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Ophthalmology Update SPECIAL EDITION 2017 from Cole Eye Institute 2 Ophthalmology Update SPECIAL EDITION 2017 From Cole Eye Institute 2 Table of Contents 3 | Legacy of retina leadership 12 | Preventing ROP 14 | Retinal regeneration 15 | Retina in the EMR 16 | Advances in treating dry AMD 17 | Advances in treating wet AMD 18 | Protocol T and DME treatment 19 | Is aflibercept worth the cost? 20 | Gene therapy 24 | New frontiers in OCT 25 | Innovations in Argus implantation 28 | A new era in surgical visualization 30 | New views of flow 32 | Clinical trials 34 | Staff Cover image: see figure caption on p. 12 for description. OPHTHALMOLOGY UPDATE | SPECIAL EDITION 2017 3 a Legacy of Leaders The History of Retina at Cleveland Clinic CLEVELAND CLINIC | COLE EYE INSTITUTE 4 In 1969, Froncie Gutman, MD, became the first retina specialist to practice at Cleveland Clinic. At the time, Roscoe J. Kennedy, MD, and James Nousek, MD, ran a two-person general practice that had been well-respected in the region since its establishment in 1924. Dr. Gutman’s appointment marked the beginning of a new era for retina, anterior segment surgery, cornea and external disease, pedi- ophthalmology at Cleveland Clinic. Trained as a vitreoretinal special- atric ophthalmology, neuro-ophthalmology, glaucoma and uveitis. ist, he established the department as a leader in retina. Over the next Richard Chenoweth, MD, Sanford Myers, MD, Nicholas Zakov, 22 years as chair, Dr. Gutman grew the department into a team MD, and Hernando Zegarra, MD, constituted a leading-edge retina of 17 physicians, including subspecialists in medical and surgical practice for a number of years. Richard Chenoweth, MD Sanford Myers, MD Nicholas Zakov, MD Hernando Zegarra, MD The department continued expanding its technological capabilities, Central Vein Occlusion Study (CVOS), two multicenter, randomized educational programs and high-profile clinical research activity. clinical trials sponsored by the National Eye Institute. In 1970, it opened the first ophthalmic laboratory in Cleveland Many of the staff members became leaders in the field through with a full-time staff of photographers who performed fluorescein their appointment or election to office in professional ophthalmic angiography studies. Ophthalmic electrophysiology and ultrasonog- organizations. Gutman was elected chairman of the American raphy soon followed. High-level clinical research became a fixture Board of Ophthalmology and served as president of the American in the department, with Dr. Gutman serving as principal investiga- Academy of Ophthalmology. tor for the Collaborative Ocular Melanoma Study (COMS) and the OPHTHALMOLOGY UPDATE | SPECIAL EDITION 2017 5 Dr. Gutman credits the department’s growing expertise to a busy at a large group practice.” Not long after Cleveland Clinic cardiac and challenging clinical practice. “All of our contributions to the surgeons performed the first coronary artery bypass in 1967, Dr. literature grew out of clinical experiences with our patients,” he Gutman and his colleagues partnered with them to explore ocular says. “We also had a tremendous opportunity and advantage being complications of the new procedure. In 1993, Hilel Lewis, MD, a vitreoretinal specialist and researcher from California, succeeded Gutman as chairman. Dr. Lewis built on the department’s legacy of expertise in retina, significantly improved the quality of the residency program, and established fellowships in retina, pediatrics, uveitis, cornea, refractive surgery and glaucoma. His fundraising efforts led to the creation of Cole Eye Institute and the standalone facilities it enjoys today. CLEVELAND CLINIC | COLE EYE INSTITUTE 6 Cole Eye Institute Today Daniel F. Martin, MD, was appointed chairman in 2008. During the first eight years of his tenure, the department has more than doubled in size. The numbers of patients seen and surgeries performed have expanded dramatically, such that Cole Eye Institute is now one of the largest academic clinical practices in the United States. OPHTHALMOLOGY UPDATE | SPECIAL EDITION 2017 7 Dr. Gutman’s and Dr. Lewis’ contributions created the foundation for Cole Eye Institute. But Daniel F. Martin, MD, current Chairman of Cole Eye Institute, and his staff of internationally recognized leaders are shaping the future of ophthalmology beyond the walls of the institute. “Looking back on my years there, what happened pales in comparison to the incredible changes occurring now under Dr. Martin’s leadership,” says Dr. Gutman. The Retina Service, featured in this publication, has grown from four physicians to 12 national- ly and internationally known specialists, and is widely regarded as one of the premier academic retina groups in the U.S. Many staff have served in national leadership roles for major clinical trials. Peter K. Kaiser, MD, was a leader for the clinical trials that evaluated aflibercept for neovascular AMD, and Dr. Martin served as study chairman for the Comparison of AMD Treatments Trials (CATT). The Retina Service also includes four specialists in uveitis, making it one of the most dynamic and accomplished uveitis services in the U.S. Research at Cole Eye Institute has grown from a few R01 grants to a large department supported by a CORE grant, a P30 grant, a T32 training grant, new ophthalmic imaging laboratories and staff serving CLEVELAND CLINIC | COLE EYE INSTITUTE in leadership roles for many major ophthalmic journals. Pioneering “The growth we have experienced in the past eight years has been 8 retina research is ongoing in inherited retinal disease, regenerative unprecedented, well beyond anything I anticipated,” Dr. Martin medicine, intraoperative OCT and retinopathy of prematurity. In continues. “We rapidly filled the physical space at Cole Eye and be- 2015, the institute implanted its first Argus II bionic eye, and is gan adding many new locations in the region. In the past five years now one of the largest practices for this treatment in the U.S. alone, we have added eight satellite offices with more than 100 eye examination lanes. Like Drs. Gutman and Lewis before him, Dr. Martin has visionary plans for Cole Eye’s future in service of Cleveland Clinic’s mission “But those locations are now full, and the expanded regional pres- of “Patients First” and as The Barbara and A. Malachi Mixon III ence has only increased the demand for tertiary care service on the Institute Chair of Ophthalmology. main campus. In addition, our research and educational programs have grown. All of this has led to an acute need for more space on “The Retina Service at Cole Eye Institute is a truly special group of the main campus,” says Dr. Martin. Recently, Cole Eye launched people. Not only are they extraordinarily talented, but they are the a $100 million campaign to dramatically expand the footprint of most collegial and enjoyable group of people with whom you could its signature building. In addition, the campaign seeks to increase ever hope to work. They truly put patients first. Many are actively support for its research and education missions. engaged in research that has great promise for breakthrough discov- eries,” says Dr. Martin. Cole Eye Institute has built a legacy of leadership reflective of its 90 years of service and transformative contributions to the field through “In our future, I see our Retina Service contributing to and leading its global leadership in retina and other subspecialties, a large team the way for new and improved treatments for neovascular AMD of accomplished clinicians, and award-winning research laborato- and diabetic macular edema, the possibility of eradicating infantile ries. With new facilities anticipated in the near future and a growing blindness due to ROP, new treatments for patients with inherited and dynamic faculty, the future of ophthalmology at Cleveland retinal diseases, further advances in imaging and intraoperative Clinic is bright indeed. technology, and continued leadership in uveitis and oncology. OPHTHALMOLOGY UPDATE | SPECIAL EDITION 2017 Jeffrey and Patricia Cole Donate $31 Million 9 to Cole Eye Institute Jeffrey A. Cole and his wife, Patricia O’Brien Cole, have made a transformational gift to continue their philanthropic legacy at Cleveland Clinic’s Cole Eye Institute. This $31 million commitment will help Cole Eye Institute expand its clinical and surgical capabil- ities as well as enhance its research and educational mission. This will be accomplished primarily through a future expansion to the existing Cole Eye Institute, which would be named the Jeffrey and Patricia Cole Building. With this gift, the Cole family’s philanthropic support of Cole Eye Institute totals $45 million. Cleveland Clinic’s Cole Eye Institute has been ranked in the top 10 in U.S. News & World Report for the past five years. Cole Eye Institute is a comprehensive eye institute, with over 100 professional staff physicians and researchers who diagnose, treat and investigate the entire spectrum of conditions of the eye, including complex problems such as diabetic retinopathy, retinal detachments, macular degeneration, glaucoma, cata- racts, uveitis, strabismus and pediatric eye disorders. Each year, physicians carry out more than 275,000 patient visits and perform more than 13,000 surgeries — volumes that are among the highest in the nation. In addition, Cole Eye Institute includes basic and clinical research teams dedicated to understanding genetic- and nongenetic-based eye diseases, in hopes of finding tomorrow’s cures. “Jeff has been a good friend to Cole Eye Institute over the years, and we are excited to continue
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