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.
Innovation and discovery
Many retina specialists, especially in larger group practices, participate in nationwide drug trials for large pharmaceutical companies such as Novartis, Genentech, Regeneron, and others. They treat patients according to instructions from the drug company or clinical trial sponsor, and provide patient data to the drug company. They are often highly paid for collecting these results. For some practices, clinical trial data collection for drug compaines, “research”, is a significant part of their business.
Instead, Dr. Luttrull’s interest is in innovation and discovery: finding new and better treatments to prevent visual loss for his patients. Some of these are listed below:
Dr Luttrull’s “Firsts”
- 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.
- 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. This observation was confirmed with the advent of optical coherent tomography years later. 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.
- In the late 1980’s Dr. Luttrull developed an innovative new technique for the safe and successful treatment of the most complicated and typically blinding types of glaucoma. 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.
- 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.
- 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. This 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.
- 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.
- 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.
- 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 Retinal 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.
- The treatment of “wet” age-related macular degeneration with miraculous new drugs, such as Avastin, Lucentis, and Eylea 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.
- 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 Laser” 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 inherently dangerous and damaging conventional laser treatment, however, SDM has no adverse treatment (side) effects. In fact, SDM appears to improve the health and function of the retina, rather than damaging and destroying the retina like conventional laser photocoagulation. 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. SDM has also been found to be safe and effective for macular edema due to retinal vein occlusions and vision loss due to central serous chorioretinopathy. Potential new applications to other common retinal disorders are under investigation. 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, Spink CJ, Musch DA: Subthreshold diode micropulse panretinal photocoagulation for proliferative diabetic retinopathy. Eye, 2008 May; 22 (5): 607–12. 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. Luttrull JK, Sramek C, Palanker D, Spink CJ, Musch DC. Long-term safety, high-resolution imaging, and tissue temperature modeling of subvisible diode micropulse photocoagulation for retinovascular macular edema. Retina 2012;32 (2):375-86. 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, Dorin G. Subthreshold diode micropulse photocoagulation as invisible retinal phototherapy for diabetic macular edema. A review. Clinical Diabetes Reviews, in press, April 2012. Luttrull JK. Subthreshold diode micropulse photocoagulation: welcome to invisible retinal phototherapy for diabetic macular edema! Ophthalmology Times Europe, in press, June 2012.
- 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 safe 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
- “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
- Treatment of the fovea. Swelling of the very center of the retina, the “fovea”, is the main cause of vision loss in many disorders, particularly diabetes and retinal vein occlusions. Treatment of this area with lasers has traditionally been impossible, as laser-induced retinal damage would result in immediate loss of vision. This is a significant limitation of conventional laser treatment. Dr. Luttrull was the first perform and report safe and effective treatment of the fovea with SDM, upending 50 years of teaching to the contrary and opening new doors for improved treatment of macular edema in diabetes and other disorders. As importantly, this work has removed the final impediments to an entirely new approach to the management of diabetic retinopathy: preventative treatment.
- Luttrull JK, Dorin G. Subthreshold diode micropulse photocoagulation as invisible retinal phototherapy for diabetic macular edema. A review. Current Diabetes Reviews, 2012, 8, 274-284.
- Luttrull JK, Sinclair SD, Midena E. Instructors in clinical course, American Society of Retina Specialists annual meeting, Toronto, Canada, August 27, 2013.
- Luttrull JK, Sinclair SD. Safety of transfoveal subthreshold diode micropulse laser for intra-foveal diabetic macular edema in eyes with good visual acuity. Free paper presentation, American Society of Retina Specialists, Toronto, Canada, August 28, 2013. Submitted for publication August 2013.
- Keunen J, Luttrull JK, Chong V, Midena E. Clinical instructors for course in Subthreshold diode micropulse laser for diabetic macular edema. European Society of Retina Specialist annual meeting, Hamburg, Germany, Sept 27, 2013.
- Bypass surgery for retinal vein occlusions. Retinal vein occlusion (RVO) is one of the most common causes of vision loss. Laser treatment is often helpful, but modern drugs have dramatically improved our ability to treat RVO and improve vision. Despite the effectiveness of current drug therapy, there are drawbacks. First, at this point drugs treat only the effects of the RVO and do not solve the underlying problem: blockage of the vein. Second, these drugs must be injected directly into the eye, often every month or two, for several years to maintain effect. Third, in some patients these drugs stop working. Dr. Luttrull has pioneered a new surgical procedure which “bypasses” the RVO, addressing the problem directly. In so doing, Dr. Luttrull’s experience with the procedure suggests that it may produce better final results than drugs alone, and in many if not most people eliminate or reduce the need for eye injections. Luttrull JK, Spink CJ. Pars plana vitrectomy with multiple transvenous chorioretinotomies for macular edema due to retinal vein occlusion. Ophthalmic Surg Lasers Imaging Retina. 2013 Jul 1;44(4):366-73.
- Laser treatment for “wet” age-related macular degeneration. Dr. Luttrull and coauthors reported the first effective treatment for patients with “wet” macular degeneration for whom drug injections have become ineffective. Dr. Luttrull’s discovery will help patients around the world avoid vision loss by keeping drugs effective. By making drug treatment more effective, Dr. Luttrull has found that drug injections in “wet” AMD can be significantly reduced. Luttrull JK, Chang DB, Margolis BWL, Dorin G, Luttrull DK. Laser re-sensitization of medically unresponsive neovascular age-related macular degeneration: Efficacy and implications. Retina 2015 Jun; 35(6): 1184-1194.
- How retinal laser treatment works: Retinal laser treatment has been indispensable in the prevention of blindness due to retinal disease for 60 years – yet no one understood how it worked. In conjunction with the findings on SDM laser application to age-related macular degeneration, Dr. Luttrull and colleagues disclose a new theory for the mechanism of action of retinal laser treatment called “Reset to Default Theory”. Reset Theory will change how doctors understand and use lasers to prevent blindness, and suggest many other diseases that may benefit from retinal laser treatment. Luttrull JK, Chang DB, Margolis BWL, Dorin G, Luttrull DK. Laser re-sensitization of medically unresponsive neovascular age-related macular degeneration: Efficacy and implications. Retina 2015 Jun; 35(6): 1184-1194.
- “Functionally guided Retinal Protective Therapy™ for age-related and inherited retinal degenerations. Building on 15 years of research and the resulting understanding of the mechanism of retinal laser treatment (“Reset to Default Theory“), Dr Luttrull was able, for the first time, to improve retinal function and health in dry age-related macular degeneration and inherited retinal degenerations like Stargardt’s disease and retinitis pigmentosa. By improving retinal function, and thus health, progression of the disease should be slowed and risks of visual loss reduced. This groundbreaking work opens the door, for the first time, for early preventive treatment for chronic progressive retinopathies which are the main causes of vision loss worldwide. Retinal protective therapy™ has no side effects and can be renewed if it wears off (this can be determined by special retinal function testing also pioneered by Dr. Luttrull). By allowing treatment based on retinal function testing, instead of the current use of retina imaging such as OCT, treatment can be started earlier, prior to retina damage and visual loss, thus preventing them. Luttrull JK, Margolis BWL. Functionally guided retinal protective therapy as prophylaxis for age-related and inherited retinal degenerations. A pilot study. Invest Ophthalmol Vis Sci. 2016 Jan 1;5 7(1):265-75. doi: 10.1167/iovs.15-18163
- The first treatment to reduce the risk of vision loss from “dry” age-related macular degeneration. Dr. Luttrull’s discovery of SDM and the mechanism of retinal laser treatment successfully predicted that retinal laser should work for many things that laser treatment had never been used for before. One prediction was that SDM should improve retinal function and health in dry AMD. By doing this, the rate of progression and risk of vision loss should be reduced. In one of the most exciting and important discoveries of in the history of ophthalmology, in 2016 Dr. Luttrull found that SDM Retinal Protective Therapy™ reduces the risk of vision loss in dry AMD (due to the development of “wet” AMD) by as much as 95-98% compared to use of AREDS eye vitamins alone. Thus, Dr. Luttrull’s SDM retinal protective therapy is the first, and only, treatment to help dry AMD, and it does so very significantly. These important findings will be shared with ophthalmologists around the world over the coming year by Dr. Luttrull at international scientific meetings and in major medical journals. This latest groundbreaking discovery by Dr. Luttrull will prevent visual loss in millions around the world; and save many billions in future healthcare costs. This groundbreaking study will be published in PLos ONE Medicine in August 2018 “Low incidence of choroidal neovascularization following subtreshold diode micropulse laser (SDM) in high-risk AMD”.
- First clinically effective treatment for retinitis pigmentosa. Dr. Luttrull’s work on the mechanism of action of retinal laser treatment lead to his discovery that retinal laser treatment can be both therapeutic and preventative for all types of chronic progressive retinopathies. This includes previously untreatable like retinitis pigmentosa – by improving visual acuity, visual fields, and retinal function. In this way Dr. Luttrull hopes that continued treatment can slow disease progression and prevent or delay visual loss until a cure is found. (Luttrull JK. Improved retinal and visual function following subthreshold diode micropulse laser (SDM) for retinitis pigmentosa. Eye (London), December 18 2017, in press.)
- First neuroprotective treatment for open angle glaucoma. In May 2018, with colleagues John Samples, MD, David Kent, MD, and Bryant J Lum, MD, Dr. Luttrull published his work entitled “Panmacular subthreshold diode micropulse laser (SDM) as neuroprotective therapy in open angle glaucoma”. This reports Dr. Luttrull’s discovery that SDM can improve visual acuity, visual fields, and optic nerve function in eyes with advanced glaucoma, becoming the first treatment for glaucoma other than lowering of the eye pressure. As more than 60% of patients with glaucoma continue to lose vision despite eye pressure control, it is hoped that SDM can reduce this risk by making the eye and optic nerve healthier.
- First treatment to slow progression of Age-Related Macular Degeneration and age-related Geographic atrophy. In January 2019 Dr. Luttrull submitted for publication his analysis of the effect of SDM laser on progression of age-related GA. GA is the worst and most rapidly progressive form of dry AMD. Until now there has been no treatment. All attempts to slow GA by other types of laser treatment and drug therapy have failed. However, analysis of patients managed with SDM laser for their AMD revealed that SDM reduced the rate of GA progression by 55% per year compared to AREDS vitamins alone. This means that over 3 years of maintained treatment, patients receiving SDM would worsen 83% less that if they did not have SDM treatment. SDM is thus the first treatment to safely and significantly (p=0.0002) reduce the rate of progression of dry AMD and first reduce the risk of visual loss from GA. Dr. Luttrull will be presenting his groundbreaking findings at medical meetings around the world throughout 2019.