From gingivitis to glaucoma

When she was a student in dental school at the University of Chile, M. Rosario Hernandez, D.D.S., didn’t expect that one day she’d be an expert on glaucoma and the optic nerve.

She didn’t picture herself coming to St. Louis or even to the United States. She had just completed dental school when Chilean general Augusto Pinochet toppled the regime of President Salvador Allende.

“We were treated terribly,” she recalls. “Three days after Pinochet took power, they re-opened the university, but we all had armed troops guarding us. All of our shelves had been turned upside down and our papers stacked in the middle of the floor. They had searched the whole place. It was unbelievable, a shock I don’t wish on anybody.”

As time passed, the violence subsided, but there were still times when Hernandez encountered problems just driving down the street and suddenly finding herself in the midst of a rock-throwing mob.

The university was somewhat uncomfortable, too. The dean of the medical school was a doctor, but the university president was a military man. And many people simply disappeared.

“Every Monday, we used to count the students because once in awhile, one of them would be gone,” she says. “I got to know people that disappeared forever. I also knew some who disappeared and then reappeared in Europe years later. I was not political, but it was a very, very difficult time.”

The political situation was what convinced her to come to the United States. How she got from dentistry to studying glaucoma is an equally compelling tale.

An eye for research

Hernandez may not have pictured herself leaving Chile, but she didn’t see herself drilling molars either. After earning a D.D.S., Hernandez began what she hoped would be a satisfying life in academic medicine.

“I did not do a standard residency when I finished dental school,” she explains. “I wrote a thesis and did research instead.”

She was interested in connective tissue, and for her thesis she studied changes that occur in the temporomandibular joint — the joint in the jaw that clicks when problems develop — as people grow from infancy to old age. Working with the connective tissue in that joint would eventually bring her to the United States.

“The turmoil and the political situation in Chile was so confusing and difficult and even unsafe for my children and me that when I had a chance to come to the States, I jumped at it,” she says.

She became a research associate in ophthalmology and anatomy at the New York Medical College in Valhalla, N.Y. Her first project there was a study that involved the gums, trying to learn why pregnant women often had problems with gingivitis.

But as the junior person in the lab, she also worked on other projects. One was a study of how steroid receptors in the eye can mediate rises in intraocular pressure and lead to glaucoma. Suddenly, the woman with the dental degree was learning about what happens in the eye when glaucoma develops.

“And those were my first steps in glaucoma research,” she recalls. “And things had improved somewhat in Chile, so I applied for two grants to study glaucoma at the medical school back in Santiago, and I went back and stayed for two years.”

But continued political instability convinced her that academic life might be easier — and safer — in North America, and in 1984 she came back to the United States to stay.

Studying the optic nerve

She took her children and headed back to New York and later to Boston, where she worked at the Schepens Eye Research Institute with fellow glaucoma researcher and future husband Arthur Neufeld, Ph.D., now the Bernard Becker Professor of Ophthalmology and Visual Sciences and a professor of molecular biology and pharmacology.

“He convinced me to concentrate my research on the back of the eye and look at how glaucoma changes the optic nerve disc,” she says. “I’ve been studying the optic nerve ever since.”

For the past 20 years, Hernandez has concentrated on changes in the structure of the optic nerve, both in aging and disease. She was the first to isolate and culture astrocytes from human eyes — the major cell population in the optic nerve head — and use them to study the effects of pressure.

Researchers have long known that people at risk for glaucoma tend to have elevated pressure in their eyes. Hernandez studies how that pressure contributes to the disease.

Michael A. Kass, M.D., professor and head of the Department of Ophthalmology and Visual Sciences, also is the national chairman of the Ocular Hypertension Treatment Study, which has demonstrated that using drops to lower eye pressure can prevent or delay glaucoma.

He says at a very basic level, Hernandez is discovering what really goes on in glaucoma.

“She has done the groundbreaking work on what happens in the optic nerve when it’s under pressure,” he says. “Her work is helping to elucidate the things we’ve been observing in the Ocular Hypertension Treatment Study.”

One thing that study confirmed is that African-Americans are at higher risk for glaucoma than the rest of the population, so Hernandez has become the first scientist in the country to compare tissue from African-American eyes to cells from the eyes of Caucasians. Early results show there are differences.

“The differences are related to the structure of the optic nerve,” she says. “As we learn more, we hope to be able to explain why African-Americans are so much more susceptible to elevated pressure and to glaucoma so that we may be able to alter those risks someday.”

Academia runs deep

The oldest of eight children, Hernandez grew up in an academic family. Her father was a dean at the Catholic University in Santiago. She gives him credit for supporting his daughters and encouraging them to become intellectuals and professionals. She says she also owes a debt to the all-girl, German school she attended before college.

“I’m a firm believer that girls’ schools develop strong women because you can compete without having to think about the boy who is sitting next to you,” she says. “I certainly think it helped me.”

Hernandez has two sons, one in Chile and one in New Jersey. She also has a stepson and stepdaughter on the East Coast. Her office walls are pasted with pictures of her grandchildren.

“Last Christmas we went to Chile to meet my new granddaughter, whose name is Montserrat,” she beams. “And two months ago, my son Sebastian had twins, Rafael and Luca.”

Now that the political situation has been stable for several years, she has talked about spending more time in Chile, something she’s even more eager to do now because her granddaughter is there. She and Neufeld also have a lake house in New Hampshire, which has become the family center for vacations in both summer and winter.

And they spend a lot of time socializing with their colleagues Glen Conroy, Ph.D., and Jane Phillips-Conroy, Ph.D., both professors of anatomy and neurobiology and of anthropology.

“Rosario is constantly energized by the research she does, and she possesses a seemingly endless supply of ideas,” Phillips-Conroy says. “She’s also become a grandmother thrice over in the past year, and having known her as a scientist, colleague and friend, it’s been wonderful to see this other dimension of her.”

Hernandez helps the Conroys teach gross anatomy to medical students. She teaches them about the head and neck, putting some of her old dental-school training to good use.

“I really like going to anatomy lab to do dissections and help students,” Hernandez says. “It’s not molecular biology, but it’s fun. And I would hope that every physician that comes out of this medical school would know their anatomy very well.”