Background:

After Dr. Luttrull’s first year of college in 1974 he decided to pursue medicine rather than music as a career. He left the University of California system for the unusually successful pre-medical program at Point Loma College in San Diego. There, under the tutelage of great men and scientists like chemists Victor L. Heasley, PhD, and Dale F. Shellhamer, PhD, Dr Luttrull was introduced to the world of basic science research. As a college student at Point Loma, Dr. Luttrull had the unusual opportunity to co-author 3 research papers in organic chemistry which were published in major chemistry peer-review journals.

His research activities continued in medical school and his ophthalmology residency at the University of Southern California and Doheny Eye Institute. Despite pursuing his medical career as a solo private practitioner, Dr. Luttrull has continues to conduct original research, publishing regularly in major peer review journals and presenting his research at major international medical meetings.

Dr Luttrull’s “Firsts”:

1. In 1995, Dr Luttrull and coauthors reported the first series of patients successfully treated for intraocular fungal infections with non-toxic pills alone. Previously the treatment of such infections had typically required surgery and use of dangerous and toxic drugs injected into the eye and given intravenously requiring prolonged hospitalization, often associated with severe side effects and often requiring surgery. Dr Luttrull showed most such infections could be successfully treated at home with safe oral medications.

Luttrull, J.K., Wan, W.L., Kubak, B., Smith, M.D., Oster, H.A..: Treatment of Ocular Fungal Infections with Oral Fluconazole. Am. J. Ophthalmol. 1995. 119:477-481.

2. Also in 1995, Dr Luttrull reported two cases of a rare macular disease called “acute retinal pigment epitheliitis”. Dr Luttrull was the first to document and report this disease in its earliest stages. His observations lead him to suggest that the disease had been previously misunderstood and mis-named, and was the first to correctly identify the primary focus of the disease as the retinal photoreceptor outer segments, not the retinal pigment epithelium as previously thought.

Luttrull, JK, Chittum ME.: Acute Retinal Pigment Epitheliitis. Am. J. Ophthalmol. 1995. 120:389 - 391. Luttrull, J.K.: Acute Retinal Pigment Epitheliitis. Am. J. Ophthalmol. 1997.123: 127 - 129.

3. In 1995 and 2000 Dr Luttrull and coauthors reported the results of a innovative and new surgical technique developed by Dr Luttrull for the treatment of the most severe and complicated types of glaucoma, particularly neovascular glaucoma, the most common cause of complete blindness in diabetes and other disorders. This procedure, called the “pneumatically stented implant”, or “PSI” technique makes novel use of an intraocular gas bubble to reduce surgical complications and enhance the effectiveness of the surgery. The PSI technique remains the safest and most effective procedure to treat complicated glaucoma and preserve good vision.

Luttrull, J.K., Avery, R. L.: Pars Plana Implant and Vitrectomy for Treatment of Neovascular Glaucoma. RETINA. 1995. 15: 379 -387. Luttrull JK, Avery RL, Baerveldt G.S, Easley, K.: Initial experience with pneumatically stented pars plana modified Baerveldt implant for treatment of complicated glaucoma. Ophthalmology, 2000; 107:143-150. Luttrull JK, Avery RL: “Augmentation of trabeculectomy with perfluoropropane gas: a pilot clinical and experimental study”. (Letter) Ophthalmology, 2000; 107: 224.

4. The use of perfluorocarbon liquids (PFL) in retinal surgery, introduced by Stanley Chang, MD, of Columbia University, has been one of the great advances in recent years. PFLs have revolutionized the repair of complicated retinal detachments, particularly those due to giant retinal tears. At first, access to PFL was very limited. However, by virtue of his background in organic chemistry, Dr Luttrull became the first retinal specialist in Southern California to employ PFLs in his surgical practice. In addition, out of respect for his colleagues and concern for their patients as well as his own, Dr Luttrull made PFLs available to other retinal surgeons throughout Southern California, allowing them to immediately offer state of the art surgery to their patients as well until commercial sources of PFLs for retinal surgery became available sometime later.

5. Dr Luttrull’s work with implants for complicated glaucoma lead him to patent the concept and design for world’s the first permanent refillable implanted drug delivery device for the eye. Although this patent was awarded many years before the pharmaceutical industry had developed drugs that could be administered through such an implant, that technology has now arrived. Through the hard work of co-inventor Robert Avery, MD, the device and method has been licensed for commercial development (“Replenish”) and may someday benefit thousands of patients with chronic eye – and other - diseases.

Avery RL, Luttrull JK: Intraocular drug delivery device:
1. US Pat. No. 5,830,173. Filed August 1, 1997.
2. US Pat. No. 5,725,493. Filed December 12, 1994.
3. US Pat. No. 6,251,090 B1. Filed November 2, 1998.

6. In 1999 Dr Luttrull reported the first documented case of retinal injury caused by a laser pointer. Moral: No matter how safe something might be, you can still hurt yourself given sufficient poor judgment and determination.

Luttrull JK, Hallisey J: Laser pointer- induced macular injury. Am. J. Ophthalmol. 1999; 127: 95 -96.

7. In the same year (1999) Dr Luttrull and colleagues reported and described the first cases of an unusual manifestation of an unusual retinal disorder (the Multiple Evanescent White Dot Syndrome). Such reports help doctors correctly diagnose and treat their patients.

Luttrull JK, Marmor M, Nanda M: Progressive confluent peripapillary multiple evanescent white-dot syndrome. Am. J. Ophthalmol. 1999; 128: 378-380.

8. Photodynamic therapy (PDT) is an important tool in the treatment armamentarium against “wet” macular degeneration. Concomitant intraocular steroid injections were found to significantly improve the results of PDT, but the reason was unclear. In 2007 Dr Luttrull and Certified Retina Angiographer Charles Spink published the first report describing the unique effect of intraocular steroids used in conjunction with PDT, improving our understanding of the treatment and disease process.

Luttrull JK, Spink CJ. Prolonged choroidal hypofluorescence following verteporfin photodynamic therapy combined with intravitreal triamcinolone acetonide injection. RETINA, 2007 Jul-Aug, 27 (6): 688-92.

9. The treatment of “wet” age-related macular degeneration with miraculous new drugs, such as Avastin and Lucentis, is one of the great stories in medicine in recent years. Millions of patients who would otherwise have lost their sharp central vision and ability to read and drive can now often continue to lead normal lives. Despite successful drug treatment for their macular degeneration (beneath the retina), some patients continue to have limited visual acuity due to scarring on the surface of the retina (“epiretinal membrane”) not directly related to their macular degeneration. Dr Luttrull reported the first series of patients undergoing surgery for epiretinal membranes / vitreomacular disease after successful drug therapy for their macular degeneration. Dr Luttrull showed that surgery in such patients could offer them even more improvement in their vision than was achieved by medicine alone.

Luttrull JK, Spink CJ: Vitrectomy following anti-VEGF therapy for epiretinal membranes coincident with age-related subfoveal neovascularization. . 2008; 39: 455 - 459.

10. Diabetes mellitus is becoming epidemic throughout the world, and diabetic retinopathy increasingly one of leading causes of visual loss and disability globally. Since the 1970’s, laser treatment has been the mainstay of treatment for diabetic retinopathy. Conventional, traditional, laser treatment intentionally burns and scars the retina. Although beneficial, the risks, complications, and limitations of conventional laser treatment are significant. It had always been believed that the retinal damage caused by the laser was necessary for the treatment to work.

In April 2000, Dr Luttrull developed a new technique (“subthreshold diode micropulse photocoagulation” or “SDM”) for laser treatment of diabetic retinopathy. Like conventional laser treatment, it is effective against diabetic macular edema, the main cause of vision loss in diabetes. Unlike conventional laser treatment, however, SDM is the first completely harmless laser treatment for diabetic macular edema, doing absolutely no damage to the retina. Dr Luttrull’s surprising discovery has been confirmed by researchers around the world and is increasingly replacing unnecessarily harmful traditional laser treatment techniques. The safety and effectiveness of SDM and the concepts it embodies are improving the treatment of diabetic retinopathy and similar retinal disorders for patients throughout the world.

Luttrull JK, Musch MC, Mainster MA: Subthreshold diode micropulse photocoagulation for the treatment of clinically significant diabetic macular edema. Br J Ophthalmol 2005 89:1; 74-80. Luttrull JK, Spink CJ: Serial optical coherence tomography of subthreshold diode laser micropulse photocoagulation for diabetic macular edema. Ophthalmic Surgery, Lasers & Imaging, Sept/Oct 2006;37: 370-377. Luttrull, JK. Atraumatic photocoagulation for retinovascular disease. Case studies of micropulsed 810 nm diode laser photocoagulation in the management of diabetic retinopathy. Retinal Physician, 2005;2: 65-87. Is effective retinal photocoagulation without laser-induced damage possible? Retina Today, Winter 2006-07; 22-25. Luttrull JK: Subthreshold retinal photocoagulation for diabetic retinopathy. In Retinal and Vitreoretinal Diseases and Surgery, Boyd S, Cortez R, Sabates N eds. ISBN: 98-9962-678-23-6. Jaypee- Highlighlights Medical Publishers, Inc, Panama Rep. of Panama. 2010. Luttrull JK, Sramek C, Palanker D, Spink CJ, Musch DC. Assessment of long-term safety, high resolution imaging, and computational tissue temperature modeling of subvisible diode micropulse photocoagulation for retinovascular macular edema. Submitted for publication. Dec 2010. Revision in review Jan 2011.

11. The causes of the complications of the most advanced form of diabetic retinopathy, or “proliferative diabetic retinopathy” (PDR) increasingly appear to be similar to the causes of diabetic macular edema. Conventional laser treatment for PDR, called “pan retinal photocoagulation” (PRP) involves using the laser to burn and destroy most of the peripheral retina to prevent blindness. However, such widespread retinal destruction has many drawbacks and complications, including pain, visual loss, loss of night vision, and loss of peripheral vision.

At the same time he developed SDM for treatment of diabetic macular edema, Dr Luttrull began using SDM to treat proliferative diabetic retinopathy. In 2008 Dr Luttrull reported the first effective and completely harmless laser treatment for proliferative diabetic retinopathy. Studies based on Dr Luttrull’s work with SDM for PDR are currently ongoing around the world.

Luttrull JK, Spink CJ, Musch DA : Subthreshold diode micropulse panretinal photocoagulation for proliferative diabetic retinopathy. Eye, 2007 Feb [Epub ahead of print] PMID 17293791; Print pub Eye 2008; 22: 607-612. Luttrull JK, Musch D, Spink CJ: Subthreshold diode micropulse photocoagulation for proliferative diabetic retinopathy. Letter (Reply) Eye. Advance online publication Jan 2009; doi: 10.1038/eye.2008.418

12. “Premium” multifocal intraocular lenses in cataract surgery are increasingly popular, permitting many patients to function without need for glasses after cataract surgery. There are many different designs of such lenses, each with particular advantages and disadvantages. One such intraocular lens, which incorporates many concentric rings of various focal powers molded onto its surface, can occasionally cause bothersome symptoms where patients see these rings in their vision. In 2010 Dr Luttrull was the first to note, document and report with colleagues, that images of these rings can be photographed projecting onto the patient’s retina, corresponding to their unusual symptoms. Such discoveries improve our understanding of visual optics and may suggest better ways of designing new intraocular lens implants.

Luttrull JK, Dougherty PJ, Zhao H, Mainster MA: Concentric ring dysphotopsias in diffractive multifocal pseudophakia. July 27, 2010. Ophthalmic Surgery, Lasers and Imaging. 2010 Sep 29;41 Online. doi: 10.3928/15428877-20100929-11