Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
A New Age of Veterinary Ophthalmology
What are the hidden potentials and challenges in veterinary ophthalmology? Join us as we sit down with Michala Henriksen to discuss inflammatory ocular diseases. Michala's research, featured in the December JAVMA ophthalmology supplemental issue, brings to light the promising safety profile of CBD, while also raising important questions about its efficacy and unexpected ties to elevated liver enzymes. We also navigate through the harrowing 2020 Colorado wildfires with Michala, understanding their severe impact on canine eye health, particularly the rise in corneal ulcerations.
But the journey doesn’t stop with canines. Michala shares her personal and professional evolution from veterinary school in Copenhagen to groundbreaking research in equine fibrin. Her passion for inflammation and ophthalmology unfolds through her experiences with fungal keratitis in horses, leading to innovative treatments like platelet-rich fibrin. We also uncover the surprising link between TPA injections and increased glaucoma risk. Wrapping up, we venture into the world of artificial intelligence in veterinary medicine, exploring its potential and challenges in advancing research and education, all while reflecting on the collaborative efforts at the University of Copenhagen and the University of Florida that have helped shape Michala’s remarkable career.
A New Age of Veterinary Ophthalmology JAVMA supplemental issue: Journal of the American Veterinary Medical Association Volume 262 Issue S2: A New Age of Veterinary Ophthalmology (2024)
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You're listening to Veterinary Vertex, a podcast of the AVMA Journals. In this episode we chat about the December JAVMA ophthalmology supplemental issue A New Age of Veterinary Ophthalmology with our guest Michaela Henriksen.
Speaker 2:Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have Michaela joining us. Michaela, thank you so much for taking time out of this busy holiday schedule to be with us here today.
Speaker 3:Yeah, thank you. Thanks for having me. This is very exciting.
Speaker 1:All right, let's dive right in and learn all about ophthalmology. So, michaela, you author several articles in the java supplemental issue a new age of veterinary ophthalmology. Please share with our listeners the background for your articles yes, they're.
Speaker 3:You could say a little bit different, uh, but the overall is actually from my three papers uh, inflammation. So, um, the first one, which is the one that I'm first author on, that one is about CBD treatment of dogs. It's just a review. So cannabidiol and I'm at North Carolina State University now, but I've been before. I came here in 2023.
Speaker 3:I was six years at Colorado State University and that's where I did a lot of CBD research in docs, just because it's a good place to do CBD research in Colorado, and so I felt that it was a good time to like have a review, because when you go down to the local pits store, pit smart, petco, wherever there are so many CBD products out there and me, as an ophthalmologist, my concern is just is it safe? So, first thing, is it safe to use? And then next thing is does it actually do anything to the eyes? Again, I'm an ophthalmologist, so our first study at CSU was that we looked into is it safe. So we actually kind of piggybacked on a bigger study that was run by Dr McGrath there and we looked like this dogs were on CBD, two different doses, and then we had a control and we did that for 36 weeks, so a very long time, and what we found was that they actually don't. They did not have any effect on their intraocular pressures or their tear production. So that's good, because there are some who says that potentially, cbd could cause dry out. And then there are some older studies saying that CBD potentially could cause elevated intraocular pressure, where we know that THC, which is toxic for dogs and we don't want to give that to dogs, but that that can be used for glaucoma. So basically, the first study that I just told you about that one showed that it's safe to use but it doesn't really do anything. We did find that we found CBD in tears for these dogs.
Speaker 3:So that was a start. So that's where I'm like I think it's good to have a review about, like, what is it for diseases that we think potentially CBD can be used for? But I will say I still are waiting to find the disease in dogs where I'm like this is where you can use CBD. But it's not a long review, so I actually feel like it came out really well and it gives a really good idea about, like what the thought process behind using CBD for eye diseases, both in humans and then also on animals.
Speaker 2:Yeah, I really liked in your article how you put about you know the why. Why might you consider this? You know a lot of people wouldn't think of ocular inflammation and I'm curious on your take. You know a lot of people that are truly in drug approval, like at the FDA level, would say there's no safety without efficacy. Right, nothing can be safe unless it's efficacious. I mean, of course, our mantras do no harm, but there is harm in the wallet of the owner of the administering the CBD. You have to go and buy it. So all these things I'm curious in your personal take on that, your professional take.
Speaker 3:Well, no, it's true. And also what we did find, and what I've seen in some of my other studies and other people have found, is that CBD will elevate some of your liver enzymes. So even though it doesn't do any harm to the eyes, it still does something, and I think they're like the internal medicine and so on are like looking at, well, that elevation. Is that to be concerned about or not?
Speaker 3:Me, as an ophthalmologist, I do get concerned every time something is not normal, um. So I did a study, um that I'm in process of getting written up and published, where we also did CBD for cataract surgery docs, just because, again, there are so many owners who's like, hey, I want to give this and this and this and I do the same. I have two docs and I also have them in all kind of supplements. But that's where, as you said, like, is it necessary and is it actually safe enough to use? And that's where we just still need to do so much more research with CBD before we can say for sure that maybe it doesn't do any harm, but maybe for the eyes, but maybe there's other areas that's not so good for.
Speaker 1:Well, we look forward to hopefully receiving your future manuscripts.
Speaker 3:Thanks. So that was one of the papers. Another one which is a really sad topic, but also something that I feel is really relevant, is about wildfires and how that affects eyes in dogs, and that came from that. I was in Colorado in 2020, when we had a really really bad fire, actually right next to Fort Collins, and we saw that there were so many dogs coming in with corneal serrations that was very infected with, like weird infectious agents, and Colorado we didn't actually see that much corneal like. We saw corneal ulcerations, but definitely not Like. Now.
Speaker 3:I'm back at North Carolina in the Southeast, where it's like really hot and humid. So we see fungal keratitis and also horrible bacterial keratitis in all our animals, which we just didn't see as much in Colorado. But in that time of that wildfire we had a lot of infectious diseases or we just felt that we saw more. So I had a really good student vet student at CSU who wanted to do some ophthalmology at that time. So she actually wrote up, as a summer scholarship student, a retrospective study where we could show that we actually did see more infectious ulcerative keratitis in that period compared to two previous years where we did not have wildfires. So the same student, dr Katie Jones, which is now our first year resident here at NC State, we did a study where we set up a prospective. So we kind of waited for wildfires, which is really horrible and we didn't really wanted it, but we need an iCook to do this kind of study.
Speaker 3:So 2022 was supposed to be a big wildfire season because it was really dry, but we actually didn't get it. So we waited until the year later 2023, we had some smoke coming down from from Canada. So what we did was that we just looked at normal dogs. So it was actually all her friends, vet students, dogs plus some of ours my two was included where we just looked at them when the air quality index was good, when it was moderate, which like normal when you follow air quality index on your phone you can actually do that. It kind of goes between good and moderate, like it's not really have anything to do with wildfire, but as soon as we get all that smoke in, it goes up to unhealthy and like bad.
Speaker 3:So what we did was we did an eye exam, we did Schumer's tear test, intraocular pressure not because we really think wildfires have anything to do with pressures and then tear film breakup time we took culture from these dogs and then we just looked at them to see do they have signs of conjunctivitis, which is chemosis and hyperemia, and then we had, for good, moderate and severe air quality index. And then we actually also teamed up when we came here to North Carolina with one from a science department who looked into air quality actually who looked into air quality actually? So also with PM2.5, which is particle matters, so it's like tiny small particles under 2.5 micrometer, which we see a lot in wildfires, and then ozones and other really toxic substances in the air when you have wildfire. And then we kind of like just kind of look to see if there are any correlations.
Speaker 3:So what we did find was that when you do have that wildfire going on and you have an elevated air quality index, especially with elevation of PM 2.5, the particle matter, then your dogs have a higher risk of getting chemosis and hyperemia, which is a science of conjunctivitis. So I mean it's not rocket science, because it's kind of what we think that when we have wildfires we all have really itchy eyes and runny eyes. But now we know and now we can also tell owners to be careful. And if you live in an area that has wildfire smoke coming over, then just maybe keep your dogs inside so they're not so exposed. Maybe flush their eyes with eye wash and just be careful, because if they rub their eyes they get ulcers and then we know that they could potentially get those infected ulcers with bad bacteria.
Speaker 1:Know that they could potentially get those infected ulcers with bad bacteria. Yeah, it's super cool. I lived in Vancouver, british Columbia, for a little bit and the wildfires they're so bad in my eyes they would get dry and never thought about how affected pets though.
Speaker 3:Yeah, it's horrible. I mean that 2020 wildfire season in Colorado really taught me that it's horrible. So definitely a very interesting research area, but also really sad. And then the last one. So the last paper is one where I'm just a co-author. It's actually dr brian gilger, who is a primary investigator, but he had one of our interns at nc state writing this retrospective study up and that's in horses, um, and it's about fibrin and hyphema, so kind of like fibrin and blood inside of the eye and then just to see what's the outcome and so on. So there's a lot of horses in this study more than 200. And it's really cool. I think they got a really good product out of it.
Speaker 3:And basically the take-home message is that if you do have a horse that has fibrin, first of all, if it's so severe, then often they will be nucleated, unfortunately. But if they do not get nucleated by the first visit, then they have a good prognosis to get over it. But it is best to actually do TPA injections. So it's not a bad idea if you're a referral and to like actually send them into someone ophthalmologist or someone who can do that TPA injection. So TPA is tissue plus minogen activator that can go in and break down the fibrin. Just because fibrin does um like if it sits too long, we can get post-euthynia cataracts and other complications that can lead to blindness. Um, whereas if it's hyphema, so blot um, we don't need tpa often, um, especially not if it's actively bleeding, because then you'll just cause even more bleeding.
Speaker 2:Yeah, that's pretty impressive to have three manuscripts in one supplement. So congratulations again on just thinking of all the different projects that you can do with naturally occurring diseases.
Speaker 3:Yeah, it is, but thank you, but yeah, so that's where it's like they're very different, but also I mean the big, big picture is inflammation. So yeah, so that's where it's like they're very different, but also I mean the big picture is inflammation. So yeah, it was fun, Good projects.
Speaker 2:You're clearly curious within the field of ophthalmology and probably in life in general, and what specifically sparked your research interest in inflammation and ophthalmology?
Speaker 3:Well, so ophthalmology. I had a horse when I was a vet student. So I'm from Denmark, so I did my vet school at University of Copenhagen and my own horse got a fungal keratitis when I was a vet student and she was not an easy mare to treat at all. We were like two vet students trying to pull her head down to get the ointment in her eye and that did not work really well. I had a really good study partner who where I had my horse with and he really tried to and there were no way we could do this. So eventually we sent her into the vet school and she had a sub-health people of our system, the SBL system, placed, which this is like 20 years ago, so it was not the most common thing to do, so that was a big deal. And then she also needed a lot of medication and again she was not easy to treat. So the professor in equine surgery, pia Halper, at that time she was like, can you just treat her during the night? So we know that she's getting her treatment in. So I did a lot of treatment on her and with that I also read a lot about fungal keratitis and that was at that time Dennis Brooks at University of Florida and then Brian Gilger here at NC State. Dennis Brooks at University of Florida and then Brian Gilger here at NC State that had written all that or a lot of that. So that was kind of how I got hooked. So I did my residency in Florida because I contacted Dennis Brooks afterward and could see if I could come down and see some horses and, yeah, the rest is history. The rest is history. Yes, so that's from there.
Speaker 3:And then the inflammation is also. University of Copenhagen. The equine group is doing a lot of inflammation research. Saa was a big thing when I was there. So I think I'm just like very naturally got hooked on to like inflammatory diseases and inflammation in general and that's kind of where so now. So then when I was at CSU, it's like alternative medicine and how to decrease inflammation. I thought that was very interesting with the CBD and then here at NC State, just because CBD research is a little difficult when you're in North Carolina compared to Colorado. So I'm kind of like more shifting it over to regenerative medicine, where I'm doing research now with PRF, platelet-rich fibrin and what we can do with that. So that's very, very exciting and Dr Gilliger is very supportive of that, so it's a great team to be involved with.
Speaker 2:Yeah, NC State has a great orthobiologics team as well, so lots of good people to work with. Yes, you talked to Sarah a little bit earlier about maybe the biggest take-home messages, especially of the two articles looking at air quality, but always when we do novel studies we find something that surprises us. What when you wrote those other two? Maybe not so much the CBD, because it's a review, although you can still be surprised and learn something what things did Michaela learn? Like wow, I didn't expect that in writing these manuscripts.
Speaker 3:So the fibrin, the equine fibrin study, it was interesting because actually the horses that had a TPA injection, they also had a higher risk of getting glaucoma. So we were really talking a lot about like, why is that? And it's probably because those eyes also, I would think, is the one that's most damaged, so there's probably just more inflammation and then you just have a higher risk of getting glaucoma. Or potentially, when you start breaking down the fibrin, could it go into the iriticonial angle, stop it for a little bit and then you get the glaucoma. But that was just like I mean, it's always interesting when you do studies that you find something and you're like, oh, I did not think about that.
Speaker 3:The wildfire, one thing I did not mention that we did not show a significant correlation between, like, high air quality index and then also a tear film break break up time, which it almost and I think we may be, if we had more docs I think actually we would be able to find that, but you know we couldn't show it, so I can't say that that's there.
Speaker 3:But tear film break up time is when you start having poor quality of your tears, so it's not like, even though you produce tears, it just flushes out. So that's why your breakup time gets changed, and we did see that it was going in the trend direction of that. It's just that the trend is not really something you're allowed to say in papers anymore, so so that irritated me a little bit, because it does make I mean, it would make the story even better, right, because I do feel like, um, wildfire smoke goes in and interfere with your uh tear film and you just get like, as we just said, like you get really runny, itchy eyes, um, so yeah, but that we could not find a correlation there.
Speaker 3:Only a trend.
Speaker 2:You said a little bit earlier that you're really interested in platelet-rich fiber and then inflammation. How do those come together in your future steps in research?
Speaker 3:oh, uh, thanks for that question. Well, so prf is where you can spin down blot in a specific method with a blot tube that has no additive. So it's the second generation after prp, which a lot of people probably have heard about. Prp, platelet-rich plasma, um, so the fibrin PRF is just more pure and it's easier to make actually, and you get this fibrin clot or a solution, liquid PRF that after some like 10-15 minutes will turn into fibrin. So then what we've been using it on is corneal ulcerations in horses, and what's nice with it is that it has a lot of growth factors and cytokines inflammatory cytokines so it's meant to go in and increase healing, like tissue healing. So dentist is using it a lot, and then also it's actually being used a lot in human medicine or in facial aesthetics.
Speaker 3:So I think a lot of people have heard about like microneedling with PRP, like, and now they're starting to use PRF instead. So just those growth factors and cytokines that's meant to go in and increase wound healing or inflammatory tissue, and that's where it's like really interesting to try to use that on our corneal serrations. So I have, like I'm involved with a master program at University of Copenhagen and we had two master students who wrote up a paper about it in docs where they use PRF and they it's a case series and they had really good outcome. So now we're just starting to use that on horses too. I mean, the big dream is to find a product that will go in and increase corneal ulceration healing in horses and then cause like mescalization and epithelialization so we can just get them to heal so much faster. That would be my big dream, sure.
Speaker 2:You'll get there. Sure, ai, artificial intelligence and LLM and those sorts of things are everywhere. Do you see a role for it in ophthalmology?
Speaker 3:I was just telling you guys before we started that this is my first podcast.
Speaker 3:I am so old fashioned, so artificial intelligence, it scares me a little bit, but I mean I think we need to be open for it and I do think that it will come.
Speaker 3:Right now what I can use it for is probably I don't know, I like to use my own brain and kind of come up with my own ideas. But then what I feel I'm using it for is like if I'm like putting in like a question, googling, and then I've seen that now it comes up as an answer from artificial intelligence where they go in and like pick uh, different papers, so somehow it's like I mean that's cool, I like that, um, but I still think that we need to be careful not just to let it run our life and kind of like I know a lot of people is like hey, you can diagnose where I'm like, but you need to be able to diagnose it yourself. So I think that's where the teacher in me as a faculty, in a university, that I'm like I don't want the student just to start using artificial intelligence to come up with the answer. I do want them to like know the basic two.
Speaker 1:Yeah, I think that's a great answer and for our listeners. We do have actually a artificial intelligence supplement coming out in AJBR this spring, so definitely stay tuned if you're looking for practical applications of AI in veterinary medicine.
Speaker 3:That's really cool.
Speaker 1:I will look forward to read that.
Speaker 3:Awesome, great. We'll send you the link when it's live. Something I do like with it is that I feel like sometimes I can make really cool figures for my papers. So I do like that. I mean it's a good tool. I just don't want it to take over completely exactly.
Speaker 1:You definitely still need people to do certain things. Yeah, and for those of you just joining us, we're discussing the javma ophthalmology supplemental issue with our guest michela hendrickson. So, michela, we were discussing your advanced training and how you did your residency at university of florida and veterinary school at university of copenhagen. How did this training prepare you to write these articles?
Speaker 3:so I also also I did my PhD as a combination, so it's from University of Copenhagen, but some of it was done at University of Florida too, and I think, like I don't know, I really liked my PhD from University of Copenhagen.
Speaker 3:I know a lot of PhD students are like pulling their hair hair out when they're doing a PhD, but I really enjoyed it and I think they just prepared me for doing all this studies with not too much money and I feel like that's where that has benefited me, because it's like bonding. Finding money to do studies is really hard and it's like I don't think everyone knows that when they're reading, like a supplement like this, that there's a lot of going on in the background to actually get started on this studies and the whole thing about getting, unfortunately, funded research is hard. It research is hard. So that's where it's like I feel like my PhD prepared me to do a lot of good ground basic studies but with not as much money. So, yeah, and then like my interest for inflammation, as we already talked about, from University of Copenhagen, so, yeah, that's probably what I would say my background.
Speaker 1:Very practical skill to have and honestly, I don't think anyone's actually said that before is their answer too.
Speaker 3:So no, yeah, no, I think I mean it's always fun when we were like doing a journal club with the residents and it's like you're going through all this papers and they're like, why didn't they do this and this and this, this? And I'm like, do you know how much that would cost? And like, yes, we do need to do it correct. Um, but we also just need to like I mean, otherwise we will not be able to do all this research. So, yeah, so it's wonderful when people wants to support our research, for sure.
Speaker 2:When I was running my laboratory, it was always something to say too, to say you know, each of you think how much you're paid per hour per year or whatever it is, and add 65% on top of that, and that's how much money I need to raise. It adds up super fast.
Speaker 3:It really does. I mean, it's insane, so yeah, so it's important to have good sponsors and people who wants to support. So that's also where it's like it's really important what you guys are doing to get our new information out.
Speaker 1:Definitely, and we believe in fostering the next generation of researchers and editors too. So we actually have journal awards that do include like discounted, like open access fees and things like that to help our early career researchers get more out there.
Speaker 3:Yeah, and I think that's really important to like the our junior researchers.
Speaker 3:Like what I said with Katie Jones, that was my.
Speaker 3:I got involved with her at CSU when she was second year vet student and then we've just done we actually done quite a bit of research together and I feel like it's just important to kind of show the young investigators that research is fun and but you also need to show that you can actually go all the way right.
Speaker 3:So you need to like do the study, apply for a grant and then write your study up and or perform the study and intern with me to the European College of Ender Medicine or Ophthalmology in Europe last year and I mean that's just a great experience for them to go to ECVO. It's great to go to the American conferences too, but it's like they need to see how much fun it is to do research, because it's also really hard and there's a lot of like rejections and so on, so and then you need to read, like rewrite your paper and so, so there's a lot of hard work to it. So I also just feel like it's important to show them the good side so we actually get people into academia to do research too. So that's one of my hit P2 that I just want to show the young investigators that it is a lot of fun and it's rewarding.
Speaker 1:So this next set of questions is going to be really important for our listeners and, as we discussed, you contributed three articles to the supplemental issue, so maybe we can focus on inflammation, which seems to be the underlying theme for all of them. So what's one piece of information the veterinarian should know about your articles in the JAVMA ophthalmology supplemental issue?
Speaker 3:So take one each. That's what you want, if you can do one overall.
Speaker 1:To summarize all the information like what should people know? What should?
Speaker 3:people know Well that, be aware of inflammation, and there can be inflammation in so many different ways and we just need to make sure we're diagnosing it correct so we can actually do the correct treatment of it.
Speaker 1:Excellent. And then, on the other side of the relationship, what's one thing clients should know about? Your articles in the JAPMA Ophthalmology Supplemental Issue Again thinking about inflammation, umbrella.
Speaker 3:The inflammation umbrella.
Speaker 3:Well, that's a hard one because I actually wanted to like each one. That's a hard one because I actually wanted to like each one, but just be aware, it kind of goes to the CBD. But I just don't want people just to like use artificial intelligence or Googling and think that that's the final answer. I do think that it's important to go to the vet because just because they see that, oh, he has a red eye and that's probably because of wildfire, there could be something else underlying that red eye. So inflammation has a lot of faces and artificial intelligence is not enough to like diagnose that. So I do want them to sometimes go to the vet too.
Speaker 2:Well summarized and don't go just to Dr Google.
Speaker 3:Exactly.
Speaker 2:Mikkel, it's been really great to have you and again, thank you for these wonderful contributions. As we wind down a little bit, we like to ask a really fun question, and our question for you is what is your favorite animal fact?
Speaker 3:And our question for you is what is your favorite animal fact? So doing COVID? I wrote a paper about octopus and ophthalmology and I learned some really fun facts that I didn't know that the octopus actually have a hole in their cornea like as a normal thing, so the seawater actually can run right through into the anterior chamber, which I find, as an ophthalmologist, very fascinating, because that seems to be not the best thing. I mean, there's probably something to do with pressure that they're going up and down, but it's also just if they're in water that has bacteria or something, then it just runs right into the eye. So I find that very fascinating. It was a great paper to write.
Speaker 2:I didn't know that. Now I'm thinking of, like when I go swimming or scuba diving or snorkeling, and you see all the particulate matter like how big is that hole?
Speaker 3:That is actually a good question and there's not actually written up a lot about that area of a hole. It's up dorsal and it's not all. It says when you're reading the literature that it's not all octopus who has it, like all the species of them, but they don't say which one has it and which one do not have it, so that I cannot answer you. But yeah, but those like particles, that's like in the water. I'm guessing it could go into the eye. I don't know. It's an area that would be very interesting to do some more research.
Speaker 2:Yeah, even more fascinating that some have it and some don't, so thank you for that great fact. Yeah, that's cool.
Speaker 3:Yeah, that was a good paper to write, doing COVID.
Speaker 1:Well, Nicola, you're in a very fortunate spot because you actually have one of the invert experts at NC State, Greg Lubart, so maybe a project you guys can collaborate on in the future Maybe I should Well, Nicola. Thank you so much again for being here today and for contributing your three articles to the ophthalmology supplemental issue.
Speaker 3:Yeah well, thank you so much for having me.
Speaker 1:This was fun To our listeners. You can read Nicola's articles in JAPMA. I'm Sarah Wright with Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
