Ophthalmology Update - Cleveland Clinic
Ophthalmology Update - Cleveland Clinic
Ophthalmology Update - Cleveland Clinic
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COLE EYE INSTITUTE<br />
<strong>Ophthalmology</strong><br />
<strong>Update</strong><br />
Special Edition 2009
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
in this<br />
Issue<br />
02 Investigations<br />
16 Innovation<br />
20 Staff<br />
28 Education<br />
34 Research
D E A R C O L L E A G U E S<br />
I am pleased to present the 2009 <strong>Cleveland</strong> <strong>Clinic</strong> Cole<br />
Eye Institute Special Edition of <strong>Ophthalmology</strong> <strong>Update</strong>.<br />
As you will see in the pages that follow, Cole Eye<br />
Institute has enjoyed great success in the past year in<br />
both clinical care and cutting-edge research. At the<br />
same time, it also has been a year of significant change.<br />
In December 2008, I was honored to join the Cole Eye<br />
Institute as its new Chairman. The tradition of academic<br />
and clinical excellence, as well as the people who<br />
make up this great institute, were the primary reasons<br />
that I accepted this position. I feel most fortunate to be<br />
here working with this highly acclaimed staff.<br />
In this year’s special edition, you can read about a non-invasive drug delivery system for<br />
ocular disease that is under development by Dr. Rishi Singh in collaboration with Buckeye<br />
Ocular (p.5) and a superiorly based bilobed flap for reconstruction of nasojugal fold<br />
region defects being used by Dr. Julian Perry (p.7). We also provide an update on the three<br />
largest ongoing multicenter randomized clinical trials evaluating treatments for neovascular<br />
(wet) age-related macular degeneration, including (p.3) the Comparison of AMD<br />
Treatments Trials (CATT), the DENALI trial and (p.10) the VEGF Trap-Eye Phase III study.<br />
Members of our staff play leadership roles in all three of these studies.<br />
I hope that you are able to spend some time reviewing <strong>Ophthalmology</strong> <strong>Update</strong> and find<br />
it valuable and helpful in your practice. I look forward to sharing with you additional<br />
updates as the year progresses regarding our ever-expanding research program and our<br />
efforts to further improve patient care. Please feel free to contact us at 216.444.2020 if you<br />
have any questions or would like to refer a patient. As always, we welcome the opportunity<br />
to work with you.<br />
Sincerely,<br />
Daniel F. Martin, MD<br />
Chairman, Cole Eye Institute<br />
1
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
Investigations<br />
STRIVING FOR ANSWERS
Daniel F. Martin, MD<br />
Two of the nation’s most important clinical trials<br />
in age-related macular degeneration (AMD) are<br />
now lead by retina specialists at <strong>Cleveland</strong> <strong>Clinic</strong>’s<br />
Cole Eye Institute.<br />
When Daniel F. Martin, MD, became Chairman<br />
of Cole Eye Institute in late 2008, coming from<br />
Emory University in Atlanta, he brought with him<br />
his role as Study Chairman of the Comparison of<br />
AMD Treatments Trials (CATT).<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | INVESTIGATIONS<br />
New Chairman Brings CATT Study to Cole Eye Institute<br />
Colleague Peter K. Kaiser, MD, is chairman of the<br />
DENALI trial, which is evaluating the combination<br />
of injectable verteporfin (Visudyne ® ) photodynam-<br />
ic therapy and ranibizumab (Lucentis ® ) for the<br />
treatment of AMD. The 24-month study will<br />
compare the ranibizumab combination therapy<br />
with ranibizumab monotherapy in patients with<br />
subfoveal choroidal neovascularization (CNV)<br />
secondary to neovascular AMD. Dr. Kaiser also is<br />
involved in the leadership of the VEGF Trap-Eye<br />
Phase III study (see related article, p. 10).<br />
The CATT study has generated much publicity<br />
in recent months. Genentech’s ranibizumab is<br />
approved by the FDA for treatment of AMD, but<br />
many ophthalmologists believe that another of<br />
the company’s drugs, bevacizumab (Avastin ® ),<br />
delivers equal results for a fraction of the price.<br />
“Two of the nation’s most important clinical<br />
trials in age-related macular degeneration<br />
(AMD) are now lead by retina specialists at<br />
<strong>Cleveland</strong> <strong>Clinic</strong>’s Cole Eye Institute.”<br />
Dr. Martin agrees that comparing the drugs in a<br />
head-to-head trial is an important issue. However,<br />
he believes that the study’s second question,<br />
which addresses the issues of preferred dosing<br />
frequency, is just as important.<br />
“The clinical trials that led to FDA approval of<br />
ranibizumab only evaluated a fixed monthly<br />
dosing schedule. However, in clinical practice,<br />
Continued<br />
3
4<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
CATT Study continued<br />
no one is using this drug or bevacizumab this way,”<br />
he says. “Most retina specialists are using these<br />
drugs on an as-needed basis. It is essential to<br />
understand whether or not we are compromising<br />
long-term visual outcomes with these reduced<br />
dosing frequencies and whether or not we can<br />
identify a subset of patients who do very well with<br />
fewer injections.”<br />
“Most retina specialists are using these drugs on an<br />
as-needed basis, and we are eager to learn if that is<br />
the optimal way to use them, or if a fixed schedule<br />
would deliver superior outcomes,” he says.<br />
To help answer both questions, patients are being<br />
randomly assigned to one of four groups for<br />
treatment during the first year (doses are 0.5 mg<br />
for ranibizumab and 1.25 mg for bevacizumab):<br />
• Ranibizumab on a fixed schedule of every<br />
four weeks for a year.<br />
• Bevacizumab on fixed schedule of every<br />
four weeks for a year.<br />
• Ranibizumab on variable schedule dosing;<br />
i.e., after initial treatment, monthly evaluation<br />
of the need for treatment based on signs of<br />
lesion activity.<br />
• Bevacizumab on variable schedule dosing;<br />
i.e., after initial treatment, monthly evaluation<br />
of the need for treatment based on signs of<br />
lesion activity.<br />
Optical coherence tomography will drive retreatment<br />
decisions in the PRN groups, he explains. If<br />
any subretinal, intraretinal or sub-retinal pigment<br />
epithelium fluid is seen, the eye will receive an<br />
injection. If there is no fluid but there are other<br />
signs of active CNV, the eye will be treated as<br />
well. Examples of signs include new or persistent<br />
subretinal or intraretinal hemorrhage or unexplained<br />
decreased visual acuity. Fluorescein<br />
angiography results may be considered at the<br />
physician’s discretion, and findings that would<br />
elicit particular concern would include increased<br />
lesion size or leakage.<br />
The primary outcome measure is change in visual<br />
acuity. Secondary outcome measures include<br />
number of treatments, retinal thickness at the<br />
fovea, adverse events and cost.<br />
Dr. Martin expects the two-year trial to complete<br />
enrollment — 1,200 participants at 43 sites — by<br />
the fourth quarter of 2009. One-year outcomes are<br />
expected to be released early in 2011.<br />
For more information,<br />
contact ophthalmologyupdate@ccf.org.
Non-invasive Drug Delivery System<br />
for Ocular Disease Under Development<br />
Rishi P. Singh, MD<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | INVESTIGATIONS<br />
The current method of delivery of ocular therapeutics<br />
is through injections in the eye. In the case of<br />
age-related macular degeneration (AMD), treatments<br />
can be as frequent as every four weeks.<br />
These injections have been associated with<br />
significant side effects such as pain, infection,<br />
bleeding and retinal detachment. Beyond the<br />
socioeconomic impact of monthly patient visits,<br />
intravitreal injections must be administered by an<br />
ophthalmologist and place significant demands<br />
on ophthalmic practices given the growth of the<br />
number of patients with AMD.<br />
At the <strong>Cleveland</strong> <strong>Clinic</strong> Cole Eye Institute, Rishi P.<br />
Singh, MD, is collaborating with Buckeye Ocular,<br />
Beachwood, Ohio, to develop a drug delivery system<br />
that is non-invasive, low-cost and effective with<br />
minimal side effects. Together, they are adapting<br />
a proprietary technology and drug formulation<br />
combination, Macroesis , which Buckeye Ocular’s<br />
parent company, Buckeye Pharmaceuticals, had<br />
developed to revolutionize the treatment of<br />
onychomycosis and herpes labialis.<br />
Nanodielectrophoresis<br />
• AC signal applies a non-uniform electric field to a chemical<br />
compound.<br />
• This induces a dipole (areas of equal charge separated by a<br />
distance) in the compound and generates an electrical field<br />
gradient that provides an electromotive force.<br />
• This forces varies in magnitude and direction with applied<br />
frequency, among other factors.<br />
“The delivery technology uses a series of optimallytuned<br />
alternating current (AC) signals applied with<br />
a custom-designed combination of successive<br />
electrodes that induces temporary polarization,<br />
preconcentrates and enhances mobility in AMD<br />
drugs, making them candidates for active transcleral<br />
delivery,” Dr. Singh says.<br />
Two in-vitro models of drug delivery were used<br />
for recent validity studies with ranibizumab and<br />
triamcinolone acetonide. These studies, the results<br />
of which were presented at the Retina Society and<br />
Prototype Device Design<br />
Continued<br />
5
6<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
Non-invasive Drug Delivery System continued<br />
American Society of Retina Specialists annual<br />
meetings in 2008, concluded that macroesis<br />
can successfully deliver ranibizumab, an<br />
FDA-approved intravitreal injection for treating<br />
AMD, and triamcinolone acetonide, a topical<br />
corticosteroid, in a non-invasive manner using<br />
the Buckeye Ocular delivery system.<br />
The technology is akin to iontophoresis, a delivery<br />
platform for steroids to be transported to a joint<br />
that uses direct current (DC), Dr. Singh explains.<br />
“The beauty of macroesis is that you can actually<br />
optimally tune the drug for the delivery,” he says.<br />
“If I have a drug that is hard to diffuse to tissue, I<br />
can use a certain wave length and voltage to fine<br />
tune its delivery for a superior outcome. It’s almost<br />
like iontophoresis on steroids.”<br />
Dr. Singh and his collaborators recently received<br />
$35,000 in product development funds from<br />
<strong>Cleveland</strong> <strong>Clinic</strong> Innovations to conduct preclinical<br />
studies. The study has two aims: 1) To transport<br />
ranibizumab through an eye animal model to<br />
a saline solution vitreous fluid analog using a<br />
laboratory-generated electrical signal. 2) To build<br />
an alpha prototype embodying the laboratorygenerated<br />
signaling to transport the pharmacological<br />
agents through the cadaver animal model.<br />
Dr. Singh says the prototype will be like a contact<br />
lens that is inserted on the patient’s eye and runs<br />
off of four AA batteries. The consumable electrode<br />
preloaded with the approved AMD drug would<br />
be designed to be nurse-administered in a<br />
clinical setting.<br />
“If the device can succeed in being both<br />
inexpensive and convenient, Dr. Singh says,<br />
it has the potential to eliminate some existing<br />
barriers to AMD treatment.”<br />
Such a treatment, he says, could be performed<br />
in as little as five to 10 minutes in an outpatient<br />
setting, or perhaps even at home.<br />
If the device can succeed in being both inexpensive<br />
and convenient, Dr. Singh says, it has the potential<br />
to reduce some existing barriers to AMD treatment.<br />
“The gold standard for AMD treatment is monthly<br />
injections,” he says. “But this is many times<br />
prohibitive for patients. If we could use this<br />
technology successfully, maybe we would have<br />
better compliance and improved outcomes.”<br />
Another exciting aspect of the technology is its<br />
potential for pairing with any FDA-approved drug.<br />
“Currently, we’re focusing on AMD, but it could<br />
conceivably be used for any ocular disease.<br />
Perhaps it could be used with anti-inflammatory<br />
medications to treat uveitis or with chemotherapeutic<br />
medication for ocular melanoma<br />
or metastasis.”<br />
For more information,<br />
contact ophthalmologyupdate@ccf.org.
Superiorly Based Bilobed Flap Effective for Inferior Medial Canthal and<br />
Nasojugal Fold Defect Reconstruction<br />
Julian D. Perry, MD<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | INVESTIGATIONS<br />
Reconstruction of the inferior medial canthal, nasal<br />
sidewall and nasojugal fold after surgical resection<br />
of cutaneous malignancy presents many challenges.<br />
The medial canthal region represents a multi-contoured<br />
area with great variation in skin thickness,<br />
color, texture and appendage density, and it includes<br />
contributions from the orbital and tarsal portions<br />
of the upper and lower eyelids, the nasal sidewall<br />
and the glabella. Local landmarks, including the<br />
lacrimal drainage apparatus and eyebrows, limit<br />
flap design, as does the lack of significant horizontal<br />
tissue redundancy in this region.<br />
To evaluate the use of a superiorly based bilobed flap<br />
for reconstruction of nasojugal fold region defects,<br />
Cole Eye Institute oculoplastic surgeon Julian D.<br />
Perry, MD, and his team conducted a retrospective<br />
review of all patients undergoing medial canthal,<br />
nasal sidewall and nasojugal fold region reconstruction<br />
using a superiorly based bilobed flap from<br />
October 2000 through March 2008. Charts were<br />
reviewed for patient age and gender, indication,<br />
defect size and location, flap(s) used and follow-up<br />
time. Outcome measures included ability to<br />
completely close the defect without tension,<br />
cosmetic appearance, complications and need<br />
for further surgery.<br />
Eighteen cases of medial canthal and nasojugal<br />
fold area reconstruction were performed using a<br />
superiorly based bilobed flap in 17 patients. There<br />
were eight male and nine female patients with an<br />
average age of 68.2 years (range, 11 to 88 years) and<br />
mean follow-up time of 17.8 months (range, 1 to 60<br />
months). Mean defect size measured 2.0 x 1.4 cm<br />
(range, 0.7 to 4 cm). One patient underwent<br />
simultaneous glabellar flap repair, two patients<br />
underwent simultaneous lateral lower eyelid<br />
rotational flap repair, and one patient underwent<br />
simultaneous upper eyelid V-Y advancement flap.<br />
All defects closed completely with no wound<br />
tension. No cases of hemorrhage, infection,<br />
a b c<br />
Preoperative (a), immediate postoperative (b) and one-year postoperative (c) photographs of a patient who underwent successful<br />
reconstruction of a typical nasojugal region defect using a superiorly based bilobed flap.<br />
dehiscence or necrosis developed during the<br />
follow-up period. Cosmetic satisfaction was<br />
achieved in 16 of 17 patients. Complications<br />
included mild medial ectropion (two patients) and<br />
canalicular stenosis (one patient). None of these<br />
patients elected re-operation. Trapdoor deformity<br />
did not occur in any case. Two patients underwent<br />
re-operation for local tumor recurrence.<br />
Dr. Perry and the team concluded that a superiorly<br />
based bilobed flap adequately reconstructs inferior<br />
medial canthal, nasal sidewall and nasojugal<br />
fold defects.<br />
For more information,<br />
contact ophthalmologyupdate@ccf.org.<br />
7
8<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
Case Study: DSAEK to Treat Amantadine-associated Corneal Edema<br />
Christopher T. Hood, MD<br />
Roger H.S. Langston, MD<br />
William J. Dupps, Jr.,<br />
MD, PhD<br />
Presentation:<br />
A 45-year-old Caucasian woman presented to the<br />
Cole Eye Institute for management of corneal<br />
edema. She described experiencing six months of<br />
blurry vision in both eyes that was worse in the<br />
morning and improved slightly throughout the day.<br />
She denied redness, pain or photophobia. She was<br />
being treated with Muro 128 ointment four times<br />
daily in the right eye upon referral.<br />
She denied any history of ocular trauma, surgery<br />
or inflammatory disease. Her medical history was<br />
significant for a longstanding diagnosis of multiple<br />
sclerosis, for which she was taking baclofen, methyl-<br />
phenidate, glatiramer acetate injection, neurontin,<br />
amantadine, escitalopram oxalate and bupropion.<br />
She denied any family history of eye disease.<br />
Examination:<br />
On examination, visual acuity was 20/800 in the right<br />
eye and 20/400 in the left eye. Pupils were equal<br />
in size and reactive, without an afferent pupillary<br />
defect. Extraocular movements were full. Intraocular<br />
pressures were 12 mm Hg in the right eye and 10<br />
mm Hg in the left eye. Anterior segment examination<br />
demonstrated normal eyelids, sclera and conjunc-<br />
tiva. Bilateral diffuse stromal and epithelial edema<br />
was observed with marked Descemet membrane<br />
folds and pre-Descemet membrane opacification<br />
without guttae (Figure 1). Ultrasound pachymetry<br />
demonstrated a central corneal thickness of 867<br />
µm in the right eye and 700 µm in the left eye. The<br />
anterior chambers were deep and quiet. The iris<br />
and lens were normal. Dilated fundus examination<br />
of both eyes was unremarkable.<br />
Diagnosis:<br />
Diagnoses considered included Fuchs endothelial<br />
dystrophy, endotheliitis, congenital hereditary<br />
endothelial dystrophy and posterior polymorphous<br />
dystrophy. In this case, a lack of guttae on examina-<br />
tion combined with the historical features of no<br />
previous intraocular surgery and amantadine use<br />
led to the diagnosis of amantadine-associated<br />
corneal edema. With the approval of the patient’s<br />
neurologist, amantadine was discontinued and the<br />
patient was followed for six weeks with minimal<br />
improvement of the bilateral corneal edema.<br />
Prednisolone acetate 1 percent was initiated four<br />
times daily in both eyes and the patient was followed<br />
for an additional six weeks. Although she demonstrated<br />
initial improvement, best corrected vision<br />
was 20/200 in both eyes.<br />
The patient was offered Descemet’s stripping<br />
automated endothelial keratoplasty (DSAEK) in the<br />
right eye. After informed consent was obtained, she<br />
underwent uncomplicated surgery. The patient, who<br />
had no appreciable nuclear sclerosis, was left phakic<br />
and was given topical pilocarpine 1 percent preoperatively.<br />
Descemet stripping was performed under air,<br />
and a donor lenticule was prepared on an artificial<br />
anterior chamber and punched to 8.5 mm just prior to<br />
insertion. Controlled tamponade of the graft against<br />
the host stroma was performed with air infusion and<br />
air-fluid exchange as described previously. 1 Three<br />
months after surgery, the patient’s best corrected<br />
visual acuity was 20/30+ in the right eye. Her cornea<br />
was clear and compact with minimal anterior stromal<br />
haze and the posterior donor lenticule was wellcentered<br />
(Figure 2). DSAEK is planned in the left eye.<br />
Discussion:<br />
Amantadine was developed for short-term use as<br />
an antiviral drug against influenza A, also is used<br />
chronically to treat tremors and stiffness in Parkinson’s<br />
disease and fatigue associated with multiple<br />
sclerosis. The mechanism of its action is not well<br />
understood. Reported ocular side effects include<br />
visual loss, hallucination, oculogyric crises and<br />
mydriasis. 2 Corneal side effects include superficial<br />
punctuate keratitis, punctuate subepithelial opacities,<br />
and epithelial and stromal edema. 2 Corneal edema<br />
occurs from a few weeks to many years after commencing<br />
amantadine therapy. 2-6 <strong>Clinic</strong>al exam<br />
demonstrates bilateral, diffuse stromal and microcystic<br />
epithelial edema, without guttae or inflammatory
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | INVESTIGATIONS<br />
Figure 1a Figure 1b Figure 1c<br />
signs. First-line management consists of discontinu-<br />
ing amantadine, which results in the resolution of<br />
corneal edema in most cases. 2-6 However, it has<br />
recently been reported that corneal edema may be<br />
irreversible, and penetrating keratoplasty has been<br />
employed with good anatomic and visual outcomes. 2<br />
The pathophysiology of amantadine-associated<br />
corneal edema is not fully understood, but the<br />
medication is thought to damage endothelial cells, as<br />
evidenced by the presence of rare endothelial cells<br />
on routine light microscopy and areas of denuded<br />
endothelial cells on scanning electron microscopy. 2<br />
The presence of a posterior collagenous layer by<br />
transmission electron microscopy supports the<br />
hypothesis that amantadine leads to endothelial<br />
stress. 2 Other authors have demonstrated a low<br />
endothelial cell density by specular microscopy after<br />
discontinuation of amantadine, even in corneas<br />
that cleared and returned to normal thickness. 3<br />
It remains unclear why only a small fraction of patients<br />
treated with amantadine develops corneal edema.<br />
References<br />
1. Meisler DM, Dupps WJ, Jr., Covert DJ, Koenig SB.<br />
Use of an air-fluid exchange system to promote graft<br />
adhesion during Descemet’s stripping automated<br />
endothelial keratoplasty. J Cataract Refract Surg.<br />
2007;33(5):770-2.<br />
2. Jeng BH, Galor A, Lee MS, et al. Amantadineassociated<br />
corneal edema potentially irreversible<br />
even after cessation of the medication.<br />
<strong>Ophthalmology</strong>. 2008;115(9):1540-4.<br />
3. Chang KC, Kim MK, Wee WR, Lee JH. Corneal<br />
endothelial dysfunction associated with amantadine<br />
toxicity. Cornea. 2008;27(10):1182-5.<br />
4. Hughes B, Feiz V, Flynn SB, Brodsky MC.<br />
Reversible amantadine-induced corneal edema<br />
in an adolescent. Cornea. 2004;23(8):823-4.<br />
DSAEK, a partial thickness transplantation of<br />
the posterior corneal surface, is emerging as the<br />
preferred procedure for managing endothelial<br />
dysfunction in the absence of stromal opacities<br />
because of its more predictable refractive outcomes,<br />
faster visual recovery, and maintenance of the<br />
structural integrity of the eye. Although most com-<br />
monly used for Fuch’s dystrophy and pseudophakic<br />
or aphakic bullous keratopathy, DSAEK also has been<br />
7, 8<br />
used in cases of iridocorneal endothelial syndrome.<br />
To our knowledge, this is the first patient in which<br />
DSAEK was employed in amantadine-associated<br />
corneal edema, and a successful outcome was<br />
achieved for our patient. This case highlights the<br />
importance of considering amantadine toxicity in the<br />
differential diagnosis of corneal edema without an<br />
identifiable ocular cause and suggests the utility of<br />
DSAEK in the treatment of this rare condition.<br />
Dr. Hood is a resident at Cole Eye Institute. For more<br />
information, contact ophthalmologyupdate@ccf.org.<br />
5. Kubo S, Iwatake A, Ebihara N, et al. Visual<br />
impairment in Parkinson’s disease treated with<br />
amantadine: case report and review of the literature.<br />
Parkinsonism Relat Disord. 2008;14(2):166-9.<br />
6. Pond A, Lee MS, Hardten DR, et al. Toxic corneal<br />
oedema associated with amantadine use.<br />
Br J Ophthalmol. 2009;93(3):281,413.<br />
7. Price MO, Price FW, Jr. Descemet stripping with<br />
endothelial keratoplasty for treatment of iridocorneal<br />
endothelial syndrome. Cornea. 2007;26(4):493-7.<br />
8. Jeng BH, Dupps WJ, Jr., Meisler DM, Schoenfield L.<br />
Epithelial debridement for the treatment of<br />
epithelial basement membrane abnormalities<br />
coincident with endothelial disorders. Cornea.<br />
2008;27(10):1207-11.<br />
9
10<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
VEGF Trap-Eye for AMD in Phase III Trials<br />
Phase II results promising; <strong>Cleveland</strong> <strong>Clinic</strong> Cole Eye Institute specialist on executive committee<br />
Peter K. Kaiser, MD<br />
Phase III trials of VEGF Trap-Eye, a promising new<br />
treatment for age-related macular degeneration<br />
(AMD), are under way nationally and a <strong>Cleveland</strong><br />
<strong>Clinic</strong> Cole Eye Institute retina specialist has a key<br />
leadership role in the research.<br />
Peter K. Kaiser, MD, who is on the Executive<br />
Committee of the 150-plus site Phase III study,<br />
explains that the results of the Phase II study of<br />
VEGF Trap-Eye, for which the Cole Eye Institute<br />
was the central reading center, were very positive.<br />
“The number of treatments required to achieve the<br />
desired results was considerably less than with our<br />
current standards of care, ranibizumab injection<br />
(Lucentis ® ) and bevacizumab (Avastin ® ),” he says.<br />
VEGF Trap-Eye is a unique fusion protein that<br />
binds all forms of VEGF (vascular endothelial<br />
growth factor) and PLGF (placental growth factor),<br />
which is another member of the VEGF family that<br />
binds to the VEGF receptor 1 and activates VEGF<br />
receptor signaling. PLGF indirectly increases VEGF<br />
concentration, is upregulated in neovascularization<br />
and is thought to be involved in the pathophysiology<br />
of AMD.<br />
Dr. Kaiser explains that VEGF Trap-Eye is a soluble<br />
receptor decoy that works in a manner similar to<br />
ranibizumab or bevacizumab but binds VEGF<br />
tighter than these drugs and even the native<br />
receptors, so it may last longer and/or achieve<br />
better outcomes.<br />
In the multicenter Phase II study, 157 patients<br />
received an initial intravitreal injection and then<br />
were randomly assigned to one of five VEGF Trap<br />
dosing schedules:<br />
-0.5 mg every four weeks<br />
-2 mg every four weeks<br />
-0.5 mg every 12 weeks<br />
-2 mg every 12 weeks<br />
-4 mg every 12 weeks<br />
“VEGF Trap-Eye achieved clinically<br />
meaningful and durable vision improvement<br />
over one year with almost two lines gained<br />
at week 52 and an excellent reduction in<br />
central retinal lesion thickness at week 52<br />
as measured by OCT.”<br />
All patients were redosed no later than week 12.<br />
As-needed (PRN) dosing began at week 16 and<br />
continued through week 52. Criteria for the PRN<br />
dosing after 16 weeks included persistent fluid as<br />
visualized with optical coherence tomography<br />
(OCT), a loss of ≥ 5 ETDRS letters with recurrent<br />
fluid on OCT, new or persistent leakage seen via<br />
fluorescein angiography, a new macular hemor-<br />
rhage, central retinal thickness ≥100 µm as seen<br />
on OCT or new onset classic neovascularization.<br />
At 12 weeks, mean change central retinal/lesion<br />
thickness (CR/LT), which was the study’s primary<br />
endpoint, was best in the 2 mg every four weeks<br />
group. Mean change in visual acuity, the secondary<br />
endpoint, was best in the patients receiving<br />
treatment every four weeks, with approximately a<br />
1.5-line gain in vision, but even the patients treated<br />
every 12 weeks gained around one line in vision.<br />
The mean number of doses given during the PRN<br />
phase averaged 2.1 across all treatment groups.<br />
“Patients received, on average, only two addition-<br />
al injections over the 40-week PRN-dosing phase.<br />
No additional injections were used after week 12<br />
in 19 percent of patients,” Dr. Kaiser says. “VEGF<br />
Trap-Eye achieved clinically meaningful and<br />
durable vision improvement over one year with<br />
almost two lines gained at week 52 and an<br />
excellent reduction in central retinal lesion<br />
thickness at week 52 as measured by OCT.”<br />
The drug was generally well tolerated, he adds.
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | INVESTIGATIONS<br />
Regeneron and Bayer HealthCare are collaborating on<br />
the development of VEGF Trap-Eye for the treatment<br />
of wet AMD, diabetic eye diseases and other eye<br />
disorders. Bayer HealthCare will market VEGF<br />
Trap-Eye outside the United States, while Regeneron<br />
maintains exclusive rights in the United States.<br />
The companies have initiated the Phase III trial<br />
to evaluate dosing at 0.5 mg every four weeks,<br />
2 mg every four weeks or 2 mg every eight weeks,<br />
following three monthly doses, in direct comparison<br />
with ranibizumab administered 0.5 mg every<br />
four weeks. PRN dosing will be evaluated during<br />
the second year. This study is ongoing throughout<br />
AngioQuest<br />
Peter K. Kaiser, MD, is Chief Medical Officer<br />
of a new <strong>Cleveland</strong> <strong>Clinic</strong>-owned company,<br />
AngioQuest.<br />
The company has three anti-angiogenic platforms<br />
that are in pre-clinical testing. One is based on<br />
the work by Cole Eye Institute researcher Bela<br />
Anand-Apte, PhD, with tissue inhibitor of<br />
metalloproteinase (TIMP3). The second is based<br />
on the work of Tatiana Byzova, PhD, in <strong>Cleveland</strong><br />
the world and at the Cole Eye Institute.<br />
“We are always looking for better treatments for<br />
macular degeneration that can offer our patients<br />
the best outcomes with fewer treatments,” Dr.<br />
Kaiser says. “We hope that the Phase III trials will<br />
confirm that VEGF Trap-Eye is an incremental step<br />
over what we currently have.”<br />
For more information,<br />
contact ophthalmologyupdate@ccf.org.<br />
<strong>Clinic</strong>’s Department of Molecular Cardiology,<br />
regarding AlphavBeta3 integrin. The third<br />
involves carboxyethyl pyrrole (CEP), work led<br />
by Dr. Anand-Apte and John W. Crabb, PhD,<br />
also of the Cole Eye Institute.<br />
For more information about AngioQuest, please<br />
contact Neema Mayhugh, PhD, at 216.445.7176 or<br />
mayhugn@ccf.org.<br />
11
12<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
Cole Eye Institute Researchers Describe a Difference<br />
in the Biomechanical Impact of Hyperopic Versus Myopic LASIK<br />
William J. Dupps, Jr.,<br />
MD, PhD<br />
By thinning the cornea and severing anterior<br />
corneal lamellae, LASIK and other photoablative<br />
keratorefractive procedures induce changes in<br />
corneal material properties. In some patients,<br />
these structural alterations can contribute to residual<br />
postoperative refractive error or even biomechanical<br />
instability in the form of ectasia. At the<br />
Cole Eye Institute, William J. Dupps, Jr., MD, PhD,<br />
has been actively involved in conducting research<br />
in this field, including developing methods for<br />
assessing the cornea’s biomechanical properties<br />
and studies to determine how they are affected by<br />
corneal pathology and surgery.<br />
Results from a recent study using the Ocular<br />
Response Analyzer (ORA, Reichert) to investigate<br />
biomechanical changes early after myopic and<br />
hyperopic LASIK support the hypothesis that<br />
differences in the ablation pattern of these two<br />
procedures leads to marked differences in their<br />
biomechanical impact. The work was performed in<br />
collaboration with Fabricio W. Medeiros, MD, and<br />
Abhijit Sinha Roy, PhD, of the Cole Eye Institute<br />
Laboratory of Ocular Biomechanics & Imaging.<br />
Extrapolating these findings to clinical outcomes,<br />
Dr. Dupps postulates they may account for the<br />
observation that post-LASIK ectasia occurs more<br />
often after myopic versus hyperopic keratorefractive<br />
ablation procedures. The results also may explain<br />
the greater artifactual decrease in IOP after myopic<br />
versus hyperopic corneal ablative surgery.<br />
“Interest in understanding the underlying mechanisms<br />
of patient-specific outcomes after laser<br />
vision refractive surgery has been one motivation<br />
driving corneal biomechanics research. With the<br />
ORA, researchers have for the first time a useful<br />
tool for collecting in vivo data in a clinical setting,”<br />
notes Dr. Dupps.<br />
“Previous investigations using this instrument<br />
have shown significant differences in the corneal<br />
biomechanical properties of post-LASIK eyes<br />
compared with normal, virgin corneas. To our<br />
knowledge, ours is the first study investigating<br />
how LASIK-induced changes in corneal material<br />
properties are affected by the specific photo<br />
ablation pattern.”<br />
The study was a retrospective analysis of preop-<br />
erative and one-week postoperative data extract-<br />
ed from chart review of 13 eyes of 13 myopic<br />
patients and 11 eyes of 11 hyperopic patients.<br />
In order to isolate a potential influence of<br />
differences in the photoablative pattern on<br />
corneal biomechanics, other factors that might<br />
affect the outcome were evaluated.<br />
All myopic and hyperopic procedures were<br />
performed with the same flap construction<br />
method using the same femtosecond laser with<br />
similar energy settings to create thin flaps of<br />
similar attempted depth and diameter. In addition,<br />
the ablations were performed with a single excimer<br />
laser system, and the mean total number of fixed<br />
spot-size photoablative pulses, which is a surro-<br />
gate for ablated corneal volume, was comparable<br />
in the myopic and hyperopic groups. Statistical<br />
analyses showed the two groups also were similar<br />
preoperatively with respect to mean values for<br />
central corneal thickness as well as for the two<br />
ORA-derived biomechanical measures, corneal<br />
hysteresis (CH) and corneal resistance factor (CRF).<br />
ORA measurements performed at one week after<br />
surgery showed significant differences between<br />
the myopes and hyperopes that demonstrated<br />
the hyperopic procedures had less impact on the<br />
ORA’s standard corneal viscoelastic parameters.<br />
Compared with the hyperopes, the myopes had<br />
both significantly lower mean CH and CRF values<br />
and a significantly greater decrease in both<br />
measures. In addition, there was a significantly<br />
greater reduction in Goldmann-equivalent IOP<br />
(IOPg) after surgery in the myopic group compared<br />
with the hyperopes.
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | INVESTIGATIONS<br />
“Results from a recent study using the Ocular Response Analyzer (ORA, Reichert) to investigate<br />
biomechanical changes early after myopic and hyperopic LASIK support the hypothesis that<br />
differences in the ablation pattern of these two procedures leads to marked differences in<br />
their biomechanical impact.”<br />
“A tendency for IOP to be underestimated by<br />
applanation tonometry in eyes that have undergone<br />
myopic LASIK has been previously recognized<br />
and was originally attributed to thinning<br />
of the central cornea where the IOP measurement<br />
is made. Our data corroborate this postoperative<br />
change in IOP with central ablation but also<br />
demonstrate that a change in the biomechanical<br />
status of the cornea with little removal of tissue in<br />
the central 3 mm impacts the IOP measurement<br />
after surgery,” Dr. Dupps says.<br />
Regression analyses performed to examine any<br />
relationship between the number of laser pulses<br />
delivered and the changes in CH and CRF values<br />
showed no statistical correlations in the hyperopic<br />
group or for change in CH in the myopic group.<br />
However, there was a statistically significant inverse<br />
relationship between change in CRF and the number<br />
of laser pulses delivered for the myopic ablations.<br />
Dr. Dupps observes that the lesser impact of the<br />
hyperopic ablation on corneal biomechanics might<br />
be predicted based on knowledge of regional<br />
differences in corneal tissue architecture. Relative<br />
to the central ablation of myopic corrections,<br />
hyperopic procedures remove a paracentral annulus<br />
of tissue and involve an area of the cornea that is<br />
relatively thicker and biomechanically stronger.<br />
“The cornea is thinnest in the center and becomes<br />
thicker moving toward the periphery, and the<br />
collagen lamellae become more tightly interwoven<br />
moving anteriorly toward the epithelium and<br />
outward toward the limbus. Therefore, hyperopic<br />
LASIK removes proportionally less corneal<br />
thickness than myopic corrections and leaves<br />
a stronger underlying interlamellar network.<br />
Together, these features may be important<br />
in minimizing the biomechanical impact of<br />
hyperopic ablation profiles,” he explains.<br />
One other factor that could contribute to the<br />
measured differences in the biomechanical impact<br />
of myopic and hyperopic ablation profiles could be<br />
that ORA data are derived from reflections of<br />
infrared light off the central 3 mm of the cornea.<br />
“Previous work from our laboratory, as well as<br />
emerging clinical data, suggest that central<br />
corneal biomechanical behavior and, therefore,<br />
ORA measurements are affected by in the mechanical<br />
conditions outside the central cornea, suggesting<br />
that device spatial sampling bias may not be<br />
sufficient to explain the measured differences,”<br />
notes Dr. Dupps.<br />
Continuing their research, Dr. Dupps and colleagues<br />
are adding more patients to their study<br />
groups. In addition, they have designed several<br />
new variables based on custom signal waveform<br />
analysis of the ORA measurements to try to gain<br />
more sensitive and specific indicators of biomechanical<br />
change. Preliminary analyses reveal<br />
differences between several variables in their<br />
responses to myopic versus hyperopic surgery.<br />
“Currently, we are analyzing multiple candidate<br />
variables not only for the purpose of identifying<br />
additional predictors of the biomechanical and<br />
optical responses to refractive surgery, but also<br />
for early detection of keratoconus in a refractive<br />
surgery screening setting,” says Dr. Dupps.<br />
For more information,<br />
contact ophthalmologyupdate@ccf.org.<br />
13
14<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
Reducing the Progression of Retinopathy of Prematurity<br />
Jonathan E. Sears, MD<br />
Two recent <strong>Cleveland</strong> <strong>Clinic</strong> publications highlight<br />
the idea that stimulating angiogenesis can prevent<br />
retinopathy of prematurity (ROP). 1,2<br />
In the March 2009 issue of <strong>Ophthalmology</strong>,<br />
<strong>Cleveland</strong> <strong>Clinic</strong> ophthalmologist Jonathan E.<br />
Sears, MD, and Fairview Hospital neonatologist<br />
Jeffrey Pietz, MD, reported that a modified oxygen<br />
protocol showed not only a reduction in threshold<br />
retinopathy, but more importantly, an increase in<br />
the incidence of normal, orderly development of<br />
the retina without the disease phenotype.<br />
Adjusting Oxygen Saturation by Age<br />
The new protocol calls for decreasing the oxygen<br />
saturation targets when infants are less than 34<br />
weeks, and increasing the saturation targets when<br />
infants are 34 weeks or more. These targets appear<br />
to match in utero saturations and thereby enable<br />
the sequential development of the retina without<br />
provoking the typical disease progression of ROP.<br />
“Our findings in the clinic gave us the idea that we<br />
could use pharmaceutical preconditioning in the<br />
same way as oxygen,” notes Dr. Sears, Principal<br />
Investigator and member of <strong>Cleveland</strong> <strong>Clinic</strong>’s<br />
departments of Ophthalmic Research and Cell<br />
Biology. In a study published in the December 2008<br />
Proceedings of the National Academy of Sciences, he<br />
reported that increasing the activity of hypoxiainducible<br />
factor during early premature age<br />
prevents ROP in a mouse model.<br />
Preventing Many Complications<br />
“The work of Drs. Sears and Pietz opens new<br />
horizons for the prevention of ROP,” says Ricardo<br />
Rodriguez, MD, Director of Neonatal Care at<br />
<strong>Cleveland</strong> <strong>Clinic</strong> Children’s Hospital. “It demonstrates<br />
that inducing normal development of<br />
the retina — either pharmaceutically or by the<br />
judicious use of oxygen — allows for sequential<br />
and orderly retinal development. This has tremendous<br />
implications for the systemic complications<br />
of prematurity found in the lungs and brain.”<br />
Currently, progressive disease is treated surgically,<br />
through laser ablation of the avascular<br />
retina. Advanced proliferative disease requires<br />
more aggressive surgical intervention and has<br />
mixed results.<br />
Reversing Phases for Infants’ Benefit<br />
Both of these studies by Dr. Sears’ group demonstrate<br />
that “reversal” of these stages, either by<br />
hypoxic or pharmaceutical preconditioning, may<br />
benefit children. This process prevents ischemia<br />
and may therefore have application to a wide<br />
range of diseases, such as diabetes and stroke.<br />
“In our NICUs, changes in oxygen administration<br />
practices have significantly decreased the incidence<br />
of ROP,” says Dr. Rodriguez. “We treat the<br />
administration of oxygen just as we do any other<br />
drugs. We are very careful in optimizing oxygen<br />
delivery and monitoring oxygen saturation levels<br />
in these tiny babies to avoid the detrimental effects<br />
of wide blood oxygen level fluctuations on the<br />
immature retina.”<br />
For more information,<br />
contact ophthalmologyupdate@ccf.org.<br />
References<br />
1. Sears JE, Pietz J, Sonnie C, Dolcini D, Hoppe G. A<br />
change in oxygen supplementation can decrease<br />
the incidence of retinopathy of prematurity.<br />
<strong>Ophthalmology</strong>. 2009 Mar;116(3):513-8.<br />
2. Sears JE, Hoppe G, Ebrahem Q, Anand-Apte B.<br />
Prolyl hydroxylase inhibition during hyperoxia<br />
prevents oxygen-induced retinopathy. Proc Natl<br />
Acad Sci USA. 2008 Dec 16;105(50):19898-903.
Case Study: Fundus Photography Useful<br />
for Detecting AMD in Asymptomatic Patient<br />
Rishi P. Singh, MD<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | INVESTIGATIONS<br />
Presentation:<br />
The patient is a 68-year-old man with a medical<br />
history significant for hypertension, hyperglyceridemia<br />
and carotid occlusive disease. He presented for<br />
his annual Executive Health physical examination<br />
and was asked to undergo remote ophthalmology<br />
screening evaluation.<br />
Examination:<br />
On examination, his visual acuity was 20/20 in both<br />
eyes at both distance and near with correction.<br />
Air puff tonometry measurements of intraocular<br />
pressure showed measurements of 12 mm Hg in<br />
the right eye and 11 mm Hg in the left eye. The<br />
non-dilated funduscopic photograph was significant<br />
for large, soft drusen in both eyes with retinal<br />
pigment epithelial changes. The diagnosis of<br />
age-related macular degeneration (AMD) was made<br />
and the patient was referred for full ophthalmologic<br />
evaluation with a retina specialist at Cole Eye<br />
Institute. The follow-up examination confirmed the<br />
diagnosis of dry AMD (category 3) and the patient<br />
was asked to start Age-Related Eye Disease Study<br />
(AREDS) vitamin therapy and monitor his vision<br />
with an Amsler grid for acute changes.<br />
Discussion:<br />
Non-mydriatic fundus photography is a type of<br />
medical imaging of the retina. A customized camera<br />
is used to take high-resolution images, which can<br />
be used to diagnose certain ocular diseases and<br />
monitor disease progression. No medications or<br />
dilation of the pupil is required for the exam.<br />
Through our Cole Fundus Screening Network,<br />
fundus photos of undilated eyes are taken by a<br />
technician in a physician office. The process is<br />
simple, painless and takes about five to seven<br />
minutes. The images are remotely uploaded to the<br />
electronic medical record for review by a fellowshiptrained<br />
retina specialist at Cole Eye Institute.<br />
Readings are performed within two business<br />
days. The report can be shared with patients and<br />
ophthalmologists when referrals are needed.<br />
In the case of this patient, remote ophthalmology<br />
examination resulted in the diagnosis of advanced<br />
dry AMD in a patient with no clinical symptoms and<br />
good vision. AREDS, sponsored by the National Eye<br />
Institute, was designed to determine the clinical<br />
course and prognosis of AMD and cataracts. In<br />
addition, AREDS evaluated the possible risk factors<br />
associated with the development of AMD and<br />
cataracts; the nutritional risk factors were evaluated<br />
and published in October 2001.<br />
Study results showed that antioxidant vitamins and<br />
zinc therapy reduced the risk of developing advanced<br />
AMD in participants with intermediate and greater<br />
risk of developing AMD (categories 3 and 4) by 25<br />
percent. The risk of vision loss of three lines or more<br />
on the logarithmic visual acuity charts was reduced<br />
by 19 percent for these participants. For those who<br />
developed AMD, their risk of vision loss was reduced<br />
by 25 percent. Antioxidants and zinc are now<br />
recommended for patients who have an intermediate<br />
risk of developing advanced AMD.<br />
This case is a prime example of how fundus photog-<br />
raphy is being used at Cole Eye Institute to help<br />
screen patients remotely. We are currently studying<br />
whether this technology has the potential to screen<br />
mass populations easily and effectively for AMD,<br />
diabetic macular edema and glaucoma — conditions<br />
in which timely diagnoses are key to optimal<br />
vision outcomes.<br />
For more information,<br />
contact ophthalmologyupdate@ccf.org.<br />
15
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
Innovation<br />
DEFINING WHAT MAKES US DIFFERENT
I N S T I T U T E O V E R V I E W<br />
At <strong>Cleveland</strong> <strong>Clinic</strong> Cole Eye Institute, we have assembled a<br />
team of the world’s foremost clinicians and researchers who<br />
are committed not only to delivering the finest healthcare<br />
available, but also to improving tomorrow’s care through<br />
innovative basic, clinical and translational research.<br />
We believe that research and patient care are interdependent.<br />
Therefore, we forge synergistic relationships through analytical<br />
and integrative processes, such as surgical outcomes analysis.<br />
We are pioneering treatment protocols for complex vision-<br />
threatening disorders through our clinical trials and aggressive<br />
research programs to shorten the gap between the laboratory<br />
discoveries of today and the patient care of tomorrow. Our goal:<br />
Answering tomorrow’s medical problems through today’s<br />
laboratory and research endeavors.<br />
<strong>Clinic</strong>al Expertise<br />
As one of the leading comprehensive eye institutes in the world,<br />
we are able to enhance the lives of our patients and serve our<br />
referring physicians by providing early, accurate diagnosis and<br />
excellent, efficient state-of-the-art care. Our program consis-<br />
tently ranks amongst the highest in the U.S.News & World<br />
Report annual survey. We have some of the largest patient<br />
volumes in the United States, with more than 140,000 patient<br />
visits and more than 5,000 surgeries per year. We offer primary,<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | INNOVATIONS<br />
secondary and tertiary ophthalmologic services for all ages.<br />
Our internationally recognized staff of 33 ophthalmologists<br />
and researchers is composed almost entirely of subspecialists,<br />
and seven optometrists round out our comprehensive services.<br />
Patient-Centered Facilities<br />
We deliver care in a state-of-the-art building that demonstrates<br />
our dedication to putting patients first. Our facilities deliver<br />
maximum patient comfort, service and quality. We offer<br />
one-stop care, with our exam lanes, diagnostic services suite<br />
and operating rooms all in one building, which includes such<br />
special features as:<br />
• Windows with special filters to minimize light on dilated<br />
or newly treated eyes.<br />
• A comfortable waiting room that includes a special play area<br />
for children.<br />
• Amenities such as valet parking and an easy postoperative<br />
pickup area.<br />
• Conveniently located food services.<br />
Our regional eye care program also brings care into the<br />
community, providing services in six convenient suburban<br />
locations and one ambulatory surgery center.<br />
Continued<br />
17
18<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
I N S T I T U T E O V E R V I E W continued<br />
Fostering Innovation<br />
Our institute is specially designed to enable clinicians to develop<br />
tomorrow’s advances; our facility includes an Experimental<br />
Surgery Suite — one of the few in the country with full operating<br />
capacity. Training future eye specialists is greatly enhanced in<br />
the Education Pavilion, with the James P. Storer Conference<br />
Center (designed with tele-video technology), as well as video<br />
rooms, resident carrels and ample conference space.<br />
Unique Programs at Cole Eye Institute<br />
The Center for Genetic Eye Diseases: The Center for Genetic Eye<br />
Diseases provides multidisciplinary clinical diagnostic and<br />
therapeutic services for patients with inherited eye conditions<br />
such as corneal and retinal dystrophies and microphthalmia.<br />
Patients with inherited disorders that involve the eye, such as<br />
neurofibromatosis, albinism, neurodegenerative disorders<br />
and Marfan syndrome, are referred to the Center by physicians<br />
from around the country. A regular specialty clinic is dedicated<br />
to patients with retinal dystrophies and their families.<br />
A National Eye Donor Program: The Foundation Fighting Blind-<br />
ness’ Center, a central collection agency for eyes donated by<br />
individuals across the United States for blindness research,<br />
shares tissue samples with researchers worldwide. Formally<br />
known as the Retinal Degeneration Pathophysiology Facility,<br />
the collection center accepts eye donations after death from<br />
any person of any age who has normal vision or any degree of<br />
vision loss resulting from a retinal-degenerative disease. Cole<br />
Eye Institute staff members prepare a detailed medical report<br />
about each donated eye to help researchers track the effects of<br />
eye disease in different types of people and environments.<br />
For more information or to refer a patient,<br />
please call 216.444.2020 or 800.223.2273 ext. 42020<br />
or visit clevelandclinic.org/OUspecial.<br />
2008 Key Statistics<br />
Total <strong>Clinic</strong> Visits ......................................... 144,929<br />
Total Surgical Procedures ..................................8,171<br />
Total Surgeries ................................................ 5,215<br />
Total Cataract Procedures ................................. 2,545<br />
Total Cornea Procedures .....................................253<br />
Total Glaucoma Procedures ................................. 341<br />
Total Retina Procedures ....................................3,191<br />
Total Oncology Procedures ............................... 1,062<br />
Total Oculoplastics Procedures .......................... 1,460<br />
Total Strabismus Procedures ................................553<br />
Total Refractive Procedures .............................. 1,498<br />
Total Laser Procedures ..................................... 1,458<br />
Total Intraocular Drug Procedures ...................... 2,248
O U T C O M E S : C R E AT I N G B E N C H M A R K S,<br />
S T R I V I N G F O R I M P R O V E M E N T<br />
<strong>Clinic</strong>al outcomes allow us to understand and objectively measure<br />
the success of our surgical results.<br />
Cole Eye Institute has recently released its 2008 Outcomes<br />
review. This is the third year we have shared our clinical<br />
outcomes with referring physicians, alumni and potential<br />
patients around the country.<br />
Our key evaluatory measures continue to be visual acuity and<br />
the rate of surgical complications, and we continue to use<br />
ETDRS protocol refraction as the means of measuring visual<br />
acuity. The key measurement variables are mentioned under<br />
each section in the book. In addition to clinical outcomes,<br />
world-class customer service is very important to us. Conse-<br />
quently, we have spent significant time understanding patient<br />
flow process and experience. We continue to seek best practice<br />
measurement processes for both clinical and administrative<br />
areas. We strive to set the standard for excellence by innovating<br />
and by consistent follow-up and measurement to evaluate our<br />
overall clinical proficiency.<br />
The Outcomes book has data from across the full spectrum<br />
of ophthalmic surgery, including:<br />
• Cataract surgery<br />
• Cornea surgery<br />
• Glaucoma surgery<br />
• Oculoplastic surgery<br />
• Oncologic eye procedures<br />
• Refractive surgery<br />
• Vitreoretinal surgery<br />
• Strabismus surgery<br />
Almost all of the surgical procedures performed at the Cole Eye<br />
Institute have been tracked and reported. As a regional, national<br />
and international referral center, many of our patients are<br />
followed by their local ophthalmologists, and the data do not<br />
include patients who are not followed at the Cole Eye Institute.<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | INNOVATIONS<br />
The scope of the Cole Eye Institute outcomes project is signifi-<br />
cant, our approach is innovative, and in spite of the complexity of<br />
cases and lack of a clear benchmark, our outcomes are excellent.<br />
Our physicians strive to push the boundaries of science and<br />
technology to provide excellence for our patients. We hope that<br />
by reviewing and analyzing information, we will continue to<br />
improve and offer patients better outcomes.<br />
<strong>Cleveland</strong> <strong>Clinic</strong> has created a series of outcomes books<br />
for its institutes. The Outcomes books contain a summary<br />
of our surgical and medical trends and approaches; data<br />
on patient volume and outcomes; and a review of new<br />
technologies and innovations.<br />
To view all our outcomes books, or to download a copy of Cole Eye<br />
Institute’s 2008 <strong>Clinic</strong>al Outcomes book, visit <strong>Cleveland</strong> <strong>Clinic</strong>’s<br />
Quality Web site at clevelandclinic.org/quality/outcomes.<br />
19
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
Staff<br />
IDENTIFYING WHO WE ARE
ARVO Awards Highest Honor to Cole Eye Institute Director of<br />
Ophthalmic Research<br />
Joe G. Hollyfield, PhD, the inaugural Director of Ophthalmic<br />
Research at Cole Eye Institute, has earned the 2009 Proctor<br />
Medal from the Association for Research in Vision and<br />
<strong>Ophthalmology</strong> (ARVO).<br />
Dr. Hollyfield, who joined <strong>Cleveland</strong> <strong>Clinic</strong> in 1995, also is<br />
Professor of <strong>Ophthalmology</strong> at the <strong>Cleveland</strong> <strong>Clinic</strong> Lerner<br />
College of Medicine of Case Western Reserve University and<br />
Director of the Foundation Fighting Blindness Research Center<br />
at the Cole Eye Institute.<br />
He was awarded the prestigious medal for his significantly<br />
advancing the understanding of the cell biology of photoreceptors,<br />
interphotoreceptor matrix and the pigment epithelium.<br />
The Proctor Medal is the oldest and highest award presented by<br />
ARVO to honor an individual for exceptional contributions to<br />
ophthalmology and visual science. The award was established<br />
in 1949 as a memorial to Dr. Francis I. Proctor, an ophthalmologist<br />
who conducted research on the etiology and treatment of<br />
trachoma. The Proctor Medal was the first ophthalmology-related<br />
award to honor both non-clinical and clinical scientists.<br />
N E W C O L E E Y E IN S T I T U T E S TA F F IN 20 0 9<br />
Paul J. Rychwalski, MD, joined Cole Eye<br />
Institute’s Pediatric <strong>Ophthalmology</strong> and<br />
Strabismus Department in January 2009.<br />
Dr. Rychwalski is a graduate of the<br />
Medical College of Wisconsin. He<br />
completed his residency at the Saint Louis<br />
University School of Medicine, Saint Louis,<br />
Mo., and his fellowship in pediatric ophthalmology and adult<br />
strabismus at the University of Kentucky School of Medicine.<br />
His specialty interests include ocular diseases of children,<br />
strabismus, retinopathy of prematurity, congenital cataracts,<br />
pathogenesis of myopia, amblyopia and shaken<br />
baby syndrome.<br />
He can be reached at rychwap@ccf.org.<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | STAFF<br />
JOE G. HOLLYFIELD, PHD, RECEIVES PRO CTOR MEDAL<br />
Dr. Hollyfield received the award and delivered the Proctor<br />
Award Lecture “Progress in understanding the initiating<br />
events in age-related macular degeneration” at the ARVO<br />
Annual Meeting on May 3-6, 2009.<br />
ARVO was founded in 1928 in Washington, DC, and was<br />
originally named the Association for Research in <strong>Ophthalmology</strong><br />
(ARO). The word “vision” was added in 1970 to better reflect<br />
the scientific profile of its members. ARVO’s membership is<br />
comprised of more than 11,500 individuals from multiple<br />
specialties, encompassing both clinical and basic researchers.<br />
Jonathan A. Eisengart, MD, joined Cole<br />
Eye Institute’s Glaucoma staff in July 2009.<br />
Dr. Eisengart received his medical<br />
degree from The Ohio State University,<br />
Columbus, Ohio. He completed his<br />
residency and fellowship in glaucoma<br />
and anterior segment surgery at the<br />
University of Michigan, Kellogg Eye Center, in Ann Arbor, Mich.<br />
His specialty interests include medical, laser and surgical<br />
glaucoma management, including filtering surgery with<br />
antimetabolites, glaucoma tube shunts, cyclodestructive<br />
procedures, combined cataract and glaucoma surgery and<br />
anti-VEGF therapy in glaucoma.<br />
He can be reached at eisengj@ccf.org.<br />
21
22<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
L E A D E R S H I P R O L E S<br />
ROLES IN PUBLISHING<br />
American Journal of <strong>Ophthalmology</strong><br />
Executive Editor, Genetics Section<br />
Elias I. Traboulsi, MD<br />
Executive Editor, Oculoplastic Section<br />
Julian D. Perry, MD<br />
Editorial Board<br />
Peter K. Kaiser, MD<br />
Elias I. Traboulsi, MD<br />
Reviewers/Referees<br />
Peter K. Kaiser, MD<br />
Ronald R. Krueger, MD<br />
Careen Y. Lowder, MD, PhD<br />
Daniel F. Martin, MD<br />
Julian D. Perry, MD<br />
Edward J. Rockwood, MD<br />
Andrew P. Schachat, MD<br />
Jonathan E. Sears, MD<br />
Rishi P. Singh, MD<br />
Steven E. Wilson, MD<br />
Archives of Facial Plastic Surgery<br />
Reviewer/Referee<br />
Julian D. Perry, MD<br />
Archives of <strong>Ophthalmology</strong><br />
Reviewers/Referees<br />
William J. Dupps, Jr., MD, PhD<br />
Peter K. Kaiser, MD<br />
Gregory S. Kosmorsky, DO<br />
Ronald R. Krueger, MD<br />
Careen Y. Lowder, MD, PhD<br />
Daniel F. Martin, MD<br />
Julian D. Perry, MD<br />
Paul J. Rychwalski, MD<br />
Andrew P. Schachat, MD<br />
Jonathan E. Sears, MD<br />
British Journal of <strong>Ophthalmology</strong><br />
Editor-in-Chief (U.S.)<br />
Arun D. Singh, MD<br />
Editorial Board<br />
Jonathan E. Sears, MD<br />
Reviewers/Referees<br />
William J. Dupps, Jr., MD, PhD<br />
Peter K. Kaiser, MD<br />
Rishi P. Singh, MD<br />
<strong>Clinic</strong>al and Experimental Optometry<br />
Reviewer/Referee<br />
William J. Dupps, Jr., MD, PhD<br />
<strong>Clinic</strong>al <strong>Ophthalmology</strong><br />
Reviewers<br />
Gregory S. Kosmorsky, DO<br />
Edward J. Rockwood, MD<br />
<strong>Clinic</strong>al Ophthalmic Oncology<br />
Section Editor<br />
Julian D. Perry, MD<br />
Comprehensive <strong>Ophthalmology</strong> <strong>Update</strong><br />
Reviewer/Referee<br />
Peter K. Kaiser, MD<br />
Contemporary <strong>Ophthalmology</strong><br />
Editorial Board<br />
Elias I. Traboulsi, MD<br />
Cornea<br />
Editorial Board<br />
Steven E. Wilson, MD<br />
Reviewers/Referees<br />
William J. Dupps, Jr., MD, PhD<br />
Ronald R. Krueger, MD
Current Eye Research<br />
Reviewers/Referees<br />
William J. Dupps, Jr., MD, PhD<br />
Peter K. Kaiser, MD<br />
Current Concepts in Retina (Dothen<br />
Healthcare Press, Morristown, N.J.)<br />
Editor-in-Chief<br />
Peter K. Kaiser, MD<br />
Developmental Neuropsychology<br />
Reviewer<br />
Paul J. Rychwalski, MD<br />
Documenta Ophthalmolgica<br />
Editorial Board<br />
Neal S. Peachey, PhD<br />
Experimental Eye Research<br />
Executive Editor, Editor-in-Chief<br />
Joe G. Hollyfield, PhD<br />
Section Editor<br />
Steven E. Wilson, MD<br />
Editorial Board<br />
Bela Anand-Apte, MBBS, PhD<br />
John W. Crabb, PhD<br />
Steven E. Wilson, MD<br />
Reviewer/Referee<br />
William J. Dupps, Jr., MD, PhD<br />
Neal S. Peachey, PhD<br />
Jonathan E. Sears, MD<br />
Eye<br />
Reviewer/Referee<br />
Rishi P. Singh, MD<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | STAFF<br />
Investigative <strong>Ophthalmology</strong><br />
and Visual Science<br />
Editorial Board<br />
Steven E. Wilson, MD<br />
Reviewer/Referee<br />
Edward J. Rockwood, MD<br />
Jonathan E. Sears, MD<br />
Journal of Cataract & Refractive Surgery<br />
Reviewer<br />
Edward J. Rockwood, MD<br />
Journal of Glaucoma<br />
Reviewer<br />
Edward J. Rockwood, MD<br />
Journal of Refractive Surgery<br />
Editorial Board<br />
Steven E. Wilson, MD<br />
Reviewer<br />
Paul J. Rychwalski, MD<br />
Ophthalmic Genetics<br />
Editor-in-Chief<br />
Elias I. Traboulsi, MD<br />
<strong>Ophthalmology</strong><br />
Editor-in-Chief<br />
Andrew P. Schachat, MD<br />
Reviewer/Referee<br />
Ronald R. Krueger, MD<br />
Careen Y. Lowder, MD, PhD<br />
Daniel F. Martin, MD<br />
Julian D. Perry, MD<br />
Jonathan E. Sears, MD<br />
Rishi P. Singh, MD<br />
Steven E. Wilson, MD<br />
Optometry & Visual Science<br />
Reviewer/Referee<br />
William J. Dupps, Jr., MD, PhD<br />
Pediatric Perspectives<br />
Editorial Board<br />
Elias I. Traboulsi, MD<br />
Proceedings of the National<br />
Academy of Science USA<br />
Reviewer/Referee<br />
John W. Crabb, PhD<br />
23
24<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
L E A D E R S H I P R O L E S continued<br />
Retina<br />
Editorial Board<br />
Peter K. Kaiser, MD<br />
Reviewer/Referee<br />
Peter K. Kaiser, MD<br />
Careen Y. Lowder, MD, PhD<br />
Daniel F. Martin, MD<br />
Andrew P. Schachat, MD<br />
Rishi P. Singh, MD<br />
Retina Case Reports<br />
Editorial Advisory Board<br />
Andrew P. Schachat, MD<br />
Retinal Degeneration Symposia<br />
(Springer Publishers)<br />
Co-editor<br />
Joe G. Hollyfield, PhD<br />
Retinal Physician<br />
Editorial Board<br />
Peter K. Kaiser, MD<br />
Retina Today<br />
Editorial Board<br />
Peter K. Kaiser, MD<br />
Review of Endocrinology<br />
Editorial Board; Reviewer/Referee<br />
Peter K. Kaiser, MD<br />
Review of Refractive Surgery<br />
Editorial Board<br />
Ronald R. Krueger, MD<br />
Ryan’s Retina<br />
Editor<br />
Andrew P. Schachat, MD<br />
Survey of <strong>Ophthalmology</strong><br />
Reviewer/Referee<br />
Ronald R. Krueger, MD<br />
Wiley Interdisciplinary Reviews:<br />
Systems Biology & Medicine<br />
Reviewer/Referee<br />
William J. Dupps, Jr., MD<br />
Xenotransplantation<br />
Reviewer/Referee<br />
William J. Dupps, Jr., MD<br />
LE ADERSHIP ROLES<br />
AT CONFERENCES<br />
World Forum of Ophthalmological<br />
Journal Editors<br />
Co-Chair<br />
Andrew P. Schachat, MD<br />
2010 Gordon Conference<br />
Conference co-organizer<br />
Steven E. Wilson, MD<br />
2010 International Congress of<br />
Eye Research<br />
Cornea Section Organizer<br />
Steven E. Wilson, MD
ROLES IN PROFESSIONAL<br />
SOCIETIES AND ORGANIZ ATIONS<br />
American Academy of <strong>Ophthalmology</strong><br />
International Council Representative;<br />
Executive Committee Member; Program<br />
Committee Subcommittee Member;<br />
Education Committee Chair<br />
Ronald R. Krueger, MD<br />
Pre-Academy Retina Subspecialty<br />
Symposium, Planning Committee<br />
Daniel F. Martin, MD<br />
Chairman, Self-Assessment Print<br />
Subcommittee; Maintenance of<br />
Certification Education Committee;<br />
LEO Committee, SAC Liason; Breakfast<br />
with the Experts Panel<br />
Edward J. Rockwood, MD<br />
Board of Trustees<br />
Andrew P. Schachat, MD<br />
American Association for Pediatric<br />
<strong>Ophthalmology</strong> and Strabismus<br />
Chair, Website Committee; Membership<br />
and Credentials Committee<br />
Paul J. Rychwalski, MD<br />
American Board of <strong>Ophthalmology</strong><br />
Director<br />
David M. Meisler, MD<br />
American Glaucoma Society<br />
Research Committee Expert Panel<br />
Edward J. Rockwood, MD<br />
American Health Assistance Foundation<br />
Chairman, Macular Degeneration<br />
Review Panel<br />
Joe G. Hollyfield, PhD<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | STAFF<br />
American Society of Ophthalmic Plastic<br />
and Reconstructive Surgery<br />
Fellowship<br />
Julian D. Perry, MD<br />
American Society of Retina Specialists<br />
Board Member<br />
Andrew P. Schachat, MD<br />
Case Western University School<br />
of Medicine<br />
Chairman, Annual Fund of the CWRU<br />
School of Medicine; Medical Alumni<br />
Association Board<br />
Allen S. Roth, MD<br />
<strong>Cleveland</strong> Browns,<br />
National Football League<br />
Team Ophthalmologist<br />
Peter K. Kaiser, MD<br />
<strong>Cleveland</strong> Cavaliers,<br />
National Basketball Association<br />
Team Ophthalmologist<br />
Peter K. Kaiser, MD<br />
Board of Directors, Assistant Medial<br />
Director, Chairman of the Medical<br />
Advisory Committee<br />
Allen S. Roth, MD<br />
25
26<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
L E A D E R S H I P R O L E S continued<br />
<strong>Cleveland</strong> Indians,<br />
Major League Baseball<br />
Team Ophthalmologist<br />
Peter K. Kaiser, MD<br />
<strong>Cleveland</strong> Ophthalmological Society<br />
Bylaws Committee<br />
Elias I. Traboulsi, MD<br />
Educational Committee<br />
Careen Y. Lowder, MD, PhD<br />
<strong>Cleveland</strong> Sight Center<br />
Board of Trustees<br />
Andrew P. Schachat, MD<br />
The Eye Care Professional<br />
Advisory Committee<br />
Elias I. Traboulsi, MD<br />
Foundation Fighting Blindness<br />
Scientific Advisory Board,<br />
Cell Biology Committee<br />
Joe G. Hollyfield, PhD<br />
GANSU, INC. (Gaining a New<br />
Sight for Unsighted in China)<br />
President, Board of Directors<br />
Ronald R. Krueger, MD<br />
Heed Ophthalmic Foundation<br />
Heed Award, 2008<br />
Andrew P. Schachat, MD<br />
The Helen Keller Eye<br />
Research Foundation<br />
Scientific Advisory Board and<br />
Director, External Research<br />
Joe G. Hollyfield, PhD<br />
International Society of Refractive<br />
Surgery of the American Academy<br />
of <strong>Ophthalmology</strong><br />
Co-sponsorship Subcommittee Chair<br />
Ronald R. Krueger, MD<br />
Program Planning Committee<br />
Steven E. Wilson, MD<br />
Knights Templar Eye Foundation, Inc.<br />
Scientific Advisory Board<br />
Joe G. Hollyfield, PhD<br />
National Ophthalmic Genotyping<br />
Network (eyeGENE)<br />
Steering Committee<br />
Elias I. Traboulsi, MD<br />
Pan American Association<br />
of <strong>Ophthalmology</strong><br />
Board of Directors<br />
Careen Y. Lowder, MD, PhD<br />
Pan American Society of<br />
Ocular Inflammatory Diseases<br />
President<br />
Careen Y. Lowder, MD, PhD<br />
Society of Heed<br />
Fellows Foundation<br />
Executive Secretary<br />
Froncie A. Gutman, MD<br />
South African Retinitis<br />
Pigmentosa Foundation<br />
Scientific Advisory Board<br />
Joe G. Hollyfield, PhD<br />
University of Oklahoma<br />
Medical Sciences Center<br />
COBRE External Advisory Committee,<br />
Department of <strong>Ophthalmology</strong><br />
Joe G. Hollyfield, PhD<br />
AWARDS & RECOGNITION<br />
American Academy<br />
of <strong>Ophthalmology</strong><br />
Lans Distinguished Award<br />
by the ISRS/AAO, 2008<br />
Ronald R. Krueger, MD<br />
Lifelong Education for the<br />
Ophthalmologist Award, 2008<br />
Edward J. Rockwood, MD<br />
Best Poster, 2008<br />
Jonathan E. Sears, MD
American Society of Cataract<br />
and Refractive Surgery<br />
Best Paper Award, Corneal<br />
Crosslinking and Segments Session<br />
William J. Dupps, Jr., MD, PhD<br />
American Society of Ophthalmic<br />
Plastic & Reconstructive Surgery<br />
Awards Committee<br />
Julian D. Perry, MD<br />
Association for Research<br />
in Vision in <strong>Ophthalmology</strong><br />
Proctor Medal, May 2009<br />
Joe G. Hollyfield, PhD<br />
Gold Fellow 2009<br />
Joe G. Hollyfield, PhD<br />
Steven E. Wilson, MD<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | STAFF<br />
Best Doctors in America, 2008<br />
Gregory S. Kosmorsky, DO<br />
Roger H.S. Langston, MD<br />
Careen Y. Lowder, MD, PhD<br />
Andreas Marcotty, MD<br />
Edward J. Rockwood, MD<br />
Jonathan E. Sears, MD<br />
Elias I. Traboulsi, MD<br />
Stephen E. Wilson, MD<br />
Best Doctors in America:<br />
Midwest Region<br />
Edward J. Rockwood, MD<br />
Best Doctors in U.S., 2008<br />
Edward J. Rockwood, MD<br />
Best Doctors in U.S., 2009<br />
Andreas Marcotty, MD<br />
Canadian Ophthalmological Society<br />
Annual W. Bruce Jackson Lecture Award,<br />
Canadian Cornea Society, 2009<br />
Steven E. Wilson, MD<br />
Castle Connolly America’s<br />
Top Doctors<br />
Ronald R. Krueger, MD<br />
Roger H.S. Langston, MD<br />
Andrew P. Schachat, MD<br />
Elias I. Traboulsi, MD<br />
Steven E. Wilson, MD<br />
Consumers’ Research Council<br />
of America<br />
America’s Top Ophthalmologists<br />
William J. Dupps, Jr., MD, PhD<br />
Research to Prevent Blindness<br />
Steinbach Award 2008, 2009<br />
John W. Crabb, PhD<br />
27
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
Education<br />
HELPING PROFESSIONALS CONTINUE TO DEVELOP
T R A I N I N G T H E L E A D E R S O F T O M O R R O W<br />
RESIDENCY/FELLOWSHIP PROGR AMS<br />
<strong>Cleveland</strong> <strong>Clinic</strong> Cole Eye Institute is committed to offering one<br />
of the best residency and fellowship programs in the United<br />
States. These programs are highly competitive and produce<br />
superbly trained clinical and academic ophthalmologists.<br />
RESIDENCY PROGR AM<br />
The Cole Eye Institute Residency Training Program’s mission<br />
is to prepare participants to become leaders in patient care,<br />
teaching and vision research. The program meets all the<br />
requirements of the American Board of <strong>Ophthalmology</strong> and the<br />
Accreditation Council for Graduate Medical Education (ACGME).<br />
There are 12 residents in the three-year training program, with<br />
four residents who match into the program annually. Residents<br />
rotate among the Institute’s nine departments and a residentrun<br />
clinic at MetroHealth Medical Center, while completing<br />
their board requirements. They work under the direct supervision<br />
of the staff during each rotation in the following areas:<br />
• Cornea, external disease, anterior segment<br />
• Glaucoma<br />
• Neuro-ophthalmology/oncology<br />
• Ophthalmic pathology<br />
• Ophthalmic plastic, reconstructive and orbital surgery<br />
• Pediatric ophthalmology and adult strabismus<br />
• Refractive surgery<br />
• Retina, vitreous, low vision<br />
• Uveitis, ocular inflammatory disease and immunology<br />
This curriculum provides a balanced exposure to all subspecialty<br />
areas of ophthalmology, ensuring graduates the ability<br />
to perform general ophthalmology with skill, knowledge and<br />
confidence. Each resident works in a one-on-one relationship<br />
with a staff physician to provide the best opportunity to study<br />
disease processes and their medical and surgical management.<br />
This arrangement also provides excellent supervision and<br />
optimal continuity of patient care in the outpatient and<br />
hospital settings.<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | EDUCATION<br />
Residents are expected to participate in clinical and basic<br />
research activities utilizing the staff’s expertise. They complete<br />
independent clinical research projects which involve reviewing<br />
the literature, developing a hypothesis and designing and<br />
executing the study. Activities are carefully supervised by an<br />
experienced clinical investigator. Residents are expected to<br />
submit and present their research at national meetings and<br />
to write several papers for publication based on their research<br />
activities. Each June, ophthalmology residents, fellows and<br />
staff participate in the Annual Research, Residents and<br />
Alumni Meeting, a scientific forum for the presentation<br />
of research projects.<br />
Residency Graduates, 6/09<br />
Brian Lee, MD<br />
Thu Pham, MD<br />
Ying Qian, MD<br />
Residents, 1st Year, 7/09<br />
Baseer Ahmad, MD Theodore Pasquali, MD<br />
Eric Ahn, MD Xiang Qi Werdich, MD, PhD<br />
Residents, 2nd Year, 7/09<br />
James Kim, MD, PhD Benjamin Nicholson, MD<br />
Breno Lima, MD Reecha Sachdeva, MD<br />
Residents, 3rd Year, 7/09<br />
Jeffrey Goshe, MD Ahmad Tarabishy, MD<br />
Christopher Hood, MD Mary Beth Turell, MD<br />
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OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
T R A I N I N G T H E L E A D E R S O F T O M O R R O W continued<br />
FELLOWSHIP PROGR AM<br />
<strong>Cleveland</strong> <strong>Clinic</strong> Cole Eye Institute also offers high-quality<br />
fellowship training opportunities in a variety of subspecialties.<br />
These fellowships train the next generation of academic leaders<br />
in the respective fields by combining an excellent academic<br />
environment with mentorship support in a state-of-the-art<br />
eye care facility.<br />
Our fellowships include:<br />
• 2-year vitreoretinal fellowship<br />
(slots rotate — even years = 1, uneven years = 2)<br />
• 1-year cornea, external disease and refractive surgery<br />
fellowship (2 slots)<br />
• 1-year glaucoma fellowship (1 slot)<br />
• 1-year pediatric-ophthalmology fellowship (1 slot)<br />
• 2-year oculoplastics fellowship (sponsored by ASOPRS) (1 slot)<br />
For more information about Cole Eye Institute fellowship<br />
programs, visit clevelandclinic.org/eyefellowships or<br />
contact Jane Sardelle at sardelj@ccf.org.<br />
Fellow Graduates, 6/09<br />
Vitreoretinal Fellows<br />
Hajir Dadgostar, MD<br />
Mehran Taban, MD<br />
Cornea, External Disease and Refractive Surgery Fellow<br />
Andrew Esposito, MD<br />
Ricardo Sepulveda, MD<br />
Glaucoma Fellow<br />
Samantha Chai, MD<br />
Pediatric <strong>Ophthalmology</strong> Fellow<br />
Michelle Ariss, MD<br />
Fellows, 7/09<br />
Vitreoretinal Fellows<br />
Omar Ahmad, MD<br />
Nathan Steinle, MD<br />
Cornea, External Disease & Refractive Surgery<br />
Hooman Harooni, MD<br />
Ravindrah Shah, MD
G R A N D R O U N D S<br />
Cole Eye Institute hosts Grand Rounds every Monday from 7<br />
to 8 a.m. during the academic year (except holidays and major<br />
meeting times). For the academic year 2009-2010, meetings<br />
will begin in mid-September, and run through mid-June. The<br />
meetings are designed for residents, fellows and staff physicians<br />
of the Cole Eye Institute, as well as other comprehensive<br />
and subspecialty ophthalmologists. We are pleased to offer<br />
Category 1 continuing education credits for each meeting.<br />
Evaluations are offered online following each meeting and<br />
attendance certificates can be printed or saved for your<br />
record-keeping purposes.<br />
The Grand Rounds’ forum consists of two clinical cases<br />
presented by Cole Eye Institute residents, followed by<br />
extensive discussion. Cases selected for presentation<br />
represent outstanding teaching examples and are either<br />
difficult-to-manage cases, unusual presentations of common<br />
disorders, rare conditions or cases that highlight state-of-theart<br />
diagnosis or management. In addition, approximately<br />
every six weeks, M&M cases are presented and discussed<br />
by third-year residents with follow-up discussion.<br />
The meetings are held the James P. Storer Conference Room<br />
the first floor of the Cole Eye Institute and registration is not<br />
required to attend. Park in the patient/visitor lot at E. 102nd<br />
Street (facing the front of the Cole Eye Institute), or the patient/<br />
visitors garage at E. 100th Street and Carnegie Avenue. Parking<br />
tickets will be validated.<br />
For questions, email Jane Sardelle at sardelj@ccf.org.<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | EDUCATION<br />
31
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OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
D I S T I N G U I S H E D L E C T U R E S E R I E S<br />
The <strong>Cleveland</strong> <strong>Clinic</strong> Cole Eye Institute is proud to present the<br />
2009 Distinguished Lecture Series, which provides a forum for<br />
renowned researchers in the visual sciences to present their<br />
latest research findings. This series of lectures will feature<br />
advances in many areas of ophthalmic research presented by<br />
noted basic and clinical scientists from throughout the world.<br />
Ample opportunity for questions and answers will be provided.<br />
September 17, 2009<br />
NEW INSIGHTS INTO THE MOLECUL AR<br />
AND CELLUL AR REGUL ATION OF<br />
CORNE AL IMMUNIT Y<br />
Reza Dana, MD, MPH, MSc<br />
Director of Cornea and Refractive Surgery Services<br />
Massachusetts Eye & Ear Infirmary<br />
Professor and Senior Scientist, Harvard Medical School<br />
W. Clement Stone Scholar & Director of the Corneal Immunology<br />
Lab Schepens Eye Research Institute<br />
Director, Harvard-Vision <strong>Clinic</strong>al Scientist Development Program<br />
Boston<br />
October 15, 2009<br />
ROLE OF VEGF IN BLOOD VESSEL<br />
GROW TH AND STABILIT Y IMPLICATIONS<br />
FOR ANTI-ANGIOGENIC THER APIES<br />
Patricia A. D’Amore, PhD<br />
Senior Scientist<br />
Ankeny Scholar of Retinal Molecular Biology<br />
Professor, Harvard Medical School<br />
The Schepens Eye Research Institute<br />
Boston<br />
Please join us for these insights into ophthalmic research<br />
and the promises they hold for patient care. No registration<br />
is required; call 216.444.5832 with any questions.<br />
All programs will be held in the James P. Storer Conference<br />
Center of the Cole Eye Institute from 7 to 8 a.m. Attendees<br />
should park in the East 102nd Street parking lot (facing the<br />
front of the Cole Eye Institute) or the visitor’s parking garage<br />
at East 100th Street and Carnegie Avenue. We will validate<br />
your parking ticket.<br />
November 19, 2009<br />
EMERGING CONCEPTS IN UVE AL MEL ANOMA<br />
Hans E. Grossniklaus, MD, MBA<br />
F. Phinizy Calhoun Jr. Professor of <strong>Ophthalmology</strong><br />
Director, L.F. Montgomery Pathology Laboratory<br />
Vice-Chairman, Department of <strong>Ophthalmology</strong><br />
Emory Eye Center<br />
Emory University<br />
Atlanta, Ga.
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | EDUCATION<br />
P R O G R A M S I N O P H T H A L M I C E D U C AT I O N 2 0 0 9 -2 010<br />
Physicians are invited to attend the following ophthalmic<br />
continuing medical education courses at <strong>Cleveland</strong> <strong>Clinic</strong>’s<br />
Cole Eye Institute. For more information, contact Jane Sardelle,<br />
program coordinator, at 216.444.2010 or 800.223.2273, ext.<br />
42010, or sardelj@ccf.org.<br />
COMPREHENSIVE OPHTHALMOLOGY UPDATE<br />
December 5, 2009<br />
Location: Cole Eye Institute<br />
UVEITIS UPDATE<br />
March 6, 2010<br />
Location: Cole Eye Institute<br />
NORTH COAST VITREORETINAL COURSE<br />
May 22, 2010<br />
Location: Cole Eye Institute<br />
ANNUAL RESEARCH, RESIDENTS & ALUMNI MEETING<br />
June 19, 2010<br />
Location: Cole Eye Institute<br />
33
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
Research<br />
PURSUING ANSWERS
C L I N I C A L T R I A L S<br />
The following studies are currently enrolling. All studies have<br />
been approved by the Institutional Review Board.<br />
AGE-RELATED MACULAR DEGENERATION<br />
A Phase I Open-label, Dose Escalation Trial of REDD14NP<br />
Delivered by a Single Intravitreal Injection to Patients with<br />
Choroidal Neovascularization Secondary to Exudative<br />
Age-related Macular Degeneration (QUARK)<br />
Objective: This is an open-label, dose-escalation study in which<br />
patents will receive a single intravitreal injection of REDD14NP.<br />
The primary objective of the study is to determine the safety<br />
and pharmacokinetics of REDD14NP when administered as<br />
a single intravitreal injection.<br />
Contact: Peter K. Kaiser, MD, 216.444.6702 or Lynn Bartko, RN,<br />
216.444.7137<br />
A Randomized, Double Masked, Active Controlled Phase III<br />
Study of the Efficacy, Safety and Tolerability of Repeated<br />
Doses of Intravitreal VEGF Trap in Subjects with Neovascular<br />
Age-Related Macular Degeneration (VEGF Trap)<br />
Objective: This study is a Phase III, double-masked, randomized,<br />
study of the efficacy and safety of VEGF Trap-Eye in<br />
patients with neovascular age-related macular degeneration.<br />
Contact: Peter K. Kaiser, MD, 216.444.6702 or Laura Holody,<br />
216.445.2264<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | RESEARCH<br />
RETINAL VEIN OCCLUSION<br />
An Open-Label, Multicenter Extension Study To Evaluate<br />
the Safety and Tolerability of Ranibizumab in Subjects with<br />
Macular Edema Secondary to Retinal Vein Occlusion (RVO)<br />
Who Have Completed a Genentech-sponsored Ranibizumab<br />
Study (HORIZON 2)<br />
Objective: This is an open-label, multicenter extension study<br />
of intravitreally administered ranibizumab in subjects with<br />
macular edema secondary to RVO who have completed the<br />
six-month treatment and six-month observation phases (12<br />
months total) of a Genentech-sponsored study (FVF4165g or<br />
FVF4166g).<br />
Contact: Rishi P. Singh, MD, 216.445.9497 or Gail Kolin, RN,<br />
216.445.4086<br />
35
36<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
C L I N I C A L T R I A L S continued<br />
DIABETIC RETINOPATHY<br />
Vascular Remodeling and Effects of Angiogenic Inhibition in<br />
Diabetic Retinopathy (NIH)<br />
Objective: This study will test whether the pattern of the retinal<br />
vasculature changes in patients with different levels of diabetic<br />
retinopathy can be quantified using computerized image<br />
analysis. In addition, the study will evaluate whether new<br />
drugs to treat diabetic retinopathy will be able to reverse these<br />
vascular changes.<br />
Contact: Peter K. Kaiser, MD, 216.444.6702 or Ly Pung, RN,<br />
216.445.6497<br />
UVEITIS<br />
A Prospective, Multicenter, Randomized, Double-Masked,<br />
Safety, Tolerability and Efficacy Study of Four Iontophoretic<br />
Doses of Dexamethasone Phosphate Ophthalmic Solution<br />
in Patients with Non-Infectious Acute Anterior Segment<br />
Uveitis (EYEGATE)<br />
Objective: The purpose of this Phase II study is to define a safe<br />
and effective dose of iontophoretic delivery of dexamethasone<br />
phosphate ophthalmic solution using the EyeGate ® II Drug<br />
Delivery System in patients with non-infectious acute anterior<br />
segment uveitis.<br />
Contact: Careen Lowder, MD, PhD, 216.444.3642 or Ly Pung, RN,<br />
216.445.6497<br />
An Open-Label, Multicenter, Phase II Trial of Adalimumab<br />
(Humira ® ) in the Treatment of Refractory Non-infectious<br />
Uveitis (HUMIRA)<br />
Objective: This study will assess the safety and efficacy<br />
of adalimumab, a humanized monoclonal antibody,<br />
against TNF-α (Abbott) in the treatment of refractory,<br />
vision-threatening, non-infectious uveitis.<br />
Contact: Careen Lowder, MD, PhD, 216.444.3642 or Laura Holody,<br />
216.445.2264<br />
PEDIATRIC EYE DISEASE<br />
Infant Aphakia Treatment Study (IATS)<br />
Objective: The primary purpose of this study is to determine<br />
whether infants with a unilateral congenital cataract are more<br />
likely to develop better vision following cataract extraction<br />
surgery if they undergo primary implantation of an intraocular<br />
lens or if they are treated primarily with a contact lens. In<br />
addition, the study will compare the occurrence of postoperative<br />
complications and the degree of parental stress between<br />
the two treatments.<br />
Contact: Elias Traboulsi, MD, 216.444.4363 or Sue Crowe, RN,<br />
216.445.3840
GENETICS<br />
Studies of the Molecular Genetics of Eye Diseases (BRTT)<br />
Objective: The objective of this project is to study the molecular<br />
genetics of ophthalmic disorders through the compilation of a<br />
collection of DNA, plasma and eye tissue samples from patients<br />
and from families with a broad range of eye diseases and<br />
malformations.<br />
Contact: Elias Traboulsi, MD, 216.444.4363 or Patrice Nerone, RN,<br />
216.445.9886<br />
CORNEA /REFRACTIVE SURGERY<br />
A <strong>Clinic</strong>al Safety and Efficacy Comparison of Nevanac ® 0.1% to<br />
Vehicle Following Cataract Surgery in Diabetic Retinopathy<br />
Patients (NEVANAC)<br />
Objective: The purpose of this study is to determine whether<br />
Nepafenac is safe and effective for reducing the incidence<br />
of macular edema following cataract surgery in diabetic<br />
retinopathy patients.<br />
Contact: Richard Gans, MD, 216.444.0848 or Gail Kolin, RN,<br />
216.445.4086<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | RESEARCH<br />
IN FOLLOWUP<br />
The following studies have completed patient enrollment<br />
in the last year at Cole Eye Institute and are in<br />
follow up:<br />
• A 24-month Randomized, Double-masked, Controlled,<br />
Multicenter, Phase IIIB study Assessing<br />
Safety and Efficacy of Verteporfin (Visudyne ® )<br />
Photodynamic Therapy Administered in Conjunction<br />
with Ranibizumab (Lucentis ® ) versus Ranibizumab<br />
(Lucentis ® ) Monotherapy in Patients with Subfoveal<br />
Choroidal Neovascularization Secondary to Agerelated<br />
Macular Degeneration (DENALI)<br />
• A Phase III, Multicenter, Randomized,<br />
Sham-Controlled Study of the Efficacy and<br />
Safety of Ranibizumab Compared with Sham<br />
in Subjects with Macular Edema Secondary to<br />
Central Retinal Vein Occlusion (CRVO)<br />
• A Phase III, Double-Masked, Multicenter, Randomized,<br />
Sham-Controlled Study of the Efficacy and<br />
Safety of Ranibizumab Injection in Subjects with<br />
<strong>Clinic</strong>ally Significant Macular Edema with Center<br />
Involvement Secondary to Diabetes Mellitus (DME)<br />
• An 8-Week, Multicenter, Masked, Randomized Trial<br />
to Assess the Safety and Efficacy of 700 µg and 350 µg<br />
Dexamethasone Posterior Segment Drug Delivery<br />
System Applicator System Compared with Sham<br />
DEX PS DDS Applicator System in the Treatment of<br />
Non-Infectious Ocular Inflammation of the Posterior<br />
Segment in Patients with Intermediate Uveitis<br />
(POSURDEX UVEITIS)<br />
• Posterior Lamellar Endothelial Keratoplasty Study<br />
(PLEK)<br />
• US <strong>Clinic</strong>al Study of the ACRYSOF Angle-Supported<br />
Phakic IOL<br />
• A 2-year, Multicenter, Randomized, Controlled,<br />
Masked, Dose-finding Trial to Assess the Safety and<br />
Efficacy of Multiple Intravitreal Injections of AGN<br />
211745 in Patients with Subfoveal Choroidal<br />
Neovascularization Secondary to Age-related<br />
Macular Degeneration (SIRIUS)<br />
37
38<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
G R A N T S<br />
GUND FOUNDATION SUPPORTS CHAIR FOR<br />
CLE VEL AND CLINIC E YE RESE ARCH<br />
<strong>Cleveland</strong> <strong>Clinic</strong> has received a $2 million gift from the Llura<br />
and Gordon Gund Foundation to expand research into retinal<br />
diseases that cause vision loss and blindness.<br />
The gift establishes the Llura and Gordon Gund Endowed Chair<br />
for <strong>Ophthalmology</strong> Research. Joe G. Hollyfield, PhD, will be the<br />
inaugural chair holder. Dr. Hollyfield is director of research at<br />
Cole Eye Institute, which has current research grant awards<br />
totaling $22 million.<br />
“Dr. Hollyfield has made extraordinary contributions to the field<br />
of retinal disease research and Llura and I are pleased to support<br />
continued study of these causes of vision loss,” says Mr. Gund.<br />
Mr. Gund, a <strong>Cleveland</strong> native, is chairman of Gund Investment<br />
Corporation and was past majority owner of the National<br />
Basketball Association’s <strong>Cleveland</strong> Cavaliers. He was diagnosed<br />
as a young adult with retinitis pigmentosa. Mr. Gund has<br />
experienced blindness since 1970.<br />
Dr. Hollyfield is known for his research of cell and developmental<br />
biology of the retina in both normal and degenerative<br />
tissues. He is currently Editor-in-Chief of the journal, Experimental<br />
Eye Research, and serves on the scientific advisory board<br />
of the Foundation Fighting Blindness, a national nonprofit<br />
organization founded by a group including Llura and Gordon<br />
Gund, and where Mr. Gund is board chairman.<br />
“Joe leads a sophisticated research group which is at the<br />
forefront of investigation of retinal disease. This gift will<br />
provide resources to expand our inquiry into causes and<br />
potential treatment options for eye conditions which cause<br />
vision loss and blindness,” said Daniel F. Martin, MD,<br />
Chairman of the Cole Eye Institute.<br />
PRE VENT BLINDNESS OHIO<br />
Prevent Blindness Ohio has awarded a fellowship grant to Rao<br />
Fu, Cole Eye Institute, through its Young Investigators Student<br />
Fellowship Award for Female Scholars in Vision Research. This<br />
program encourages female scientists at the beginning of their<br />
careers to pursue vision research that can contribute toward the<br />
early detection and treatment discoveries that will be needed to<br />
curb the growth of vision loss in Ohio. Fu is conducting research<br />
that has the potential for significantly impacting an important,<br />
but poorly understood aspect of photoreceptor biology relevant<br />
to human retinal disease, including retinitis pigmentosa.<br />
Results could ultimately lead to the discovery of new approaches<br />
for the detection, prevention, and treatment of vision loss.<br />
Cole Eye Institute Research Funding Sources<br />
Industry<br />
23%<br />
Non-Profit<br />
24%<br />
State 3%<br />
Federal<br />
50%
<strong>Cleveland</strong> <strong>Clinic</strong> Cole Eye Institute had an aggregate annual grant<br />
level of $22,298,900 in 2009*, with $12,444,277 coming from<br />
Cole Eye Basic Research Funding<br />
federal sources. As part of this funding, Cole Eye Institute<br />
researchers received the institute’s first endowed chair for<br />
ophthalmic research.<br />
Title Source Sponsor ID Investigator<br />
Role of TIMP-3 in<br />
Ocular Neovascularization<br />
Inhibition of VEGF Mediated<br />
Angiogenesis by TIMP-3<br />
Age-related Changes in<br />
Epithelia Microvilli<br />
Proteomic Studies of Age Related<br />
Macular Degeneration<br />
Federal NIH EY016490 Bela Anand-Apte, MBBS, PhD<br />
Federal NIH CA106415 Bela Anand-Apte, MBBS, PhD<br />
Federal NIH EY07153 Vera Bonilha, PhD<br />
Federal NIH EY014239 John W. Crabb, PhD<br />
Role of TULP1 in Photoreceptor Cells Federal NIH EY016072 Stephanie Hagstrom, PhD<br />
Initiating Events in AMD:<br />
An Animal Model for the Human<br />
Corneal Epithelial Growth Factors<br />
and Receptors<br />
Can CD 133 Cells prevents hypoxia<br />
driven retinal neovascularization in<br />
a rodent model?<br />
Analysis of Neural Retina<br />
Transport Function<br />
Study of Retinal<br />
Degenerative Diseases<br />
Federal NIH R56 EY014240 Joe G. Hollyfield, PhD<br />
Federal NIH EY010056 Steven E. Wilson, MD<br />
Federal<br />
sub-award<br />
Federal<br />
sub-award<br />
NIH EY018784 Bela Anand-Apte, MBBS, PhD<br />
NIH EY012830 Neal S. Peachey, PhD<br />
Non-Profit Foundation for<br />
Fighting Blindness<br />
Lew Wasserman Award Non-Profit Research to<br />
Prevent Blindness<br />
Identification of Biomarkers Non-Profit Ruth & Milton<br />
Steinbach Foundation<br />
RPB Unrestricted Grant Non-Profit Research to Prevent<br />
Blindness<br />
The Role of Complement Regulation in<br />
Maintaining Outer Retinal Integrity<br />
Stimulating Retina Development During<br />
Phase I of Retinopathy of Prematurity<br />
* through June 2009<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | RESEARCH<br />
Non-Profit American Health<br />
Assistance Foundation<br />
Non-Profit Knights Templar<br />
Eye Foundation<br />
CMM-0707-0407;<br />
CMM-0707-0408;<br />
CMM-0707-0409;<br />
CMM-0707-0410<br />
Joe G. Hollyfield, PhD;<br />
John W. Crabb, PhD;<br />
Stephanie A. Hagstrom, PhD;<br />
Neal S. Peachey, PhD<br />
Bela Anand-Apte, MBBS, PhD<br />
John W. Crabb, PhD<br />
Daniel F. Martin, MD<br />
Neal S. Peachey, PhD<br />
Jonathan Sears, MD<br />
39
40<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
P U B L I C AT I O N S<br />
Journal Publications<br />
Ahuja Y, Kohl S, Traboulsi EI. CNGA3 mutations in two United<br />
Arab Emirates families with achromatopsia. Mol Vis.<br />
2008;14:1293-1297.<br />
Ambrosio R, Jr., Tervo T, Wilson SE. LASIK-associated dry<br />
eye and neurotrophic epitheliopathy: pathophysiology and<br />
strategies for prevention and treatment. J Refract Surg. 2008<br />
Apr;24(4):396-407.<br />
Applegate RA, Krueger RR. Introduction to the proceedings of<br />
the 9th International Congress of Wavefront and Presbyopic<br />
Refractive Corrections. J Refract Surg. 2008 Nov;24(9):963-964.<br />
Asbell PA, Colby KA, Deng S, McDonnell P, Meisler DM,<br />
Raizman MB, Sheppard JD, Jr., Sahm DF. Ocular TRUST:<br />
nationwide antimicrobial susceptibility patterns in ocular<br />
isolates. Am J Ophthalmol. 2008 Jun;145(6):951-958.<br />
Bollinger KE, Langston RHS. What can patients expect from<br />
cataract surgery? Cleve Clin J Med. 2008 Mar;75(3):193-200.<br />
Bollinger KE, Kattouf V, Arthur B, Weiss AH, Kivlin J, Kerr N,<br />
West CE, Kipp M, Traboulsi EI. Hypermetropia and esotropia<br />
in myotonic dystrophy. J AAPOS. 2008 Feb;12(1):69-71.<br />
Callanan DG, Jaffe GJ, Martin DF, Pearson PA, Comstock TL.<br />
Treatment of posterior uveitis with a fluocinolone acetonide<br />
implant: three-year clinical trial results. Arch Ophthalmol.<br />
2008 Sep;126(9):1191-1201.<br />
Chappelow AV, Reid J, Parikh S, Traboulsi EI. Aicardi syndrome<br />
in a genotypic male. Ophthalmic Genet. 2008 Dec;29(4):181-183.<br />
Chappelow AV, Kaiser PK. Neovascular age-related macular<br />
degeneration: potential therapies. Drugs. 2008;68(8):1029-1036.<br />
Chappelow AV, Singh AD, Perez VL, Lichtin A, Pohlman B,<br />
Macklis R. Bilateral panocular involvement with mantle-cell<br />
lymphoma. J Clin Oncol. 2008 Mar 1;26(7):1167.
Charkoudian LD, Gower EW, Solomon SD, Schachat AP, Bressler<br />
NM, Bressler SB. Vitamin usage patterns in the prevention of<br />
advanced age-related macular degeneration. <strong>Ophthalmology</strong>.<br />
2008 Jun;115(6):1032-1038.e4.<br />
Cohen VML, Sweetenham J, Singh AD. Ocular adnexal<br />
lymphoma: What is the evidence for an infectious aetiology?<br />
Br J Ophthalmol. 2008 Apr;92(4):446-448.<br />
Dadgostar H, Waheed N. The evolving role of vascular endothelial<br />
growth factor inhibitors in the treatment of neovascular<br />
age-related macular degeneration. Eye. 2008 Jun;22(6):761-767.<br />
de Medeiros FW, Mohan RR, Suto C, Sinha S, Bonilha VL,<br />
Chaurasia SS, Wilson SE. Haze development after photorefractive<br />
keratectomy: mechanical vs ethanol epithelial removal in<br />
rabbits. J Refract Surg. 2008 Nov;24(9):923-927.<br />
Doyle V, Schachat AP. Increased transparency: making the journal<br />
better for readers and for authors. <strong>Ophthalmology</strong>. 2008<br />
Sep;115(9):1443-1444.<br />
Dua HS, Singh AD. The British Journal of <strong>Ophthalmology</strong>.<br />
At a glance. Br J Ophthalmol. 2008 Jul;92(7):869.<br />
Dupps WJ, Jr., Qian Y, Meisler DM. Multivariate model of<br />
refractive shift in Descemet-stripping automated endothelial<br />
keratoplasty. J Cataract Refract Surg. 2008 Apr;34(4):578-584.<br />
Fu EX, Kosmorsky GS, Traboulsi EI. Giant intracavernous<br />
carotid aneurysm presenting as isolated sixth nerve palsy in<br />
an infant. Br J Ophthalmol. 2008 Apr;92(4):576-577.<br />
Fuller ML, Sweetenham J, Schoenfield L, Singh AD. Uveal<br />
lymphoma: a variant of ocular adnexal lymphoma. Leuk<br />
Lymphoma. 2008 Dec;49(12):2393-2397.<br />
Galor A, Lowder CY, Kaiser PK, Perez VL, Sears JE. Surgical<br />
drainage of chronic serous retinal detachment associated with<br />
uveitis. Retina. 2008 Feb;28(2):282-288.<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | RESEARCH<br />
Gorovoy MS, Meisler DM, Dupps WJ, Jr. Late repeat Descemetstripping<br />
automated endothelial keratoplasty. Cornea. 2008<br />
Feb;27(2):238-240.<br />
Grant LW, Anderson C, Macklis RM, Singh AD. Low dose<br />
irradiation for diffuse choroidal hemangioma. Ophthalmic<br />
Genet. 2008 Dec;29(4):186-188.<br />
Gupta OP, Ho AC, Kaiser PK, Regillo CD, Chen S, Dyer DS, Dugel<br />
PU, Gupta S, Pollack JS. Short-term outcomes of 23-gauge pars<br />
plana vitrectomy. Am J Ophthalmol. 2008 Aug;146(2):193-197.<br />
Heur M, Costin B, Crowe S, Grimm RA, Moran R, Svensson LG,<br />
Traboulsi EI. The value of keratometry and central corneal<br />
thickness measurements in the clinical diagnosis of marfan<br />
syndrome. Am J Ophthalmol. 2008 Jun;145(6):997-1001.e1.<br />
Iseli HP, Spoerl E, Wiedemann P, Krueger RR, Seiler T. Efficacy<br />
and safety of blue-light scleral cross-linking. J Refract Surg.<br />
2008 Sep;24(7):S752-S755.<br />
41
42<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
P U B L I C AT I O N S continued<br />
Jeng BH, Marcotty A, Traboulsi EI. Descemet stripping automated<br />
endothelial keratoplasty in a 2-year-old child. J AAPOS.<br />
2008 Jun;12(3):317-318.<br />
Jeng BH, Dupps WJ, Jr., Meisler DM, Schoenfield L. Epithelial<br />
debridement for the treatment of epithelial basement membrane<br />
abnormalities coincident with endothelial disorders.<br />
Cornea. 2008 Dec;27(10):1207-1211.<br />
Jeng BH, Galor A, Lee MS, Meisler DM, Hollyfield JG, Schoenfield<br />
L, McMahon JT, Langston RHS. Amantadine-associated<br />
corneal edema potentially irreversible even after cessation of<br />
the medication. <strong>Ophthalmology</strong>. 2008 Sep;115(9):1540-1544.<br />
Kaiser PK. Ranibizumab: The evidence of its therapeutic value in<br />
neovascular age-related macular degeneration. Core Evidence.<br />
2008;2(4):273-294.<br />
Keeler R, Singh AD, Dua HS. Anatomical eye model.<br />
Br J Ophthalmol. 2008 Sep;92(9):1179.<br />
Keeler R, Singh A, Dua H. Focimeter. Br J Ophthalmol. 2008<br />
May;92(5):593.<br />
Kim SJ, Lo WR, Hubbard GB, III, Srivastava SK, Denny JP,<br />
Martin DF, Yan J, Bergstrom CS, Cribbs BE, Schwent BJ,<br />
Aaberg TM, Sr. Topical ketorolac in vitreoretinal surgery: a<br />
prospective, randomized, placebo-controlled, double-masked<br />
trial. Arch Ophthalmol. 2008 Sep;126(9):1203-1208.<br />
Koenig SB, Meisler DM, Dupps WJ, Rubenstein JB, Kumar R.<br />
External refinement of the donor lenticule position during<br />
Descemet’s stripping and automated endothelial keratoplasty.<br />
Ophthalmic Surg Lasers Imaging. 2008 Nov;39(6):522-523.<br />
Kosmorsky GS, Dupps WJ, Jr., Drake RL. Nonuniform pressure<br />
generation in the optic chiasm may explain bitemporal<br />
hemianopsia. <strong>Ophthalmology</strong>. 2008 Mar;115(3):560-565.<br />
Kovoor TA, Bahl D, Singh AD, Ufret-Vincenty R. Bilateral<br />
isolated choroidal melanocytosis. Br J Ophthalmol. 2008<br />
Jul;92(7):892, 1008.<br />
Krueger RR, Ramos-Esteban JC, Kanellopoulos AJ. Staged<br />
intrastromal delivery of riboflavin with UVA cross-linking in<br />
advanced bullous keratopathy: laboratory investigation and<br />
first clinical case. J Refract Surg. 2008 Sep;24(7):S730-S736.
Krueger RR, Trattler W, Yee R. Introduction to the proceedings of<br />
the Sixth International Congress on Advanced Surface Ablation<br />
& SBK. J Refract Surg. 2008 Jan;24(1):S55-S56.<br />
Krueger RR. September consultation # 4. J Cataract Refract Surg.<br />
2008 Sep;34(9):1430-1431.<br />
Krueger RR, Mrochen M. Introduction to the proceedings of<br />
the Third International Congress of Corneal Cross-Linking.<br />
J Refract Surg. 2008 Sep;24(7):S713-S714.<br />
Krueger RR, Rocha KM. Introduction to wavefront-optimized,<br />
wavefront-guided, and topography-guided customized<br />
ablation: fifth year in review. J Refract Surg. 2008<br />
Apr;24(4):S417-S418.<br />
Krueger RR, Thornton IL, Xu M, Bor Z, van den Berg TJTP.<br />
Rainbow glare as an optical side effect of IntraLASIK.<br />
<strong>Ophthalmology</strong>. 2008 Jul;115(7):1187-1195.e1.<br />
Kutz WE, Wang LW, Dagoneau N, Odrcic KJ, Cormier-Daire V,<br />
Traboulsi EI, Apte SS. Functional analysis of an ADAMTS10<br />
signal peptide mutation in Weill-Marchesani syndrome<br />
demonstrates a long-range effect on secretion of the full-length<br />
enzyme. Hum Mutat. 2008 Dec;29(12):1425-1434.<br />
Lee BJ, Jeng BH, Singh AD. OCT and ultrasound biomicroscopic<br />
findings in iris arteriovenous malformation. Ophthalmic Surg<br />
Lasers Imaging. 2008 Sep;39(5):426-428.<br />
Lee BJ, Traboulsi EI. <strong>Update</strong> on the morning glory disc anomaly.<br />
Ophthalmic Genet. 2008 Jun;29(2):47-52.<br />
Lee MS, Kosmorsky GS, Cook JR, Barton JJS, Briemberg HR.<br />
My, what asthenia you have. Surv Ophthalmol. 2008<br />
Sep;53(5):506-511.<br />
Lewis C, Traboulsi EI. Use of Tegaderm for postoperative eye<br />
dressing in children. J AAPOS. 2008 Aug;12(4):420.<br />
Li Y, Meisler DM, Tang M, Lu ATH, Thakrar V, Reiser BJ, Huang<br />
D. Keratoconus diagnosis with optical coherence tomography<br />
pachymetry mapping. <strong>Ophthalmology</strong>. 2008<br />
Dec;115(12):2159-2166.<br />
Liesegang TJ, Albert DM, Schachat AP. Not for your eyes:<br />
information concealed through publication bias. Am J<br />
Ophthalmol. 2008 Nov;146(5):638-640.<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | RESEARCH<br />
Liesegang TJ, Albert DM, Schachat AP. How to ensure<br />
our readers’ trust: the proper attribution of authors and<br />
contributors. Am J Ophthalmol. 2008 Sep;146(3):337-340.<br />
Lin DTC, Holland SR, Rocha KM, Krueger RR. Method for<br />
optimizing topography-guided ablation of highly aberrated eyes<br />
with the ALLEGRETTO WAVE Excimer Laser. J Refract Surg.<br />
2008 Apr;24(4):S439-S445.<br />
Loddenkemper T, Friedman NR, Ruggieri PM, Marcotty A,<br />
Sears J, Traboulsi EI. Pituitary stalk duplication in association<br />
with moya moya disease and bilateral morning glory disc<br />
anomaly - broadening the clinical spectrum of midline defects.<br />
J Neurol. 2008 Jun;255(6):885-890.<br />
Margolis R, Singh RP, Bhatnagar P, Kaiser PK. Intravitreal<br />
triamcinolone as adjunctive treatment to laser panretinal<br />
photocoagulation for concomitant proliferative diabetic<br />
retinopathy and clinically significant macular edema.<br />
Acta Ophthalmol Scand. 2008 Feb;86(1):105-110.<br />
McKay TL, Gedeon DJ, Vickerman MB, Hylton AG, Ribita D, Olar<br />
HH, Kaiser PK, Parsons-Wingerter P. Selective inhibition of<br />
angiogenesis in small blood vessels and decrease in vessel<br />
diameter throughout the vascular tree by triamcinolone<br />
acetonide. Invest Ophthalmol Vis Sci. 2008 Mar;49(3):1184-1190.<br />
Mohan RR, Stapleton WM, Sinha S, Netto MV, Wilson SE. A<br />
novel method for generating corneal haze in anterior stroma<br />
of the mouse eye with the excimer laser. Exp Eye Res. 2008<br />
Feb;86(2):235-240.<br />
Nehemy MB, Zisman M, Marigo FA, Nehemy PG, Schachat AP.<br />
Ultrasound biomicroscopy after vitrectomy in eyes with normal<br />
intraocular pressure and in eyes with chronic hypotony. Eur J<br />
Ophthalmol. 2008 Jul;18(4):614-618.<br />
Netto MV, Barreto J, Jr., Santo R, Bechara S, Kara-Jose N, Wilson<br />
SE. Synergistic effect of ethanol and mitomycin C on corneal<br />
stroma. J Refract Surg. 2008 Jun;24(6):626-632.<br />
Nolan WP, See JL, Aung T, Friedman DS, Chan YH, Smith SD,<br />
Zheng C, Huang D, Foster PJ, Chew PTK. Changes in angle<br />
configuration after phacoemulsification measured by anterior<br />
segment optical coherence tomography. J Glaucoma. 2008<br />
Sep;17(6):455-459.<br />
43
44<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
P U B L I C AT I O N S continued<br />
Otri AM, Singh AD, Dua HS. Cover illustration. Abu Bakr Razi.<br />
Br J Ophthalmol. 2008 Oct;92(10):1324.<br />
Perry JD. Periocular reflation creates better facial rejuvenating<br />
effect. Ocular Surgery News. 2008 Apr 10;(Suppl):32-35.<br />
Qian Y, Zakov ZN, Schoenfield L, Singh AD. Iris melanoma<br />
arising in iris nevus in oculo(dermal) melanocytosis. Surv<br />
Ophthalmol. 2008 Jul;53(4):411-415.<br />
Ramos-Esteban JC, Bamba S, Krueger RR. Tracking difficulties<br />
after femtosecond laser flap creation with the LADARVision<br />
excimer laser system. J Refract Surg. 2008 Nov;24(9):953-956.<br />
Renganathan K, Ebrahem Q, Vasanji A, Gu X, Lu L, Sears J,<br />
Salomon RG, Anand-Apte B, Crabb JW. Carboxyethylpyrrole<br />
adducts, age-related macular degeneration and neovascularization.<br />
Adv Exp Med Biol. 2008;613:261-267.<br />
Rocha KM, Ramos-Esteban JC, Qian Y, Herekar S, Krueger RR.<br />
Comparative study of riboflavin-UVA cross-linking and<br />
“flash-linking” using surface wave elastometry. J Refract Surg.<br />
2008 Sep;24(7):S748-S751.<br />
Sautter NB, Citardi MJ, Perry J, Batra PS. Paranasal sinus<br />
mucoceles with skull-base and/or orbital erosion: Is the<br />
endoscopic approach sufficient? Otolaryngol Head Neck Surg.<br />
2008 Oct;139(4):570-574.<br />
Sayanagi K, Sharma S, Kaiser PK. Spectral domain optical<br />
coherence tomography and fundus autofluorescence findings<br />
in pseudoxanthoma elasticum. Ophthalmic Surg Lasers<br />
Imaging. 2008 Jul-Aug;39(4 Suppl):S108-S110.<br />
Schachat AP. A new look at an old treatment for diabetic macular<br />
edema. <strong>Ophthalmology</strong>. 2008 Sep;115(9):1445-1446.<br />
Sears JE. Anti-vascular endothelial growth factor and retinopathy<br />
of prematurity. Br J Ophthalmol. 2008 Nov;92(11):1437-1438.<br />
Singh AD, Schachat AP, Diener-West M, Reynolds SM. Small<br />
choroidal melanoma. <strong>Ophthalmology</strong>. 2008 Dec;115(12):2319.<br />
Singh AD, Triozzi PL. Endoresection for choroidal melanoma:<br />
palliative or curative intent? Br J Ophthalmol. 2008<br />
Aug;92(8):1015-1016.<br />
Singh AD, Kivela T, Seregard S, Robertson D, Bena JF. Primary<br />
transpupillary thermotherapy of “small” choroidal melanoma:<br />
is it safe? Br J Ophthalmol. 2008 Jun;92(6):727-728.<br />
Singh RP, Bando H, Brasil OFM, Williams DR, Kaiser PK.<br />
Evaluation of wound closure using different incision techniques<br />
with 23-gauge and 25-gauge microincision vitrectomy systems.<br />
Retina. 2008 Feb;28(2):242-248.<br />
Stapleton WM, Chaurasia SS, Medeiros FW, Mohan RR, Sinha S,<br />
Wilson SE. Topical interleukin-1 receptor antagonist inhibits<br />
inflammatory cell infiltration into the cornea. Exp Eye Res.<br />
2008 May;86(5):753-757.
Taban M, Taban M, Perry JD. Lower eyelid position after<br />
transconjunctival lower blepharoplasty with versus without a<br />
skin pinch. Ophthal Plast Reconstr Surg. 2008 Jan-Feb;24(1):7-9.<br />
Taban M, Ventura AACM, Sharma S, Kaiser PK. Dynamic<br />
evaluation of sutureless vitrectomy wounds: an optical<br />
coherence tomography and histopathology study.<br />
<strong>Ophthalmology</strong>. 2008 Dec;115(12):2221-2228.<br />
Taban M, Taban M, Sears JE. Ocular findings following trauma<br />
from paintball sports. Eye. 2008 Jul;22(7):930-934.<br />
Taban M, Lowder CY, Hajj-Ali R, Singh AD. Anterior scleritis as<br />
the presenting sign of metastatic lung cancer. Br J Ophthalmol.<br />
2008 Jan;92(1):147.<br />
Thornton I, Xu M, Krueger RR. Comparison of standard (0.02%)<br />
and low dose (0.002%) mitomycin in the prevention of corneal<br />
haze following surface ablation for myopia. J Refract Surg.<br />
2008 Jan;24(1):S68-S76.<br />
Traboulsi EI. Reply [Congenital cranial dysinnervation disorders/<br />
syndrome]. J AAPOS. 2008 Aug;12(4):421.<br />
Traboulsi EI, Ellison J, Sears J, Maumenee IH, Avallone J,<br />
Mohney BG. Aniridia with preserved visual function: A report of<br />
four cases with no mutations in PAX6. Am J Ophthalmol. 2008<br />
Apr;145(4):760-764.<br />
Traboulsi EI, Sarfarazi M. The use of microarray technology<br />
in deciphering the cause of genetic eye diseases: LOXL1 and<br />
exfoliation syndrome. Am J Ophthalmol. 2008<br />
Mar;145(3):391-393.<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | RESEARCH<br />
Triozzi PL, Eng C, Singh AD. Targeted therapy for uveal<br />
melanoma. Cancer Treat Rev. 2008 May;34(3):247-258.<br />
Utz VM, Krueger RR. Management of irregular astigmatism<br />
following rotationally disoriented free cap after LASIK. J Refract<br />
Surg. 2008 Apr;24(4):383-391.<br />
Vasconcelos-Santos DV, Nehemy PG, Schachat AP, Nehemy MB.<br />
Secondary ocular hypertension after intravitreal injection of<br />
4 mg of triamcinolone acetonide: incidence and risk factors.<br />
Retina. 2008 Apr;28(4):573-580.<br />
Weiss JS, Kruth HS, Kuivaniemi H, Tromp G, Karkera J,<br />
Mahurkar S, Lisch W, Dupps WJ, Jr., White PS, Winters RS,<br />
Kim C, Rapuano CJ, Sutphin J, Reidy J, Hu FR, Lu DW,<br />
Ebenezer N, Nickerson ML. Genetic analysis of 14 families with<br />
Schnyder crystalline corneal dystrophy reveals clues to UBIAD1<br />
protein function. Am J Med Genet A. 2008 Feb 1;146(3):271-283.<br />
Wilkinson DA, Kolar M, Fleming PA, Singh AD. Dosimetric<br />
comparison of 106Ru and 125I plaques for treatment of shallow<br />
(
46<br />
OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
P U B L I C AT I O N S continued<br />
Book Chapters<br />
AGE-REL ATED MACUL AR DEGENER ATION<br />
Singh RP, Chung JY, Kaiser PK. Fundus autofluorescence in<br />
age-related macular degeneration. In: Lim JI, ed. Age-related<br />
macular degeneration. 2nd ed. New York, NY: Informa<br />
Healthcare; 2008. Chapter 12. p. 191-202.<br />
ALBERT & JAKOBIEC’S PRINCIPLES<br />
AND PR ACTICE OF OPHTHALMOLOGY<br />
Chalita MR, Krueger RR. Wavefront-guided excimer laser<br />
surgery. In: Albert DM, ed. Albert & Jakobiec’s principles and<br />
practice of ophthalmology. 3rd ed. Philadelphia, PA: Saunders/<br />
Elsevier; 2008. Volume 1. Chapter 80. p. 1041-1049.<br />
Do DV, Schachat AP. Leukemias. In: Albert DM, ed. Albert &<br />
Jakobiec’s principles and practice of ophthalmology. 3rd ed.<br />
Philadelphia, PA: Saunders/Elsevier; 2008. Volume 4. Chapter<br />
358. p. 4949-4952.<br />
Dupps WJ, Jr., Wilson SE. Biomechanics and wound healing<br />
in refractive surgery. In: Albert DM, ed. Albert & Jakobiec’s<br />
principles and practice of ophthalmology. 3rd ed. Philadelphia,<br />
PA: Saunders/Elsevier; 2008. Volume 1. Chapter 72. p. 971-980.<br />
Singh AD, Sisley K, Wackernagel W. Genetics of uveal melanoma.<br />
In: Albert DM, ed. Albert & Jakobiec’s principles and<br />
practice of ophthalmology. 3rd ed. Philadelphia, PA: Saunders/<br />
Elsevier; 2008. Volume 4. Chapter 355. p. 4925-4934.<br />
Traboulsi EI, Singh AD. The phakomatoses. In: Albert DM, ed.<br />
Albert & Jakobiec’s principles and practice of ophthalmology.<br />
3rd ed. Philadelphia, PA: Saunders/Elsevier; 2008. Volume 4.<br />
Chapter 366. p. 5009-5024.<br />
ANTERIOR SEGMENT OPTICAL<br />
COHERENCE TOMOGR APHY<br />
Wackernagel W, Rao NA, Steinert RF, Singh AD. Optical<br />
coherence tomography for anterior segment tumors. In:<br />
Steinert RF, Huang D, eds. Anterior segment optical coherence<br />
tomography. Thorofare, NJ: SLACK; 2008. Chapter 12.<br />
p. 127-136.<br />
CORNE AL SURGERY: THEORY,<br />
TECHNIQUE, AND TISSUE<br />
Cox CA, Dupps WJ, Jr., Brent GJ, Meisler DM. Corneal and<br />
scleral ruptures and lacerations. In: Brightbill FS, ed. Corneal<br />
surgery: theory, technique, and tissue. 4th ed. [St. Louis, MO.]:<br />
Mosby/Elsevier; 2009. Chapter 71. p. 617-626.<br />
Dupps WJ, Jr. Principles of biomechanics in refractive surgery.<br />
In: Brightbill FS, ed. Corneal surgery: theory, technique, and<br />
tissue. 4th ed. [St. Louis, MO.]: Mosby/Elsevier; 2009. Chapter<br />
81. p. 711-719.<br />
CURRENT CLINICAL MEDICINE 2009<br />
Chung JY, Singh RP. Preventive measures and screening for<br />
ophthalmic problems. In: Carey WD, ed. Current clinical<br />
medicine 2009. Philadelphia, PA: Saunders/Elsevier;<br />
2009. p. 1321-1324.<br />
DIABETIC RETINOPATHY<br />
Margolis R, Kaiser PK. Diagnostic modalities in diabetic<br />
retinopathy. In: Duh E, ed. Diabetic retinopathy. Totowa, NJ:<br />
Humana Press; 2008. Chapter 4. p. 109-133.<br />
IRREGUL AR ASTIGMATISM:<br />
DIAGNOSIS AND TRE ATMENT<br />
Jankov MR, II, Krueger RR. Corneal cross-linking with<br />
riboflavin and ultraviolet irradiation in unstable corneas<br />
with progressive irregular astigmatism. In: Wang M, Swartz<br />
TS, eds. Irregular astigmatism: diagnosis and treatment.<br />
Thorofare, NJ: SLACK; 2008. Chapter 15. p. 145-148.
MANAGEMENT OF COMPLICATIONS<br />
IN REFR ACTIVE SURGERY<br />
Ramos-Esteban JC, Wilson SE. Dry eye. In: Alio JL, Azar DT,<br />
eds. Management of complications in refractive surgery.<br />
Berlin: Springer; 2008. Chapter 5.1. p. 74-85.<br />
MECHANISMS OF THE GL AUCOMAS: DISE ASE<br />
PROCESSES AND THER APEUTIC MODALITIES<br />
Bhattacharya SK, Crabb JW. Proteomic advances toward<br />
understanding mechanisms of glaucoma pathology. In:<br />
Tombran-Tink J, Barnstable CJ, Shields MB, eds. Mechanisms<br />
of the glaucomas: disease processes and therapeutic modalities.<br />
Totowa, NJ: Humana Press; 2008. Chapter 24. p. 443-458.<br />
CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | RESEARCH<br />
OCUL AR THER APEUTIC S:<br />
E YE ON NEW DISCOVERIES<br />
Wilson SE, Medeiros FW. Refractive surgery - Corneal opacity<br />
(haze) after surface ablation. In: Yorio T, Clark AF, Wax MB,<br />
eds. Ocular therapeutics: eye on new discoveries. Amsterdam;<br />
Boston, MA: Academic; 2008. Chapter 7. p. 133-141.<br />
REDOX BIOCHEMISTRY<br />
Lou MF, Crabb JW. Oxidative stress in the eye: Age-related<br />
cataract and retinal degeneration. In: Banerjee R, ed. Redox<br />
biochemistry. Hoboken, NJ: Wiley-Interscience; 2008. Chapter<br />
5.2. p. 194-204.<br />
REFR ACTIVE SURGERY<br />
Krueger RR. The LadarVision system. In: Roy FH, ed. Refractive<br />
surgery. Philadelphia, PA: Saunders/Elsevier; 2008. Chapter 3.<br />
p. 47-56.<br />
Books<br />
Anderson RE, LaVail MM, Hollyfield JG. Recent advances in<br />
retinal degeneration. New York, NY: Springer; 2008. 423 p.<br />
(Advances in Experimental Medicine and Biology; v.613).<br />
47
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OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION<br />
C L E V E L A N D C L I N I C E Y E C A R E L O C AT I O N S<br />
REFERR ALS<br />
General <strong>Cleveland</strong> <strong>Clinic</strong><br />
Patient Referral<br />
24/7 hospital transfers or<br />
physician consults<br />
800.553.5056<br />
Cole Eye Institute<br />
Appointments/Referrals<br />
216.444.2020 or 800.223.2273, ext. 42020<br />
On the Web at clevelandclinic.org/eye<br />
INSTITUTE LOCATIONS<br />
Main Campus<br />
9500 Euclid Ave./i20<br />
<strong>Cleveland</strong>, OH 44195<br />
216.444.2020<br />
Beachwood<br />
25101 Chagrin Blvd.<br />
Beachwood, OH 44122<br />
216.831.0120<br />
Brunswick<br />
3574 Center Road<br />
Brunswick, OH 44212<br />
330.225.8886<br />
Independence<br />
5001 Rockside Road<br />
Crown Center II<br />
Independence, OH 44131<br />
216.986.4000<br />
Lorain<br />
Lakeland Eye Surgeons<br />
5700 Cooper Foster Park Rd.<br />
Lorain, OH 44053<br />
440.204.7400<br />
South Pointe<br />
4110 Warrensville Center Road<br />
Warrensville Heights, OH 44122<br />
216.752.2263<br />
Strongsville<br />
16761 SouthPark Center<br />
Strongsville, OH 44136<br />
440.878.2500<br />
Twinsburg<br />
2365 Edison Blvd.<br />
Twinsburg, OH 44087<br />
330.963.4843
<strong>Cleveland</strong> <strong>Clinic</strong> Access Guide<br />
S e r v i c e s f o r<br />
Physicians<br />
Physician Directory<br />
View all <strong>Cleveland</strong> <strong>Clinic</strong> staff online at clevelandclinic.org/staff.<br />
Physician Liaison<br />
Referring physicians have a direct and personal link to <strong>Cleveland</strong><br />
<strong>Clinic</strong> with our Physician Liaison. For help with any interaction<br />
involving <strong>Cleveland</strong> <strong>Clinic</strong>, please use our online webmail feature<br />
at clevelandclinic.org/ContactKate.<br />
Track Your Patient’s Care Online<br />
Whether you are referring from near or far, DrConnect<br />
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<strong>Cleveland</strong> <strong>Clinic</strong>. To establish a DrConnect account, visit<br />
clevelandclinic.org/drconnect or email drconnect@ccf.org.<br />
S e r v i c e s f o r<br />
Patients<br />
Critical Care Transport Worldwide<br />
<strong>Cleveland</strong> <strong>Clinic</strong>’s critical care transport team serves critically<br />
ill and highly complex patients across the globe. The transport<br />
fleet comprises mobile ICU vehicles, helicopters and fixed-wing<br />
aircraft. The transport teams are staffed by physicians, critical<br />
care nurse practitioners, critical care nurses, paramedics and<br />
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216.444.8302 or 800.553.5056<br />
Remote Consults<br />
Request a remote medical second opinion from <strong>Cleveland</strong> <strong>Clinic</strong>.<br />
MyConsult is particularly valuable for patients who wish to avoid<br />
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email eclevelandclinic@ccf.org or call 800.223.2273, ext 43223.<br />
CME Opportunities: Live and Online<br />
<strong>Cleveland</strong> <strong>Clinic</strong>’s Center for Continuing Education’s website,<br />
clevelandclinicmeded.com, offers convenient, complimentary<br />
learning opportunities, from webcasts and podcasts to a host<br />
of medical publications and a schedule of live CME courses.<br />
Many live CME courses are hosted in <strong>Cleveland</strong>, an economical<br />
option for business travel. Physicians can manage their CME<br />
credits by using the myCME Web Portal, available 24/7.<br />
Medical Concierge<br />
Complimentary assistance for out-of-state patients and families<br />
800.223.2273, ext. 55580, or email medicalconcierge@ccf.org<br />
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Complimentary assistance for national and international<br />
patients and families<br />
001.216.444.8184 or visit clevelandclinic.org/ic
The <strong>Cleveland</strong> <strong>Clinic</strong> Foundation<br />
Cole Eye Institute<br />
9500 Euclid Avenue / AC311<br />
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<strong>Cleveland</strong> <strong>Clinic</strong> is a nonprofit multispecialty academic<br />
medical center. Founded in 1921, it is dedicated to<br />
providing quality specialized care and includes an<br />
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beds, an education institute and a research institute.<br />
Please direct any correspondence to:<br />
Steven E. Wilson, MD<br />
Medical Editor<br />
Cole Eye Institute/i32<br />
<strong>Cleveland</strong> <strong>Clinic</strong><br />
9500 Euclid Avenue<br />
<strong>Cleveland</strong>, Ohio 44195<br />
Chairman, <strong>Cleveland</strong> <strong>Clinic</strong> Cole Eye Institute<br />
Daniel F. Martin, MD<br />
Vice Chairman for <strong>Clinic</strong>al Affairs<br />
Andrew P. Schachat, MD<br />
Director, Residency Training Program<br />
Vice Chairman for Education<br />
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© The <strong>Cleveland</strong> <strong>Clinic</strong> Foundation 2009<br />
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