FOCUS ON RESIDENTS FOCUS ON THE INSTITUTE S PRING/SUMMER, 2006 VISIONS A PUBLICATION OF THE DEPARTMENT OF OPHTHALMOLOGY

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1 VISIONS A PUBLICATION OF THE DEPARTMENT OF OPHTHALMOLOGY ROCKY MOUNTAIN LIONS EYE INSTITUTE UNIVERSITY OF COLORADO S PRING/SUMMER, 2006 S PRING/SUMMER, 2006 FOCUS ON THE INSTITUTE Dear Friends and Colleagues, The year 2006 is proving to be another successful year for the Department of Ophthalmology and the Rocky Mountain Lions Eye Institute (RMLEI). The theme of this issue is collaboration and cooperation. As our institution grows, we have come to realize, more than ever, that the two C s are key elements in the recipe for achieving our mission. One need only look outside our windows at RMLEI to see the tremendous growth here on the Fitzsimons campus. The growth is truly unparalleled by any health care center in the country. Our Department has expanded similarly. We currently have 16 full time faculty members and 21 total faculty in the Department. This brings unique opportunities for collaboration and cooperation for the Department and the RMLEI. Our faculty is working with clinical and basic researchers in many Departments and institutes in the UCDHSC as well as each of our four principal hospitals: University of Colorado Hospital, The Veterans Hospital, The Children s Hospital, and Denver Health Medical Center. The clinical research division is actively collaborating with corporations and the National Eye Institute (NEI) / National Institutes of Health (NIH) on many clinical trials. I am proud that cooperation and collaboration are in the mainstream in the Department. Each division (oculoplastics, cornea, retina, glaucoma, pediatrics, neurophthalmology, low vision rehabilitation) is pursuing projects which significantly overlap projects of other divisions within the Department. Our multidisciplinary environment is critical for the development of innovative technologies and all discovery in general. Recently, our residency program was given a 5 year accreditation by the RRC and the ACGME, the longest possible award of accreditation. This was possible only because of the cooperative environment created by our residency program staff, residents, and our dedicated and committed faculty. Teamwork and collaboration were required to achieve this, which will be remembered as one of this Department s finest distinctions. I am proud that our residency program continues to meet the highest standards of quality and integrity, which are expected by the mission statement of the RMLEI and the Department. Associate Professor and Interim Chair FOCUS ON RESIDENTS CLASS OF 2006 From the left: Ly Nguyen, MD, Scott Oliver, MD, Christopher Gelston, MD, Ryan Prall, MD We offer congratulations to the Graduates of our 2006 Residency Class and wish them success as they move on in their careers. Christopher Gelston, MD Dr. Gelston has been accepted into a Cornea Fellowship at the Rocky Mountain Lions Eye Institute, University of Colorado School of Medicine. Ly Nguyen, MD - Dr. Nguyen has accepted a position as a General Ophthalmologist with Dr. David Mettleman in West Palm Beach, FL. Scott Oliver, MD Dr. Oliver has been accepted into a two year fellowship in Vitreoretinal Surgery and Disease at The Jules Stein Eye Institute, UCLA. Ryan Prall, MD Dr. Prall will be going to Cape Coast Ghana for three months to practice general ophthalmology. Upon his return he will be interviewing for fellowships and hopes to work with the SEVA foundation in Africa, India and Nepal. Richard Cannon, MD Scott Thomas, MD Suzanne Falkenberry, MD Eric Hink, MD CLASS OF 2007 CLASS OF 2008 Lee Kramm, MD Lauren Zimski, MD Parin Gohel, MD Anand Shah, MD WE WELCOME OUR INCOMING CLASS OF 2009 Geetha Athappilly, MD, Michigan State University College of Human Medicine, East Lansing MI G. Ryan Berger, MD, Dartmouth-Hitchcock Medical Center, Lebanon NH Drew Dixon, MD, University of Colorado School of Medicine, Denver CO Ginny Kullman, MD, Tulane University School of Medicine, New Orleans LA

2 AGE RELATED MACULAR DEGENERATION: NEW TREATMENTS Age-related macular degeneration (AMD) is the leading cause of legal blindness in patients aged 65 or over and the most common overall cause of blindness in the western world. The disease significantly affects quality of life and activities required for daily living, causing many affected individuals to lose their independence in their retirement years. AMD affects more than 8 million individuals in the USA and the advanced form or wet form of the disease causes significant visual loss in more than 1.75 million individuals. It is obvious that this disease is a major public health concern in the United States, and also a major concern of those individuals with AMD. FEATURE FOCUS mechanically destroy the new blood vessels by using lasers, but Macugen, injected into the eye, causes the blood vessels to become less leaky and sometimes inactive by blocking a growth factor called Vascular Endothelial Growth Factor, or VEGF. The results showed a general improvement over PDT with 70% of patients avoiding severe vision loss (three or more line loss on the eye chart), 33% maintaining their current vision and 6% gaining three lines of vision on the eye chart. Macugen received FDA approval in December 2004 and began an era of pharmacotherapy for age-related macular degeneration. More hope was given for patients with AMD with the announcement in the fall of 2005, of the one-year results for a new drug called Lucentis. This medication which is also injected into the eye and blocks VEGF, resulted in 95% of patients avoiding severe vision loss and 33% showing three lines of visual gain. These results have set a new standard in which visual gain is possible for some patients, rather than only prevention of vision loss. Because of this, Lucentis has recently been granted an expedited review by the Food and Drug Administration (FDA) and may be available at the end of this summer. The RMLEI will soon be enrolling patients in a clinical trial using Lucentis for AMD. For more information call our study coordinator at Courtesy of: CJ Barnett, photographer Two forms of AMD exist: dry and wet. The wet form of macular degeneration is more severe and causes new blood vessels to grow under the retina, which leads to blood and fluid accumulating under the retina. This causes distortion and central vision loss and eventually scarring of the retina and permanent central vision loss. The dry form also causes vision loss although typically slowly over decades. 10% of people with the dry form will develop the wet. For many years the only treatment available was to use a hot laser or an argon laser which most often led to instant central vision loss, but had the advantage of limiting the spread or extension of the disease. In 2001 results from the clinical trials using Photodynamic Therapy (PDT) with a drug called Visudyne became available showing that after two years of treatment, approximately 60% of patients avoided severe vision loss (losing more than three lines of vision on the eye chart). This treatment requires infusion of a medication into a vein followed by a cold laser used to treat the area where new blood vessels are growing. Although, PDT was a significant improvement, vision gain was unlikely with the treatment and some patients (3-4%) experience sudden vision loss after the treatment. In 2002, the Rocky Mountain Lions Eye Institute began enrolling patients in a clinical trial, called the VISION trial. This trial sought to evaluate the efficacy of a new injectable medication, Macugen, for the treatment of macular degeneration. All previous treatments attempted to Avastin is a medication that was derived from the same precursor molecule as Lucentis and is currently FDA approved for use in colorectal cancer. For approximately one year, Avastin has been used off-label for the treatment of AMD. Small case series have been reported with delivery by intravenous (IV) infusion or more commonly by direct injection into the eye, similar to Lucentis and Macugen. The main concern with a drug that is being used off-label is safety. In the clinical trials in which the medication was used in patients with colon cancer and given intravenously, a small percentage of patients developed hypertension and blood clots attributable to the drug. This medication has been injected into the eyes of hundreds, if not thousands, of patients worldwide without, to our knowledge, the side effects noted using the IV route of administration. This is not surprising since the amount injected into the eye is 1/400th of the IV dose. Although Avastin has not been studied in a formal clinical trial (although clinical trials are currently being designed), the small case series that have been published show significant promise with some patients experiencing improved vision. At the RMLEI, we have been using Avastin and our preliminary results are encouraging. It is exciting to see the standard of care for AMD changing right before our very eyes. The benchmark for success in the future will not be vision stabilization but vision improvement. Early detection and timely therapy will always be critical in attaining the best visual acuities. The retina service at the RMLEI is committed to offering these cutting edge technologies and treatments to our patients. Nathan Rudometkin, MD Jeffrey Olson, MD

3 FOCUS ON FACULTY MISSION STATEMENT To be a nationally recognized Department of Ophthalmology that serves the people of the Rocky Mountain region by providing exemplary patient care founded on educational leadership, innovative research, and high ethical standards. NEWS FROM OUR PEDIATRIC OPHTHALMOLOGY TEAM: Arlene Drack, MD and Cameile Moore, CO, COMT, MS participated in the first University of Iowa Ophthalmic Genetics Conference in Iowa City, April 3-6, The pediatric team is pleased to announce the addition of several new members: Jenny Banker, CO, Connie Schamber, RN who is the ROP Coordinator, and technician Carmen Sotelo. The pediatric team is enrolled in the Pediatric Eye Disease Investigation Group Nasolacrimal Duct Obstruction Study II, a prospective study of surgical procedures for the treatment of persistent nasolacrimal duct obstruction in children less than four years old. This study will document the response to surgical treatment after the child has failed an initial probing. The pediatric team has completed the instruction of the Residents in their Pediatric Ophthalmology Basic Science course to prepare them for their annual OKAP examination. Dr. Rebecca Sands spoke about the management of pediatric glaucoma patients to the Perioperative Services Meeting held at The Children s Hospital of Denver. The pediatric ophthalmology service participated in the American Association of Pediatric Ophthalmology and Strabismus meeting in Keystone, CO in March, Dr. Drack and Dr. Sands presented a workshop on ways to manage complicated strabismus patients. RESIDENT CLASSES PRESENT POSTERS ATTENDING AAPOS: From left: Residents Scott Thomas, MD, Scott Oliver, MD, Associate Professor Arlene Drack, MD, and Assistant Professor Rebecca Sands, MD AAPOS American Association of Pediatric Ophthalmology and Strabismus Scott Oliver, MD, Ryan Prall, MD, Scott Thomas, MD ARVO Association for Research in Vision and Ophthalmology Parin Gohel, MD, Ryan Prall, MD (2), Anand Shah, MD, Lauren Zimski, MD ASCRS American Society of Cataract and Refractive Surgery Ly Nguyen, MD (2) FELLOWS PRESENT POSTERS Nathan Rudometkin, MD at ARVO Daniel Kessler, MD at ASCRS FACULTY RECOGNITION ON NOTABLE LISTS The inclusion of our faculty members on these lists is an indication of the quality of medical care our patients receive at the Rocky Mountain Lions Eye Institute. They are representative of the entire faculty at RMLEI. Guide to America s Top Ophthalmologists 2004, 2005, 2006 Prepared by Consumers Research Council of America Cornea and Refractive Surgery Michael J. Taravella, MD Retina/Vitreous Surgery Oculoplastic and Orbital Surgery Vikram Durairaj, MD Best Doctors in America Pediatric Ophthalmology, Genetics and Bronwyn J. Bateman, MD Arlene Drack, MD ON THE CUTTING EDGE The Cornea Service at the Rocky Mountain Lions Eye Institute is one of the first ophthalmic practices in the Rocky Mountain Region to offer Descemet s Stripping Automated Endothelial Keratoplasty (DSAEK). Corneal transplants are performed when a patient s cornea has become swollen or scarred causing one s vision to become cloudy. A corneal transplant is performed by removing the diseased cornea using a device analogous to a very fancy cookie cutter called a trephine and replacing that cornea with a cornea donated by someone who has recently passed away. Traditionally, the new cornea is sewn into place by hand using very thin suture material. DSAEK surgery is appropriate for patients who have dysfunction of the corneal endothelium (the innermost layer of the cornea). Examples of conditions that may lead to endothelial cell loss include patients with Fuchs Corneal Dystrophy, Congenital Hereditary Endothelial Dystrophy, or patients with endothelial damage following cataract surgery or other intraocular procedures. With DSAEK surgery, rather than transplant the entire cornea, only the posterior (back) portion of the cornea is transplanted. The potential benefits of DSAEK surgery include less post-operative astigmatism leading to faster visual recovery, less disruption of the overall strength of the eye, and less chance of corneal graft rejection. Dr. Richard Davidson and Dr. Michael Taravella are performing this new surgery. For more information about DSAEK, please contact

4 FOCUS ON RESEARCH I recently accepted the position of assistant professor of ophthalmology and director of clinical research at the Rocky Mountain Lions Eye Institute (RMLEI). This is an exciting time in ophthalmology with new discoveries leading to innovative clinical and surgical solutions for many ocular diseases. RMLEI is among the premier institutions for research in eye care and will continue to grow stronger under the direction of both clinical and research faculty. In order to take the department s research program to the next level, we must develop both clinical and basic science endeavors which help us provide exemplary care for our patients while seeking new answers for difficult questions. RMLEI has been actively involved with clinical trials investigating new medications and diagnostic tools. Our retina service has participated in national trials concerned with treating macular degeneration and macular edema (swelling in the retina). The cornea service has been a leader in refractive surgery care while also studying postoperative antibiotic therapy delivery systems. The glaucoma service has investigated the effects of intraocular injections on eye pressure while detailing the effects of steroids on future development of eye disease. The pediatric ophthalmology department is well recognized for studies involving congenital cataracts and retinopathy of prematurity. Neuro-ophthalmology is involved in clinical and basic science research looking at retinal and optic nerve disorders and the oculoplastics department continues to explore new surgical techniques while remaining active in publishing. While RMLEI has had a strong history in developing research, we remain committed to being part of future discovery and innovation. We aim to work together with the broader research community within the University of Colorado at Denver and Health Sciences Center, while fostering relationships with industry to nurture an environment of creativity and discovery. Additional clinical trials studying medications and instrumentation will begin soon, giving patients the opportunity to participate and benefit from cutting edge medical care. We will also redouble our efforts in exploring diseases from a basic science perspective. New efforts will explore methods of detecting ocular disease earlier and understanding how disease affects the overall health of patients. Scientific advancement in clinical care requires impressive infrastructure with the latest in modern diagnostic devices and services. The Rocky Mountain Lions Eye Institute provides impressive facilities in the form of an outstanding modern clinic equipped with innovative diagnostic lasers and imaging devices. Our outstanding faculty is committed to advancing technology, which will lead to the best in clinical care for our patients. I am honored to be part of the Department of Ophthalmology at the Rocky Mountain Lions Eye Institute and look forward to a bright future. Malik Kahook, MD Incoming, Glaucoma Department of Ophthalmology REACHING INTO THE COMMUNITY In January, Kara Hanson, OD, Low Vision Specialist, spoke to the Anchor Center on, Low Vision Device Options for the Visually Impaired Child and to the residents of Shalom Park Retirement Community on The Aging Eye. In February she spoke to the Colorado Department of Vocational Rehabilitation s statewide counselors for the blind on ocular anatomy and function. In February, Dr. Michael Taravella, Cornea and Lasik Specialist, spoke to a large group of Lions from the Louisville, Golden, Lafayette and Thornton Lions Clubs about advances in treatment, related to cataracts and corneal transplants. The Rocky Mountain Lions Eye Institute, as part of our educational service, may be able to provide informational speakers. Please contact the Community Relations office at for further information. DEPARTMENT OF OPHTHALMOLOGY ADVISORY BOARD We are grateful for the volunteer service of the advisory board. These members serve as ambassadors in the community in addition to organizing and supporting our fundraising efforts. Jean Appleman William Jackson, MD Joseph Bailey Kel Jones Patricia Cavaliere Wayne Matthai Robert Drabkin Carolyn Meske Craig Fales Brian O Meara Sue Goodin Marbeth Shay Sally Hooks Robert Sweeney Kenneth Hovland, MD FOCUS ON DEVELOPMENT GIFT GIVING OPPORTUNITIES To discuss gift-giving opportunities to benefit the programs of the Department of Ophthalmology, housed in the Rocky Mountain Lions Eye Institute, please contact Gail Phillips, Community Relations and Development Director at or gail.phillips@uchsc.edu. Suggested ways to help: Help to fund the resident/fellows training program Support clinical and basic research Support the Low Vision Rehabilitation Service Endow a professorship or chair Contribute to the Surgical Training Laboratory You, as a donor, have the unique capacity to affect change in the amount and quality of services and programs at the Rocky Mountain Lions Eye Institute. Your tax-deductible gift can make a difference! Give the Gift of Sight!

5 FOCUS ON FELLOWS Dr. Daniel Kessler (Cornea and External Diseases) We congratulate Dr. Kessler on successfully completing his cornea fellowship and wish him success and happiness as he and his family move to a private practice on the east coast. Dr. Nathan Rudometkin (Retina) Dr. Rudometkin continues his retina fellowship into its second year, working with Retina Specialists, Jeffrey Olson, MD and Antonio Ciardella, MD. Dr. Christopher Gelston (Cornea and External Diseases) Dr. Gelston completed his residency in our department of ophthalmology and is remaining here to complete a Cornea fellowship under the tutelage of Dr. Michael Taravella, Dr. Richard Davidson, Dr. Darren Gregory and Dr. Michael Erlanger. FOCUS ON ALUMNI Training Tomorrow s Colleagues: Since 1930, the Department of Ophthalmology has graduated 197 Ophthalmologists from its residency program. Many of these ophthalmologists have remained in the Rocky Mountain States, enhancing the eye care of our neighbors. We take pride in the accomplishments and careers of our alumni and the current faculty is working very hard to maintain the highest level of educational excellence in the program. Based on our 2005 review by the Accreditation Council for Graduate Medical Education, the department has been awarded a five year accreditation. We are very appreciative of recent gifts from some of our alumni in support of this residency program. Maintaining a high level of excellence will be more possible with continuing annual support. By giving directly to the training of our students, these gifts are ensuring student attendance at national ophthalmology meetings and their preparation and presentation of good research posters. Equipment and supplies for the residents study room and practice surgical laboratory are other direct uses for taxdeductible donations made to the Residents Education Fund. Donations can be made payable to the University of Colorado Foundation and sent to RMLEI with the designation - Resident Education or contact FOCUS ON LOW VISION REHABILITATION SERVICE The Low Vision Rehabilitation Service opened in January. Dr. Kara Hanson, OD, FAAO is providing a personalized treatment plan featuring a comprehensive functional evaluation and rehabilitative training. This personalized rehabilitation plan can help the patient: Read newspapers, books and mail Pay bills and write checks Recognize people Enjoy hobbies Watch television Drive View family photographs Access materials at work or in the classroom Build confidence in mobility and orientation The on-site technology area is equipped with the newest low vision video devices including closedcircuit televisions and portable video magnifiers. If you have difficulty reading, even while wearing glasses, or have a diagnosed eye condition such as glaucoma, AMD or diabetic retinopathy resulting in reduced vision, then you may wish to schedule an appointment with Dr. Hanson to see if we can help you improve your daily life through better visual efficiency. For appointments with Dr. Hanson call: FUTURE FOCUS ANNOUNCING 10th ANNUAL RESIDENT, FELLOW, FACULTY AND ALUMNI RESEARCH DAY We are pleased to announce the 10th annual presentation of original research, interesting case histories and resident research projects. Saturday, June 17th, :00 am to 4:00 pm in the Boettcher Auditorium on the third floor of the Rocky Mountain Lions Eye Institute 10th ANNUAL SYMPOSIUM DEPARTMENT OF OPHTHALMOLOGY CU School of Medicine Rocky Mountain Lions Eye Institute SAVE THE DATE! SEPTEMBER 29 & 30, 2006 Watch for your symposium brochure!

6 J. Bronwyn Bateman, MD Professor Pediatric Ophthalmology & Ophthalmic Genetics Theodore Curtis, MD Pediatric Ophthalmology & Richard Davidson, MD Cornea & External Diseases Refractive Surgery Jon Braverman, MD Associate Clinical Professor Comprehensive Ophthalmology FACULTY LISTING Our full time faculty at the Rocky Mountain Lions Eye Institute is comprised of Ophthalmologists with specialties that serve all your ophthalmic needs. CALL FOR APPOINTMENTS WITH THE FOLLOWING DOCTORS: Arlene Drack, MD Darren Gregory, MD Associate Professor Pediatric Ophthalmology & Cornea & External Diseases Ophthalmic Genetics Vikram Durairaj, MD Ophthalmic Plastic and Reconstructive Surgery Orbital Surgery Michael Erlanger, MD Cornea & External Diseases CALL AT DENVER HEALTH FOR APPOINTMENTS WITH: Antonio Ciardella, MD Vitreoretinal Disease CALL AT UCH FOR APPOINTMENTS WITH: Jeffrey Bennett, MD Associate Professor Neuro-ophthalmology Kara Hanson, OD Clinical Instructor Low Vision Rehabilitation Douglas MacKenzie, MD Glaucoma Associate Professor Interim Chair Vitreoretinal Disease Victoria Pelak, MD Neuro-ophthalmology Jeffrey Olson, MD Vitreoretinal Disease Rebecca Sands, MD Pediatric Ophthalmology & Michael Taravella, MD Associate Professor Cornea & External Diseases Refractive Surgery Nicholas Faberowski, MD Glaucoma DEPARTMENT OF OPHTHALMOLOGY ROCKY MOUNTAIN LIONS EYE INSTITUTE MAIL STOP F NORTH URSULA ST. BOX 6510 AURORA, CO is your direct link to the Rocky Mountain Lions Eye Institute for appointments or consultations with an ophthalmology specialist. General Administration For more information visit us on the web at VISIONS S PRING/SUMMER, 2006 Gail Phillips - Editor