Setting her sights on a career in ophthalmology, Manonmani Murugappan was excited about conducting hands-on, clinical 
research—a project that culminated with presentations of her work at local events, a national conference, and the 2016 Undergraduate Student Symposium.
“To come away from this presenting at several places, traveling to a national conference, and possibly publishing a paper, I would not have had these opportunities without this project,” said Murugappan, a biology major, Honors student, and participant in the Dual Admission Program for the D.O. degree program.
“This project helps me move toward my career because this is clinical work. I’m interacting with people, which is an important aspect toward becoming a doctor. Not many students get to do this.”
Hosted by the NSU Farquhar Honors College, the annual symposium showcases the outstanding scholarship of undergraduate students from all majors through poster displays, oral presentations, performances, and original short films. The projects are judged by faculty based on scholarship and presentation skills. 2016 marked the 15th anniversary of the event.
Murugappan presented her research in Seattle at the 2016 Annual Meeting of the Association for Research in Vision and Ophthalmology, the largest gathering of eye and vision researchers in the world with more than 11,000 attendees from more than 75 countries. Locally, she has presented at NSU’s Health Professions Division Research Day and at a South Florida STEM conference. She is working on a paper detailing the study results with plans to submit it for publication in a peer-reviewed vision science journal.
Working under the guidance of Ava Bittner, O.D., Ph.D., associate professor at NSU’s College of Optometry, Murugappan spent weeks in the laboratory where she conducted vision testing on dozens of adults whose ages span seven decades. During the past two years, Bittner also has been a mentor to three other NSU undergraduates interested in optometry and who assisted with this study, and she plans to work with two pre-optometry students pursuing research internships this fall.
The study’s goal was to measure the participants’ visual acuity and contrast sensitivity—which typically declines with age—using a new quick Contrast Sensitivity Function (qCSF) test. In this test, participants read letters of varying sizes and contrast on a computer screen.
Contrast sensitivity is an important measure of visual function, particularly in situations with low light levels, such as reading a menu in a dimly lit restaurant or the newspaper, as well as driving in rain or fog, when the contrast between objects and their background is reduced.
Murugappan’s research showed a decline in contrast sensitivity among adults in their 50s who had normal visual acuity and further declines in contrast beyond age 70. Her study also found that the qCSF test provided “reliable results” among all age groups and was correlated with the findings of the vision acuity and Pelli-Robson contrast sensitivity charts. However, the qCSF test is capable of providing more information about someone’s visual loss and has greater precision to detect changes.
The results were compared with tests on the same participants using the standard visual acuity eye chart and the gold-standard Pelli-Robson contrast sensitivity chart. The study included adults (from their 20s to their 80s) with normal vision and others with ocular disease (retinitis pigmentosa). Each participant was tested twice in two separate sessions.
“I am thrilled that [Murugappan] and the undergraduate students had the opportunity to make significant contributions to this important study,” Bittner said. “Its findings are valuable to investigators who use the qCSF test to evaluate ocular disease patients and need to know if their results are outside of normal.
“Also, we were the first group to use the qCSF test in retinitis pigmentosa patients and our results indicate excellent sensitivity to detect change. So this new test may help determine if possible treatments may be helpful to improve vision in patients with no current therapeutic options.”
Murugappan’s research presentation—titled “Quick Contract Sensitivity Function Testing in Adults without Ocular Disease and Patients with Retinitis Pigmentosa”—was the focal point of her work in a two-semester Internship in Biology course led by Mark Jaffe, D.P.M., associate professor at the NSU Halmos College of Natural Sciences and Oceanography.
“This type of research endeavor, especially clinical research, is invaluable to our students,” Jaffe said. “Experiential learning, particularly in the undergraduate’s field of interest, provides the student with ‘real life’ outside-the-classroom experience that affirms their educational choices. It also provides them with a competitive advantage when competing for graduate programs.
“At the Halmos College, our faculty are expanding these research opportunities through independent study, internships, and the new practicum in biology course so that even more of our students will have these opportunities in the future,” Jaffe said.
After summer volunteer work at the lab, Murugappan began her symposium project in fall 2015. She worked independently over the course of two semesters, scheduling and conducting the exams herself, collecting and analyzing data, and creating a poster, with mentorship from Bittner. Even after her symposium presentation, she continued to conduct the testing to meet the study’s goal of evaluating 100 participants.
“The biggest challenge was recruitment. It was easy to get the 20-year-olds. Any age above that was more difficult,” said Murugappan, who was assisted by Annette Bade, O.D., M.S., associate professor at the College of Optometry, in recruitment for the study.
After putting the poster together and answering questions at presentations, “what I was doing made a lot more sense to me as far as understanding the data and the numbers,” Murugappan said. “I noticed a change in myself in administering the tests before the symposium and after the symposium. I understand what those results mean now.”
At the symposium, “my peers were there, and a lot of my friends were presenting. It was nice to see what all of us were doing come together. A lot of my friends were saying, ‘so this is what you’ve been doing!’
“This taught me a lot of responsibility,” she said. “I’ve learned some things that I probably wouldn’t have learned until medical school—how the eye works, the anatomy of the eye, eye disease, technology, patient interaction skills. A lot of the questions people asked me were the questions I asked my professors.”