Karen M. Joos, M.D., Ph.D.



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Faculty Appointments
Professor of Ophthalmology and Visual Sciences Professor of Biomedical EngineeringJoseph N. and Barbara H. Ellis Family Chair in Ophthalmology
Ph.D., Anatomy, University of Iowa, Iowa City, IowaM.D., Medicine, University of Iowa, Iowa City, IowaB.S., GENERAL SCIENCE, University of Iowa, Iowa City, Iowa
Office Address
Vanderbilt Eye Institute
2311 Pierce Avenue
Nashville, TN 37232
Research Description
The Joos’ research program is divided into two programs. The first seeks to understand the unique laser-tissue properties of new lasers for the development of surgical procedures, and the second seeks to investigate the role of systemic and environmental components upon the regulation of intraocular pressure and blood flow within the eye.

The first program is designed to understand the structural and functional significance of new lasers such as the table-top Raman-shifted alexandrite mid-infrared laser with ocular tissues. The broad aims are to investigate the properties of the particular laser energy and identify how these capabilities interact with specific ocular components and biomaterials. A favorable and efficient outcome may proceed to the development of new clinical procedures. Approaches include: histology, morphometry, immunohistochemistry, electroretinography, intraocular pressure response, and biomaterial delivery in models as well as designing unique laser delivery and imaging instruments with endoscopy and optical coherence tomography (OCT).

The second program is designed to investigate the role of systemic components such as the autonomic nervous system, and blood pressure upon the regulation of intraocular pressure and blood flow within the eye in healthy aging individuals as well as in diseases such as glaucoma. I hypothesize that ischemia/reperfusion is contributing a larger role to this loss of regulation than is currently believed. Approaches include a rat model, intraocular pressure measurements, histology, morphometry, immunohistochemistry, Western blots, and real-time PCR.

Research Keywords
Ophthalmology Mid-infrared Laser Glaucoma Glaucoma animal model Novel surgical devices Surgery Translational research Vision Optical Coherence Tomography Endoscopic surgery
Clinical Research Keywords
Pediatric Glaucoma Normal Pressure Glaucoma Glaucoma
Joos K, Kammer J. Advances in glaucoma drainage implants. US Ophthalmic Review. 2008; 3: 21-3.

Joos KM and Kuchtey RW.. In Albert D, Miller J, Azar D, and Blodi B., eds. Albert and Jakobiec?s Principles and Practice of Ophthalmology, 3rd edition, Elsevier, Canada. [place unknown: publisher unknown]; 2008.

Shah RJ, Shen JH, Joos KM. Endoscopic free electron laser technique development for minimally invasive optic nerve sheath fenestration. Lasers Surg Med. 2007 Aug; 39(7): 589-96. PMID: 17868109, DOI: 10.1002/lsm.20531, ISSN: 0196-8092.

Mackanos MA, Simanovskii D, Joos KM, Schwettman HA, Jansen ED. Mid infrared optical parametric oscillator (OPO) as a viable alternative to tissue ablation with the free electron laser (FEL). Lasers Surg Med. 2007 Mar; 39(3): 230-6. PMID: 17304561, DOI: 10.1002/lsm.20461, ISSN: 0196-8092.

Tai TY, Mills MD, Beck AD, Joos KM, Ying GS, Liu C, Piltz-Seymour JR. Central corneal thickness and corneal diameter in patients with childhood glaucoma. J. Glaucoma. 2006 Dec; 15(6): 524-8. PMID: 17106366, PII: 00061198-200612000-00009, DOI: 10.1097/01.ijg.0000212293.93292.c9, ISSN: 1057-0829.

Joos KM, Shah RJ, Robinson RD, Shen JH. Optic nerve sheath fenestration with endoscopic accessory instruments versus the free electron laser (FEL). Lasers Surg Med. 2006 Oct; 38(9): 846-51. PMID: 16977612, DOI: 10.1002/lsm.20397, ISSN: 0196-8092.

Bui CM, Chen H, Shyr Y, Joos KM. Discontinuing nasal steroids might lower intraocular pressure in glaucoma. J. Allergy Clin. Immunol [print-electronic]. 2005 Nov; 116(5): 1042-7. PMID: 16275373, PII: S0091-6749(05)01724-0, DOI: 10.1016/j.jaci.2005.07.031, ISSN: 0091-6749.

Mackanos MA, Kozub JA, Hachey DL, Joos KM, Ellis DL, Jansen ED. The effect of free-electron laser pulse structure on mid-infrared soft-tissue ablation: biological effects. Phys Med Biol [print-electronic]. 2005 Apr 4/21/2005; 50(8): 1885-99. PMID: 15815102, PII: S0031-9155(05)90784-7, DOI: 10.1088/0031-9155/50/8/017, ISSN: 0031-9155.

Mawn LA, Shen JH, Jordan DR, Joos KM. Development of an orbital endoscope for use with the free electron laser. Ophthal Plast Reconstr Surg. 2004 Mar; 20(2): 150-7. PMID: 15083085, PII: 00002341-200403000-00013, ISSN: 0740-9303.

Singleton CD, Robertson D, Byrne DW, Joos KM. Effect of posture on blood and intraocular pressures in multiple system atrophy, pure autonomic failure, and baroreflex failure. Circulation [print-electronic]. 2003 Nov 11/11/2003; 108(19): 2349-54. PMID: 14597588, PII: 01.CIR.0000097114.11038.26, DOI: 10.1161/01.CIR.0000097114.11038.26, ISSN: 1524-4539.

Joos KM, Mawn LA, Shen JH, Casagrande VA. Chronic and acute analysis of optic nerve sheath fenestration with the free electron laser in monkeys. Lasers Surg Med. 2003; 32(1): 32-41. PMID: 12516068, DOI: 10.1002/lsm.10146, ISSN: 0196-8092.

31. Edwards GS, Austin RH, Carroll FE, Copeland ML, Couprie ME, Gabella WE, Haglund RF, Hooper BA, Hutson MS, Jansen ED, Joos KM, Kiehart DP, Lindau I, Miao J, Pratisto HS, Shen JH, Tokutake Y, van der Meer AFG, Xie A.. Free-electron-laser-based biophysical and biomedical instrumentation. Review of Scientific Instruments. 2003; 74: 3207-45.

Semchyshyn TM, Tsai JC, Joos KM. Supplemental transscleral diode laser cyclophotocoagulation after aqueous shunt placement in refractory glaucoma. Ophthalmology. 2002 Jun; 109(6): 1078-84. PMID: 12045047, PII: S0161-6420(02)01019-9, ISSN: 0161-6420.

Joos KM, Laviña AM, Tawansy KA, Agarwal A. Posterior repositioning of glaucoma implants for anterior segment complications. Ophthalmology. 2001 Feb; 108(2): 279-84. PMID: 11158799, PII: S0161-6420(00)00521-2, ISSN: 0161-6420.

Shen JH, Harrington JA, Edwards GS, Joos KM. Hollow-glass waveguide delivery of an infrared free-electron laser for microsurgical applications. Appl Opt. 2001 Feb 2/1/2001; 40(4): 583-7. PMID: 18357034, PII: 63001, ISSN: 0003-6935.

Joos KM, Shen JH. An ocular endoscope enables a goniotomy despite a cloudy cornea. Arch. Ophthalmol. 2001 Jan; 119(1): 134-5. PMID: 11146740, PII: ecr0101-1, ISSN: 0003-9950.

Shen J, Harrington J, Edwards G, Joos K.. Hollow-glass waveguide delivery of infrared free electron laser for microsurgical applications. Applied Optics: Optical Technology and Biomedical Optics. 2001; 40: 583-7.

Sun W, Shen JH, Shetlar DJ, Joos KM. Endoscopic goniotomy with the free electron laser in congenital glaucoma rabbits. J. Glaucoma. 2000 Aug; 9(4): 325-33. PMID: 10958607, ISSN: 1057-0829.

Joos KM, Shen JH, Shetlar DJ, Casagrande VA. Optic nerve sheath fenestration with a novel wavelength produced by the free electron laser (FEL). Lasers Surg Med. 2000; 27(3): 191-205. PMID: 11013381, PII: 10.1002/1096-9101(2000)27:3<191::AID-LSM1>3.0.CO;2-D, ISSN: 0196-8092.

25. Singh K, Mehta K, Shaikh NM, Tsai JC, Moster MR, Budenz DL, Greenfield DS, Chen PP, Cohen JS, Baerveldt GS, Shaikh S, the Primary Trabeculectomy Antimetabolite Study Group.. Trabeculectomy with intraoperative mitomycin C versus 5-fluorouracil. Ophthalmology. 2000; 107: 2305-9.

Joos KM, Kay MD, Pillunat LE, Harris A, Gendron EK, Feuer WJ, Steinwand BE. Effect of acute intraocular pressure changes on short posterior ciliary artery haemodynamics. Br J Ophthalmol. 1999 Jan; 83(1): 33-8. PMID: 10209431, PMCID: PMC1722788, ISSN: 0007-1161.

Joos KM, Kakaria SK, Lai KS, Shannon JR, Jordan J. Intraocular pressure and baroreflex failure. Lancet. 1998 Jun 6/6/1998; 351(9117): 1704. PMID: 9734892, PII: S0140-6736(05)77741-2, DOI: 10.1016/S0140-6736(05)77741-2, ISSN: 0140-6736.

Khoury JM, Joos KM, Shen JH, Davis D, O'Day DM. Half corneal light shield as a delivery system for standardized application of mitomycin C. J. Glaucoma. 1998 Feb; 7(1): 8-11. PMID: 9493108, ISSN: 1057-0829.

Joos KM, Pillunat LE, Knighton RW, Anderson DR, Feuer WJ. Reproducibility of laser Doppler flowmetry in the human optic nerve head. J. Glaucoma. 1997 Aug; 6(4): 212-6. PMID: 9264299, ISSN: 1057-0829.

Pillunat LE, Anderson DR, Knighton RW, Joos KM, Feuer WJ. Autoregulation of human optic nerve head circulation in response to increased intraocular pressure. Exp. Eye Res. 1997 May; 64(5): 737-44. PMID: 9245904, PII: S0014-4835(96)90263-8, DOI: 10.1006/exer.1996.0263, ISSN: 0014-4835.

Shen JH, Joos KM, Manns F, Ren Q, Fankhauser F, Denham D, Söderberg PG, Parej JM. Ablation rate of PMMA and human cornea with a frequency-quintupled Nd:YAG laser (213 nm). Lasers Surg Med. 1997; 21(2): 179-85. PMID: 9261795, PII: 10.1002/(SICI)1096-9101(1997)21:2<179::AID-LSM9>3.0.CO;2-N, ISSN: 0196-8092.

Harris A, Joos K, Kay M, Evans D, Shetty R, Sponsel W, Martin B.. Acute IOP elevation with scleral suction: effects on retrobulbar hemodynamics. British Journal of Ophthalmology. 1996; 80: 1055-9.

Joos K. The Archives Attends: Association for Research in Vision and Ophthalmology Annual Meeting, 1996. Archives of Ophthalmology. 1996; 114: 1153.

Harris A, Anderson DR, Pillunat LE, Joos KM, Knighton RW, Kagemann L, Martin B. Laser Doppler flowmetry measurement of changes in human optic nerve head blood flow in response to blood gas perturbations. Journal of Glaucoma. 1996; 5: 258-65.

Joos KM, Bueche MJ, Palmberg PF, Feuer WJ, Grajewski AL. One-year follow-up results of combined mitomycin C trabeculectomy and extracapsular cataract extraction. Ophthalmology. 1995 Jan; 102(1): 76-83. PMID: 7831046, ISSN: 0161-6420.

Hayreh SS, Joos KM, Podhajsky PA, Long CR. Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy. Am. J. Ophthalmol. 1994 Dec 12/15/1994; 118(6): 766-80. PMID: 7977604, ISSN: 0002-9394.

Joos KM, Kimura AE, Vandenburgh K, Bartley JA, Stone EM. Ocular findings associated with a Cys39Arg mutation in the Norrie disease gene. Arch. Ophthalmol. 1994 Dec; 112(12): 1574-9. PMID: 7993212, ISSN: 0003-9950.

Joos KM, Alward WL, Folberg R. Experimental endoscopic goniotomy. A potential treatment for primary infantile glaucoma. Ophthalmology. 1993 Jul; 100(7): 1066-70. PMID: 8321530, ISSN: 0161-6420.

Joos KM, Brown DM, Alward WL. A multilens case [letter]. Arch. Ophthalmol. 1991 Oct; 109(10): 1343-4. PMID: 1929910, ISSN: 0003-9950.

Joos KM, Sandra A. Microarterial synthetic graft repair: interstitial cellular components. Microsurgery. 1990; 11(4): 268-77. PMID: 2255244, ISSN: 0738-1085.

Joos KM, Blair WF, Brown TD, Gable RH. Flow field mapping in the anesthetized rat. Microsurgery. 1990; 11(1): 12-8. PMID: 2139157, ISSN: 0738-1085.

Joos KM, Blair WF, Brown TD, Gabel RH. Peripheral hemodynamic stability during prolonged anesthesia in the rat. Microsurgery. 1986; 7(4): 178-82. PMID: 3796270, ISSN: 0738-1085.

Joos KM, Blair WF, Maynard JA. A histologic comparison of continuous and interrupted microarteriorrhaphy. Microsurgery. 1985; 6(3): 141-6. PMID: 3903426, ISSN: 0738-1085.

Blair W, Pedersen D, Joos K, Green E, and Bondi D. Microarteriorrhaphy: Blood flow after wound healing. Microsurgery. 1985; 6: 116-20.

Blair W, Pedersen D, Joos K, and Bondi D. Interrupted and continuous microarteriorrhaphy techniques: A hemodynamic comparison. Journal of Orthopaedic Research. 1984; 2: 419-24.

Blair W, and Joos K. The innervation of flexor carpi radialis: An interfascicular dissection. Archives of Neurology. 1982; 39: 647-9.