“I am working with Yusuf Shaikh at Brighton…to convey to you how deep and intense the feelings of gratitude he has towards you. He just can’t stop praising you! Every single day he praises you at least a few times and I can see these coming from the depth of his heart!” I have always harboured similar feelings since the time I did clinical attachment with you when I came to UK for the first time. Working for you is a lifetime opportunity for anybody”
“Thank you once again for your huge effort over here. The feedback I have received from my colleagues is fabulous. More than one has said its some of the best lectures they have ever heard.”
“Your lectures and the Dua course were highly appreciated by the delegates. Several young residents and fellows were immensely inspired by your work and your attitude.”
“…to hear you speak is always a delight, and the feedback from the juniors and the consultants that that our talks were the best they had ever heard. Mr Yang, who is one of our VR consultants, said to me that he wished he had heard you career in ophthalmology talk when he was a trainee as he felt it was a real inspirational talk. It might have changed his career direction!”
“Thank you so much for coming to lecture at the RSM on Thursday evening. Your presentation was a very helpful guide to the procedures required in the management of the Ocular Surface. The audience enjoyed the videos, and it will give them the confidence to try and perform some of the procedures themselves.”
“Your address was a highlight of the Conference and I know from the many comments that I received, that it was a delight to hear by the delegates. That a President of the Royal College as busy as you took the time and trouble to attend and speak at our Conference alone was very much appreciated but to speak in such a collaborative way was music to our ears and I cannot begin to tell you how much it changed perceptions of many long standing members of our sector. There is absolutely no doubt that our sectors working together is in the best interests of patients and the future of a cash strapped NHS and your presentation very much enhanced that message.”
“Thanks for sharing your inspirational journey at BAPIO meeting. I would be very grateful if you could give your wonderful quotes and 14 point advice slide to spread the inspiration to my junior doctors and medical students in Cardiff. I was so involved in your talk that I could not write up. As an Indian I am very proud of you.”
“I am writing to express my gratitude and appreciation for taking the trouble to come all the way to Cardiff and giving a fantastic and inspiring talk to the audience. Everyone without exception felt motivated and think you as their role model. I personally found it humbling and it is unimaginable that someone could achieve so much. You are truly a leader not only for the Indian community but for the whole medical fraternity.”
“I would like to thank you again for the contribution that you made to the Ophthalmic Trauma Symposium at the Oxford Congress this year. The feedback regarding the symposium was excellent and your talk received particular comment – very clear for a very useful topic.”
“I am writing to thank you for the superb organisation of a very successful meeting. I much enjoyed each aspect of the event, both scientifically and socially. Liverpool is a great venue (not in the least because I am married to a Mancunian...). Your presidential influence is recognized and acknowledged throughout. Your notoriously sharp and short speeches will remain imprinted in my memory. Many thanks, and hopefully we will meet again somewhere else in the orbit.”
“On another note and a very happy one - thanks so much for what was one of the finest lectures I have heard in ages, last Monday morning at the Optometry conference. A complete revelation and so clear for all to see. Huge congratulations on the discovery and I hope it leads to many more insights into cornea function. It was privilege to be there.”
“The conference was very inspiring, particularly Prof. Dua's lecture. It has given me a renewed enthusiasm for research.”
“Thank you very much for your excellent lecture 'Deep anterior lamellar keratoplasty: Tips and Trips through Clips' at the Cornea & Cataract Day Symposium in Liverpool last week. Your presentation was much appreciated by the audience for its content and style and feedback was very positive and I personally found it very informative. I appreciate the time and effort it takes to put together such presentations. Thank you so much for your valued contribution to the meeting. I hope you will be able to support the Society in future events.”
“It was really an honour to meet you in person and to have been able to talk with you. Thank you so much for being humble and willing to share. Your humility and wisdom are what I admire most and is what I would like to continue to learn from you. Kindly be my mentor. I would like to express my thanks and appreciation for the wonderful presentations and wise speech you delivered during this Conference.”
For more information about treatments offered by Prof. Harminder Dua, consultant eye doctor in Nottingham, United Kingdom, please get in touch.