Ophthalmology Update - Cleveland Clinic

COLE EYE INSTITUTE 

Ophthalmology 

Update 

Special Edition 2009

OPHTHALMOLOGY UPDATE 2009 SPECIAL EDITION 

in this 

Issue 

02 Investigations 

16 Innovation 

20 Staff 

28 Education 

34 Research

D E A R C O L L E A G U E S 

I am pleased to present the 2009 Cleveland Clinic Cole 

Eye Institute Special Edition of Ophthalmology Update. 

As you will see in the pages that follow, Cole Eye 

Institute has enjoyed great success in the past year in 

both clinical care and cutting-edge research. At the 

same time, it also has been a year of significant change. 

In December 2008, I was honored to join the Cole Eye 

Institute as its new Chairman. The tradition of academic 

and clinical excellence, as well as the people who 

make up this great institute, were the primary reasons 

that I accepted this position. I feel most fortunate to be 

here working with this highly acclaimed staff. 

In this year’s special edition, you can read about a non-invasive drug delivery system for 

ocular disease that is under development by Dr. Rishi Singh in collaboration with Buckeye 

Ocular (p.5) and a superiorly based bilobed flap for reconstruction of nasojugal fold 

region defects being used by Dr. Julian Perry (p.7). We also provide an update on the three 

largest ongoing multicenter randomized clinical trials evaluating treatments for neovascular 

(wet) age-related macular degeneration, including (p.3) the Comparison of AMD 

Treatments Trials (CATT), the DENALI trial and (p.10) the VEGF Trap-Eye Phase III study. 

Members of our staff play leadership roles in all three of these studies. 

I hope that you are able to spend some time reviewing Ophthalmology Update and find 

it valuable and helpful in your practice. I look forward to sharing with you additional 

updates as the year progresses regarding our ever-expanding research program and our 

efforts to further improve patient care. Please feel free to contact us at 216.444.2020 if you 

have any questions or would like to refer a patient. As always, we welcome the opportunity 

to work with you. 

Sincerely, 

Daniel F. Martin, MD 

Chairman, Cole Eye Institute 

1


Investigations 

STRIVING FOR ANSWERS


Two of the nation’s most important clinical trials 

in age-related macular degeneration (AMD) are 

now lead by retina specialists at Cleveland Clinic’s 

Cole Eye Institute. 

When Daniel F. Martin, MD, became Chairman 

of Cole Eye Institute in late 2008, coming from 

Emory University in Atlanta, he brought with him 

his role as Study Chairman of the Comparison of 

AMD Treatments Trials (CATT). 

CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | INVESTIGATIONS 

New Chairman Brings CATT Study to Cole Eye Institute 

Colleague Peter K. Kaiser, MD, is chairman of the 

DENALI trial, which is evaluating the combination 

of injectable verteporfin (Visudyne ® ) photodynam- 

ic therapy and ranibizumab (Lucentis ® ) for the 

treatment of AMD. The 24-month study will 

compare the ranibizumab combination therapy 

with ranibizumab monotherapy in patients with 

subfoveal choroidal neovascularization (CNV) 

secondary to neovascular AMD. Dr. Kaiser also is 

involved in the leadership of the VEGF Trap-Eye 

Phase III study (see related article, p. 10). 

The CATT study has generated much publicity 

in recent months. Genentech’s ranibizumab is 

approved by the FDA for treatment of AMD, but 

many ophthalmologists believe that another of 

the company’s drugs, bevacizumab (Avastin ® ), 

delivers equal results for a fraction of the price. 

“Two of the nation’s most important clinical 

trials in age-related macular degeneration 

(AMD) are now lead by retina specialists at 

Cleveland Clinic’s Cole Eye Institute.” 

Dr. Martin agrees that comparing the drugs in a 

head-to-head trial is an important issue. However, 

he believes that the study’s second question, 

which addresses the issues of preferred dosing 

frequency, is just as important. 

“The clinical trials that led to FDA approval of 

ranibizumab only evaluated a fixed monthly 

dosing schedule. However, in clinical practice, 

Continued 

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4 


CATT Study continued 

no one is using this drug or bevacizumab this way,” 

he says. “Most retina specialists are using these 

drugs on an as-needed basis. It is essential to 

understand whether or not we are compromising 

long-term visual outcomes with these reduced 

dosing frequencies and whether or not we can 

identify a subset of patients who do very well with 

fewer injections.” 

“Most retina specialists are using these drugs on an 

as-needed basis, and we are eager to learn if that is 

the optimal way to use them, or if a fixed schedule 

would deliver superior outcomes,” he says. 

To help answer both questions, patients are being 

randomly assigned to one of four groups for 

treatment during the first year (doses are 0.5 mg 

for ranibizumab and 1.25 mg for bevacizumab): 

• Ranibizumab on a fixed schedule of every 

four weeks for a year. 

• Bevacizumab on fixed schedule of every 

four weeks for a year. 

• Ranibizumab on variable schedule dosing; 

i.e., after initial treatment, monthly evaluation 

of the need for treatment based on signs of 

lesion activity. 

• Bevacizumab on variable schedule dosing; 

i.e., after initial treatment, monthly evaluation 

of the need for treatment based on signs of 

lesion activity. 

Optical coherence tomography will drive retreatment 

decisions in the PRN groups, he explains. If 

any subretinal, intraretinal or sub-retinal pigment 

epithelium fluid is seen, the eye will receive an 

injection. If there is no fluid but there are other 

signs of active CNV, the eye will be treated as 

well. Examples of signs include new or persistent 

subretinal or intraretinal hemorrhage or unexplained 

decreased visual acuity. Fluorescein 

angiography results may be considered at the 

physician’s discretion, and findings that would 

elicit particular concern would include increased 

lesion size or leakage. 

The primary outcome measure is change in visual 

acuity. Secondary outcome measures include 

number of treatments, retinal thickness at the 

fovea, adverse events and cost. 

Dr. Martin expects the two-year trial to complete 

enrollment — 1,200 participants at 43 sites — by 

the fourth quarter of 2009. One-year outcomes are 

expected to be released early in 2011. 

For more information, 

contact ophthalmologyupdate@ccf.org.

Non-invasive Drug Delivery System 

for Ocular Disease Under Development 

Rishi P. Singh, MD 


The current method of delivery of ocular therapeutics 

is through injections in the eye. In the case of 

age-related macular degeneration (AMD), treatments 

can be as frequent as every four weeks. 

These injections have been associated with 

significant side effects such as pain, infection, 

bleeding and retinal detachment. Beyond the 

socioeconomic impact of monthly patient visits, 

intravitreal injections must be administered by an 

ophthalmologist and place significant demands 

on ophthalmic practices given the growth of the 

number of patients with AMD. 

At the Cleveland Clinic Cole Eye Institute, Rishi P. 

Singh, MD, is collaborating with Buckeye Ocular, 

Beachwood, Ohio, to develop a drug delivery system 

that is non-invasive, low-cost and effective with 

minimal side effects. Together, they are adapting 

a proprietary technology and drug formulation 

combination, Macroesis , which Buckeye Ocular’s 

parent company, Buckeye Pharmaceuticals, had 

developed to revolutionize the treatment of 

onychomycosis and herpes labialis. 

Nanodielectrophoresis 

• AC signal applies a non-uniform electric field to a chemical 

compound. 

• This induces a dipole (areas of equal charge separated by a 

distance) in the compound and generates an electrical field 

gradient that provides an electromotive force. 

• This forces varies in magnitude and direction with applied 

frequency, among other factors. 

“The delivery technology uses a series of optimallytuned 

alternating current (AC) signals applied with 

a custom-designed combination of successive 

electrodes that induces temporary polarization, 

preconcentrates and enhances mobility in AMD 

drugs, making them candidates for active transcleral 

delivery,” Dr. Singh says. 

Two in-vitro models of drug delivery were used 

for recent validity studies with ranibizumab and 

triamcinolone acetonide. These studies, the results 

of which were presented at the Retina Society and 

Prototype Device Design 

Continued 

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6 


Non-invasive Drug Delivery System continued 

American Society of Retina Specialists annual 

meetings in 2008, concluded that macroesis 

can successfully deliver ranibizumab, an 

FDA-approved intravitreal injection for treating 

AMD, and triamcinolone acetonide, a topical 

corticosteroid, in a non-invasive manner using 

the Buckeye Ocular delivery system. 

The technology is akin to iontophoresis, a delivery 

platform for steroids to be transported to a joint 

that uses direct current (DC), Dr. Singh explains. 

“The beauty of macroesis is that you can actually 

optimally tune the drug for the delivery,” he says. 

“If I have a drug that is hard to diffuse to tissue, I 

can use a certain wave length and voltage to fine 

tune its delivery for a superior outcome. It’s almost 

like iontophoresis on steroids.” 

Dr. Singh and his collaborators recently received 

$35,000 in product development funds from 

Cleveland Clinic Innovations to conduct preclinical 

studies. The study has two aims: 1) To transport 

ranibizumab through an eye animal model to 

a saline solution vitreous fluid analog using a 

laboratory-generated electrical signal. 2) To build 

an alpha prototype embodying the laboratorygenerated 

signaling to transport the pharmacological 

agents through the cadaver animal model. 

Dr. Singh says the prototype will be like a contact 

lens that is inserted on the patient’s eye and runs 

off of four AA batteries. The consumable electrode 

preloaded with the approved AMD drug would 

be designed to be nurse-administered in a 

clinical setting. 

“If the device can succeed in being both 

inexpensive and convenient, Dr. Singh says, 

it has the potential to eliminate some existing 

barriers to AMD treatment.” 

Such a treatment, he says, could be performed 

in as little as five to 10 minutes in an outpatient 

setting, or perhaps even at home. 

If the device can succeed in being both inexpensive 

and convenient, Dr. Singh says, it has the potential 

to reduce some existing barriers to AMD treatment. 

“The gold standard for AMD treatment is monthly 

injections,” he says. “But this is many times 

prohibitive for patients. If we could use this 

technology successfully, maybe we would have 

better compliance and improved outcomes.” 

Another exciting aspect of the technology is its 

potential for pairing with any FDA-approved drug. 

“Currently, we’re focusing on AMD, but it could 

conceivably be used for any ocular disease. 

Perhaps it could be used with anti-inflammatory 

medications to treat uveitis or with chemotherapeutic 

medication for ocular melanoma 

or metastasis.” 


contact ophthalmologyupdate@ccf.org.

Superiorly Based Bilobed Flap Effective for Inferior Medial Canthal and 

Nasojugal Fold Defect Reconstruction 

Julian D. Perry, MD 


Reconstruction of the inferior medial canthal, nasal 

sidewall and nasojugal fold after surgical resection 

of cutaneous malignancy presents many challenges. 

The medial canthal region represents a multi-contoured 

area with great variation in skin thickness, 

color, texture and appendage density, and it includes 

contributions from the orbital and tarsal portions 

of the upper and lower eyelids, the nasal sidewall 

and the glabella. Local landmarks, including the 

lacrimal drainage apparatus and eyebrows, limit 

flap design, as does the lack of significant horizontal 

tissue redundancy in this region. 

To evaluate the use of a superiorly based bilobed flap 

for reconstruction of nasojugal fold region defects, 

Cole Eye Institute oculoplastic surgeon Julian D. 

Perry, MD, and his team conducted a retrospective 

review of all patients undergoing medial canthal, 

nasal sidewall and nasojugal fold region reconstruction 

using a superiorly based bilobed flap from 

October 2000 through March 2008. Charts were 

reviewed for patient age and gender, indication, 

defect size and location, flap(s) used and follow-up 

time. Outcome measures included ability to 

completely close the defect without tension, 

cosmetic appearance, complications and need 

for further surgery. 

Eighteen cases of medial canthal and nasojugal 

fold area reconstruction were performed using a 

superiorly based bilobed flap in 17 patients. There 

were eight male and nine female patients with an 

average age of 68.2 years (range, 11 to 88 years) and 

mean follow-up time of 17.8 months (range, 1 to 60 

months). Mean defect size measured 2.0 x 1.4 cm 

(range, 0.7 to 4 cm). One patient underwent 

simultaneous glabellar flap repair, two patients 

underwent simultaneous lateral lower eyelid 

rotational flap repair, and one patient underwent 

simultaneous upper eyelid V-Y advancement flap. 

All defects closed completely with no wound 

tension. No cases of hemorrhage, infection, 

a b c 

Preoperative (a), immediate postoperative (b) and one-year postoperative (c) photographs of a patient who underwent successful 

reconstruction of a typical nasojugal region defect using a superiorly based bilobed flap. 

dehiscence or necrosis developed during the 

follow-up period. Cosmetic satisfaction was 

achieved in 16 of 17 patients. Complications 

included mild medial ectropion (two patients) and 

canalicular stenosis (one patient). None of these 

patients elected re-operation. Trapdoor deformity 

did not occur in any case. Two patients underwent 

re-operation for local tumor recurrence. 

Dr. Perry and the team concluded that a superiorly 

based bilobed flap adequately reconstructs inferior 

medial canthal, nasal sidewall and nasojugal 

fold defects. 


contact ophthalmologyupdate@ccf.org. 

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Case Study: DSAEK to Treat Amantadine-associated Corneal Edema 

Christopher T. Hood, MD 

Roger H.S. Langston, MD 

William J. Dupps, Jr., 

MD, PhD 

Presentation: 

A 45-year-old Caucasian woman presented to the 

Cole Eye Institute for management of corneal 

edema. She described experiencing six months of 

blurry vision in both eyes that was worse in the 

morning and improved slightly throughout the day. 

She denied redness, pain or photophobia. She was 

being treated with Muro 128 ointment four times 

daily in the right eye upon referral. 

She denied any history of ocular trauma, surgery 

or inflammatory disease. Her medical history was 

significant for a longstanding diagnosis of multiple 

sclerosis, for which she was taking baclofen, methyl- 

phenidate, glatiramer acetate injection, neurontin, 

amantadine, escitalopram oxalate and bupropion. 

She denied any family history of eye disease. 

Examination: 

On examination, visual acuity was 20/800 in the right 

eye and 20/400 in the left eye. Pupils were equal 

in size and reactive, without an afferent pupillary 

defect. Extraocular movements were full. Intraocular 

pressures were 12 mm Hg in the right eye and 10 

mm Hg in the left eye. Anterior segment examination 

demonstrated normal eyelids, sclera and conjunc- 

tiva. Bilateral diffuse stromal and epithelial edema 

was observed with marked Descemet membrane 

folds and pre-Descemet membrane opacification 

without guttae (Figure 1). Ultrasound pachymetry 

demonstrated a central corneal thickness of 867 

µm in the right eye and 700 µm in the left eye. The 

anterior chambers were deep and quiet. The iris 

and lens were normal. Dilated fundus examination 

of both eyes was unremarkable. 

Diagnosis: 

Diagnoses considered included Fuchs endothelial 

dystrophy, endotheliitis, congenital hereditary 

endothelial dystrophy and posterior polymorphous 

dystrophy. In this case, a lack of guttae on examina- 

tion combined with the historical features of no 

previous intraocular surgery and amantadine use 

led to the diagnosis of amantadine-associated 

corneal edema. With the approval of the patient’s 

neurologist, amantadine was discontinued and the 

patient was followed for six weeks with minimal 

improvement of the bilateral corneal edema. 

Prednisolone acetate 1 percent was initiated four 

times daily in both eyes and the patient was followed 

for an additional six weeks. Although she demonstrated 

initial improvement, best corrected vision 

was 20/200 in both eyes. 

The patient was offered Descemet’s stripping 

automated endothelial keratoplasty (DSAEK) in the 

right eye. After informed consent was obtained, she 

underwent uncomplicated surgery. The patient, who 

had no appreciable nuclear sclerosis, was left phakic 

and was given topical pilocarpine 1 percent preoperatively. 

Descemet stripping was performed under air, 

and a donor lenticule was prepared on an artificial 

anterior chamber and punched to 8.5 mm just prior to 

insertion. Controlled tamponade of the graft against 

the host stroma was performed with air infusion and 

air-fluid exchange as described previously. 1 Three 

months after surgery, the patient’s best corrected 

visual acuity was 20/30+ in the right eye. Her cornea 

was clear and compact with minimal anterior stromal 

haze and the posterior donor lenticule was wellcentered 

(Figure 2). DSAEK is planned in the left eye. 

Discussion: 

Amantadine was developed for short-term use as 

an antiviral drug against influenza A, also is used 

chronically to treat tremors and stiffness in Parkinson’s 

disease and fatigue associated with multiple 

sclerosis. The mechanism of its action is not well 

understood. Reported ocular side effects include 

visual loss, hallucination, oculogyric crises and 

mydriasis. 2 Corneal side effects include superficial 

punctuate keratitis, punctuate subepithelial opacities, 

and epithelial and stromal edema. 2 Corneal edema 

occurs from a few weeks to many years after commencing 

amantadine therapy. 2-6 Clinical exam 

demonstrates bilateral, diffuse stromal and microcystic 

epithelial edema, without guttae or inflammatory


Figure 1a Figure 1b Figure 1c 

signs. First-line management consists of discontinu- 

ing amantadine, which results in the resolution of 

corneal edema in most cases. 2-6 However, it has 

recently been reported that corneal edema may be 

irreversible, and penetrating keratoplasty has been 

employed with good anatomic and visual outcomes. 2 

The pathophysiology of amantadine-associated 

corneal edema is not fully understood, but the 

medication is thought to damage endothelial cells, as 

evidenced by the presence of rare endothelial cells 

on routine light microscopy and areas of denuded 

endothelial cells on scanning electron microscopy. 2 

The presence of a posterior collagenous layer by 

transmission electron microscopy supports the 

hypothesis that amantadine leads to endothelial 

stress. 2 Other authors have demonstrated a low 

endothelial cell density by specular microscopy after 

discontinuation of amantadine, even in corneas 

that cleared and returned to normal thickness. 3 

It remains unclear why only a small fraction of patients 

treated with amantadine develops corneal edema. 

References 

1. Meisler DM, Dupps WJ, Jr., Covert DJ, Koenig SB. 

Use of an air-fluid exchange system to promote graft 

adhesion during Descemet’s stripping automated 

endothelial keratoplasty. J Cataract Refract Surg. 

2007;33(5):770-2. 

2. Jeng BH, Galor A, Lee MS, et al. Amantadineassociated 

corneal edema potentially irreversible 

even after cessation of the medication. 

Ophthalmology. 2008;115(9):1540-4. 

3. Chang KC, Kim MK, Wee WR, Lee JH. Corneal 

endothelial dysfunction associated with amantadine 

toxicity. Cornea. 2008;27(10):1182-5. 

4. Hughes B, Feiz V, Flynn SB, Brodsky MC. 

Reversible amantadine-induced corneal edema 

in an adolescent. Cornea. 2004;23(8):823-4. 

DSAEK, a partial thickness transplantation of 

the posterior corneal surface, is emerging as the 

preferred procedure for managing endothelial 

dysfunction in the absence of stromal opacities 

because of its more predictable refractive outcomes, 

faster visual recovery, and maintenance of the 

structural integrity of the eye. Although most com- 

monly used for Fuch’s dystrophy and pseudophakic 

or aphakic bullous keratopathy, DSAEK also has been 

7, 8 

used in cases of iridocorneal endothelial syndrome. 

To our knowledge, this is the first patient in which 

DSAEK was employed in amantadine-associated 

corneal edema, and a successful outcome was 

achieved for our patient. This case highlights the 

importance of considering amantadine toxicity in the 

differential diagnosis of corneal edema without an 

identifiable ocular cause and suggests the utility of 

DSAEK in the treatment of this rare condition. 

Dr. Hood is a resident at Cole Eye Institute. For more 

information, contact ophthalmologyupdate@ccf.org. 

5. Kubo S, Iwatake A, Ebihara N, et al. Visual 

impairment in Parkinson’s disease treated with 

amantadine: case report and review of the literature. 

Parkinsonism Relat Disord. 2008;14(2):166-9. 

6. Pond A, Lee MS, Hardten DR, et al. Toxic corneal 

oedema associated with amantadine use. 

Br J Ophthalmol. 2009;93(3):281,413. 

7. Price MO, Price FW, Jr. Descemet stripping with 

endothelial keratoplasty for treatment of iridocorneal 

endothelial syndrome. Cornea. 2007;26(4):493-7. 

8. Jeng BH, Dupps WJ, Jr., Meisler DM, Schoenfield L. 

Epithelial debridement for the treatment of 

epithelial basement membrane abnormalities 

coincident with endothelial disorders. Cornea. 

2008;27(10):1207-11. 

9

10 


VEGF Trap-Eye for AMD in Phase III Trials 

Phase II results promising; Cleveland Clinic Cole Eye Institute specialist on executive committee 

Peter K. Kaiser, MD 

Phase III trials of VEGF Trap-Eye, a promising new 

treatment for age-related macular degeneration 

(AMD), are under way nationally and a Cleveland 

Clinic Cole Eye Institute retina specialist has a key 

leadership role in the research. 

Peter K. Kaiser, MD, who is on the Executive 

Committee of the 150-plus site Phase III study, 

explains that the results of the Phase II study of 

VEGF Trap-Eye, for which the Cole Eye Institute 

was the central reading center, were very positive. 

“The number of treatments required to achieve the 

desired results was considerably less than with our 

current standards of care, ranibizumab injection 

(Lucentis ® ) and bevacizumab (Avastin ® ),” he says. 

VEGF Trap-Eye is a unique fusion protein that 

binds all forms of VEGF (vascular endothelial 

growth factor) and PLGF (placental growth factor), 

which is another member of the VEGF family that 

binds to the VEGF receptor 1 and activates VEGF 

receptor signaling. PLGF indirectly increases VEGF 

concentration, is upregulated in neovascularization 

and is thought to be involved in the pathophysiology 

of AMD. 

Dr. Kaiser explains that VEGF Trap-Eye is a soluble 

receptor decoy that works in a manner similar to 

ranibizumab or bevacizumab but binds VEGF 

tighter than these drugs and even the native 

receptors, so it may last longer and/or achieve 

better outcomes. 

In the multicenter Phase II study, 157 patients 

received an initial intravitreal injection and then 

were randomly assigned to one of five VEGF Trap 

dosing schedules: 

-0.5 mg every four weeks 

-2 mg every four weeks 

-0.5 mg every 12 weeks 

-2 mg every 12 weeks 

-4 mg every 12 weeks 

“VEGF Trap-Eye achieved clinically 

meaningful and durable vision improvement 

over one year with almost two lines gained 

at week 52 and an excellent reduction in 

central retinal lesion thickness at week 52 

as measured by OCT.” 

All patients were redosed no later than week 12. 

As-needed (PRN) dosing began at week 16 and 

continued through week 52. Criteria for the PRN 

dosing after 16 weeks included persistent fluid as 

visualized with optical coherence tomography 

(OCT), a loss of ≥ 5 ETDRS letters with recurrent 

fluid on OCT, new or persistent leakage seen via 

fluorescein angiography, a new macular hemor- 

rhage, central retinal thickness ≥100 µm as seen 

on OCT or new onset classic neovascularization. 

At 12 weeks, mean change central retinal/lesion 

thickness (CR/LT), which was the study’s primary 

endpoint, was best in the 2 mg every four weeks 

group. Mean change in visual acuity, the secondary 

endpoint, was best in the patients receiving 

treatment every four weeks, with approximately a 

1.5-line gain in vision, but even the patients treated 

every 12 weeks gained around one line in vision. 

The mean number of doses given during the PRN 

phase averaged 2.1 across all treatment groups. 

“Patients received, on average, only two addition- 

al injections over the 40-week PRN-dosing phase. 

No additional injections were used after week 12 

in 19 percent of patients,” Dr. Kaiser says. “VEGF 

Trap-Eye achieved clinically meaningful and 

durable vision improvement over one year with 

almost two lines gained at week 52 and an 

excellent reduction in central retinal lesion 

thickness at week 52 as measured by OCT.” 

The drug was generally well tolerated, he adds.


Regeneron and Bayer HealthCare are collaborating on 

the development of VEGF Trap-Eye for the treatment 

of wet AMD, diabetic eye diseases and other eye 

disorders. Bayer HealthCare will market VEGF 

Trap-Eye outside the United States, while Regeneron 

maintains exclusive rights in the United States. 

The companies have initiated the Phase III trial 

to evaluate dosing at 0.5 mg every four weeks, 

2 mg every four weeks or 2 mg every eight weeks, 

following three monthly doses, in direct comparison 

with ranibizumab administered 0.5 mg every 

four weeks. PRN dosing will be evaluated during 

the second year. This study is ongoing throughout 

AngioQuest 

Peter K. Kaiser, MD, is Chief Medical Officer 

of a new Cleveland Clinic-owned company, 

AngioQuest. 

The company has three anti-angiogenic platforms 

that are in pre-clinical testing. One is based on 

the work by Cole Eye Institute researcher Bela 

Anand-Apte, PhD, with tissue inhibitor of 

metalloproteinase (TIMP3). The second is based 

on the work of Tatiana Byzova, PhD, in Cleveland 

the world and at the Cole Eye Institute. 

“We are always looking for better treatments for 

macular degeneration that can offer our patients 

the best outcomes with fewer treatments,” Dr. 

Kaiser says. “We hope that the Phase III trials will 

confirm that VEGF Trap-Eye is an incremental step 

over what we currently have.” 



Clinic’s Department of Molecular Cardiology, 

regarding AlphavBeta3 integrin. The third 

involves carboxyethyl pyrrole (CEP), work led 

by Dr. Anand-Apte and John W. Crabb, PhD, 

also of the Cole Eye Institute. 

For more information about AngioQuest, please 

contact Neema Mayhugh, PhD, at 216.445.7176 or 

mayhugn@ccf.org. 

11

12 


Cole Eye Institute Researchers Describe a Difference 

in the Biomechanical Impact of Hyperopic Versus Myopic LASIK 

William J. Dupps, Jr., 

MD, PhD 

By thinning the cornea and severing anterior 

corneal lamellae, LASIK and other photoablative 

keratorefractive procedures induce changes in 

corneal material properties. In some patients, 

these structural alterations can contribute to residual 

postoperative refractive error or even biomechanical 

instability in the form of ectasia. At the 

Cole Eye Institute, William J. Dupps, Jr., MD, PhD, 

has been actively involved in conducting research 

in this field, including developing methods for 

assessing the cornea’s biomechanical properties 

and studies to determine how they are affected by 

corneal pathology and surgery. 

Results from a recent study using the Ocular 

Response Analyzer (ORA, Reichert) to investigate 

biomechanical changes early after myopic and 

hyperopic LASIK support the hypothesis that 

differences in the ablation pattern of these two 

procedures leads to marked differences in their 

biomechanical impact. The work was performed in 

collaboration with Fabricio W. Medeiros, MD, and 

Abhijit Sinha Roy, PhD, of the Cole Eye Institute 

Laboratory of Ocular Biomechanics & Imaging. 

Extrapolating these findings to clinical outcomes, 

Dr. Dupps postulates they may account for the 

observation that post-LASIK ectasia occurs more 

often after myopic versus hyperopic keratorefractive 

ablation procedures. The results also may explain 

the greater artifactual decrease in IOP after myopic 

versus hyperopic corneal ablative surgery. 

“Interest in understanding the underlying mechanisms 

of patient-specific outcomes after laser 

vision refractive surgery has been one motivation 

driving corneal biomechanics research. With the 

ORA, researchers have for the first time a useful 

tool for collecting in vivo data in a clinical setting,” 

notes Dr. Dupps. 

“Previous investigations using this instrument 

have shown significant differences in the corneal 

biomechanical properties of post-LASIK eyes 

compared with normal, virgin corneas. To our 

knowledge, ours is the first study investigating 

how LASIK-induced changes in corneal material 

properties are affected by the specific photo 

ablation pattern.” 

The study was a retrospective analysis of preop- 

erative and one-week postoperative data extract- 

ed from chart review of 13 eyes of 13 myopic 

patients and 11 eyes of 11 hyperopic patients. 

In order to isolate a potential influence of 

differences in the photoablative pattern on 

corneal biomechanics, other factors that might 

affect the outcome were evaluated. 

All myopic and hyperopic procedures were 

performed with the same flap construction 

method using the same femtosecond laser with 

similar energy settings to create thin flaps of 

similar attempted depth and diameter. In addition, 

the ablations were performed with a single excimer 

laser system, and the mean total number of fixed 

spot-size photoablative pulses, which is a surro- 

gate for ablated corneal volume, was comparable 

in the myopic and hyperopic groups. Statistical 

analyses showed the two groups also were similar 

preoperatively with respect to mean values for 

central corneal thickness as well as for the two 

ORA-derived biomechanical measures, corneal 

hysteresis (CH) and corneal resistance factor (CRF). 

ORA measurements performed at one week after 

surgery showed significant differences between 

the myopes and hyperopes that demonstrated 

the hyperopic procedures had less impact on the 

ORA’s standard corneal viscoelastic parameters. 

Compared with the hyperopes, the myopes had 

both significantly lower mean CH and CRF values 

and a significantly greater decrease in both 

measures. In addition, there was a significantly 

greater reduction in Goldmann-equivalent IOP 

(IOPg) after surgery in the myopic group compared 

with the hyperopes.


“Results from a recent study using the Ocular Response Analyzer (ORA, Reichert) to investigate 

biomechanical changes early after myopic and hyperopic LASIK support the hypothesis that 

differences in the ablation pattern of these two procedures leads to marked differences in 

their biomechanical impact.” 

“A tendency for IOP to be underestimated by 

applanation tonometry in eyes that have undergone 

myopic LASIK has been previously recognized 

and was originally attributed to thinning 

of the central cornea where the IOP measurement 

is made. Our data corroborate this postoperative 

change in IOP with central ablation but also 

demonstrate that a change in the biomechanical 

status of the cornea with little removal of tissue in 

the central 3 mm impacts the IOP measurement 

after surgery,” Dr. Dupps says. 

Regression analyses performed to examine any 

relationship between the number of laser pulses 

delivered and the changes in CH and CRF values 

showed no statistical correlations in the hyperopic 

group or for change in CH in the myopic group. 

However, there was a statistically significant inverse 

relationship between change in CRF and the number 

of laser pulses delivered for the myopic ablations. 

Dr. Dupps observes that the lesser impact of the 

hyperopic ablation on corneal biomechanics might 

be predicted based on knowledge of regional 

differences in corneal tissue architecture. Relative 

to the central ablation of myopic corrections, 

hyperopic procedures remove a paracentral annulus 

of tissue and involve an area of the cornea that is 

relatively thicker and biomechanically stronger. 

“The cornea is thinnest in the center and becomes 

thicker moving toward the periphery, and the 

collagen lamellae become more tightly interwoven 

moving anteriorly toward the epithelium and 

outward toward the limbus. Therefore, hyperopic 

LASIK removes proportionally less corneal 

thickness than myopic corrections and leaves 

a stronger underlying interlamellar network. 

Together, these features may be important 

in minimizing the biomechanical impact of 

hyperopic ablation profiles,” he explains. 

One other factor that could contribute to the 

measured differences in the biomechanical impact 

of myopic and hyperopic ablation profiles could be 

that ORA data are derived from reflections of 

infrared light off the central 3 mm of the cornea. 

“Previous work from our laboratory, as well as 

emerging clinical data, suggest that central 

corneal biomechanical behavior and, therefore, 

ORA measurements are affected by in the mechanical 

conditions outside the central cornea, suggesting 

that device spatial sampling bias may not be 

sufficient to explain the measured differences,” 

notes Dr. Dupps. 

Continuing their research, Dr. Dupps and colleagues 

are adding more patients to their study 

groups. In addition, they have designed several 

new variables based on custom signal waveform 

analysis of the ORA measurements to try to gain 

more sensitive and specific indicators of biomechanical 

change. Preliminary analyses reveal 

differences between several variables in their 

responses to myopic versus hyperopic surgery. 

“Currently, we are analyzing multiple candidate 

variables not only for the purpose of identifying 

additional predictors of the biomechanical and 

optical responses to refractive surgery, but also 

for early detection of keratoconus in a refractive 

surgery screening setting,” says Dr. Dupps. 



13

14 


Reducing the Progression of Retinopathy of Prematurity 

Jonathan E. Sears, MD 

Two recent Cleveland Clinic publications highlight 

the idea that stimulating angiogenesis can prevent 

retinopathy of prematurity (ROP). 1,2 

In the March 2009 issue of Ophthalmology, 

Cleveland Clinic ophthalmologist Jonathan E. 

Sears, MD, and Fairview Hospital neonatologist 

Jeffrey Pietz, MD, reported that a modified oxygen 

protocol showed not only a reduction in threshold 

retinopathy, but more importantly, an increase in 

the incidence of normal, orderly development of 

the retina without the disease phenotype. 

Adjusting Oxygen Saturation by Age 

The new protocol calls for decreasing the oxygen 

saturation targets when infants are less than 34 

weeks, and increasing the saturation targets when 

infants are 34 weeks or more. These targets appear 

to match in utero saturations and thereby enable 

the sequential development of the retina without 

provoking the typical disease progression of ROP. 

“Our findings in the clinic gave us the idea that we 

could use pharmaceutical preconditioning in the 

same way as oxygen,” notes Dr. Sears, Principal 

Investigator and member of Cleveland Clinic’s 

departments of Ophthalmic Research and Cell 

Biology. In a study published in the December 2008 

Proceedings of the National Academy of Sciences, he 

reported that increasing the activity of hypoxiainducible 

factor during early premature age 

prevents ROP in a mouse model. 

Preventing Many Complications 

“The work of Drs. Sears and Pietz opens new 

horizons for the prevention of ROP,” says Ricardo 

Rodriguez, MD, Director of Neonatal Care at 

Cleveland Clinic Children’s Hospital. “It demonstrates 

that inducing normal development of 

the retina — either pharmaceutically or by the 

judicious use of oxygen — allows for sequential 

and orderly retinal development. This has tremendous 

implications for the systemic complications 

of prematurity found in the lungs and brain.” 

Currently, progressive disease is treated surgically, 

through laser ablation of the avascular 

retina. Advanced proliferative disease requires 

more aggressive surgical intervention and has 

mixed results. 

Reversing Phases for Infants’ Benefit 

Both of these studies by Dr. Sears’ group demonstrate 

that “reversal” of these stages, either by 

hypoxic or pharmaceutical preconditioning, may 

benefit children. This process prevents ischemia 

and may therefore have application to a wide 

range of diseases, such as diabetes and stroke. 

“In our NICUs, changes in oxygen administration 

practices have significantly decreased the incidence 

of ROP,” says Dr. Rodriguez. “We treat the 

administration of oxygen just as we do any other 

drugs. We are very careful in optimizing oxygen 

delivery and monitoring oxygen saturation levels 

in these tiny babies to avoid the detrimental effects 

of wide blood oxygen level fluctuations on the 

immature retina.” 



References 

1. Sears JE, Pietz J, Sonnie C, Dolcini D, Hoppe G. A 

change in oxygen supplementation can decrease 

the incidence of retinopathy of prematurity. 

Ophthalmology. 2009 Mar;116(3):513-8. 

2. Sears JE, Hoppe G, Ebrahem Q, Anand-Apte B. 

Prolyl hydroxylase inhibition during hyperoxia 

prevents oxygen-induced retinopathy. Proc Natl 

Acad Sci USA. 2008 Dec 16;105(50):19898-903.

Case Study: Fundus Photography Useful 

for Detecting AMD in Asymptomatic Patient 



Presentation: 

The patient is a 68-year-old man with a medical 

history significant for hypertension, hyperglyceridemia 

and carotid occlusive disease. He presented for 

his annual Executive Health physical examination 

and was asked to undergo remote ophthalmology 

screening evaluation. 

Examination: 

On examination, his visual acuity was 20/20 in both 

eyes at both distance and near with correction. 

Air puff tonometry measurements of intraocular 

pressure showed measurements of 12 mm Hg in 

the right eye and 11 mm Hg in the left eye. The 

non-dilated funduscopic photograph was significant 

for large, soft drusen in both eyes with retinal 

pigment epithelial changes. The diagnosis of 

age-related macular degeneration (AMD) was made 

and the patient was referred for full ophthalmologic 

evaluation with a retina specialist at Cole Eye 

Institute. The follow-up examination confirmed the 

diagnosis of dry AMD (category 3) and the patient 

was asked to start Age-Related Eye Disease Study 

(AREDS) vitamin therapy and monitor his vision 

with an Amsler grid for acute changes. 

Discussion: 

Non-mydriatic fundus photography is a type of 

medical imaging of the retina. A customized camera 

is used to take high-resolution images, which can 

be used to diagnose certain ocular diseases and 

monitor disease progression. No medications or 

dilation of the pupil is required for the exam. 

Through our Cole Fundus Screening Network, 

fundus photos of undilated eyes are taken by a 

technician in a physician office. The process is 

simple, painless and takes about five to seven 

minutes. The images are remotely uploaded to the 

electronic medical record for review by a fellowshiptrained 

retina specialist at Cole Eye Institute. 

Readings are performed within two business 

days. The report can be shared with patients and 

ophthalmologists when referrals are needed. 

In the case of this patient, remote ophthalmology 

examination resulted in the diagnosis of advanced 

dry AMD in a patient with no clinical symptoms and 

good vision. AREDS, sponsored by the National Eye 

Institute, was designed to determine the clinical 

course and prognosis of AMD and cataracts. In 

addition, AREDS evaluated the possible risk factors 

associated with the development of AMD and 

cataracts; the nutritional risk factors were evaluated 

and published in October 2001. 

Study results showed that antioxidant vitamins and 

zinc therapy reduced the risk of developing advanced 

AMD in participants with intermediate and greater 

risk of developing AMD (categories 3 and 4) by 25 

percent. The risk of vision loss of three lines or more 

on the logarithmic visual acuity charts was reduced 

by 19 percent for these participants. For those who 

developed AMD, their risk of vision loss was reduced 

by 25 percent. Antioxidants and zinc are now 

recommended for patients who have an intermediate 

risk of developing advanced AMD. 

This case is a prime example of how fundus photog- 

raphy is being used at Cole Eye Institute to help 

screen patients remotely. We are currently studying 

whether this technology has the potential to screen 

mass populations easily and effectively for AMD, 

diabetic macular edema and glaucoma — conditions 

in which timely diagnoses are key to optimal 

vision outcomes. 



15


Innovation 

DEFINING WHAT MAKES US DIFFERENT

I N S T I T U T E O V E R V I E W 

At Cleveland Clinic Cole Eye Institute, we have assembled a 

team of the world’s foremost clinicians and researchers who 

are committed not only to delivering the finest healthcare 

available, but also to improving tomorrow’s care through 

innovative basic, clinical and translational research. 

We believe that research and patient care are interdependent. 

Therefore, we forge synergistic relationships through analytical 

and integrative processes, such as surgical outcomes analysis. 

We are pioneering treatment protocols for complex vision- 

threatening disorders through our clinical trials and aggressive 

research programs to shorten the gap between the laboratory 

discoveries of today and the patient care of tomorrow. Our goal: 

Answering tomorrow’s medical problems through today’s 

laboratory and research endeavors. 

Clinical Expertise 

As one of the leading comprehensive eye institutes in the world, 

we are able to enhance the lives of our patients and serve our 

referring physicians by providing early, accurate diagnosis and 

excellent, efficient state-of-the-art care. Our program consis- 

tently ranks amongst the highest in the U.S.News & World 

Report annual survey. We have some of the largest patient 

volumes in the United States, with more than 140,000 patient 

visits and more than 5,000 surgeries per year. We offer primary, 

CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | INNOVATIONS 

secondary and tertiary ophthalmologic services for all ages. 

Our internationally recognized staff of 33 ophthalmologists 

and researchers is composed almost entirely of subspecialists, 

and seven optometrists round out our comprehensive services. 

Patient-Centered Facilities 

We deliver care in a state-of-the-art building that demonstrates 

our dedication to putting patients first. Our facilities deliver 

maximum patient comfort, service and quality. We offer 

one-stop care, with our exam lanes, diagnostic services suite 

and operating rooms all in one building, which includes such 

special features as: 

• Windows with special filters to minimize light on dilated 

or newly treated eyes. 

• A comfortable waiting room that includes a special play area 

for children. 

• Amenities such as valet parking and an easy postoperative 

pickup area. 

• Conveniently located food services. 

Our regional eye care program also brings care into the 

community, providing services in six convenient suburban 

locations and one ambulatory surgery center. 

Continued 

17

18 


I N S T I T U T E O V E R V I E W continued 

Fostering Innovation 

Our institute is specially designed to enable clinicians to develop 

tomorrow’s advances; our facility includes an Experimental 

Surgery Suite — one of the few in the country with full operating 

capacity. Training future eye specialists is greatly enhanced in 

the Education Pavilion, with the James P. Storer Conference 

Center (designed with tele-video technology), as well as video 

rooms, resident carrels and ample conference space. 

Unique Programs at Cole Eye Institute 

The Center for Genetic Eye Diseases: The Center for Genetic Eye 

Diseases provides multidisciplinary clinical diagnostic and 

therapeutic services for patients with inherited eye conditions 

such as corneal and retinal dystrophies and microphthalmia. 

Patients with inherited disorders that involve the eye, such as 

neurofibromatosis, albinism, neurodegenerative disorders 

and Marfan syndrome, are referred to the Center by physicians 

from around the country. A regular specialty clinic is dedicated 

to patients with retinal dystrophies and their families. 

A National Eye Donor Program: The Foundation Fighting Blind- 

ness’ Center, a central collection agency for eyes donated by 

individuals across the United States for blindness research, 

shares tissue samples with researchers worldwide. Formally 

known as the Retinal Degeneration Pathophysiology Facility, 

the collection center accepts eye donations after death from 

any person of any age who has normal vision or any degree of 

vision loss resulting from a retinal-degenerative disease. Cole 

Eye Institute staff members prepare a detailed medical report 

about each donated eye to help researchers track the effects of 

eye disease in different types of people and environments. 

For more information or to refer a patient, 

please call 216.444.2020 or 800.223.2273 ext. 42020 

or visit clevelandclinic.org/OUspecial. 

2008 Key Statistics 

Total Clinic Visits ......................................... 144,929 

Total Surgical Procedures ..................................8,171 

Total Surgeries ................................................ 5,215 

Total Cataract Procedures ................................. 2,545 

Total Cornea Procedures .....................................253 

Total Glaucoma Procedures ................................. 341 

Total Retina Procedures ....................................3,191 

Total Oncology Procedures ............................... 1,062 

Total Oculoplastics Procedures .......................... 1,460 

Total Strabismus Procedures ................................553 

Total Refractive Procedures .............................. 1,498 

Total Laser Procedures ..................................... 1,458 

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, 

S T R I V I N G F O R I M P R O V E M E N T 

Clinical outcomes allow us to understand and objectively measure 

the success of our surgical results. 

Cole Eye Institute has recently released its 2008 Outcomes 

review. This is the third year we have shared our clinical 

outcomes with referring physicians, alumni and potential 

patients around the country. 

Our key evaluatory measures continue to be visual acuity and 

the rate of surgical complications, and we continue to use 

ETDRS protocol refraction as the means of measuring visual 

acuity. The key measurement variables are mentioned under 

each section in the book. In addition to clinical outcomes, 

world-class customer service is very important to us. Conse- 

quently, we have spent significant time understanding patient 

flow process and experience. We continue to seek best practice 

measurement processes for both clinical and administrative 

areas. We strive to set the standard for excellence by innovating 

and by consistent follow-up and measurement to evaluate our 

overall clinical proficiency. 

The Outcomes book has data from across the full spectrum 

of ophthalmic surgery, including: 

• Cataract surgery 

• Cornea surgery 

• Glaucoma surgery 

• Oculoplastic surgery 

• Oncologic eye procedures 

• Refractive surgery 

• Vitreoretinal surgery 

• Strabismus surgery 

Almost all of the surgical procedures performed at the Cole Eye 

Institute have been tracked and reported. As a regional, national 

and international referral center, many of our patients are 

followed by their local ophthalmologists, and the data do not 

include patients who are not followed at the Cole Eye Institute. 

CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | INNOVATIONS 

The scope of the Cole Eye Institute outcomes project is signifi- 

cant, our approach is innovative, and in spite of the complexity of 

cases and lack of a clear benchmark, our outcomes are excellent. 

Our physicians strive to push the boundaries of science and 

technology to provide excellence for our patients. We hope that 

by reviewing and analyzing information, we will continue to 

improve and offer patients better outcomes. 

Cleveland Clinic has created a series of outcomes books 

for its institutes. The Outcomes books contain a summary 

of our surgical and medical trends and approaches; data 

on patient volume and outcomes; and a review of new 

technologies and innovations. 

To view all our outcomes books, or to download a copy of Cole Eye 

Institute’s 2008 Clinical Outcomes book, visit Cleveland Clinic’s 

Quality Web site at clevelandclinic.org/quality/outcomes. 

19


Staff 

IDENTIFYING WHO WE ARE

ARVO Awards Highest Honor to Cole Eye Institute Director of 

Ophthalmic Research 

Joe G. Hollyfield, PhD, the inaugural Director of Ophthalmic 

Research at Cole Eye Institute, has earned the 2009 Proctor 

Medal from the Association for Research in Vision and 

Ophthalmology (ARVO). 

Dr. Hollyfield, who joined Cleveland Clinic in 1995, also is 

Professor of Ophthalmology at the Cleveland Clinic Lerner 

College of Medicine of Case Western Reserve University and 

Director of the Foundation Fighting Blindness Research Center 

at the Cole Eye Institute. 

He was awarded the prestigious medal for his significantly 

advancing the understanding of the cell biology of photoreceptors, 

interphotoreceptor matrix and the pigment epithelium. 

The Proctor Medal is the oldest and highest award presented by 

ARVO to honor an individual for exceptional contributions to 

ophthalmology and visual science. The award was established 

in 1949 as a memorial to Dr. Francis I. Proctor, an ophthalmologist 

who conducted research on the etiology and treatment of 

trachoma. The Proctor Medal was the first ophthalmology-related 

award to honor both non-clinical and clinical scientists. 

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 

Paul J. Rychwalski, MD, joined Cole Eye 

Institute’s Pediatric Ophthalmology and 

Strabismus Department in January 2009. 

Dr. Rychwalski is a graduate of the 

Medical College of Wisconsin. He 

completed his residency at the Saint Louis 

University School of Medicine, Saint Louis, 

Mo., and his fellowship in pediatric ophthalmology and adult 

strabismus at the University of Kentucky School of Medicine. 

His specialty interests include ocular diseases of children, 

strabismus, retinopathy of prematurity, congenital cataracts, 

pathogenesis of myopia, amblyopia and shaken 

baby syndrome. 

He can be reached at rychwap@ccf.org. 

CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | STAFF 

JOE G. HOLLYFIELD, PHD, RECEIVES PRO CTOR MEDAL 

Dr. Hollyfield received the award and delivered the Proctor 

Award Lecture “Progress in understanding the initiating 

events in age-related macular degeneration” at the ARVO 

Annual Meeting on May 3-6, 2009. 

ARVO was founded in 1928 in Washington, DC, and was 

originally named the Association for Research in Ophthalmology 

(ARO). The word “vision” was added in 1970 to better reflect 

the scientific profile of its members. ARVO’s membership is 

comprised of more than 11,500 individuals from multiple 

specialties, encompassing both clinical and basic researchers. 

Jonathan A. Eisengart, MD, joined Cole 

Eye Institute’s Glaucoma staff in July 2009. 

Dr. Eisengart received his medical 

degree from The Ohio State University, 

Columbus, Ohio. He completed his 

residency and fellowship in glaucoma 

and anterior segment surgery at the 

University of Michigan, Kellogg Eye Center, in Ann Arbor, Mich. 

His specialty interests include medical, laser and surgical 

glaucoma management, including filtering surgery with 

antimetabolites, glaucoma tube shunts, cyclodestructive 

procedures, combined cataract and glaucoma surgery and 

anti-VEGF therapy in glaucoma. 

He can be reached at eisengj@ccf.org. 

21

22 


L E A D E R S H I P R O L E S 

ROLES IN PUBLISHING 

American Journal of Ophthalmology 

Executive Editor, Genetics Section 

Elias I. Traboulsi, MD 

Executive Editor, Oculoplastic Section 


Editorial Board 



Reviewers/Referees 


Ronald R. Krueger, MD 

Careen Y. Lowder, MD, PhD 



Edward J. Rockwood, MD 

Andrew P. Schachat, MD 



Steven E. Wilson, MD 

Archives of Facial Plastic Surgery 

Reviewer/Referee 


Archives of Ophthalmology 


William J. Dupps, Jr., MD, PhD 


Gregory S. Kosmorsky, DO 





Paul J. Rychwalski, MD 



British Journal of Ophthalmology 

Editor-in-Chief (U.S.) 

Arun D. Singh, MD 







Clinical and Experimental Optometry 



Clinical Ophthalmology 

Reviewers 



Clinical Ophthalmic Oncology 

Section Editor 


Comprehensive Ophthalmology Update 



Contemporary Ophthalmology 



Cornea 





Ronald R. Krueger, MD

Current Eye Research 




Current Concepts in Retina (Dothen 

Healthcare Press, Morristown, N.J.) 

Editor-in-Chief 


Developmental Neuropsychology 

Reviewer 


Documenta Ophthalmolgica 


Neal S. Peachey, PhD 

Experimental Eye Research 

Executive Editor, Editor-in-Chief 

Joe G. Hollyfield, PhD 

Section Editor 



Bela Anand-Apte, MBBS, PhD 

John W. Crabb, PhD 






Eye 




Investigative Ophthalmology 

and Visual Science 






Journal of Cataract & Refractive Surgery 

Reviewer 


Journal of Glaucoma 

Reviewer 


Journal of Refractive Surgery 



Reviewer 


Ophthalmic Genetics 



Ophthalmology 











Optometry & Visual Science 



Pediatric Perspectives 



Proceedings of the National 

Academy of Science USA 



23

24 


L E A D E R S H I P R O L E S continued 

Retina 









Retina Case Reports 

Editorial Advisory Board 


Retinal Degeneration Symposia 

(Springer Publishers) 

Co-editor 


Retinal Physician 



Retina Today 



Review of Endocrinology 

Editorial Board; Reviewer/Referee 


Review of Refractive Surgery 



Ryan’s Retina 

Editor 


Survey of Ophthalmology 



Wiley Interdisciplinary Reviews: 

Systems Biology & Medicine 


William J. Dupps, Jr., MD 

Xenotransplantation 


William J. Dupps, Jr., MD 

LE ADERSHIP ROLES 

AT CONFERENCES 

World Forum of Ophthalmological 

Journal Editors 

Co-Chair 


2010 Gordon Conference 

Conference co-organizer 


2010 International Congress of 

Eye Research 

Cornea Section Organizer 

Steven E. Wilson, MD

ROLES IN PROFESSIONAL 

SOCIETIES AND ORGANIZ ATIONS 

American Academy of Ophthalmology 

International Council Representative; 

Executive Committee Member; Program 

Committee Subcommittee Member; 

Education Committee Chair 


Pre-Academy Retina Subspecialty 

Symposium, Planning Committee 


Chairman, Self-Assessment Print 

Subcommittee; Maintenance of 

Certification Education Committee; 

LEO Committee, SAC Liason; Breakfast 

with the Experts Panel 


Board of Trustees 


American Association for Pediatric 

Ophthalmology and Strabismus 

Chair, Website Committee; Membership 

and Credentials Committee 


American Board of Ophthalmology 

Director 

David M. Meisler, MD 

American Glaucoma Society 

Research Committee Expert Panel 


American Health Assistance Foundation 

Chairman, Macular Degeneration 

Review Panel 



American Society of Ophthalmic Plastic 

and Reconstructive Surgery 

Fellowship 


American Society of Retina Specialists 

Board Member 


Case Western University School 

of Medicine 

Chairman, Annual Fund of the CWRU 

School of Medicine; Medical Alumni 

Association Board 

Allen S. Roth, MD 

Cleveland Browns, 

National Football League 

Team Ophthalmologist 


Cleveland Cavaliers, 

National Basketball Association 



Board of Directors, Assistant Medial 

Director, Chairman of the Medical 

Advisory Committee 

Allen S. Roth, MD 

25

26 


L E A D E R S H I P R O L E S continued 

Cleveland Indians, 

Major League Baseball 



Cleveland Ophthalmological Society 

Bylaws Committee 


Educational Committee 


Cleveland Sight Center 

Board of Trustees 


The Eye Care Professional 

Advisory Committee 


Foundation Fighting Blindness 

Scientific Advisory Board, 

Cell Biology Committee 


GANSU, INC. (Gaining a New 

Sight for Unsighted in China) 

President, Board of Directors 


Heed Ophthalmic Foundation 

Heed Award, 2008 


The Helen Keller Eye 

Research Foundation 

Scientific Advisory Board and 

Director, External Research 


International Society of Refractive 

Surgery of the American Academy 

of Ophthalmology 

Co-sponsorship Subcommittee Chair 


Program Planning Committee 


Knights Templar Eye Foundation, Inc. 

Scientific Advisory Board 


National Ophthalmic Genotyping 

Network (eyeGENE) 

Steering Committee 


Pan American Association 


Board of Directors 


Pan American Society of 

Ocular Inflammatory Diseases 

President 


Society of Heed 

Fellows Foundation 

Executive Secretary 

Froncie A. Gutman, MD 

South African Retinitis 

Pigmentosa Foundation 

Scientific Advisory Board 


University of Oklahoma 

Medical Sciences Center 

COBRE External Advisory Committee, 

Department of Ophthalmology 


AWARDS & RECOGNITION 

American Academy 


Lans Distinguished Award 

by the ISRS/AAO, 2008 


Lifelong Education for the 

Ophthalmologist Award, 2008 


Best Poster, 2008 

Jonathan E. Sears, MD

American Society of Cataract 

and Refractive Surgery 

Best Paper Award, Corneal 

Crosslinking and Segments Session 


American Society of Ophthalmic 

Plastic & Reconstructive Surgery 

Awards Committee 


Association for Research 

in Vision in Ophthalmology 

Proctor Medal, May 2009 


Gold Fellow 2009 




Best Doctors in America, 2008 




Andreas Marcotty, MD 




Stephen E. Wilson, MD 

Best Doctors in America: 

Midwest Region 


Best Doctors in U.S., 2008 


Best Doctors in U.S., 2009 

Andreas Marcotty, MD 

Canadian Ophthalmological Society 

Annual W. Bruce Jackson Lecture Award, 

Canadian Cornea Society, 2009 


Castle Connolly America’s 

Top Doctors 






Consumers’ Research Council 

of America 

America’s Top Ophthalmologists 


Research to Prevent Blindness 

Steinbach Award 2008, 2009 


27


Education 

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 

RESIDENCY/FELLOWSHIP PROGR AMS 

Cleveland Clinic Cole Eye Institute is committed to offering one 

of the best residency and fellowship programs in the United 

States. These programs are highly competitive and produce 

superbly trained clinical and academic ophthalmologists. 

RESIDENCY PROGR AM 

The Cole Eye Institute Residency Training Program’s mission 

is to prepare participants to become leaders in patient care, 

teaching and vision research. The program meets all the 

requirements of the American Board of Ophthalmology and the 

Accreditation Council for Graduate Medical Education (ACGME). 

There are 12 residents in the three-year training program, with 

four residents who match into the program annually. Residents 

rotate among the Institute’s nine departments and a residentrun 

clinic at MetroHealth Medical Center, while completing 

their board requirements. They work under the direct supervision 

of the staff during each rotation in the following areas: 

• Cornea, external disease, anterior segment 

• Glaucoma 

• Neuro-ophthalmology/oncology 

• Ophthalmic pathology 

• Ophthalmic plastic, reconstructive and orbital surgery 

• Pediatric ophthalmology and adult strabismus 

• Refractive surgery 

• Retina, vitreous, low vision 

• Uveitis, ocular inflammatory disease and immunology 

This curriculum provides a balanced exposure to all subspecialty 

areas of ophthalmology, ensuring graduates the ability 

to perform general ophthalmology with skill, knowledge and 

confidence. Each resident works in a one-on-one relationship 

with a staff physician to provide the best opportunity to study 

disease processes and their medical and surgical management. 

This arrangement also provides excellent supervision and 

optimal continuity of patient care in the outpatient and 

hospital settings. 

CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | EDUCATION 

Residents are expected to participate in clinical and basic 

research activities utilizing the staff’s expertise. They complete 

independent clinical research projects which involve reviewing 

the literature, developing a hypothesis and designing and 

executing the study. Activities are carefully supervised by an 

experienced clinical investigator. Residents are expected to 

submit and present their research at national meetings and 

to write several papers for publication based on their research 

activities. Each June, ophthalmology residents, fellows and 

staff participate in the Annual Research, Residents and 

Alumni Meeting, a scientific forum for the presentation 

of research projects. 

Residency Graduates, 6/09 

Brian Lee, MD 

Thu Pham, MD 

Ying Qian, MD 

Residents, 1st Year, 7/09 

Baseer Ahmad, MD Theodore Pasquali, MD 

Eric Ahn, MD Xiang Qi Werdich, MD, PhD 

Residents, 2nd Year, 7/09 

James Kim, MD, PhD Benjamin Nicholson, MD 

Breno Lima, MD Reecha Sachdeva, MD 

Residents, 3rd Year, 7/09 

Jeffrey Goshe, MD Ahmad Tarabishy, MD 

Christopher Hood, MD Mary Beth Turell, MD 

29

30 


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 

FELLOWSHIP PROGR AM 

Cleveland Clinic Cole Eye Institute also offers high-quality 

fellowship training opportunities in a variety of subspecialties. 

These fellowships train the next generation of academic leaders 

in the respective fields by combining an excellent academic 

environment with mentorship support in a state-of-the-art 

eye care facility. 

Our fellowships include: 

• 2-year vitreoretinal fellowship 

(slots rotate — even years = 1, uneven years = 2) 

• 1-year cornea, external disease and refractive surgery 

fellowship (2 slots) 

• 1-year glaucoma fellowship (1 slot) 

• 1-year pediatric-ophthalmology fellowship (1 slot) 

• 2-year oculoplastics fellowship (sponsored by ASOPRS) (1 slot) 

For more information about Cole Eye Institute fellowship 

programs, visit clevelandclinic.org/eyefellowships or 

contact Jane Sardelle at sardelj@ccf.org. 

Fellow Graduates, 6/09 

Vitreoretinal Fellows 

Hajir Dadgostar, MD 

Mehran Taban, MD 

Cornea, External Disease and Refractive Surgery Fellow 

Andrew Esposito, MD 

Ricardo Sepulveda, MD 

Glaucoma Fellow 

Samantha Chai, MD 

Pediatric Ophthalmology Fellow 

Michelle Ariss, MD 

Fellows, 7/09 

Vitreoretinal Fellows 

Omar Ahmad, MD 

Nathan Steinle, MD 

Cornea, External Disease & Refractive Surgery 

Hooman Harooni, MD 

Ravindrah Shah, MD

G R A N D R O U N D S 

Cole Eye Institute hosts Grand Rounds every Monday from 7 

to 8 a.m. during the academic year (except holidays and major 

meeting times). For the academic year 2009-2010, meetings 

will begin in mid-September, and run through mid-June. The 

meetings are designed for residents, fellows and staff physicians 

of the Cole Eye Institute, as well as other comprehensive 

and subspecialty ophthalmologists. We are pleased to offer 

Category 1 continuing education credits for each meeting. 

Evaluations are offered online following each meeting and 

attendance certificates can be printed or saved for your 

record-keeping purposes. 

The Grand Rounds’ forum consists of two clinical cases 

presented by Cole Eye Institute residents, followed by 

extensive discussion. Cases selected for presentation 

represent outstanding teaching examples and are either 

difficult-to-manage cases, unusual presentations of common 

disorders, rare conditions or cases that highlight state-of-theart 

diagnosis or management. In addition, approximately 

every six weeks, M&M cases are presented and discussed 

by third-year residents with follow-up discussion. 

The meetings are held the James P. Storer Conference Room 

the first floor of the Cole Eye Institute and registration is not 

required to attend. Park in the patient/visitor lot at E. 102nd 

Street (facing the front of the Cole Eye Institute), or the patient/ 

visitors garage at E. 100th Street and Carnegie Avenue. Parking 

tickets will be validated. 

For questions, email Jane Sardelle at sardelj@ccf.org. 


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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 

The Cleveland Clinic Cole Eye Institute is proud to present the 

2009 Distinguished Lecture Series, which provides a forum for 

renowned researchers in the visual sciences to present their 

latest research findings. This series of lectures will feature 

advances in many areas of ophthalmic research presented by 

noted basic and clinical scientists from throughout the world. 

Ample opportunity for questions and answers will be provided. 

September 17, 2009 

NEW INSIGHTS INTO THE MOLECUL AR 

AND CELLUL AR REGUL ATION OF 

CORNE AL IMMUNIT Y 

Reza Dana, MD, MPH, MSc 

Director of Cornea and Refractive Surgery Services 

Massachusetts Eye & Ear Infirmary 

Professor and Senior Scientist, Harvard Medical School 

W. Clement Stone Scholar & Director of the Corneal Immunology 

Lab Schepens Eye Research Institute 

Director, Harvard-Vision Clinical Scientist Development Program 

Boston 

October 15, 2009 

ROLE OF VEGF IN BLOOD VESSEL 

GROW TH AND STABILIT Y IMPLICATIONS 

FOR ANTI-ANGIOGENIC THER APIES 

Patricia A. D’Amore, PhD 

Senior Scientist 

Ankeny Scholar of Retinal Molecular Biology 

Professor, Harvard Medical School 

The Schepens Eye Research Institute 

Boston 

Please join us for these insights into ophthalmic research 

and the promises they hold for patient care. No registration 

is required; call 216.444.5832 with any questions. 

All programs will be held in the James P. Storer Conference 

Center of the Cole Eye Institute from 7 to 8 a.m. Attendees 

should park in the East 102nd Street parking lot (facing the 

front of the Cole Eye Institute) or the visitor’s parking garage 

at East 100th Street and Carnegie Avenue. We will validate 

your parking ticket. 

November 19, 2009 

EMERGING CONCEPTS IN UVE AL MEL ANOMA 

Hans E. Grossniklaus, MD, MBA 

F. Phinizy Calhoun Jr. Professor of Ophthalmology 

Director, L.F. Montgomery Pathology Laboratory 

Vice-Chairman, Department of Ophthalmology 

Emory Eye Center 

Emory University 

Atlanta, Ga.


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 

Physicians are invited to attend the following ophthalmic 

continuing medical education courses at Cleveland Clinic’s 

Cole Eye Institute. For more information, contact Jane Sardelle, 

program coordinator, at 216.444.2010 or 800.223.2273, ext. 

42010, or sardelj@ccf.org. 

COMPREHENSIVE OPHTHALMOLOGY UPDATE 

December 5, 2009 

Location: Cole Eye Institute 

UVEITIS UPDATE 

March 6, 2010 


NORTH COAST VITREORETINAL COURSE 

May 22, 2010 


ANNUAL RESEARCH, RESIDENTS & ALUMNI MEETING 

June 19, 2010 


33


Research 

PURSUING ANSWERS

C L I N I C A L T R I A L S 

The following studies are currently enrolling. All studies have 

been approved by the Institutional Review Board. 

AGE-RELATED MACULAR DEGENERATION 

A Phase I Open-label, Dose Escalation Trial of REDD14NP 

Delivered by a Single Intravitreal Injection to Patients with 

Choroidal Neovascularization Secondary to Exudative 

Age-related Macular Degeneration (QUARK) 

Objective: This is an open-label, dose-escalation study in which 

patents will receive a single intravitreal injection of REDD14NP. 

The primary objective of the study is to determine the safety 

and pharmacokinetics of REDD14NP when administered as 

a single intravitreal injection. 

Contact: Peter K. Kaiser, MD, 216.444.6702 or Lynn Bartko, RN, 

216.444.7137 

A Randomized, Double Masked, Active Controlled Phase III 

Study of the Efficacy, Safety and Tolerability of Repeated 

Doses of Intravitreal VEGF Trap in Subjects with Neovascular 

Age-Related Macular Degeneration (VEGF Trap) 

Objective: This study is a Phase III, double-masked, randomized, 

study of the efficacy and safety of VEGF Trap-Eye in 

patients with neovascular age-related macular degeneration. 

Contact: Peter K. Kaiser, MD, 216.444.6702 or Laura Holody, 

216.445.2264 

CLEVELAND CLINIC | COLE EYE INSTITUTE | CLEVELANDCLINIC.ORG/OUSPECIAL | RESEARCH 

RETINAL VEIN OCCLUSION 

An Open-Label, Multicenter Extension Study To Evaluate 

the Safety and Tolerability of Ranibizumab in Subjects with 

Macular Edema Secondary to Retinal Vein Occlusion (RVO) 

Who Have Completed a Genentech-sponsored Ranibizumab 

Study (HORIZON 2) 

Objective: This is an open-label, multicenter extension study 

of intravitreally administered ranibizumab in subjects with 

macular edema secondary to RVO who have completed the 

six-month treatment and six-month observation phases (12 

months total) of a Genentech-sponsored study (FVF4165g or 

FVF4166g). 

Contact: Rishi P. Singh, MD, 216.445.9497 or Gail Kolin, RN, 

216.445.4086 

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C L I N I C A L T R I A L S continued 

DIABETIC RETINOPATHY 

Vascular Remodeling and Effects of Angiogenic Inhibition in 

Diabetic Retinopathy (NIH) 

Objective: This study will test whether the pattern of the retinal 

vasculature changes in patients with different levels of diabetic 

retinopathy can be quantified using computerized image 

analysis. In addition, the study will evaluate whether new 

drugs to treat diabetic retinopathy will be able to reverse these 

vascular changes. 

Contact: Peter K. Kaiser, MD, 216.444.6702 or Ly Pung, RN, 

216.445.6497 

UVEITIS 

A Prospective, Multicenter, Randomized, Double-Masked, 

Safety, Tolerability and Efficacy Study of Four Iontophoretic 

Doses of Dexamethasone Phosphate Ophthalmic Solution 

in Patients with Non-Infectious Acute Anterior Segment 

Uveitis (EYEGATE) 

Objective: The purpose of this Phase II study is to define a safe 

and effective dose of iontophoretic delivery of dexamethasone 

phosphate ophthalmic solution using the EyeGate ® II Drug 

Delivery System in patients with non-infectious acute anterior 

segment uveitis. 

Contact: Careen Lowder, MD, PhD, 216.444.3642 or Ly Pung, RN, 

216.445.6497 

An Open-Label, Multicenter, Phase II Trial of Adalimumab 

(Humira ® ) in the Treatment of Refractory Non-infectious 

Uveitis (HUMIRA) 

Objective: This study will assess the safety and efficacy 

of adalimumab, a humanized monoclonal antibody, 

against TNF-α (Abbott) in the treatment of refractory, 

vision-threatening, non-infectious uveitis. 

Contact: Careen Lowder, MD, PhD, 216.444.3642 or Laura Holody, 

216.445.2264 

PEDIATRIC EYE DISEASE 

Infant Aphakia Treatment Study (IATS) 

Objective: The primary purpose of this study is to determine 

whether infants with a unilateral congenital cataract are more 

likely to develop better vision following cataract extraction 

surgery if they undergo primary implantation of an intraocular 

lens or if they are treated primarily with a contact lens. In 

addition, the study will compare the occurrence of postoperative 

complications and the degree of parental stress between 

the two treatments. 

Contact: Elias Traboulsi, MD, 216.444.4363 or Sue Crowe, RN, 

216.445.3840

GENETICS 

Studies of the Molecular Genetics of Eye Diseases (BRTT) 

Objective: The objective of this project is to study the molecular 

genetics of ophthalmic disorders through the compilation of a 

collection of DNA, plasma and eye tissue samples from patients 

and from families with a broad range of eye diseases and 

malformations. 

Contact: Elias Traboulsi, MD, 216.444.4363 or Patrice Nerone, RN, 

216.445.9886 

CORNEA /REFRACTIVE SURGERY 

A Clinical Safety and Efficacy Comparison of Nevanac ® 0.1% to 

Vehicle Following Cataract Surgery in Diabetic Retinopathy 

Patients (NEVANAC) 

Objective: The purpose of this study is to determine whether 

Nepafenac is safe and effective for reducing the incidence 

of macular edema following cataract surgery in diabetic 

retinopathy patients. 

Contact: Richard Gans, MD, 216.444.0848 or Gail Kolin, RN, 

216.445.4086 


IN FOLLOWUP 

The following studies have completed patient enrollment 

in the last year at Cole Eye Institute and are in 

follow up: 

• A 24-month Randomized, Double-masked, Controlled, 

Multicenter, Phase IIIB study Assessing 

Safety and Efficacy of Verteporfin (Visudyne ® ) 

Photodynamic Therapy Administered in Conjunction 

with Ranibizumab (Lucentis ® ) versus Ranibizumab 

(Lucentis ® ) Monotherapy in Patients with Subfoveal 

Choroidal Neovascularization Secondary to Agerelated 

Macular Degeneration (DENALI) 

• A Phase III, Multicenter, Randomized, 

Sham-Controlled Study of the Efficacy and 

Safety of Ranibizumab Compared with Sham 

in Subjects with Macular Edema Secondary to 

Central Retinal Vein Occlusion (CRVO) 

• A Phase III, Double-Masked, Multicenter, Randomized, 

Sham-Controlled Study of the Efficacy and 

Safety of Ranibizumab Injection in Subjects with 

Clinically Significant Macular Edema with Center 

Involvement Secondary to Diabetes Mellitus (DME) 

• An 8-Week, Multicenter, Masked, Randomized Trial 

to Assess the Safety and Efficacy of 700 µg and 350 µg 

Dexamethasone Posterior Segment Drug Delivery 

System Applicator System Compared with Sham 

DEX PS DDS Applicator System in the Treatment of 

Non-Infectious Ocular Inflammation of the Posterior 

Segment in Patients with Intermediate Uveitis 

(POSURDEX UVEITIS) 

• Posterior Lamellar Endothelial Keratoplasty Study 

(PLEK) 

• US Clinical Study of the ACRYSOF Angle-Supported 

Phakic IOL 

• A 2-year, Multicenter, Randomized, Controlled, 

Masked, Dose-finding Trial to Assess the Safety and 

Efficacy of Multiple Intravitreal Injections of AGN 

211745 in Patients with Subfoveal Choroidal 

Neovascularization Secondary to Age-related 

Macular Degeneration (SIRIUS) 

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G R A N T S 

GUND FOUNDATION SUPPORTS CHAIR FOR 

CLE VEL AND CLINIC E YE RESE ARCH 

Cleveland Clinic has received a $2 million gift from the Llura 

and Gordon Gund Foundation to expand research into retinal 

diseases that cause vision loss and blindness. 

The gift establishes the Llura and Gordon Gund Endowed Chair 

for Ophthalmology Research. Joe G. Hollyfield, PhD, will be the 

inaugural chair holder. Dr. Hollyfield is director of research at 

Cole Eye Institute, which has current research grant awards 

totaling $22 million. 

“Dr. Hollyfield has made extraordinary contributions to the field 

of retinal disease research and Llura and I are pleased to support 

continued study of these causes of vision loss,” says Mr. Gund. 

Mr. Gund, a Cleveland native, is chairman of Gund Investment 

Corporation and was past majority owner of the National 

Basketball Association’s Cleveland Cavaliers. He was diagnosed 

as a young adult with retinitis pigmentosa. Mr. Gund has 

experienced blindness since 1970. 

Dr. Hollyfield is known for his research of cell and developmental 

biology of the retina in both normal and degenerative 

tissues. He is currently Editor-in-Chief of the journal, Experimental 

Eye Research, and serves on the scientific advisory board 

of the Foundation Fighting Blindness, a national nonprofit 

organization founded by a group including Llura and Gordon 

Gund, and where Mr. Gund is board chairman. 

“Joe leads a sophisticated research group which is at the 

forefront of investigation of retinal disease. This gift will 

provide resources to expand our inquiry into causes and 

potential treatment options for eye conditions which cause 

vision loss and blindness,” said Daniel F. Martin, MD, 

Chairman of the Cole Eye Institute. 

PRE VENT BLINDNESS OHIO 

Prevent Blindness Ohio has awarded a fellowship grant to Rao 

Fu, Cole Eye Institute, through its Young Investigators Student 

Fellowship Award for Female Scholars in Vision Research. This 

program encourages female scientists at the beginning of their 

careers to pursue vision research that can contribute toward the 

early detection and treatment discoveries that will be needed to 

curb the growth of vision loss in Ohio. Fu is conducting research 

that has the potential for significantly impacting an important, 

but poorly understood aspect of photoreceptor biology relevant 

to human retinal disease, including retinitis pigmentosa. 

Results could ultimately lead to the discovery of new approaches 

for the detection, prevention, and treatment of vision loss. 

Cole Eye Institute Research Funding Sources 

Industry 

23% 

Non-Profit 

24% 

State 3% 

Federal 

50%

Cleveland Clinic Cole Eye Institute had an aggregate annual grant 

level of $22,298,900 in 2009*, with $12,444,277 coming from 

Cole Eye Basic Research Funding 

federal sources. As part of this funding, Cole Eye Institute 

researchers received the institute’s first endowed chair for 

ophthalmic research. 

Title Source Sponsor ID Investigator 

Role of TIMP-3 in 

Ocular Neovascularization 

Inhibition of VEGF Mediated 

Angiogenesis by TIMP-3 

Age-related Changes in 

Epithelia Microvilli 

Proteomic Studies of Age Related 

Macular Degeneration 

Federal NIH EY016490 Bela Anand-Apte, MBBS, PhD 

Federal NIH CA106415 Bela Anand-Apte, MBBS, PhD 

Federal NIH EY07153 Vera Bonilha, PhD 

Federal NIH EY014239 John W. Crabb, PhD 

Role of TULP1 in Photoreceptor Cells Federal NIH EY016072 Stephanie Hagstrom, PhD 

Initiating Events in AMD: 

An Animal Model for the Human 

Corneal Epithelial Growth Factors 

and Receptors 

Can CD 133 Cells prevents hypoxia 

driven retinal neovascularization in 

a rodent model? 

Analysis of Neural Retina 

Transport Function 

Study of Retinal 

Degenerative Diseases 

Federal NIH R56 EY014240 Joe G. Hollyfield, PhD 

Federal NIH EY010056 Steven E. Wilson, MD 

Federal 

sub-award 

Federal 

sub-award 

NIH EY018784 Bela Anand-Apte, MBBS, PhD 

NIH EY012830 Neal S. Peachey, PhD 

Non-Profit Foundation for 

Fighting Blindness 

Lew Wasserman Award Non-Profit Research to 

Prevent Blindness 

Identification of Biomarkers Non-Profit Ruth & Milton 

Steinbach Foundation 

RPB Unrestricted Grant Non-Profit Research to Prevent 

Blindness 

The Role of Complement Regulation in 

Maintaining Outer Retinal Integrity 

Stimulating Retina Development During 

Phase I of Retinopathy of Prematurity 

* through June 2009 


Non-Profit American Health 

Assistance Foundation 

Non-Profit Knights Templar 

Eye Foundation 

CMM-0707-0407; 

CMM-0707-0408; 

CMM-0707-0409; 

CMM-0707-0410 

Joe G. Hollyfield, PhD; 

John W. Crabb, PhD; 

Stephanie A. Hagstrom, PhD; 


Bela Anand-Apte, MBBS, PhD 




Jonathan Sears, MD 

39

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P U B L I C AT I O N S 

Journal Publications 

Ahuja Y, Kohl S, Traboulsi EI. CNGA3 mutations in two United 

Arab Emirates families with achromatopsia. Mol Vis. 

2008;14:1293-1297. 

Ambrosio R, Jr., Tervo T, Wilson SE. LASIK-associated dry 

eye and neurotrophic epitheliopathy: pathophysiology and 

strategies for prevention and treatment. J Refract Surg. 2008 

Apr;24(4):396-407. 

Applegate RA, Krueger RR. Introduction to the proceedings of 

the 9th International Congress of Wavefront and Presbyopic 

Refractive Corrections. J Refract Surg. 2008 Nov;24(9):963-964. 

Asbell PA, Colby KA, Deng S, McDonnell P, Meisler DM, 

Raizman MB, Sheppard JD, Jr., Sahm DF. Ocular TRUST: 

nationwide antimicrobial susceptibility patterns in ocular 

isolates. Am J Ophthalmol. 2008 Jun;145(6):951-958. 

Bollinger KE, Langston RHS. What can patients expect from 

cataract surgery? Cleve Clin J Med. 2008 Mar;75(3):193-200. 

Bollinger KE, Kattouf V, Arthur B, Weiss AH, Kivlin J, Kerr N, 

West CE, Kipp M, Traboulsi EI. Hypermetropia and esotropia 

in myotonic dystrophy. J AAPOS. 2008 Feb;12(1):69-71. 

Callanan DG, Jaffe GJ, Martin DF, Pearson PA, Comstock TL. 

Treatment of posterior uveitis with a fluocinolone acetonide 

implant: three-year clinical trial results. Arch Ophthalmol. 

2008 Sep;126(9):1191-1201. 

Chappelow AV, Reid J, Parikh S, Traboulsi EI. Aicardi syndrome 

in a genotypic male. Ophthalmic Genet. 2008 Dec;29(4):181-183. 

Chappelow AV, Kaiser PK. Neovascular age-related macular 

degeneration: potential therapies. Drugs. 2008;68(8):1029-1036. 

Chappelow AV, Singh AD, Perez VL, Lichtin A, Pohlman B, 

Macklis R. Bilateral panocular involvement with mantle-cell 

lymphoma. J Clin Oncol. 2008 Mar 1;26(7):1167.

Charkoudian LD, Gower EW, Solomon SD, Schachat AP, Bressler 

NM, Bressler SB. Vitamin usage patterns in the prevention of 

advanced age-related macular degeneration. Ophthalmology. 

2008 Jun;115(6):1032-1038.e4. 

Cohen VML, Sweetenham J, Singh AD. Ocular adnexal 

lymphoma: What is the evidence for an infectious aetiology? 

Br J Ophthalmol. 2008 Apr;92(4):446-448. 

Dadgostar H, Waheed N. The evolving role of vascular endothelial 

growth factor inhibitors in the treatment of neovascular 

age-related macular degeneration. Eye. 2008 Jun;22(6):761-767. 

de Medeiros FW, Mohan RR, Suto C, Sinha S, Bonilha VL, 

Chaurasia SS, Wilson SE. Haze development after photorefractive 

keratectomy: mechanical vs ethanol epithelial removal in 

rabbits. J Refract Surg. 2008 Nov;24(9):923-927. 

Doyle V, Schachat AP. Increased transparency: making the journal 

better for readers and for authors. Ophthalmology. 2008 

Sep;115(9):1443-1444. 

Dua HS, Singh AD. The British Journal of Ophthalmology. 

At a glance. Br J Ophthalmol. 2008 Jul;92(7):869. 

Dupps WJ, Jr., Qian Y, Meisler DM. Multivariate model of 

refractive shift in Descemet-stripping automated endothelial 

keratoplasty. J Cataract Refract Surg. 2008 Apr;34(4):578-584. 

Fu EX, Kosmorsky GS, Traboulsi EI. Giant intracavernous 

carotid aneurysm presenting as isolated sixth nerve palsy in 

an infant. Br J Ophthalmol. 2008 Apr;92(4):576-577. 

Fuller ML, Sweetenham J, Schoenfield L, Singh AD. Uveal 

lymphoma: a variant of ocular adnexal lymphoma. Leuk 

Lymphoma. 2008 Dec;49(12):2393-2397. 

Galor A, Lowder CY, Kaiser PK, Perez VL, Sears JE. Surgical 

drainage of chronic serous retinal detachment associated with 

uveitis. Retina. 2008 Feb;28(2):282-288. 


Gorovoy MS, Meisler DM, Dupps WJ, Jr. Late repeat Descemetstripping 

automated endothelial keratoplasty. Cornea. 2008 

Feb;27(2):238-240. 

Grant LW, Anderson C, Macklis RM, Singh AD. Low dose 

irradiation for diffuse choroidal hemangioma. Ophthalmic 

Genet. 2008 Dec;29(4):186-188. 

Gupta OP, Ho AC, Kaiser PK, Regillo CD, Chen S, Dyer DS, Dugel 

PU, Gupta S, Pollack JS. Short-term outcomes of 23-gauge pars 

plana vitrectomy. Am J Ophthalmol. 2008 Aug;146(2):193-197. 

Heur M, Costin B, Crowe S, Grimm RA, Moran R, Svensson LG, 

Traboulsi EI. The value of keratometry and central corneal 

thickness measurements in the clinical diagnosis of marfan 

syndrome. Am J Ophthalmol. 2008 Jun;145(6):997-1001.e1. 

Iseli HP, Spoerl E, Wiedemann P, Krueger RR, Seiler T. Efficacy 

and safety of blue-light scleral cross-linking. J Refract Surg. 

2008 Sep;24(7):S752-S755. 

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P U B L I C AT I O N S continued 

Jeng BH, Marcotty A, Traboulsi EI. Descemet stripping automated 

endothelial keratoplasty in a 2-year-old child. J AAPOS. 

2008 Jun;12(3):317-318. 

Jeng BH, Dupps WJ, Jr., Meisler DM, Schoenfield L. Epithelial 

debridement for the treatment of epithelial basement membrane 

abnormalities coincident with endothelial disorders. 

Cornea. 2008 Dec;27(10):1207-1211. 

Jeng BH, Galor A, Lee MS, Meisler DM, Hollyfield JG, Schoenfield 

L, McMahon JT, Langston RHS. Amantadine-associated 

corneal edema potentially irreversible even after cessation of 

the medication. Ophthalmology. 2008 Sep;115(9):1540-1544. 

Kaiser PK. Ranibizumab: The evidence of its therapeutic value in 

neovascular age-related macular degeneration. Core Evidence. 

2008;2(4):273-294. 

Keeler R, Singh AD, Dua HS. Anatomical eye model. 

Br J Ophthalmol. 2008 Sep;92(9):1179. 

Keeler R, Singh A, Dua H. Focimeter. Br J Ophthalmol. 2008 

May;92(5):593. 

Kim SJ, Lo WR, Hubbard GB, III, Srivastava SK, Denny JP, 

Martin DF, Yan J, Bergstrom CS, Cribbs BE, Schwent BJ, 

Aaberg TM, Sr. Topical ketorolac in vitreoretinal surgery: a 

prospective, randomized, placebo-controlled, double-masked 

trial. Arch Ophthalmol. 2008 Sep;126(9):1203-1208. 

Koenig SB, Meisler DM, Dupps WJ, Rubenstein JB, Kumar R. 

External refinement of the donor lenticule position during 

Descemet’s stripping and automated endothelial keratoplasty. 

Ophthalmic Surg Lasers Imaging. 2008 Nov;39(6):522-523. 

Kosmorsky GS, Dupps WJ, Jr., Drake RL. Nonuniform pressure 

generation in the optic chiasm may explain bitemporal 

hemianopsia. Ophthalmology. 2008 Mar;115(3):560-565. 

Kovoor TA, Bahl D, Singh AD, Ufret-Vincenty R. Bilateral 

isolated choroidal melanocytosis. Br J Ophthalmol. 2008 

Jul;92(7):892, 1008. 

Krueger RR, Ramos-Esteban JC, Kanellopoulos AJ. Staged 

intrastromal delivery of riboflavin with UVA cross-linking in 

advanced bullous keratopathy: laboratory investigation and 

first clinical case. J Refract Surg. 2008 Sep;24(7):S730-S736.

Krueger RR, Trattler W, Yee R. Introduction to the proceedings of 

the Sixth International Congress on Advanced Surface Ablation 

& SBK. J Refract Surg. 2008 Jan;24(1):S55-S56. 

Krueger RR. September consultation # 4. J Cataract Refract Surg. 

2008 Sep;34(9):1430-1431. 

Krueger RR, Mrochen M. Introduction to the proceedings of 

the Third International Congress of Corneal Cross-Linking. 

J Refract Surg. 2008 Sep;24(7):S713-S714. 

Krueger RR, Rocha KM. Introduction to wavefront-optimized, 

wavefront-guided, and topography-guided customized 

ablation: fifth year in review. J Refract Surg. 2008 

Apr;24(4):S417-S418. 

Krueger RR, Thornton IL, Xu M, Bor Z, van den Berg TJTP. 

Rainbow glare as an optical side effect of IntraLASIK. 

Ophthalmology. 2008 Jul;115(7):1187-1195.e1. 

Kutz WE, Wang LW, Dagoneau N, Odrcic KJ, Cormier-Daire V, 

Traboulsi EI, Apte SS. Functional analysis of an ADAMTS10 

signal peptide mutation in Weill-Marchesani syndrome 

demonstrates a long-range effect on secretion of the full-length 

enzyme. Hum Mutat. 2008 Dec;29(12):1425-1434. 

Lee BJ, Jeng BH, Singh AD. OCT and ultrasound biomicroscopic 

findings in iris arteriovenous malformation. Ophthalmic Surg 

Lasers Imaging. 2008 Sep;39(5):426-428. 

Lee BJ, Traboulsi EI. Update on the morning glory disc anomaly. 

Ophthalmic Genet. 2008 Jun;29(2):47-52. 

Lee MS, Kosmorsky GS, Cook JR, Barton JJS, Briemberg HR. 

My, what asthenia you have. Surv Ophthalmol. 2008 

Sep;53(5):506-511. 

Lewis C, Traboulsi EI. Use of Tegaderm for postoperative eye 

dressing in children. J AAPOS. 2008 Aug;12(4):420. 

Li Y, Meisler DM, Tang M, Lu ATH, Thakrar V, Reiser BJ, Huang 

D. Keratoconus diagnosis with optical coherence tomography 

pachymetry mapping. Ophthalmology. 2008 

Dec;115(12):2159-2166. 

Liesegang TJ, Albert DM, Schachat AP. Not for your eyes: 

information concealed through publication bias. Am J 

Ophthalmol. 2008 Nov;146(5):638-640. 


Liesegang TJ, Albert DM, Schachat AP. How to ensure 

our readers’ trust: the proper attribution of authors and 

contributors. Am J Ophthalmol. 2008 Sep;146(3):337-340. 

Lin DTC, Holland SR, Rocha KM, Krueger RR. Method for 

optimizing topography-guided ablation of highly aberrated eyes 

with the ALLEGRETTO WAVE Excimer Laser. J Refract Surg. 

2008 Apr;24(4):S439-S445. 

Loddenkemper T, Friedman NR, Ruggieri PM, Marcotty A, 

Sears J, Traboulsi EI. Pituitary stalk duplication in association 

with moya moya disease and bilateral morning glory disc 

anomaly - broadening the clinical spectrum of midline defects. 

J Neurol. 2008 Jun;255(6):885-890. 

Margolis R, Singh RP, Bhatnagar P, Kaiser PK. Intravitreal 

triamcinolone as adjunctive treatment to laser panretinal 

photocoagulation for concomitant proliferative diabetic 

retinopathy and clinically significant macular edema. 

Acta Ophthalmol Scand. 2008 Feb;86(1):105-110. 

McKay TL, Gedeon DJ, Vickerman MB, Hylton AG, Ribita D, Olar 

HH, Kaiser PK, Parsons-Wingerter P. Selective inhibition of 

angiogenesis in small blood vessels and decrease in vessel 

diameter throughout the vascular tree by triamcinolone 

acetonide. Invest Ophthalmol Vis Sci. 2008 Mar;49(3):1184-1190. 

Mohan RR, Stapleton WM, Sinha S, Netto MV, Wilson SE. A 

novel method for generating corneal haze in anterior stroma 

of the mouse eye with the excimer laser. Exp Eye Res. 2008 

Feb;86(2):235-240. 

Nehemy MB, Zisman M, Marigo FA, Nehemy PG, Schachat AP. 

Ultrasound biomicroscopy after vitrectomy in eyes with normal 

intraocular pressure and in eyes with chronic hypotony. Eur J 

Ophthalmol. 2008 Jul;18(4):614-618. 

Netto MV, Barreto J, Jr., Santo R, Bechara S, Kara-Jose N, Wilson 

SE. Synergistic effect of ethanol and mitomycin C on corneal 

stroma. J Refract Surg. 2008 Jun;24(6):626-632. 

Nolan WP, See JL, Aung T, Friedman DS, Chan YH, Smith SD, 

Zheng C, Huang D, Foster PJ, Chew PTK. Changes in angle 

configuration after phacoemulsification measured by anterior 

segment optical coherence tomography. J Glaucoma. 2008 

Sep;17(6):455-459. 

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Otri AM, Singh AD, Dua HS. Cover illustration. Abu Bakr Razi. 

Br J Ophthalmol. 2008 Oct;92(10):1324. 

Perry JD. Periocular reflation creates better facial rejuvenating 

effect. Ocular Surgery News. 2008 Apr 10;(Suppl):32-35. 

Qian Y, Zakov ZN, Schoenfield L, Singh AD. Iris melanoma 

arising in iris nevus in oculo(dermal) melanocytosis. Surv 

Ophthalmol. 2008 Jul;53(4):411-415. 

Ramos-Esteban JC, Bamba S, Krueger RR. Tracking difficulties 

after femtosecond laser flap creation with the LADARVision 

excimer laser system. J Refract Surg. 2008 Nov;24(9):953-956. 

Renganathan K, Ebrahem Q, Vasanji A, Gu X, Lu L, Sears J, 

Salomon RG, Anand-Apte B, Crabb JW. Carboxyethylpyrrole 

adducts, age-related macular degeneration and neovascularization. 

Adv Exp Med Biol. 2008;613:261-267. 

Rocha KM, Ramos-Esteban JC, Qian Y, Herekar S, Krueger RR. 

Comparative study of riboflavin-UVA cross-linking and 

“flash-linking” using surface wave elastometry. J Refract Surg. 

2008 Sep;24(7):S748-S751. 

Sautter NB, Citardi MJ, Perry J, Batra PS. Paranasal sinus 

mucoceles with skull-base and/or orbital erosion: Is the 

endoscopic approach sufficient? Otolaryngol Head Neck Surg. 

2008 Oct;139(4):570-574. 

Sayanagi K, Sharma S, Kaiser PK. Spectral domain optical 

coherence tomography and fundus autofluorescence findings 

in pseudoxanthoma elasticum. Ophthalmic Surg Lasers 

Imaging. 2008 Jul-Aug;39(4 Suppl):S108-S110. 

Schachat AP. A new look at an old treatment for diabetic macular 

edema. Ophthalmology. 2008 Sep;115(9):1445-1446. 

Sears JE. Anti-vascular endothelial growth factor and retinopathy 

of prematurity. Br J Ophthalmol. 2008 Nov;92(11):1437-1438. 

Singh AD, Schachat AP, Diener-West M, Reynolds SM. Small 

choroidal melanoma. Ophthalmology. 2008 Dec;115(12):2319. 

Singh AD, Triozzi PL. Endoresection for choroidal melanoma: 

palliative or curative intent? Br J Ophthalmol. 2008 

Aug;92(8):1015-1016. 

Singh AD, Kivela T, Seregard S, Robertson D, Bena JF. Primary 

transpupillary thermotherapy of “small” choroidal melanoma: 

is it safe? Br J Ophthalmol. 2008 Jun;92(6):727-728. 

Singh RP, Bando H, Brasil OFM, Williams DR, Kaiser PK. 

Evaluation of wound closure using different incision techniques 

with 23-gauge and 25-gauge microincision vitrectomy systems. 

Retina. 2008 Feb;28(2):242-248. 

Stapleton WM, Chaurasia SS, Medeiros FW, Mohan RR, Sinha S, 

Wilson SE. Topical interleukin-1 receptor antagonist inhibits 

inflammatory cell infiltration into the cornea. Exp Eye Res. 

2008 May;86(5):753-757.

Taban M, Taban M, Perry JD. Lower eyelid position after 

transconjunctival lower blepharoplasty with versus without a 

skin pinch. Ophthal Plast Reconstr Surg. 2008 Jan-Feb;24(1):7-9. 

Taban M, Ventura AACM, Sharma S, Kaiser PK. Dynamic 

evaluation of sutureless vitrectomy wounds: an optical 

coherence tomography and histopathology study. 

Ophthalmology. 2008 Dec;115(12):2221-2228. 

Taban M, Taban M, Sears JE. Ocular findings following trauma 

from paintball sports. Eye. 2008 Jul;22(7):930-934. 

Taban M, Lowder CY, Hajj-Ali R, Singh AD. Anterior scleritis as 

the presenting sign of metastatic lung cancer. Br J Ophthalmol. 

2008 Jan;92(1):147. 

Thornton I, Xu M, Krueger RR. Comparison of standard (0.02%) 

and low dose (0.002%) mitomycin in the prevention of corneal 

haze following surface ablation for myopia. J Refract Surg. 

2008 Jan;24(1):S68-S76. 

Traboulsi EI. Reply [Congenital cranial dysinnervation disorders/ 

syndrome]. J AAPOS. 2008 Aug;12(4):421. 

Traboulsi EI, Ellison J, Sears J, Maumenee IH, Avallone J, 

Mohney BG. Aniridia with preserved visual function: A report of 

four cases with no mutations in PAX6. Am J Ophthalmol. 2008 

Apr;145(4):760-764. 

Traboulsi EI, Sarfarazi M. The use of microarray technology 

in deciphering the cause of genetic eye diseases: LOXL1 and 

exfoliation syndrome. Am J Ophthalmol. 2008 

Mar;145(3):391-393. 


Triozzi PL, Eng C, Singh AD. Targeted therapy for uveal 

melanoma. Cancer Treat Rev. 2008 May;34(3):247-258. 

Utz VM, Krueger RR. Management of irregular astigmatism 

following rotationally disoriented free cap after LASIK. J Refract 

Surg. 2008 Apr;24(4):383-391. 

Vasconcelos-Santos DV, Nehemy PG, Schachat AP, Nehemy MB. 

Secondary ocular hypertension after intravitreal injection of 

4 mg of triamcinolone acetonide: incidence and risk factors. 

Retina. 2008 Apr;28(4):573-580. 

Weiss JS, Kruth HS, Kuivaniemi H, Tromp G, Karkera J, 

Mahurkar S, Lisch W, Dupps WJ, Jr., White PS, Winters RS, 

Kim C, Rapuano CJ, Sutphin J, Reidy J, Hu FR, Lu DW, 

Ebenezer N, Nickerson ML. Genetic analysis of 14 families with 

Schnyder crystalline corneal dystrophy reveals clues to UBIAD1 

protein function. Am J Med Genet A. 2008 Feb 1;146(3):271-283. 

Wilkinson DA, Kolar M, Fleming PA, Singh AD. Dosimetric 

comparison of 106Ru and 125I plaques for treatment of shallow 

(

46 



Book Chapters 

AGE-REL ATED MACUL AR DEGENER ATION 

Singh RP, Chung JY, Kaiser PK. Fundus autofluorescence in 

age-related macular degeneration. In: Lim JI, ed. Age-related 

macular degeneration. 2nd ed. New York, NY: Informa 

Healthcare; 2008. Chapter 12. p. 191-202. 

ALBERT & JAKOBIEC’S PRINCIPLES 

AND PR ACTICE OF OPHTHALMOLOGY 

Chalita MR, Krueger RR. Wavefront-guided excimer laser 

surgery. In: Albert DM, ed. Albert & Jakobiec’s principles and 

practice of ophthalmology. 3rd ed. Philadelphia, PA: Saunders/ 

Elsevier; 2008. Volume 1. Chapter 80. p. 1041-1049. 

Do DV, Schachat AP. Leukemias. In: Albert DM, ed. Albert & 

Jakobiec’s principles and practice of ophthalmology. 3rd ed. 

Philadelphia, PA: Saunders/Elsevier; 2008. Volume 4. Chapter 

358. p. 4949-4952. 

Dupps WJ, Jr., Wilson SE. Biomechanics and wound healing 

in refractive surgery. In: Albert DM, ed. Albert & Jakobiec’s 

principles and practice of ophthalmology. 3rd ed. Philadelphia, 

PA: Saunders/Elsevier; 2008. Volume 1. Chapter 72. p. 971-980. 

Singh AD, Sisley K, Wackernagel W. Genetics of uveal melanoma. 

In: Albert DM, ed. Albert & Jakobiec’s principles and 

practice of ophthalmology. 3rd ed. Philadelphia, PA: Saunders/ 

Elsevier; 2008. Volume 4. Chapter 355. p. 4925-4934. 

Traboulsi EI, Singh AD. The phakomatoses. In: Albert DM, ed. 

Albert & Jakobiec’s principles and practice of ophthalmology. 

3rd ed. Philadelphia, PA: Saunders/Elsevier; 2008. Volume 4. 

Chapter 366. p. 5009-5024. 

ANTERIOR SEGMENT OPTICAL 

COHERENCE TOMOGR APHY 

Wackernagel W, Rao NA, Steinert RF, Singh AD. Optical 

coherence tomography for anterior segment tumors. In: 

Steinert RF, Huang D, eds. Anterior segment optical coherence 

tomography. Thorofare, NJ: SLACK; 2008. Chapter 12. 

p. 127-136. 

CORNE AL SURGERY: THEORY, 

TECHNIQUE, AND TISSUE 

Cox CA, Dupps WJ, Jr., Brent GJ, Meisler DM. Corneal and 

scleral ruptures and lacerations. In: Brightbill FS, ed. Corneal 

surgery: theory, technique, and tissue. 4th ed. [St. Louis, MO.]: 

Mosby/Elsevier; 2009. Chapter 71. p. 617-626. 

Dupps WJ, Jr. Principles of biomechanics in refractive surgery. 

In: Brightbill FS, ed. Corneal surgery: theory, technique, and 

tissue. 4th ed. [St. Louis, MO.]: Mosby/Elsevier; 2009. Chapter 

81. p. 711-719. 

CURRENT CLINICAL MEDICINE 2009 

Chung JY, Singh RP. Preventive measures and screening for 

ophthalmic problems. In: Carey WD, ed. Current clinical 

medicine 2009. Philadelphia, PA: Saunders/Elsevier; 

2009. p. 1321-1324. 

DIABETIC RETINOPATHY 

Margolis R, Kaiser PK. Diagnostic modalities in diabetic 

retinopathy. In: Duh E, ed. Diabetic retinopathy. Totowa, NJ: 

Humana Press; 2008. Chapter 4. p. 109-133. 

IRREGUL AR ASTIGMATISM: 

DIAGNOSIS AND TRE ATMENT 

Jankov MR, II, Krueger RR. Corneal cross-linking with 

riboflavin and ultraviolet irradiation in unstable corneas 

with progressive irregular astigmatism. In: Wang M, Swartz 

TS, eds. Irregular astigmatism: diagnosis and treatment. 

Thorofare, NJ: SLACK; 2008. Chapter 15. p. 145-148.

MANAGEMENT OF COMPLICATIONS 

IN REFR ACTIVE SURGERY 

Ramos-Esteban JC, Wilson SE. Dry eye. In: Alio JL, Azar DT, 

eds. Management of complications in refractive surgery. 

Berlin: Springer; 2008. Chapter 5.1. p. 74-85. 

MECHANISMS OF THE GL AUCOMAS: DISE ASE 

PROCESSES AND THER APEUTIC MODALITIES 

Bhattacharya SK, Crabb JW. Proteomic advances toward 

understanding mechanisms of glaucoma pathology. In: 

Tombran-Tink J, Barnstable CJ, Shields MB, eds. Mechanisms 

of the glaucomas: disease processes and therapeutic modalities. 

Totowa, NJ: Humana Press; 2008. Chapter 24. p. 443-458. 


OCUL AR THER APEUTIC S: 

E YE ON NEW DISCOVERIES 

Wilson SE, Medeiros FW. Refractive surgery - Corneal opacity 

(haze) after surface ablation. In: Yorio T, Clark AF, Wax MB, 

eds. Ocular therapeutics: eye on new discoveries. Amsterdam; 

Boston, MA: Academic; 2008. Chapter 7. p. 133-141. 

REDOX BIOCHEMISTRY 

Lou MF, Crabb JW. Oxidative stress in the eye: Age-related 

cataract and retinal degeneration. In: Banerjee R, ed. Redox 

biochemistry. Hoboken, NJ: Wiley-Interscience; 2008. Chapter 

5.2. p. 194-204. 

REFR ACTIVE SURGERY 

Krueger RR. The LadarVision system. In: Roy FH, ed. Refractive 

surgery. Philadelphia, PA: Saunders/Elsevier; 2008. Chapter 3. 

p. 47-56. 

Books 

Anderson RE, LaVail MM, Hollyfield JG. Recent advances in 

retinal degeneration. New York, NY: Springer; 2008. 423 p. 

(Advances in Experimental Medicine and Biology; v.613). 

47

48 


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 

REFERR ALS 

General Cleveland Clinic 

Patient Referral 

24/7 hospital transfers or 

physician consults 

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Cole Eye Institute 

Appointments/Referrals 

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On the Web at clevelandclinic.org/eye 

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Lorain 

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Lorain, OH 44053 

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Cleveland Clinic Access Guide 

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CME Opportunities: Live and Online 

Cleveland Clinic’s Center for Continuing Education’s website, 

clevelandclinicmeded.com, offers convenient, complimentary 

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of medical publications and a schedule of live CME courses. 

Many live CME courses are hosted in Cleveland, an economical 

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Cole Eye Institute 

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clevelandclinic.org/OUspecial 

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Please direct any correspondence to: 


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Cleveland Clinic 

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© The Cleveland Clinic Foundation 2009 

09-EYE-005

Ophthalmology Update - Cleveland Clinic

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