2 Year in Review. 6 cutting-edge technology, services. 8 Research to Patient Care. 12 for Major Eye Diseases 16 Physician Garners Top Teaching Award

Transcription

1 2012 ANNUAL REPORT

2 TABLE OF CONTENTS 2 Year in Review Core lab provides access to 6 cutting-edge technology, services Clinician Translates Laboratory 8 Research to Patient Care New Options Offer Improved Outcomes 12 for Major Eye Diseases 16 Physician Garners Top Teaching Award 012 Grateful for His Care, Donor Helps Advance 20 Vision Science Research Clinical & Research Faculty & Staff 24 Clinical Trials 26 Awards, Lectures, & Publications 29 Selected Grants 36 Donor Honor Roll 37 Volunteer, Affiliate & Adjunct Faculty Members 39 Financial Highlights 39

3 FROM THE CHAIR Thank you for your interest in the Department of Ophthalmology and Visual Sciences at the University of Wisconsin School of Medicine and Public Health. We are proud of recent accomplishments and wish to highlight a few of our faculty, patients, students and the donors who help make our work possible. We teach residents and fellows in ophthalmology and subspecialty areas. We also teach the medical students the basics of ophthalmology so no matter which specialty they choose to enter, they will take with them an understanding of a basic eye exam and what the findings can indicate for overall health. Our clinical care is second-to-none. This year we ve highlighted better surgical tools and new techniques that may save vision and we ve also highlighted some of the patients who are the reason we do the work we do. Basic science research in our Department takes place in laboratories from the Fundus Photograph Reading Center on the western edge of the city of Madison, to laboratories housed within the University Hospital and Clinics, and in those located at the center of the UW Campus. A passion for understanding diseases that cause blindness connects these researchers in a shared effort. We keep a laser-like focus on the people who benefit from this understanding. Rather than investing in multiple versions of expensive tools, or hiring staff who can perform specific tasks that may not be often needed for an individual laboratory, Professor Curtis Brandt was awarded a grant for a Vision Science Core Laboratory, which allows all researchers to benefit from wide expertise in tools and techniques in vision science. (See story, page 6.) Encompassing every aspect of our mission, research that translates from basic science, to clinical trials to patient care, T. Michael Nork, MD, MS, has been involved in the development of a new treatment for age-related macular degeneration. His work in the laboratory and his care for patients dovetail in exactly the way the multiple missions of the Department fit together. Underpinning it all is the support from colleagues who challenge us to do better and donors who help fund new discoveries that enable investigation, improve care, and provide for the opportunity to train the physicians of tomorrow. I am pleased to highlight a few of the stories of the past year and invite you to contact us if you have any comments or questions. Paul L. Kaufman, MD Peter A. Duehr Professor and Department Chair UW Department of Ophthalmology and Visual Sciences University of Wisconsin School of Medicine and Public Health

4 YEAR IN REVIEW Web Hub keeps track of resident performance The residency program implemented MedHub, the ACGME s web portal, to collect and analyze resident data and performance. MedHub offers program administrators and faculty the ability to upload documents, generate reports, submit evaluations, and monitor resident compliance with program requirements, while providing residents an on-line system for reporting duty hours, reeiving direct and automated communications, and recording conference attendance and evaluations. This innovative tool has become the clearinghouse of residency program information. UW Simulation Center welcomes Phaco Course The Department of Ophthalmology and Visual Science s Multiphasic Phaco Course now uses the UW School of Medicine and Public Health s Clinical Simulation Center for the wet lab instruction portion of its two-day program. In collaboration with the University of Iowa and Medical College of Wisconsin, the course teaches more than 40 ophthalmology and Dalia Girgis, MD, former UW Ophthalmology resident now on faculty in the Department, served as one of the instructors of phaco surgery skills at the 2012 Multiphasic Phaco Course held for the first time at UW s Clinical Simulation Center. veterinary residents from across the country the basics of cataract surgery. The Simulation Center provides a state of the art training facility that has turned out to be perfect for the course. In Orbit Program engages residents and fellows Oculo-facial plastic and reconstructive surgeon Roberta Gausas, MD, former Department of Ophthalmology and Visual Sciences resident and fellow, recently returned to the UW as guest lecturer on Evaluation and Treatment of Orbital Disease. Dr. Gausas, professor at the Scheie Eye Institute, University of Pennsylvania, began the day with a grand rounds presentation on Lymphatics and the Orbit, which also recounted her fellowship year training with Richard Dortzbach, MD. Faculty on the oculo-plastics service at the UW, fellows and residents presented to an audience comprised of community and academic ophthalmologists, and other physicians. 2 UW Department of Ophthalmology and Visual Sciences

5 Conference brings former UW Pediatric Ophthalmology fellows to Madison Former fellows in Pediatric Ophthalmology and Adult Strabismus gathered in Madison for a day-long conference to share cases and professional experiences before they traveled to the American Academy of Ophthalmology meeting in Chicago last November. Burton Kushner, MD, fellowship director, was successful in creating a combined social and professional exchange among his former learners from across the country and as far away as Korea and Greece. Based on positive comments from attendees Dr. Kushner plans to hold the Madison reunion event each year the Academy meeting is held in Chicago. Nurse practitioners augment pre-surgery care Molly Kelley, BSN, MS, NP, a nurse practitioner in the Department of Ophthalmology and Visual Sciences, fondly remembers helping clear the way for a patient to have eye surgery to repair an injury from his childhood. He was living with pain from an eye injury many years ago, she said. He was so happy we could clear him for surgery on the same day he received his consultation so he did not have to make multiple trips to the clinic and prolong the amount of time before surgery. This new service provided by the Department of Ophthalmology and Visual Sciences reduces Heather Potter, MD, helps a resident practice phaco surgery during the recent course in the state-of-the art Simulation Center. the time between doctor consult dates and actual surgery dates. The Department recently hired a team of three nurse practitioners to its clinical staff to perform a basic but necessary function pre-operative examinations. The real impact of providing this service within our staff is on patient care, said Neal Barney, MD, medical director of the University Station Clinic where the nurse practitioners see patients. He also is a cornea surgeon and professor in the Department. If the pre-operative exam is done in our system, we can assure that patients receive all the appropriate screening, and that every aspect of the physical and history screen is fully available to the anesthesia group and to our surgeons. Kelley, along with her colleagues Michelle Masson, BSN, MS, NP, and Jane Seliger, BSN, MS, NP, have extensive experience working at major medical facilities, each having earned bachelor s degrees and master s degrees in Nursing as well as completing two additional years of intensive clinical training alongside physicians. They are colleagues who are highly professional and dedicated, Barney said, they are patientoriented and tremendous patient advocates. I see them becoming an integral, welcome and important part of every patient surgery. Specialized microscope lets researchers see inside live cells A spinning disk confocal microscope purchased for the Core Laboratory is allowing researchers to see what is happening inside living cells in real time. Live-cell imaging means researchers, like Aparna Lakkarju, PhD, can perform studies and understand cellular function at its most basic level. This understanding should lead to developing treatments for eye diseases such as age-related macular degeneration, which Dr. Lakkaraju studies. The microscope is available for other researchers in the University of Wisconsin to use as well and several vision science researchers have been using this exciting technology, including Robert Nickells, PhD, vice chair for Research in the Department of Ophthalmology and Visual Sciences Annual Report 3

6 YEAR IN REVIEW continued A spinning disk confocal microscope has a disk with an array of pinholes that spins very fast and illuminates the sample at very low levels of light. This prevents damage that might occur with more intense light and allows the same cell to be imaged thousands of times over just a few minutes. These images are put together to make time-lapse movies allowing researchers to visualize changes in living cells that occur on timescales of milliseconds. Seeing what is happening to a cell under stress and under normal conditions will help Dr. Lakkaraju understand how normal cell function is altered under conditions that mimic age-related changes in the eye. This is a first step to translating her research to patient care. Researchers receive grant to continue long-range study of diabetes complications Researchers at the Department of Ophthalmology and Visual Sciences were awarded more than $3 million to study long-term effects of Type 1 Diabetes. Ronald Klein, MD, MPH, and Barbara Klein, MD, MPH, have studied people with type 1 diabetes since This long-term study has allowed the researchers to understand the role of blood sugar and other factors on complications from diabetes. This new arm of the study will look at why, independent of blood glucose levels, some people with long-term type 1 diabetes have more severe complications than others. Complications from diabetes include cardiovascular disease, diabetic retinopathy, nephropathy, and cognitive dysfunction. With this grant from the National Eye Institute, the Kleins will continue to study the effects on patients they have been following for more than 30 years. Colley grant uses fruit fly to understand human retinal diseases Nansi Jo Colley, PhD, was awarded $1.5 million over four years to use Drosophila (fruit fly) to study retinal degenerative diseases like retinitis pigmentosa and age-related macular degeneration. Drosophila is a powerful molecular genetic model for studying the mechanisms of retinal degeneration. Dr. Colley has been conducting this research for more than 20 years. By using Drosophila, which is well understood genetically, Dr. Colley and her students and staff can better understand the basic mechanisms that underlie inherited forms of the diseases. Because human and fruit fly visual systems share fundamental similarities, findings in Drosophila can be applied to human processes and diseases. NEW PHYSICIANS JOIN DEPARTMENT The Department of Ophthalmology and Visual Sciences expanded its ranks with four new physicians. Megan Collins, MD, came to the Department as a pediatric ophthalmologist after completing her fellowship in pediatric ophthalmology and adult strabismus at the Hospital for Sick Children in Toronto, Ontario, Canada. Dr. Collins completed her residency at the University of Chicago Medical Center and received her medical degree from the University of Chicago Pritzker School of Medicine. I went into pediatric ophthalmology because I want to help children have the best vision possible, Dr. Collins said. In addition to comprehensive ophthalmology, pediatric ophthalmology and adult strabismus, my special areas of interest are congenital cataracts, glaucoma, retinopathy of prematurity and tear duct disorders. During medical school, Dr. Collins also completed a fellowship at the MacLean Center for Clinical Medical Ethics, with a special emphasis on 4 UW Department of Ophthalmology and Visual Sciences

7 research ethics, an area that, along with resident education, remains a strong interest for her. She practices at University Station Clinic in Madison, and also sees patients at Mercy East Medical Center in Janesville. Megan Collins, MD Neuro-ophthalmology, the science related to the sensory and motor involvement of the nervous system and the eye, not only includes ocular and pupillary movement, but also extends to structures inside the brain that are responsible for vision. A highly subspecialized field, there are a limited number of neuro-ophthalmologists the Department was fortunate to recruit two of them. Yanjun (Judy) Chen, MD, PhD, recently completed a fellowship in neuroophthalmology at the University of Iowa Hospitals and Clinics. She completed a neurology residency at St. Louis University School of Medicine and Yanjun (Judy) Chen, MD, PhD her ophthalmology residency at Peking Union Medical College in Beijing, China. She also earned her PhD at the Schnurmacher Institute for Vision Research in New York City. Dr. Chen sees patients at University Station Clinic in Madison. Marilyn Kay, MD, sees patients two days per week, also at University Station Clinic. She completed a fellowship in neuroophthalmology at the Cullen Eye Institute at Marilyn Kay, MD Baylor College of Medicine in Houston, her ophthalmology residency at the Medical College of Wisconsin Affiliated Hospitals in Milwaukee, and earned her medical degree at Jefferson Medical College, Thomas Jefferson University in Philadelphia. Dr. Kay held positions of Acting Chair, Vice Chairman and Residency Program Director during the decade she was a full time faculty member at the Eye Institute at the Medical College of Wisconsin. In addition, she was Chief of Ophthalmology at the Clement J. Zablocki VA Medical Center in Milwaukee during the same time period. She is an associate board examiner for the American Board of Ophthalmology and has held leadership and volunteer positions in the American Academy of Ophthalmology. Dr. Kay also previously had a private practice in metropolitan Milwaukee. Dalia Girgis, MD, PhD, is a comprehensive ophthalmologist who joined the Department of Ophthalmology and Visual Sciences in She is no stranger to Wisconsin, having completed her residency and served Dalia Girgis, MD, PhD as chief resident in the Department. Dr. Girgis earned her PhD in microbiology, immunology and parasitology from Louisiana State University Health Sciences Center (New Orleans) and her MD from the University of Miami Leonard M Miller School of Medicine. Dr. Girgis is excited about participating in medical student and resident education where she completed her training. Over the years, I have had the chance to work with wonderful colleagues throughout the Department, and I look forward to continuing to foster those relationships in the years to come, she said. In addition to cataract surgery and comprehensive ophthalmology, Dr. Girgis has special interest in glaucoma and age-related macular degeneration. She sees patients at University Station, Deming Way and East eye clinics Annual Report 5

8 RESEARCH Core lab provides access to cutting-edge technology, services A researcher who needs to study treatment delivered via genes is able to do so at the UW Department of Ophthalmology and Visual Sciences. Highly specialized imaging tools are available to researchers who need them. As can a researcher who needs an animal model to test a hypothesis. All these tools are available from the Vision Research Core funded by a Core Grant from the National Eye Institute. This grant allows scientists to make use of cutting-edge technology and highly trained laboratory staff without having to have either the tool or the worker in every individual laboratory. The benefit of such service is that researchers can consider questions they don t directly have the tools to answer, because what s needed is available on campus through the Core Grant. Core facilities are often located in one laboratory on a campus. At the University of Wisconsin Department of Ophthalmology and Visual Sciences, the facility is in several locations, housed within laboratories that have the resources and staff expertise needed for particular techniques. At any given time, about 15 principal investigators are making use of at least one of the Core facilities four modules. These are Gene Delivery Vectors, directed by Curtis Brandt; PhD; Pathology and Imaging, directed by Donna Peters, PhD; Kimberly Toops, PhD, uses a spinning disk confocal microscope as part of the Core Laboratory in the Department of Ophthalmology and Visual Sciences. Dr. Toops is an expert on this specialized imaging tool, helping other researchers make use of it without a learning curve. 6 UW Department of Ophthalmology and Visual Sciences

9 Quantitative Molecular Biology, directed by Robert Nickells, PhD; and Animal Models and Methodology, directed by Paul Kaufman, MD. The Core grant provides support for investigators with qualifying NEI grants to have access to technology they could not afford, or would not use often enough to make a laboratory-centered investment. For example, in Dr. Brandt s laboratory, staff members make gene delivery vectors for other researchers to use in experiments. Researchers who use one of the Core facilities for this work have the benefit of staff members who have a great deal of experience with the techniques. It would take a month for each person to develop the proficiency to get it done themselves, Dr. Brandt says. This might be something they use only occasionally. Dr. Nickells uses a spinning disk confocal microscope located in the imaging area of the Core lab. That has opened up experimental ideas that I didn t even conceive of a few months ago, Dr. Nickells says. Now we can look at things other people haven t been able to do because they don t have access to this kind of technology. But the microscope, which cost more than $400,000, would not be affordable in an individual laboratory. Having it for all to use and having the grant cover the costs for investigators to use the microscope is what opens up the opportunity to ask and answer new questions. Dr. Kaufman says having staff in his laboratory provide services to other principal investigators allows his staff to keep up their expertise while also allowing other researchers to concentrate on the techniques they use most often. We stand out because we have a critical mass of investigators who are using Core facilities that are common to many types of research, Dr. Kaufman says. One way these tools and techniques help is that a researcher may ask for something specific, but the staff doing the work might question why it s needed. They might suggest a better way, Dr. Kaufman says. The staff doing the work know the best techniques because they use the tools every day. That advances research for everyone. Fuzzy virus part of Brandt lab Curtis Brandt, PhD, spends most of his day involved in high-level research. His focus is on virus vectors for gene delivery and he specifically studies herpes simplex virus 1, which is a leading cause of blindness. A few years ago, a company that makes fuzzy microbes contacted Dr. Brandt to see if he had electron micrographs of the herpes virus. Indeed, he did, and shared it with the company, GIANTMicrobes, based in Stamford, Connecticut. After arranging for the image, the company wanted to know what the microbe should look like. It kind of looks like a fried egg, Dr. Brandt says. That s an effect of the electron microscope. Otherwise, it would just be a big sphere. Curtis Brandt, PhD, holds a small and a giant version of the herpes simplex virus, which was created by GIANTMicrobes using Dr. Brandt s expertise. His laboratory also provided the electron micrograph of the virus for the company s packaging. Dr. Brandt considers this interruption a part of doing research at the University of Wisconsin. We support the Wisconsin Idea, where we reach out to all parts of the state and assist. We re supposed to be helping individuals and businesses and this could be counted as that. More than one person in his laboratory has a fuzzy microbe, even though they study Herpes Simplex Virus 1 and this microbe is HSV-2. Both can be sexually transmitted, and both can lead to blindness, Dr. Brandt says. Giant Microbes of many sizes and colors are available at the UW Bookstore as well as at shops around the country Annual Report 7

10 translational RESEARCH Clinician translates laboratory research to patient care Patients seen in the Retina Clinic might not be thinking about how the medication that saves their sight was developed, but you can be sure their physicians are. One of them, T. Michael Nork, MD, MS, a professor in the University of Wisconsin Department of Ophthalmology and Visual Sciences, has been involved with drug discovery and testing before using the medications to help his patients in the clinic. T. Michael Nork, MD, MS Dr. Nork is one of several clinicians at the UW who see patients in the clinic and conduct research in the laboratory. Most physicians come to research through medicine; Dr. Nork came to medicine through research. He earned his undergraduate degree in physics. Physics is quite abstract, Dr. Nork says. I wanted to be able to apply my knowledge to something tangible. So, during graduate school, he was interested in learning about practical applications for physics, and while obtaining his masters in nuclear engineering, spent a few weeks working in a hospital with a health physicist. His work was narrow and specialized, Dr. Nork recalls. I thought that as a physician I would have more options. Many researchers think mostly about the thrill of the discovery, and how the discoveries will fit into patient care is farther down the road. But for Dr. Nork, translational research connecting discoveries from the laboratory bench to the patient s bedside was a key right from the start. During medical school, the ophthalmology rotation was just fantastic, he says. You could see the pathology of diseases processes in the retina. The small vessels show a lot. That s what attracted me to retina. Dr. Nork completed his two-year retina fellowship at the University of Wisconsin, and stayed in touch with faculty here while on the faculty at West Virginia University. He returned to Wisconsin in 1993 to further his research as a subspecialist in retina and a basic science researcher. Dr. Nork is a managing member of Ocular Services On Demand (OSOD), which has contracts with outside companies to provide specific research services. He uses the funds he earns from those projects to help support the laboratory research he conducts on his own projects. His OSOD projects often involve studying medications for macular degeneration, including Eylea, which was recently approved for use in humans. Dr. Nork studied Eylea in monkeys. Then, he participated in a national clinical trial to test the medication in humans. And now, he uses it in his practice in the Retina Clinic. One of the long-term areas of Dr. Nork s own laboratory research is on glaucoma. The damage to the optic nerve occurs slowly, and is linked to elevated intraocular pressure. Even in normal-pressure glaucoma, the pressure is too high for the particular eye, Dr. Nork says. As people age, the resistance to fluid outflow increases and the optic nerve is damaged. That might be caused by decreased blood flow or mechanical damage to the optic nerve. This is a theory, widely held, of retrograde damage. 8 UW Department of Ophthalmology and Visual Sciences

11 T. Michael Nork, MD, MS, and Ryan Dashek, BS, look over an image showing fluorescent microspheres that are used to measure regional differences in blood flow to the retina Annual Report 9

12 translational RESEARCH continued But Dr. Nork, one of the few retina researchers in the world who study glaucoma, has been interested in the pathologic changes that occur in the rods and cones in various diseases. The rods are for night vision and the cones for day and color vision. There are 3 cone types red light sensitive, green light sensitive and blue light sensitive. Dr. Nork and his co-workers found that the blue cones were damaged in retinal detachment and diabetic retinopathy. Physics is quite abstract, I wanted to be able to apply my knowledge to something tangible. - T. Michael Nork, MD, MS Using an animal model of glaucoma, Dr. Nork is able to study what occurs in the cones and the photoreceptors in late-stage glaucoma. He learned that the cones are indeed affected by glaucoma. Dr. Nork is testing what he calls the anterograde hypothesis of optic nerve damage in glaucoma. It s controversial, he says. The idea is that elevated intraocular pressure leads to decreased choroidal blood flow, which leads to retinal ischemia and increased glutamate. A high magnification photo of the microtome in Dr. Nork s lab. The microtome is used to cut thin strips of retinal tissue that has been embedded in plastic. A triangular glass knife does the actual cutting. Ryan Dashek, BS, is removing one of the strips with jeweler s forceps in preparation for mounting it on a glass slide and doing histochemical staining. The specimen will then be examined under a microscope. 10 UW Department of Ophthalmology and Visual Sciences

13 This all may seem confusing, but another example of a similar process occurs in stroke. When a person has a stroke and brain cells are dying, the cells adjacent to the dying cells also die, even though they have normal blood flow to them. That s because cells that are dying release glutamate and nearby cells have a glutamate receptor that makes them highly susceptible to damage from abnormally high concentrations of glutamate. Retinal ganglion cells (which connect the retina with the brain) have the same glutamate receptor. If you inject glutamate into the vitreous, the ganglion cells will die but the rest of the retina remains intact. We use laser energy to coagulate the photoreceptors so they won t release glutamate, but we don t harm the ganglion cells the opposite of glaucoma, Dr. Nork explains. If we then induce glaucoma we find that the ganglion cells overlying areas where the cones have been destroyed are resistant to glaucoma damage. If further research supports the notion that injury to rods and cones plays a role in glaucomatous optic nerve degeneration, then it might be possible to develop drugs that either protect the ganglion cells directly or that prevent the decreased blood flow that eventually leads to glutamate toxicity. Ryan Dashek, BS, double checks results of an experiment in Dr. Nork s laboratory. This kind of cutting-edge research is the reason Dr. Nork came to the University of Wisconsin Madison and being able to continue to study the most basic elements of a treatment all the way through caring for human patients is one reason he continues to be energized in his work here. You could see the pathology of diseases processes in the retina. The small vessels show a lot. That s what attracted me to retina. - T. Michael Nork, MD, MS 2012 Annual Report 11

14 PATIENT CARE New options offer improved outcomes for major eye diseases When it comes to saving their vision, people are understandably concerned about the quality of their surgeons, techniques and tools. At the UW School of Medicine and Public Health, ophthalmologists in all subspecialties are able to provide cutting edge procedures, giving patients choices and better outcomes from chronic problems. Artificial cornea implants Sarah Nehls, MD, a cornea specialist, has implanted artificial cornea keratoprostheses in patients who have needed a subsequent human cornea transplant. The first choice for a transplant is a human donor cornea, but the donor tissue sometimes fails and grows cloudy so another transplant must be performed. Most people do well with donor corneas, or one repeat graft, but for some, an artificial cornea is a better solution. One of the patients with an artificial cornea is Margaret Malachowski, of Machesney Park, Illinois, who is thrilled with the outcome from her surgery. A few months after her procedure, Malachowski was thrilled to look at her daughter and see out of her new eye. Because she had not been able to see out 12 UW Department of Ophthalmology and Visual Sciences Margaret Malachowski, of Machesney Park, Illinois, is grateful for the artificial cornea that has improved her vision. of the eye for several years, she continues to have difficulty opening it. But she notices improvement. And my friends tell me when it looks more open, she says. It s going to take some time for this eye to function in tandem with my good one. People with these cornea implants remain under her care for the rest of their lives, Dr. Nehls explains, but the results can be very good. This is really exciting because these patients had no other options to restore vision. They appreciate the change in vision and the ability to use the eye. Pediatric glaucoma laser treatment Although cataracts are often considered a problem of older people, even very young children can develop cataracts. As many as 30 percent of children who have cataracts removed at a young age develop glaucoma. Wei Li Werner was among them. The 13-yearold girl had a cataract removed before she was adopted at 4-years-old. The first choice for treatment of pseudophakic or aphakic glaucoma is eye drops, but sometimes drops alone don t control eye pressure adequately. says Pediatric Ophthalmologist Yasmin Bradfield, MD, Wei Li s ophthalmologist. Using glaucoma medications can be challenging. Parents often find putting eye drops in their children s eyes several times a day negatively affects quality of life, for both parent and child. A treatment option is placing a tube shunt in a child s eye to redirect aqueous fluid, thus lowering eye pressure. However, this has its own problems, Dr. Bradfield says. The shunt can dislodge, it can become exposed, and the child is at risk of a serious eye infection for the rest of his or her life.

15 Margaret Malachowski and her daughter, Alexis Malachowski, walk along a park in their neighborhood. The improved vision she has following her most recent surger y has Margaret overjoyed Annual Report 13

16 PATIENT CARE continued Instead of using a shunt, Dr. Bradfield uses a minimally invasive laser to disrupt the ciliary processes which produce aqueous fluid in the eye. This treatment is called endocyclophotocoagulation (ECP) and is most often used for children who have had cataract surgery, because otherwise the natural lens blocks access to the area a surgeon must laser. I can directly see the processes through a tiny camera within the laser, Dr. Bradfield says. It is possible to improve eye pressures enough that a child no longer needs to use eye drops, and to avoid placement of a tube shunt. The surgery is safer and patients are more comfortable after the procedure. Wei Li still needs to use one eye drop to control pressure, says her mom, Sue Werner, but she has been able to reduce the number of drops she has to use. And, probably most important to Sue, Wei Li is able to participate in more activities. Wei Li used to get frequent headaches from the spiking intraocular pressure. She still gets headaches sometimes, Sue says. But she hasn t had to come home from school because they aren t as bad as they were. The laser treatment can be repeated if eye pressures don t fall enough, Dr. Bradfield says. This procedure gives us flexibility to do more if it s needed. The shunt surgery is much more complicated, and requires significantly more postoperative recovery time. Dr. Bradfield uses a special laser that most pediatric ophthalmologists don t have access to. Some ophthalmologists who refer patients to Dr. Bradfield are not aware of this novel laser treatment option. Improved surgical instruments Smaller surgical instruments are improving patient outcomes as well, says Justin Gottlieb, MD, a retina surgeon and chief of the retina service at the UW. Surgeons use 25-gauge instruments and perform procedures through an incision that is less than 2/100 of an inch. The surgery is safer and patients are more comfortable after the procedure, Dr. Gottlieb says. Smaller instruments mean smaller incisions and less inflammation after surgery, he adds. In addition, usually, the incision is so small it is self healing, meaning no suture is necessary. The size of surgical tools is another incremental improvement. The tools are continually improving, allowing us to have the same feel with a smaller instrument that we Wei Li Werner of Madison grins during a visit to her ophthalmologist. did with a larger one, he says. Remember, the larger instrument was only about 1 mm, so scale is important here. At the University of Wisconsin School of Medicine and Public Health, using the latest techniques and tools is important. We are confident we are providing improved care and outcomes for our patients, Dr. Gottlieb says. In every area, it s gratifying to be able to tell patients they are going to get the latest and best, both in instrumentation and techniques. 14 UW Department of Ophthalmology and Visual Sciences

17 Yasmin Bradfield, MD, explains the surgery she used to lower eye pressure in Wei Li Werner s eye. Wei Li, in turn, had book recommendations for Dr. Bradfield Annual Report 15

18 EDUCATION Physician garners top teaching award: gold standard for medical student teaching Students gathered on a Monday morning to learn the basics of ophthalmology and how to give an eye exam. Their teacher, Daniel Knoch, MD, made the session interesting and fun, while emphasizing the Daniel Knoch, MD seriousness of some of the eye-related conditions these medical students will see in practice. Every medical student at the University of Wisconsin School of Medicine and Public Health spent one week rotating through the Department of Ophthalmology and Visual Sciences. Those who plan to become ophthalmologists spend a longer period up to two months training in the Department, in addition to the required week. The first time a student meets with a patient in any medical specialty can be daunting. In ophthalmology, when unfamiliar technology may get between aspiring doctor and patient, it can be even more so. That s why Dr. Knoch works hard to make the week as meaningful as possible. Medical students Kacey Kronenfeld (clockwise from left), Stacy Valkenaar, Carla Bouwkamp and Kara Petrashek, listen to Dr. Knoch during a Monday-morning introduction to ophthalmology. Although none of these students plan to specialize in ophthalmology, a solid understanding of eye diseases is important in almost any specialty. We want students to come into the clinic, understand what eye-related issues they are likely to see and follow through on the most appropriate treatment, Dr. Knoch says. During his Monday-morning session with the students, he goes over how to check peripheral visual field by confrontation testing. Visual field problems may point to other health issues, he explains to the students, who note his every word. Each student practiced, with Dr. Knoch as the patient, and explained the kind of visual field loss demonstrated by the results that Dr. Knoch simulated. Some of these issues point to things like a stroke, for which quick treatment is the only way to mitigate damage. 16 UW Department of Ophthalmology and Visual Sciences

19 Dr. Knoch takes great pride in teaching future physicians, not just future ophthalmologists, about the eye. As the faculty member in charge of medical student teaching in the UW Department of Ophthalmology and Visual Sciences, Dr. Knoch interacts with the entire medical school class during the medical students third or fourth year of training. Dr. Knoch is the new gold standard in medical student education. Another student commented: Dr. Knoch was an incredible teacher, probably the best teacher I have had in medical school. He as the most organized, most interesting, and most effective teacher I had on this rotation. Dr. Knoch connects with his patients and enjoys helping them see better, and being able to teach both residents and medical students is one of the reasons he chose to make his career at the University of Wisconsin. Medical students apparently agree that this kind of in-depth arrangement is the best way to learn about ophthalmology, because the Class of 2011 awarded Dr. Knoch the Outstanding Clinical Teaching Award. This award, chosen by vote of the graduating medical school class, is given to a single clinician who has greatly shaped the educational lives of the students. Dr. Knoch is the new gold standard in medical student education, one anonymous student evaluator wrote. He kept the curriculum focused and relevant and used repetition to drive home important messages. Above, students take notes during a an earlymorning session before heading off to clinic. Below, Dr. Knoch poses as the patient while Kacey Kronenfeld checks confrontation. This is an important test because it can quickly show a visual field defect that might indicate serious problems. The patient covers his eye and so does the doctor to ensure the same lines of sight Annual Report 17

20 EDUCATION continued Although he has changed and updated the one-week clerkship since taking over, Dr. Knoch inherited the medical student training program from Richard Appen, MD. He really built the program, Dr. Knoch says of Dr. Appen. He was a very good mentor to me for what the students need to know. Even as a resident, Dr. Knoch was noted for his teaching ability, Dr. Appen recalls. The student evaluations often highlighted his work with the medical students, he says. He has made some changes to the curriculum to make it more effective for the current students. He is aware of what is most important for these students to understand. In addition to classroom time and time in the clinics seeing patients with residents and Department faculty, the medical students also scrub in for surgery, observing procedures to treat common and uncommon eye diseases. This variety helps the students feel confident in understanding the eye issues they will see in their future medical practice, and although recruiting doctors to ophthalmology is not his focus, Dr. Knoch s great introduction to ophthalmology has led some students to choose it as their subspecialty as well. Kara Petrashek, a third-year medical student, watches Dan Knoch, MD, interact with a patient in clinic. Shadowing physicians and seeing patients is part of the week-long clerkship every medical student spent in ophthalmology. 18 UW Department of Ophthalmology and Visual Sciences

21 Dr. Knoch has garnered three teaching awards in the time he has led the medical school teaching program. In 2008, he was chosen for the Medical Alumni Association Clinical Science Teaching Award. He was selected from among all the clinical teachers third year medical students work with. In 2009, Dr. Knoch was given the Resident Teaching Award, selected by the nine ophthalmology residents. In 2011, the medical school graduating class gave Dr. Knoch the Outstanding Clinical Teaching Award. This class selected him as the best teacher from its four years of medical school. That s unusual, says Gregg Heatley, MD, vice chair for Clinical Care in the Department. You would expect that the students would vote for an instructor with whom they had contact for a prolonged period of time. To be given this honor by students with whom one only has contact for one week out of four years of school is a high tribute to Dan s ability to teach and to connect with the students. Kara Petrashek practices giving an eye exam on patient John Schwarz. Dr. Knoch provides advice and guidance on proper technique. Teaching medical students is an important part of Dr. Knoch s personal mission Annual Report 19

22 DONORS Grateful for his care, donor helps advance vision science research Ronald Lewis of Madison considers himself lucky to have his good vision. Things could have turned out differently for Lewis, who has recently returned to his career as an investment adviser. As a person with glaucoma Lewis s was discovered when he was in the U.S. Navy during the Vietnam War he knows the damage can progress from good vision to very limited vision over time. He was referred to other ophthalmologists and as his disease progressed, to Gregg Heatley, MD, a glaucoma specialist at the University of Wisconsin. Gregg Heatley, MD He put me right at ease, Lewis says. He just had a wonderful way in terms of bedside manner and patient education. We even met on a Saturday afternoon one time, because that was the best time for the treatment schedule. And after that appointment, to Lewis s surprise, Dr. Heatley stayed at the office to work on a research project. It was a beautiful spring day and he was going to stay and write up research, Lewis marvels. He really must love what he does. Because of the excellent care he received, Lewis wanted to support research and education at the UW Department of Ophthalmology and Visual Sciences. By the time I saw Dr. Heatley for the first time, I had been on eye drops and the glaucoma was still advancing, Lewis recalls. He offered options for slowing the glaucoma. Because the glaucomatous damage was increasing, the window for treatment was narrower, says Dr. Heatley. He had real glaucoma with a real visual field defect, he recalls. That means we had less time to try different treatments before we needed to find one that worked. In addition to medicines, Lewis had laser procedures to enlarge the drainage system in his eye. Because of his relatively young age at the time, the wound created by the laser healed too quickly to give Lewis longterm results. Lewis and Dr. Heatley decided to perform a trabeculectomy, which opens a permanent drainage system to lower eye pressure and stop or slow continued damage. It s a complicated procedure. Following a trabeculectomy, patients often have blurry vision and they have some discomfort for several weeks. Lewis had great results and the progression of his glaucoma has slowed significantly. He does use eye drops to control the pressure in his other eye, but so far, has not needed any more procedures. By the time I saw Dr. Heatley for the first time, I had been on eye drops and the glaucoma was still advancing. - Ronald Lewis One reason Dr. Heatley likes his glaucoma subspecialty is that he gets to know his patients and care for them for many years. I ve seen Ron in a successful career, a tooshort retirement and re-emerging to another successful career. He s talked about his kids and now he is a glowing grandfather. 20 UW Department of Ophthalmology and Visual Sciences

23 Gregg Heatley, MD, a glaucoma specialist, exams Ron Lewis s eye. Lewis, a long-time patient, had very successful surgery to keep his eye pressure under control and prevent damage from glaucoma Annual Report 21

24 DONORS continued As a patient, Lewis has been grateful for the quality of care he receives. Dr Heatley has both feet on the ground, he says. He has a wonderful sense of humor and has the ability to give you confidence. For Lewis, the decision to support the Department with charitable contributions is a way of saying thank you to physicians and staff who he believes helped save his vision. For Dr. Heatley, it is an honor to be thought of that way but the gift is meaningful because of what it can do going forward. This gift and the way we use it allows Ron to positively affect more people, Dr. Heatley says. He s really allowing us to help more people in more ways than we otherwise could have. And that is why our faculty choose to be at an academic institution. Some patients may feel uncomfortable with residents and fellows ophthalmologists who are completing a year or two of advanced training in a subspecialty providing some of their care, but Lewis has no qualms. It s like having another set of hands and eyes watching out for you, he says. These people are here because our doctors are the best. They are learning at the master s bench. Dr. Heatley is grateful Lewis feels that way because teaching young ophthalmologists is a passion. In academic medicine, you treat the person who is in front of you, and you train people who will take care of other people, he says. You get to help people you ve never even met. Research does the same thing. Ron Lewis has been a patient of Dr. Heatley s for so long they have formed a bond beyond doctor patient, but Dr. Heatley had not known Lewis supported the Department philanthropically. Lewis believes he is getting the best possible treatment for his glaucoma. I am able to be cared for by a physician who is an expert in his field, and he also teaches and did research, Lewis says. I know he is connected to the leading edge of his craft. 22 UW Department of Ophthalmology and Visual Sciences

25 Ron Lewis shares a story about time with his beloved grandchildren. For Dr. Heatley, watching Lewis light up when he shares those stories is one of the pleasures of their long professional relationship Annual Report 23

26 2012 CLINICAL & RESEARCH FACULTY & STAFF Julia B. Agapov, MD, DO Assistant Professor Glaucoma, anterior segment & cataract surgery Daniel M. Albert, MD, MS Frederick Allison Davis and Lorenz E. Zimmerman Professor & Chair Emeritus Ocular oncology, ophthalmic pathology, comprehensive ophthalmology Michael M. Altaweel, MD Professor Retina, vitreous, macula, ocular melanoma Richard E. Appen, MD Professor Emeritus Neuro-ophthalmology Yonca O. Arat, MD Assistant Professor Comprehensive ophthalmology, cataract surgery Neal P. Barney, MD Professor Cornea & external disease, cornea & cataract surgery, uveitis, ocular immunology Barbara A. Blodi, MD Professor Retinal diseases including macular degeneration and diabetic retinopathy Yasmin S. Bradfield, MD Associate Professor Pediatric ophthalmology & strabismus, retinopathy of prematurity, pediatric cataract surgery & intraocular lens implantation, pediatric eyelid surgery, pediatric glaucoma Curtis R. Brandt, PhD Professor Virology, cell & molecular biology, genetic mapping & recombinant techniques, gene therapy Cat N. Burkat, MD Associate Professor Ophthalmic reconstructive & cosmetic surgery Suresh R. Chandra, MD Professor Vitreoretinal disease, macular disease, ocular melanoma, trauma, international ophthalmology Judy A. Chen, MD, PhD Assistant Professor Neuro-ophthalmology Nansi Jo Colley, PhD Professor Molecular/genetic studies of retinal degeneration in Drosophila Megan Collins, MD Assistant Professor Pediatric ophthalmology and adult strabismus Eugene D. Cropp, OD Clinical Optometrist Optometry Karen J. Cruickshanks, PhD Professor Epidemiology of agerelated ocular disorders, hearing loss, diabetes Janet Cushing, OD Clinical Optometrist Optometry Ronald P. Danis, MD Professor, Director of the Fundus Photograph Reading Center Macular degeneration, diabetic retinopathy, retinal vascular diseases & posterior ocular inflammatory disorders Matthew D. Davis, MD Professor Emeritus Vitreoretinal disease, diabetic retinopathy, clinical trials Richard K. Dortzbach, MD Professor Emeritus Ophthalmic plastic & reconstructive surgery, surgical techniques Dalia Girgis, MD, PhD Assistant Professor Comprehensive ophthalmology, cataract surgery Michael J. Feifarek, MD Instructor Comprehensive ophthalmology Thomas D. France, MD Professor Emeritus Pediatric ophthalmology & strabismus, amblyopia, visual function testing David M. Gamm, MD, PhD Justin L. Gottlieb, MD Associate Professor Associate Professor Pediatric ophthalmology Retina, vitreous, macula & strabismus, retinopathy of prematurity, pediatric cataract surgery & intraocular lens implantation, pediatric glaucoma Gregg A. Heatley, MD Associate Professor Vice-Chair/Clinical Glaucoma, anterior segment & cataract surgery Michael S. Ip, MD Associate Professor Vitreoretinal surgery for diabetic retinopathy and retinal detachment, treatment of age-related macular degeneration, clinical trials research Celeste K. Jend, OD Clinical Optometrist Optometry Ronald E. Kalil, PhD Professor Neural cell death & repair after brain damage Paul L. Kaufman, MD Peter A. Duehr Professor & Chair Glaucoma, aqueous humor dynamics, anterior segment physiology & pharmacology, presbyopia 24 UW Department of Ophthalmology and Visual Sciences

27 Marilyn Kay, MD Associate Professor Neuro-ophthalmology Barbara E.K. Klein, MD, MPH Professor Glaucoma, comprehensive ophthalmology, cataracts, diabetic retinopathy, epidemiology, preventive medicine Ronald Klein, MD, MPH Professor Vitreoretinal disease, diabetic retinopathy, age-related eye diseases, epidemiology Daniel W. Knoch, MD Assistant Professor Comprehensive ophthalmology, cataract surgery Burton J. Kushner, MD Professor Pediatric ophthalmology & strabismus, amblyopia, surgical techniques Aparna Lakkaraju, PhD Assistant Professor Retinal cell biology, pathogenesis of retinal degenerations, identification of therapeutic targets Leonard A. Levin, MD, PhD Professor Neuro-ophthalmology, ganglion cell death Mark J. Lucarelli, MD Professor Oculoplastic, cosmetic facial and orbital surgery Julie A. Mares, PhD Professor Epidemiology of eye disease, nutritional epidemiology Michele M. Martin, OD Clinical Optometrist Optometry Frank L. Myers, MD Professor Emeritus Retina Sarah M. Nehls, MD Assistant Professor Vice-Chair/CME & Faculty Development Refractive surgery, cornea & external disease, cornea & cataract surgery, uveitis Robert W. Nickells, PhD Professor Vice-Chair/Research Molecular biology of cell death in glaucoma & retinoblastoma T. Michael Nork, MD, MS Associate Professor Diseases & surgery of the retina & vitreous Cameron F. Parsa, MD Associate Professor Pediatric ophthalmology and strabismus, neuroophthalmology Richard W. Patterson, OD Clinical Optometrist Optometry Todd W. Perkins, MD Professor Glaucoma, normal tension glaucoma, implant devices, cataract surgery Arthur S. Polans, PhD Professor Cancer-related ocular pathologies Heather A.D. Potter, MD Assistant Professor Comprehensive ophthalmology, ophthalmic pathology, cataract surgery, refractive surgery Patricia C. Sabb, MD Assistant Professor Comprehensive ophthalmology, cataract surgery, refractive surgery Stephen K. Sauer, MD Associate Professor Residency Director Comprehensive ophthalmology, cataract surgery Nader Sheibani, PhD Associate Professor Diabetic retinopathy, retinopathy of prematurity, animal models and retinal vascular cell biology and signal transduction Gary W. Sterken, MD Assistant Professor Comprehensive ophthalmology, cataract surgery, glaucoma Thomas S. Stevens, MD Professor Vitreoretinal disease, macular disease, diabetic retinopathy, proliferative vitreoretinopathy Michael C. Struck, MD John E. Temprano, MD Associate Professor Associate Professor Pediatric ophthalmology Comprehensive & strabismus, retinopathy ophthalmology, of prematurity, pediatric cataract surgery cataract surgery & intraocular lens implantation, pediatric glaucoma Andrew T. Thliveris, MD, PhD James N. Ver Hoeve, PhD Associate Professor Senior Scientist Assistant Residency Director Visual electrophysiology Chief of Ophthalmology William S. Middleton Memorial Veterans Hospital Comprehensive ophthalmology, cataracts, ocular genetics Amy L. Walker, OD Clinical Optometrist Optometry 2012 Annual Report 25