SAVE THE▼ DATE Department of 200 Ophthalmology Years www.NYEE.edu Anniversary SPECIALTY REPORT | FALL 2018 www.NYEE.edu Celebration

Join us for 200 Years and Counting: Bicentennial Cocktail Celebration

October 15, 2020 Research Breakthrough: The Plaza 768 5th Avenue Gene Transfer New York, NY Therapy Restores 200 Years and Counting: Ophthalmology Vision in Mice Symposium

October 16, 2020

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Cover image: Slice of a central retina section showing all layers (ONL, INL, GCL). Red indicates rod photoreceptors, located in outer nuclear layer (ONL). Green indicates Müller glial cells, whose cell bodies are located in inner nuclear layer (INL), and their branches across all three layers. Dark blue indicates the nucleus of all cells in three layers (GCL).

Icahn School of Medicine at Medical Directors Neuro-Ophthalmology Uveitis and Ocular Immunology

Mount Sinai Departmental Mark Kupersmith, MD Douglas Jabs, MD, MBA Avnish Deobhakta, MD Leadership System Chief, System Chief, Uveitis and Ocular Medical Director, NYEE - Neuro-Ophthalmology, Immunology, MSHS James C. Tsai, MD, MBA East 85th Street MSHS President, NYEE Stephanie Llop, MD System Chair, Department of Robin N. Ginsburg, MD 3 Message From the System Chair of the DepartmentValerie Elmalem, of Ophthalmology MD Sophia Saleem, MD Ophthalmology, MSHS Medical Director, NYEE- Joel Mindel, MD East 102nd Street

Louis4 R. Pasquale,Breaking MD New Ground in Gene Transfer Therapy to Restore Vision Affiliated Leadership Ocular Oncology Site Chair, Department of Gennady Landa, MD Paul Finger, MD Ebby Elahi, MD, MBA Ophthalmology, MSH and MSQ Medical Director, NYEE- 6 This i-Doctor Is Transforming the Field of Ophthalmology President, NYEE/MSH System Vice Chair, Translational Williamsburg and Tribeca Ophthalmic Pathology Ophthalmology Alumni Ophthalmology Research, MSHS Jodi Sassoon, MD Society Kira Manusis, MD Inside Feature Site Chair, Pathology, NYEE Medical Director, NYEE- Paul A. Sidoti, MD Robert Fischer, MD Midwood Site Chair, Department • of Imaging Is a Pivotal Part of NYEE's Rich HistoryNada Farhat, MD Director of Ophthalmology,

Ophthalmology, NYEE Alan Friedman, MD Elmhurst Hospital Paul A. Sidoti, MD System Chief, Glaucoma, MSHS Codrin Iacob, MD Medical Director, NYEE- • What Do Retinal Imaging and the Hubble Telescope Share? David Goldman, MD East 14th Street Douglas Fredrick, MD Oculoplastic and Medical Director, NYEE-West The Unique Technology of Adaptive Optics. Deputy Chair for Education, MSHS Reconstructive Surgery Palm Beach Angie E. Wen, MD System Chief, Pediatric Robert Della Rocca, MD • An UnprecedentedMedical Look Director, at NYEE- Acute Solar Retinopathy Ophthalmology and Strabismus, System Chief, Oculoplastic Michelle Rhee, MD Columbus Circle MSHS and Reconstructive Surgery, Associate Director of • Targeting Macular Degeneration ThroughMSHS State-of-the-Art ImagingOphthalmology, Elmhurst Douglas A. Jabs, MD, MBA Clinical Divisions at Hospital Deputy Chair for Research, MSHS Mount Sinai Health David Della Rocca, MD Director, Eye and Vision • ResearchAn NYEE-Mount System Sinai Faculty Eye Stroke Practices Protocol Monica Saves Dweck, a YoungMD Woman’s Sight Institute, MSHS Valerie Elmalem, MD Cornea, External Diseases, Alexander Rabinovich, MD • NYEE Diagnostic Imaging Advances: 198 Years of Innovation Salvatore Loiacono, Jr. MPA and Refractive Surgery Harsha Reddy, MD NYEE = New York Eye and Ear John Seedor, MD Deputy Chair for Finance and Infirmary of Mount Sinai Administration, MSHS System Chief, Cornea and Pediatric Ophthalmology 9 NYEE Uses a Rare Retinal Transplant to Close a Patient’s Macular Hole MSHS = Mount Sinai Health System Vice President for Ophthalmology External Diseases, MSHS and Strabismus MSH = The Mount Sinai Hospital Services, NYEE Douglas Fredrick, MD MSQ = Mount Sinai Queens 11 A Clinical Trial SeeksDavid to Ritterband,Boost Patient MD Satisfaction System By Chief, Making Pediatric Intravitreal Injections Less Painful Richard B. Rosen, MD System Chief, Refractive Ophthalmology and Deputy Chair for Clinical Affairs, MSHS Surgery, MSHS Strabismus, MSHS Vice12 Chair and DirectorNew of Pediatric Ophthalmic Ophthalmology Fellowship Program Is Broadening NYEE’s Patient Services Research, NYEE Sumayya Ahmad, MD Tamiesha Frempong, MD, Priti Batta, MD MPH Christopher14 T. Spina,Faculty MS News: PromotionsAnita Gupta, MD Edward Raab, MD Senior Vice President and Chief Noga Harizman, MD Steven Rosenberg, MD Operating15 Officer,Faculty NYEE News: AppointeesRichard Koplin, MD Erin Walsh, MD Kira Manusis, MD Tamiesha Frempong, MD, MPH Angie Wen, MD Primary Care Vice16 Chair for DiversityDepartment and Inclusion, of Ophthalmology at a Glance Ophthalmology/Optometry MSHS Eye Trauma Karen Hendler-Goldberg, MD John Aljian, MD Bessie Abraham, OD Sandra K. Masur, PhD Ronald Gentile, MD Jared Hayashi, OD Vice Chair for Mentoring, MSHS Harsha Reddy, MD Vanessa Hernandez, OD Caitlin Morrison, OD Donna J. Gagliuso, MD Glaucoma Elena Schmidt, OD Affiliated Teaching Residency Program Director, MSH Paul Sidoti, MD Institutions System Chief, Glaucoma, Retina James J. Peters VA Anita Gupta, MD MSHS Nazanin Barzideh, MD Medical Center Residency Program Director, NYEE Avnish Deobhakta, MD 130 West Kingsbridge Road Director, Comprehensive Nisha Chadha, MD Robin Ginsburg, MD Bronx, NY 10468 Service, NYEE Donna Gagliuso, MD Meenakashi Gupta, MD NYC Health+Hospitals/Elmhurst Noga Harizman, MD Gennady Landa, MD 79-01 Broadway Paul S. Lee, MD Tsontcho Ianchulev, MD Jessica Lee, MD Queens, NY 11373 Associate Residency Program Nathan Radcliffe, MD Gareth Lema, MD, PhD Mount Sinai Union Square Director, MSH Robert Ritch, MD Richard Rosen, MD 10 Union Square East Chief of Ophthalmology, James J. Tania Tai, MD R. Theodore Smith, MD, PhD New York, NY 10003 Peters VA Medical Center James Tsai, MD, MBA Kateki Vinod, MD 173 MESSAGE FROM THE SYSTEM CHAIR OF THE DEPARTMENT OF OPHTHALMOLOGY

James C. Tsai, MD, MBA

The New York City metropolitan region deserves to have one of the world’s leading centers for ophthalmology and vision research. I am delighted to highlight the many steps that New York Eye and Ear Infirmary of Mount Sinai (NYEE) has taken over the past year to move ever closer to that goal. Rather than rest on our laurels as the oldest specialty hospital in America, founded in 1820, we are focused on extending our longstanding reputation for clinical excellence to that of innovation and development of exciting new treatments and approaches for complex blinding eye diseases.

Recruiting top scientific talent is an integral part of our overall strategy, as evidenced by our recent appointment of Louis Pasquale, MD, FARVO, as Vice Chair of Translational James C. Tsai, MD, MBA, President, New York Eye and Ear Infirmary of Mount Sinai, Ophthalmology Research for the Mount Sinai System Chair, Department of Ophthalmology, Delafield-Rodgers Professor of Ophthalmology, Health System and Site Chair of Ophthalmology Icahn School of Medicine at Mount Sinai at The Mount Sinai Hospital. Dr. Pasquale, who has gained international recognition for his research, will focus on integrating NYEE into the cutting-edge, Program. Together, these programs are helping to ensure we work interdisciplinary clinical and translational research network of synergistically with such well-established academic departments the Icahn School of Medicine at Mount Sinai. Our commitment to and research centers at Mount Sinai as The Friedman Brain education complements our research initiatives, which is one of the Institute, the Icahn Institute for Genomics and Multiscale Biology, reasons we have recruited Douglas Fredrick, MD, as Deputy Chair and The Black Family Stem Cell Institute. for Education in the Department of Ophthalmology and System Chief of Pediatric Ophthalmology. Among Dr. Fredrick’s priorities Our research and clinical efforts rest on another powerful pillar will be consolidating and combining the already outstanding with a rich history at NYEE: imaging. We are home to one of the ophthalmology residency programs at NYEE and The Mount Sinai leading imaging laboratories in the world under the direction Hospital into one of the largest residency programs in the nation. of Richard Rosen, MD, Vice Chair and Director of Ophthalmic In addition, our pursuit of clinical excellence is highlighted by the Research at NYEE. As the articles in this Specialty Report appointment of Paul Sidoti, MD, as Site Chair of Ophthalmology illustrate, this extraordinary imaging team, working with the most at NYEE. sophisticated equipment anywhere, is allowing us to explore and understand diseases like glaucoma and macular degeneration at a The many accomplishments of our researchers and clinicians this level we never could before. New York Eye and Ear Infirmary past year underscore the breadth of NYEE’s capabilities—and their enormous potential. For example, a team of scientists led As we approach our bicentennial in 2020, it’s important to note (Founded August, 1820) by Bo Chen, PhD, who heads up our Ocular Stem Cell Program, that 2018 marks the centennial of The American Journal of 1 restored vision in congenitally blind mice by activating and Ophthalmology (AJO). A recent article in that journal describes reprogramming retinal stem cells. This breakthrough process, how the histories of AJO and NYEE have been inextricably described in the August 15, 2018 issue of Nature, could unveil a bound. Indeed, in its venerable role as recorder of institutional promising and long-awaited new pathway for treating degenerative histories, AJO has consistently documented how a coterie of retinal disease in humans. Our scientists also developed a early ophthalmic hospitals such as NYEE has moved the field of revolutionary micro-interventional device, miLOOP™, which has the ophthalmology forward. This is a legacy embraced today by our potential to transform cataract surgery and dramatically reduce clinicians, scientists, educators, trainees, and staff, all of whom blindness around the world. are dedicated to improving and advancing patient care through innovation and collaboration. Helping us push the boundaries of discovery in the visual sciences is the recently created Mount Sinai/NYEE Eye and Vision 1Pathipati AS, Tsai JC. The Influence of Early Ophthalmic Hospitals Research Institute and the Ophthalmic Innovation and Technology on the Journal. Am J Ophthalmol. 2018 Aug; 192:xxiii-xxvii.

3 Breaking New Ground in Gene Transfer Therapy to Restore Vision

Fueled by a $2 million grant from the McGraw mice and humans, photoreceptors do not have Family Foundation, the recent arrival of Bo the ability to regenerate on their own when Chen, PhD, and his research lab is giving the retina cells are destroyed by diseases like Department of Ophthalmology at New York macular degeneration or retinitis pigmentosa, Eye and Ear Infirmary of Mount Sinai (NYEE) a causing irreversible blindness. However, the powerful platform to explore the exciting field Müller glial (MG) cells of the zebrafish have of retinal regeneration to potentially restore regenerative potential whereby they divide visual function in people with degenerative and turn into photoreceptors and other retinal glaucoma, macular degeneration, and retinitis neurons, establishing a powerful self-repair pigmentosa. The grant is enabling the new lab mechanism. to expand its work through the purchase of a Beckman ultracentrifuge to make AAV viruses To see if MG cells could be programmed for retinal gene transfer, and a Zeiss confocal to become rod photoreceptors in a living microscope to evaluate that process as well mouse, Dr. Chen induced the cells to divide as the effects of therapeutic intervention on by injecting ß-catenin into the eyes of mice Macro view of retinal stem cells in process retinal tissue. as a first step and, weeks later, injecting of division. three transcription factors—Otx2, Crx and Dr. Chen, Associate Professor of Nrl. This regenerative process, he found, Ophthalmology and Director of the Ocular Stem Cell Program not only encouraged the newly divided cells to develop into rod at the Icahn School of Medicine at Mount Sinai, has made photoreceptors, but structurally made them look no different considerable progress over the past eight years in highlighting than the real photoreceptors. Would the treatment actually work, the role of gene therapy. In his previous lab at the Yale School though, in restoring vision to mice with congenital blindness? The of Medicine, Dr. Chen worked with mouse models to better exciting finding by Dr. Chen was that light responses recorded understand the molecular and cellular pathways in major retinal from retinal ganglion cells—neurons that carry signals from degenerative diseases. In one major project—for which work photoreceptors to the brain—and measurements of brain activity continues at the Mount Sinai/NYEE Eye and Vision Research showed that the newly formed rods were in fact integrating into the Institute—he has demonstrated how the gene transfer of ß-catenin visual pathway circuitry. “Mice who were blind from birth were now Bo Chen, PhD, examining the structural elements of a and three transcription factors can successfully reprogram retinal able to see light for the first time in their lives following treatment,” retinal slice at a cellular level . glial cells into rod photoreceptors. he observes.

Photoreceptors are light-sensitive cells in the retina in the back of Dr. Chen’s groundbreaking study, published August 15, 2018, in the the eye that signal the brain when activated. In mammals, including online issue of Nature, has received national attention for opening a new pathway for potentially treating As a McGraw Family Vision Researcher, Dr. Chen says he in humans retinal degenerative relishes the ability to tap into a rich array of resources at Mount “We believe our findings diseases, which currently have Sinai and NYEE to advance his groundbreaking work. They no cure, by manipulating our own include a cutting-edge imaging capability under the leadership underscore that we are closer regenerative capability to self-repair. of Richard Rosen, MD, Vice Chair and Director of Ophthalmic “We’ve been able to show through Research at NYEE; the nationally recognized Icahn Institute for than ever to major new a gene transfer technique using Genomics and Multiscale Biology; and NYEE’s considerable AAV viruses that we could activate pool of patients. resident stem cells—the so-called therapies for people Müller glial cells—to re-enter the “Dr. Tsai [President of NYEE] has given me a broad mandate to Mouse subject being tested for cell cycle to generate a population pursue my work in retinal regeneration and neural protection,” with severe degenerative eye optomotor response (OMR) to of stem cells that differentiate into emphasizes Dr. Chen, winner of the Pew Scholars in the assess visual function following retinal neurons,” Dr. Chen explains. Biomedical Sciences Award, given to young investigators disease.” an eye injection of Otx2, Crx The scientist is now working with showing outstanding promise. “These fields represent unlimited and Nrl. The virtual stimulation Mount Sinai’s patent office to file a opportunities today for labs like mine, and we believe our findings cylinder tracks the animal�s head —Bo Chen, PhD position as pattern on cylinder From left: Postdoctoral Fellows Xinzheng Guo, PhD and Ye Xie, PhD, with provisional patent based on these underscore that we are closer than ever to major new therapies walls changes to measure OMR. Bo Chen, PhD, examining the bacterial colonies growing on an agarose plate. findings. for people with severe degenerative eye disease.

4 5 This i-Doctor Is Transforming the Field of Ophthalmology

When a New York Eye and Ear Infirmary of Mount Sinai (NYEE) eye surgeon performed a complex anterior segment surgery this June on a patient with cataracts and glaucoma, he relied on three innovative and novel technologies. One was miLOOP™, the first micro-interventional cataract fragmentation device for non-thermal cataract surgery. The second was intraoperative aberrometry, which has uprooted the 50-year-old standard for intraocular lens power determination, and the third was CyPass®, the first non-trabecular micro-stent for glaucoma.

Once the procedure was completed, the surgeon, Tsontcho Ianchulev, MD, could take pride in more than its successful surgical outcome. He had invented and pioneered all three U.S. Food and Drug Administration-approved devices, now becoming standard of care and widely used by ophthalmologists at NYEE. Dr. Ianchulev is a Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai, but as an entrepreneur, he has reached well beyond the academic bench: Through the years, his technologies have raised › continued on page 3 close to $200 million in venture financing, and have created more than $1 billion in investor value.

As a physician, inventor, and entrepreneur, Dr. Ianchulev has always had his eye on the big picture—how paradigm-shifting innovations can improve the lives of not just individual patients, but entire “Through our Ophthalmic populations around the globe. Indeed, he became acutely aware during his early years of medical training at Harvard University of Innovation and “how much we can accomplish as clinicians if we leave our comfort zone and start to innovate and come up with solutions using our scientific and technocratic minds.” Technology Program,

There is no better window on the “disruptive” mindset of Dr. Ianchulev we’re creating an environment than miLOOP. Instead of settling for incremental change to the traditional way of doing cataract surgery, he set his sights on a where the best and revolutionary new process: an easy-to-use, hand-held, pen-like device that could bridge the yawning gap between developed and developing health care systems and help all to fight the blindness brightest ideas epidemic from cataracts that affects 25 million people worldwide. are not just taken out for a spin, “Phacoemulsification has been extremely successful, but the fact is, we’re still doing cataract surgery pretty much the way we did it 50 years ago,” he explains. “It also introduces a lot of undesirable but actually brought to life.” energy and leads to corneal damage and endothelial cell loss, among other things. Also, it has not made a dent outside the —Tsontcho Ianchulev, MD developed world because its complexity and cost are incompatible with the developing world.”

› continued on page 8 6 7 › continued from page 6

This i-Doctor Is Transforming the Field of Ophthalmology

Dr. Ianchulev’s path to changing the standard was to borrow from cardiovascular surgery and interventional radiology. He recognized that some of the micro-invasive techniques that have revolutionized those fields in recent years are quite transferable to ophthalmology, particularly cataract surgery, where they have the ability to transform how the procedure is done and potentially reduce blindness around the world. So, he and his engineering team at the company he co- founded, Iantech, developed miLOOP, which allows for energy-free fragmentation of even the hardest cataracts without rupturing the 4-micron-thin capsule enveloping the lens.

Top: One of the patients treated Intraoperative aberrometry also started off as a problem in search of for cataracts by Dr. Ianchulev and a solution. While still a resident, Dr. Ianchulev realized “how imprecise the team of doctors taking part and outdated our existing technology was in figuring out the correct in the cataract blindness IOL power in cataract surgery.” The flashing light inside his head made prevention mission with “…we now have an him realize that “if you take out the lens before you put in the IOL, you Himalayan Cataract project and MiniCap Global Alliance, who have this privileged state of the eye, this pure optical system from the donated miLOOP devices. . important new cornea all the way to the retina. It’s almost like an optical biopsy of the eye that lets you figure out the total optical deficit.” From that insight Left: Lenses of patents with in our toolbox, evolved the first intraoperative biometry in ophthalmology, now known procedure cataracts removed using as Optiwave Refractive Analysis (ORA) from Wave Tec. miLOOP. and won’t be afraid to roll it out Today, Dr. Ianchulev is re-inventing one of the oldest ophthalmic devices: the eyedropper. By shrinking inkjet printer technology to a for patients who previously device the size of a smartphone, he can deliver medication to the eye in a precise and targeted way—something that conventional pipette had no good options.” eyedropper technology has not been able to do, resulting in wasting or overdosing the medication. —Ronald Gentile, MD Dr. Ianchulev is now putting his boundless creative energy and expertise to everyday work at NYEE as Director of the Ophthalmic Innovation and Technology Program. Specifically, he is building a whole ecosystem around innovation—exciting new therapies, technologies, and diagnostic modalities—that can be developed, commercialized, and pushed out to people suffering from eye disease NYEE Uses a Rare Retinal Transplant in every corner of the world. To that end, the Ophthalmic Innovation and Technology Program draws vital support from faculty, clinicians, To Close a Patient’s Macular Hole and residents at both NYEE and The Mount Sinai Hospital, as well as from a growing array of academic partners on the outside. And through its collaboration with Mount Sinai Innovation Partners, Dr. Ianchulev teaching Duaa When 68-year-old Mary Benjamin came to Ronald Gentile, MD, hole registered nearly 800 microns, making standard closure the program is forging new commercial relationships that cover Sharfi, MD, a NYEE resident, at New York Eye and Ear Infirmary of Mount Sinai (NYEE), she using the internal limiting membrane that was previously removed how to use the miLOOP everything from licensing intellectual property to participating in new had a macular hole that three surgeries elsewhere had failed to impractical, by Dr. Gentile’s reckoning. Instead, he reached for device at Jorge N. Buxton, MD close. The retinal surgeon quickly recognized the severity of the a surgical technique that had only been performed a handful entities that can capitalize on our homegrown technology. Microsurgical Education Center. case. For one thing, Ms. Benjamin’s sight had deteriorated to the of times in this country: autologous retinal transplantation. The “Through our Ophthalmic Innovation and Technology Program, we’re point where merely walking down the block became hazardous. transplant is used to close the hole and reattach the normal creating an environment where the best and brightest ideas are not “After the macular hole reopened, I could barely count the retina around the hole that was detached because of it. “It’s only just taken out for a spin, but actually brought to life,” Dr. Ianchulev number of fingers in front of my left eye,” Ms. Benjamin recalls. applicable to the very small number of patients who have failed declares. “And more importantly, we’re training our residents and “And the drops I was taking just weren’t doing the job they were multiple procedures in attempting to close a very difficult macular students not only to be excellent clinicians, but also how to staff the meant to.” hole,” explains Dr. Gentile, Clinical Professor of Ophthalmology at front lines of innovation. Our patients need it just as much as their next NYEE. “In Mary’s case, we realized it was our best chance to give doctor visit.” On clinical examination, OCT imaging revealed that the macular her something approaching a permanent fix.” › continued on page 10

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Fig 2. Quantitative autofluorescence success stories involving people with “New York Eye and Ear Advanced imaging modalities are Groundbreaking work Technology called adaptive optics light to allow for resolutions of around toolkit: optical coherence tomography image of a patient with kidney disease “[Advanced imaging technologies are] opening up … a new world of research enabling researchers at New York An NYEE-Mount Sinai Eye Stroke Protocol eye stroke who had tPA administered has allowed mighty telescopes like 2 microns, 10 times the resolution angiography (OCTA). Like AOSLO, An Unprecedented Look at Acute and advanced macular degeneration by the Advanced Retinal Infirmary is one of a few Eye and Ear Infirmary of Mount Sinai in terms of previously unexplored ocular tissue.” to the ophthalmic artery within the NASA’s Hubble to reach deep into time of optical coherence tomography the basic OCTA machine lacks the with geographic atrophy, seen as dark (NYEE) to peer into the retina in ways Saves a Young Woman’s Sight eye,” notes Christopher Kellner, Imaging Laboratory and space and send back astonishing (OCT) imaging and sufficient to detect quantitative and qualitative software to Solar Retinopathy imaging centers in lobes in the center of the measurement —R. Theodore Smith, MD, PhD they never could before, pinpointing grid. The autofluorescence levels are MD, Director of the Intracerebral images. Now, adaptive optics has been and count the individual rods in the enable physicians to know if the images at New York Eye and Clinicians at New York Eye and Ear the country able to vascular defects and blood flow much lower here. Hemorrhage Program at Mount turned inward to allow researchers to photoreceptor mosaic, which are they’re viewing substantially deviate marry When Elodie Ontala entered the Infirmary of Mount Sinai (NYEE) were abnormalities that could provide We can still be involved, though, Sinai and the neurosurgeon who Ear Infirmary of Mount investigate the human eye and diseases approximately 2.5 microns in diameter. from the norm and, if so, by how much. walk-in clinic at New York Eye and on high alert when a 26-year-old AO with other advanced clues to the biologic footprint of by providing the right antioxidant operated on Ms. Ontala. “We know that like glaucoma, diabetic retinopathy, and Dr. Chui addressed that deficiency with Ear Infirmary of Mount Sinai (NYEE) Fig 1. Initial SLO and OCT image of left eye showing paracentral acute middle maculopathy Sinai (NYEE) into woman walked through their doors just macular degeneration. “With their between geographic atrophy, the supplements and other treatments minimizing the time the clot remains retinal vein occlusion. “We’ve reversed Dr. Chui, for her part, has made adaptive software enhancements that allow for technologies like one morning last September and and VA of 20/200. days after viewing the solar eclipse of (A) Fundus (B) Microperimetry (C) Optical coherence higher and higher resolutions, these advanced dry form of age-related beneficial to macular health.” in the eye is critical. And when we use understanding the the direction. Instead of looking at outer optics an even more powerful tool precise mapping of the progression described a gray blurry cloud that August 2017, complaining of blurred tomography OCT angiography and en technologies are allowing us to more macular degeneration (AMD), and catheters that were recently developed space, we’re using adaptive optics to by developing software that enables of diabetic retinopathy, glaucoma, and was blocking her vision in her left eye, microstructure of the What Do Retinal vision and color distortion. Their accurately measure the circulation renal impairment in people with Dr. Smith’s investigative work into specifically for stroke treatment, it peer into the retina,” explains Yuen Ping users to quantify the high-resolution other vascular-related diseases. “We Fig 2. (A) Fundus image of fovea of the left eye revealed a yellow-white spot; (B) Microperimetry face OCT.” Targeting Macular the ophthalmologists on duty were suspicions were soon confirmed: a and the thickness of the layers of the AMD. While the link between AMD macular degeneration has also benefited actually becomes a very low-risk Toco Chui, PhD, Assistant Professor images they receive. What motivated have preliminary data showing our (CenterVue) showed multiple areas of decreased sensitivity paracentrally with a central absolute concerned. The 27-year-old woman human retina rests on a Imaging and the case of acute solar retinopathy and retina,” explains R. Theodore Smith, and chronic kidney disease is well from sophisticated hyperspectral procedure.” Imaging Is a of Ophthalmology at the Icahn School her efforts, she explains, was the fact software is able to diagnose preclinical scotoma in the left eye; (C) Spectral domain OCT (Heidelberg Engineering) showed abnormal —Avnish Deobhakta, MD Degeneration had sickle cell anemia, and while an photochemical burns, reinforced by near full-thickness hyperreflectivity at the center of the fovea, with hyporeflectivity of the outer MD, PhD, Director of Biomolecular known, Dr. Smith and his team were autofluorescence imaging. This rich historical foundation. of Medicine at Mount Sinai, who is Hubble Telescope that AO, for all its strengths, does not diabetic retinopathy, which is a huge emergent fluorescein angiogram failed images that were unlike any they had segment and interdigitation zone. Retinal Imaging at NYEE and Professor the first to investigate its biological technology, first used by scientists to When Ms. Ontala awakened from helping this effort through software have a user-friendly interface to help development,” says Dr. Chui. “For the to show a suspected arterial occlusion, From the very first ever seen before. Through the use of Ophthalmology and Neuroscience Through pathogenesis by looking at blood examine the surface of the Earth from the late-afternoon surgery, her vision enhancements that she has developed Share? clinicians interpret the reams of data patient, this means avoiding injection optical coherence tomography of adaptive optics scanning laser at the Icahn School of Medicine at supply to the outer portion of the space and more recently adapted to Fig 3. Color fundus and OCT imaging 3-months post tPA shows improvement in vision (VA was still blurry, not uncommon in Pivotal Part Of NYEE’sphotographs of a retina in the David E. Marrus Adaptive Optics they receive from its images. “The of fluorescein dye, using noninvasive revealed the pattern of paracentral 20/20) and mild paracentral scotoma. ophthalmoscopy (AOSLO), they were angiography (OCTA), en face OCT, and it to the foveal photoreceptor outer These findings, Dr. Deobhakta Mount Sinai. “And that’s opening up to State-of-the-Art retina—the choroidal circulation, the field of medicine, is enabling NYEE cases of this type given the retinal Imaging Laboratory at The Shelley The Unique software we’ve developed provides an imaging that provides a 3-D view of the Fig 1. Confocal AOSLO image of a acute middle maculopathy, a rare form in a living organism (a rewarded with a high-resolution, AOSLO. While OCTA was normal in both segments and the retinal pigment notes, could provide the scientific us a new world of research in terms of which can be impacted by the same researchers to capture, measure, and swelling from the ischemic injury. and Steven Einhorn Clinical Research algorithmic analysis of the image data to retinal capillaries.” large area of abnormal and non- epithelium, researchers at NYEE were analyze spectral emissions of light of retinal capillary ischemia. But another But it wasn’t long before her world of cellular-level view of damage to the wave guiding photoreceptors in the eyes and en face OCT showed reflectivity community with fresh insights on previously unexplored ocular tissue.” Imaging type of vascular dysfunction as the Fig 1. (A). High-resolution SD-OCT scan of macula in patient with coronary artery disease rabbit), taken by Henry Center of New York Eye and Ear Technology of help clinicians determine if a patient is part of Ms. Ontala’s history threw the miraculously in dissolving clots for with various forms of stroke at any darkness took a decided turn for the patient’s photoreceptor layer. shape of a moon crescent. changes, adaptive optics scanning was able to drill down even deeper this time, how photoreceptors die in a host kidneys, both being end-arterial from the retinal pigment epithelium (CAD). Orange line, border of thin choroid. Arrows, abnormal subretinal deposits of Rich History Infirmary of Mount Sinai (NYEE). likely to have early diabetic retinopathy, OCTA software enhancements from physicians into high alert: She had lost patients with strokes and heart attacks,” of Mount Sinai’s hospitals. After able to produce high-definition images as described in the December 7, 2017, of diseases involving the central One study examined choroidal organs. The researchers found that (RPE) to better understand that layer’s macular degeneration. brighter. At one week, vision in her Noyes, MD, Executive say, or glaucoma.” Dr. Chui and her team are also helping to Adaptive “We were able to literally see the of foveal cone photoreceptor mosaic online edition of JAMA Ophthalmology. part of the retina, including macular thickness in patients with coronary individuals with AMD and decreased chemical composition and its possible her other eye to an accident 13 years says Richard Rosen, MD, Director administering general anesthesia, left eye had improved from 20/200 NYEE is one of a handful of sites in the transform the early detection of primary Director of NYEE in crescent-shaped spatial damage to a Solar retinopathy is a rare form of disturbance. Specifically, they used a custom-made degeneration. And that knowledge, artery disease (CAD). Despite the renal function are more likely to role in macular health. NYEE is one of earlier. “When my sight didn’t improve of Retina Service and Ophthalmic the team began delivering 22 to 20/60. By one month she had country with adaptive optics scanning In a study reported in Investigative open-angle glaucoma and normal- made through swept source optical Optics very specific part of her retina,” recalls retinal injury that results from directly AOSLO device with both confocal in turn, could provide valuable

➝ critical role of the choroid in supplying present with geographic atrophy at the leading research laboratories in after waking up that morning, I knew I Research at NYEE, who developed the mg of intra-arterial tPA (tissue progressed to 20/25, and a three- the 1860s, to current laser ophthalmoscopy (AOSLO). This Ophthalmology & Visual Science in tension glaucoma. To that end, they are coherence tomography (SS-OCT) and

Ophthalmic artery Catheter in distal Avnish Deobhakta, MD, Assistant gazing into the sun. In the case of “New York Eye and Ear Infirmary is one and split-detector optics to image the clues about how to effectively blood to the outer third of the some point during their disease the country to deploy hyperspectral needed to get help quickly,” she recalls. ➝ protocol 10 years ago in collaboration plasminogen activator) through month follow-up visit revealed a sophisticated imaging technique— June 2015, Dr. Chui and other NYEE helping physicians identify changes in OCT angiography. Thanks to these internal carotid efforts to unravel the Professor of Ophthalmology at the the NYEE patient, damage occurred of a few imaging centers in the country cone photoreceptor mosaic at the treat them. neuroretina and the retinal pigment (Fig 2). autofluorescence imaging in the “This was my only eye.” with Mount Sinai Health System’s a catheter inserted in the femoral remarkable 20/20. part of a translational research researchers found that microscopic, the retinal nerve fiber layer and its blood state-of-the-art techniques, Dr. Smith’s artery Icahn School of Medicine at Mount when the young woman stared at the able to marry AO with other advanced fovea. What they discovered in the epithelium, details about choroidal investigation of human eye tissue. nationally recognized Department of artery of the groin, up past the heart molecular mystery of collaboration with Medical College of by compensating for distortions caused noninvasive imaging of the fine retinal supply, the radial peripapillary capillary lab has visualized (Fig 1) segments For years, ophthalmologists have Neurosurgery. “This protocol is the best to the carotid artery in the neck, With her new lease on life, Imaging Is a Sinai and a member of the NYEE sun during last year’s eclipse for 21 technologies like OCT angiography and patient’s right eye was a small region For NYEE’s latest solar retinopathy circulation have remained largely of the choroid down to the capillary “What we have to recognize is that Wisconsin and Stanford University—is by atmospheric turbulence. In the case vasculature using split-detection network, much earlier using motion struggled with how to effectively reverse clinical team that examined the patient. seconds without proper protective en face OCT,” Dr. Deobhakta says. “That of hyporeflectivity, indicating the patient, a medical breakthrough unknown due to poor resolution and this part of macular degeneration A major finding from the team’s option we now have for saving the sight and finally to the entrance of the Ms. Ontala moved to Milwaukee, retinal disease through allowing researchers and clinicians of ocular applications, adaptive optics AOSLO allowed for quantification of contrast analysis for red blood cell level, and found that individuals with arterial occlusion of the eye, an “eye of patients with central retinal artery ophthalmic artery in the brain, where where she has family, and has “We had never been able to see that eyewear. Four hours later, she noticed unique capability opens the door to presence of non-wavelength guiding able to reverse the permanent blind reproducibility of previous imaging coronary artery disease have a thinner is a systemic vascular disease, and hyperspectral imaging was that it high-resolution imaging an unprecedented view of the retinal helps achieve cellular-level imaging lumen and wall thickness. Significantly, movement. stroke,” which is as critical a medical Fig 2. Angiogram of a catheter being guided by an interventional radiologist into the distal level of precision before, because blurred vision, color distortion, and further research and investigations into photoreceptors, and disruption of the spot etched on the retina of her left techniques, including indocyanine that patients are going to have to be detected underneath the RPE a very occlusion.” the medicine was released. returned to full-time work with a Pivotal Part of NYEE’s microvascular structure and blood flow. by overcoming optical aberrations. they learned that this technique macular choroid, something that could emergency as a stroke affecting other cervical internal carotid artery to administer tPA (22 mg) into the ophthalmic artery. imaging modalities like adaptive optics metamorphopsia, which were worse diseases we weren’t able to characterize photoreceptor structure with a few eye—making everyday activities green angiography and ultrasound. treated accordingly,” says Dr. Smith, distinct spectral signature for drusen, nonprofit educational company such as adaptive optics This is accomplished by measuring has potential for early detection “We intend to make the software be a biomarker for CAD, as well as for parts of the brain. A long list of therapies For Ms. Ontala, the procedure meant While treatment of eye stroke with weren’t even available until recently in the left eye, her dominant eye. She before.” enlarged inner segments. In the left eye, like reading and TV-watching a Imaging of the choroid has improved who joined NYEE in September and drusen precursors, in the macula. there. “I’m fortunate to have had an Adaptive optics, which produces the distortions of the wavefront of of diabetic retinopathy, as well as we’ve developed at NYEE a new identifying patients with increased risk tried in the past—usually aimed at transporting her emergently to another tPA is still being actively studied, and swept source optical to examine solar retinopathy. We’re also reported seeing a black spot in the the advanced imaging showed a large challenge—couldn’t come soon dramatically, however, with the 2017 from NYU Langone Medical “This has potentially major diagnostic experienced team of physicians that did Rich History images that are high resolution and the light reflected from the eye and accurate monitoring of progression and addition to our clinical care,” emphasizes of outer retinal disease. displacing the clot—were rarely she had come to the right place. NYEE “The key is getting patients on the Health System hospital, Mount Sinai neuroradiologists have reported hopeful this kind of information will not center of her left eye. Three days later, Nowhere is that more evident than with area with ambiguous reflectivity due to enough. “At least we now have a much advent of spectral domain optical Center. “This means they should and prognostic import,” advises Dr. everything they could to help me,” she coherence tomography noninvasive, is particularly well suited compensating for them by using a treatment response. Dr. Chui. “And that will help us to better offers a treatment available at only a solar retinopathy. While past studies abnormal and non-wavelength guiding better understanding of the reason be controlled with regard to their Smith, “because if we can identify early effective, and patients typically suffered operating table within the 12-hour West. Waiting for her in an operating impressive results in patients who acknowledges a year after her ordeal. for retinal imaging. The technology was special mirror that corrects or “adapts” monitor the progress of eye disease, only help us to better understand the retinal scanning began at NYEE’s David coherence tomography (SD-OCT) Multimodal advanced imaging, handful of major medical centers around (OCT), New York Eye and conducted after solar eclipses have photoreceptors, as well as sparse, behind her injury,” acknowledges Dr. cholesterol levels, blood pressure, warning signs in patients who might be permanent, devastating vision loss, window of safety and efficacy, so that the room were members of the hospital’s were identified and treated early. “To say I’m happy with the results after built into astronomical telescopes by to those distortions, essentially Dr. Chui’s work with adaptive optics has and allow clinicians to intercede at the condition, but lead to new therapies for E. Marrus Adaptive Optics Imaging and enhanced depth imaging SD- including autofluorescence imaging, the country: the “Eye Attack Protocol” traced the mechanism of injury to intact inner segments within the area of Deobhakta, “and that represents a and cardiac status, which to some progressing to macular degeneration, Fig 1. (B). Abnormal electrocardiograms showing CAD. beyond the level of legal blindness. As neuroradiologists can administer intra- neuroradiology team, who stand by “In developing this protocol, we were suffering an eye stroke is an obvious Ear Infirmary has been in U.S. government scientists nearly 30 eliminating them. Adaptive optics produced improvements to another earliest possible stage to benefit solar retinopathy and other forms of Laboratory, using a combination OCT (EDI SD-OCT), according to Dr. also figured heavily in another study for treating acute stroke of the eye. photochemical toxicity, and localized photoreceptor disruption. huge step forward for patients.” extent takes it out of the eye clinic. we can start treatment sooner.” Ms. Ontala was about to learn, however, arterial tPA, which has worked 24/7 to treat patients who present aware of the growing numbers of understatement.” years ago to improve image resolution improves the optical transmission of mainstay of NYEE’s advanced imaging the patient.” photic injury to the retina.” of optical coherence tomography Smith. Further improvements are being designed to show the association the forefront.

1997 2002 2012 2015 2016 2018 NYEE Diagnostic “For eye diseases where we really don’t understand the 1888 1957 1961 1966 1970 1983 1990 1992 Thomas O. Muldoon, 20 years ahead of their time, Richard Rosen, MD, Patricia Garcia, MD, Mark The study of retinal microvascular disease took a leap forward with the Richard Rosen, With the introduction of OCT angiography, the Building upon earlier work underlying mechanism, imaging is a huge asset because it Edward G. Loring, New York City’s first Retina Early studies A seminal article, “The As a NYEE resident, Aran Robert Ritch, MD, joins First photo Dan Ning Hu, MD, Sheree A. Imaging Advances: NYEE and expands MD, becomes Hathaway, PhD, and Rishard Weitz, BEng, (working with Adrian Podoleanu, introduction of adaptive optics. Richard Rosen, MD, and Yuen Ping Toco MD, and Yuen clinical utility of en face OCT became widely in adaptive optics, Richard gives us a constructive pathway forward. And consistent MD, enhances Service is formally established of laser Technique of Binocular Indirect Safir, MD, invented the first of cultured McCormick, PhD, and Robert Chief of the Retina PhD, and George Dobre, PhD) turned the en face OCT into a high-resolution Chui, PhD (in collaboration with Alfredo Dubra and Joseph Carroll, PhD, at the Ping Toco Chui, recognized. By providing rapidly accessible Rosen, MD, Yuen Ping the Helmholtz by Morton L. Rosenthal, MD. photocoagulation Ophthalmoscopy,” is published automated refractometer for glaucoma research, purified human Ritch, MD, developed the 198 Years of Service. He was clinical tool by combining it with ICG angiography. This project was done in Medical College of Wisconsin) merged fluorescein imaging with adaptive optics PhD, introduced noninvasive capillary imaging, OCT angiography Toco Chui, PhD, and their with our practice over the years, we continue to develop and Ophthalmoscope Dr. Rosenthal introduced at in rabbit retina by Morton L. Rosenthal, MD, and prescribing spectacles. 1982 popularizing use of high- iris pigment methodology for isolation A team of clinician-scientists resolution ultrasound an early proponent collaboration with the University of Kent, which created the first en face OCT. visualization to reveal the internal fluid dynamics of retinal microaneurysms. quantitative opened the way for monitoring changes in patients collaborators in the Medical refine our imaging tools to complement the progress our with design NYEE techniques of indirect were conducted Seymour Fradin, MD. Illustrated epithelial (IPE) and culture of human uveal Innovation at NYEE, Virginia Lubkin, MD, biomicroscopy (1994) as a clinical tool 1992 of fluorescein analysis of capillary with glaucoma , diabetic retinopathy, and macular College of Wisconsin added Background: features to ophthalmoscopy and fundus at Bell Labs by Dr. Fradin, the methodology cells was melanocytes (UM). The first researchers and clinicians are making in critical areas like 1862 Mort Gersten, Richard Koplin, for diagnosis of complex glaucomas, 1987 Richard Rosen, MD, Thomas O. angiography, laser, density using degeneration at a resolution previously available the normative data mapping Image of macular improve drawing for visualizing the by Seymour described for a 1971 taken at NYEE’s Ocular Cell Culture photo of cultured human deviation mapping of gene therapy and breaking down ocular disease to its Henry D. Noyes, MD, NYEE’s Retina Diagnostic MD, and Dennis Gormley, MD, and clinical use of OCT (1995), paving Aran Safir, MD, (and Muldoon, MD, and David Buzawa, and vitrectomy, and helped 2007 2014 adaptive optics only with adaptive optics. Richard Rosen, MD, to OCTA imaging to enable ergonomics retinal periphery, ushering Fradin, MD, and Morton L. Rosenthal, MD, retinal exam is Lab, thanks to Dan Ning Hu, MD, Robert uveal melanocytes (UM) Dynamic Histopathology, introduced by Richard Rosen, MD, and Yuen nonperfused areas Executive Director of Center for retinal photography invented corneal topography, the way to some of the most significant Leonard Flom, MD,) MEng (in partnership with Iris foster adoption of modern retinal Taking OCT to the next dimension, Richard Rosen, MD, Patricia Garcia, MD, scanning laser and Yuen Ping Toco Chui, PhD, introduced a instantaneous quantification cellular components.” for the clinician. in a new era in (along with Charles Townes, MD, and Arthur still used Ritch, MD, and Sheree A. McCormick, was taken 12 days after the Ping Toco Chui, PhD, using adaptive optics serial imaging allowed overlaid with the NYEE takes the first and fluorescein angiography, and built the first corneal advances in the understanding and invented iris recognition Medical) developed the first clinical diagnostic and surgical technologies. Gennady Landa, MD, and Rishard Weitz, MD, integrated SLO microperimetry ophthalmoscopy with fluorescein angiography. full spectrum of quantitative tools for precision of abnormalities of blood flow modern retinal Leonard Schawlow). This would eventually today. PhD, who were the first to develop the seeding of a UM isolated superficial OCTA photographic image management of glaucoma. biometrics for unique application of transscleral viewing and OCT/SLO 3-D topography. For the first time, clinicians had one physicians for the first time to study the retinal capillary microvascular assessment and follow-up of clinical microvascular surgery. become the mainstay treatment for diabetic is established under the mapper, leading the way methodology for isolation and culture of from the choroid of This provided unprecedented clinical to the retina. image. — Richard Rosen, MD, Director of Retina Service and remodeling in live patients. of the retina in a live leadership of Thomas O. to precision corneal vision identification. and laser therapy for treatment of instrument that combined structural imaging with visual functional testing. measurements of microvascularity in the retina. disease, based upon their adaptive optics work. retinopathy. human IPE. a donor eye. Ophthalmic Research, NYEE subject, a rabbit. Muldoon, MD. correction. retinal tears and detachments.

“New York Eye and Ear Advanced imaging modalities are Fig 2. Quantitative autofluorescence success stories involving people with Groundbreaking work Technology called adaptive optics light to allow for resolutions of around toolkit: optical coherence tomography image of a patient with kidney disease “[Advanced imaging technologies are] opening up … a new world of research enabling researchers at New York eye stroke who had tPA administered has allowed mighty telescopes like 2 microns, 10 times the resolution angiography (OCTA). Like AOSLO, An Unprecedented Look at Acute and advanced macular degeneration An NYEE-Mount Sinai Eye Stroke Protocol Infirmary is one of a few Eye and Ear Infirmary of Mount Sinai to the ophthalmic artery within the by the Advanced Retinal NASA’s Hubble to reach deep into time of optical coherence tomography the basic OCTA machine lacks the with geographic atrophy, seen as dark in terms of previously unexplored ocular tissue.” (NYEE) to peer into the retina in ways eye,” notes Christopher Kellner, and space and send back astonishing (OCT) imaging and sufficient to detect quantitative and qualitative software to Solar Retinopathy imaging centers in lobes in the center of the measurement Saves a Young Woman’s Sight Imaging Laboratory they never could before, pinpointing grid. The autofluorescence levels are —R. Theodore Smith, MD, PhD MD, Director of the Intracerebral images. Now, adaptive optics has been and count the individual rods in the enable physicians to know if the images Clinicians at New York Eye and Ear the country able to vascular defects and blood flow much lower here. Hemorrhage Program at Mount at New York Eye and turned inward to allow researchers to photoreceptor mosaic, which are they’re viewing substantially deviate marry Infirmary of Mount Sinai (NYEE) were abnormalities that could provide We can still be involved, though, When Elodie Ontala entered the Sinai and the neurosurgeon who investigate the human eye and diseases approximately 2.5 microns in diameter. from the norm and, if so, by how much. Ear Infirmary of Mount on high alert when a 26-year-old AO with other advanced clues to the biologic footprint of walk-in clinic at New York Eye and operated on Ms. Ontala. “We know that like glaucoma, diabetic retinopathy, and Dr. Chui addressed that deficiency with by providing the right antioxidant woman walked through their doors just macular degeneration. “With their between geographic atrophy, the Ear Infirmary of Mount Sinai (NYEE) Fig 1. Initial SLO and OCT image of left eye showing paracentral acute middle maculopathy minimizing the time the clot remains Sinai (NYEE) into retinal vein occlusion. “We’ve reversed Dr. Chui, for her part, has made adaptive software enhancements that allow for technologies like supplements and other treatments days after viewing the solar eclipse of (A) Fundus (B) Microperimetry (C) Optical coherence higher and higher resolutions, these advanced dry form of age-related one morning last September and and VA of 20/200. in the eye is critical. And when we use the direction. Instead of looking at outer optics an even more powerful tool precise mapping of the progression beneficial to macular health.” understanding the August 2017, complaining of blurred tomography OCT angiography and en technologies are allowing us to more macular degeneration (AMD), and described a gray blurry cloud that catheters that were recently developed space, we’re using adaptive optics to by developing software that enables of diabetic retinopathy, glaucoma, and What Do Retinal vision and color distortion. Their accurately measure the circulation renal impairment in people with Dr. Smith’s investigative work into was blocking her vision in her left eye, specifically for stroke treatment, it microstructure of the peer into the retina,” explains Yuen Ping users to quantify the high-resolution other vascular-related diseases. “We Fig 2. (A) Fundus image of fovea of the left eye revealed a yellow-white spot; (B) Microperimetry face OCT.” Targeting Macular suspicions were soon confirmed: a and the thickness of the layers of the AMD. While the link between AMD macular degeneration has also benefited the ophthalmologists on duty were actually becomes a very low-risk Toco Chui, PhD, Assistant Professor images they receive. What motivated have preliminary data showing our (CenterVue) showed multiple areas of decreased sensitivity paracentrally with a central absolute human retina rests on a Imaging and the case of acute solar retinopathy and retina,” explains R. Theodore Smith, and chronic kidney disease is well from sophisticated hyperspectral concerned. The 27-year-old woman procedure.” of Ophthalmology at the Icahn School her efforts, she explains, was the fact software is able to diagnose preclinical scotoma in the left eye; (C) Spectral domain OCT (Heidelberg Engineering) showed abnormal —Avnish Deobhakta, MD Degeneration Imaging Is a photochemical burns, reinforced by near full-thickness hyperreflectivity at the center of the fovea, with hyporeflectivity of the outer MD, PhD, Director of Biomolecular known, Dr. Smith and his team were autofluorescence imaging. This had sickle cell anemia, and while an of Medicine at Mount Sinai, who is Hubble Telescope that AO, for all its strengths, does not diabetic retinopathy, which is a huge rich historical foundation. images that were unlike any they had segment and interdigitation zone. Retinal Imaging at NYEE and Professor the first to investigate its biological technology, first used by scientists to emergent fluorescein angiogram failed When Ms. Ontala awakened from helping this effort through software have a user-friendly interface to help development,” says Dr. Chui. “For the ever seen before. Through the use of Ophthalmology and Neuroscience Through pathogenesis by looking at blood examine the surface of the Earth from to show a suspected arterial occlusion, the late-afternoon surgery, her vision From the very first enhancements that she has developed Share? clinicians interpret the reams of data patient, this means avoiding injection of adaptive optics scanning laser at the Icahn School of Medicine at supply to the outer portion of the space and more recently adapted to optical coherence tomography Fig 3. Color fundus and OCT imaging 3-months post tPA shows improvement in vision (VA was still blurry, not uncommon in Pivotal Part Of NYEE’sphotographs of a retina in the David E. Marrus Adaptive Optics they receive from its images. “The of fluorescein dye, using noninvasive ophthalmoscopy (AOSLO), they were angiography (OCTA), en face OCT, and it to the foveal photoreceptor outer These findings, Dr. Deobhakta Mount Sinai. “And that’s opening up to State-of-the-Art retina—the choroidal circulation, the field of medicine, is enabling NYEE revealed the pattern of paracentral 20/20) and mild paracentral scotoma. cases of this type given the retinal Imaging Laboratory at The Shelley The Unique software we’ve developed provides an imaging that provides a 3-D view of the Fig 1. Confocal AOSLO image of a rewarded with a high-resolution, AOSLO. While OCTA was normal in both segments and the retinal pigment notes, could provide the scientific us a new world of research in terms of which can be impacted by the same researchers to capture, measure, and acute middle maculopathy, a rare form swelling from the ischemic injury. in a living organism (a and Steven Einhorn Clinical Research algorithmic analysis of the image data to retinal capillaries.” large area of abnormal and non- cellular-level view of damage to the wave guiding photoreceptors in the eyes and en face OCT showed reflectivity epithelium, researchers at NYEE were community with fresh insights on previously unexplored ocular tissue.” Imaging type of vascular dysfunction as the analyze spectral emissions of light of retinal capillary ischemia. But another But it wasn’t long before her world of Center of New York Eye and Ear Technology of help clinicians determine if a patient is Fig 1. (A). High-resolution SD-OCT scan of macula in patient with coronary artery disease rabbit), taken by Henry shape of a moon crescent. changes, adaptive optics scanning was able to drill down even deeper this time, how photoreceptors die in a host kidneys, both being end-arterial part of Ms. Ontala’s history threw the miraculously in dissolving clots for with various forms of stroke at any darkness took a decided turn for the patient’s photoreceptor layer. from the retinal pigment epithelium (CAD). Orange line, border of thin choroid. Arrows, abnormal subretinal deposits of Rich History Infirmary of Mount Sinai (NYEE). likely to have early diabetic retinopathy, OCTA software enhancements from able to produce high-definition images as described in the December 7, 2017, of diseases involving the central One study examined choroidal organs. The researchers found that (RPE) to better understand that layer’s physicians into high alert: She had lost patients with strokes and heart attacks,” of Mount Sinai’s hospitals. After brighter. At one week, vision in her Noyes, MD, Executive Adaptive say, or glaucoma.” Dr. Chui and her team are also helping to macular degeneration. “We were able to literally see the of foveal cone photoreceptor mosaic online edition of JAMA Ophthalmology. part of the retina, including macular thickness in patients with coronary individuals with AMD and decreased chemical composition and its possible her other eye to an accident 13 years says Richard Rosen, MD, Director administering general anesthesia, left eye had improved from 20/200 NYEE is one of a handful of sites in the transform the early detection of primary Director of NYEE in crescent-shaped spatial damage to a Solar retinopathy is a rare form of disturbance. Specifically, they used a custom-made degeneration. And that knowledge, artery disease (CAD). Despite the renal function are more likely to earlier. “When my sight didn’t improve of Retina Service and Ophthalmic the team began delivering 22 to 20/60. By one month she had country with adaptive optics scanning Optics In a study reported in Investigative open-angle glaucoma and normal- made through swept source optical role in macular health. NYEE is one of very specific part of her retina,” recalls retinal injury that results from directly AOSLO device with both confocal in turn, could provide valuable critical role of the choroid in supplying present with geographic atrophy at after waking up that morning, I knew I ➝ Research at NYEE, who developed the mg of intra-arterial tPA (tissue progressed to 20/25, and a three- laser ophthalmoscopy (AOSLO). This Ophthalmology & Visual Science in tension glaucoma. To that end, they are coherence tomography (SS-OCT) and the leading research laboratories in the 1860s, to current Ophthalmic artery Catheter in distal Avnish Deobhakta, MD, Assistant gazing into the sun. In the case of “New York Eye and Ear Infirmary is one and split-detector optics to image the clues about how to effectively blood to the outer third of the some point during their disease needed to get help quickly,” she recalls. ➝ protocol 10 years ago in collaboration plasminogen activator) through month follow-up visit revealed a sophisticated imaging technique— June 2015, Dr. Chui and other NYEE helping physicians identify changes in OCT angiography. Thanks to these the country to deploy hyperspectral Professor of Ophthalmology at the the NYEE patient, damage occurred of a few imaging centers in the country cone photoreceptor mosaic at the treat them. neuroretina and the retinal pigment (Fig 2). “This was my only eye.” internal carotid with Mount Sinai Health System’s a catheter inserted in the femoral remarkable 20/20. efforts to unravel the part of a translational research researchers found that microscopic, the retinal nerve fiber layer and its blood state-of-the-art techniques, Dr. Smith’s autofluorescence imaging in the Icahn School of Medicine at Mount when the young woman stared at the able to marry AO with other advanced fovea. What they discovered in the epithelium, details about choroidal artery nationally recognized Department of artery of the groin, up past the heart collaboration with Medical College of by compensating for distortions caused noninvasive imaging of the fine retinal supply, the radial peripapillary capillary lab has visualized (Fig 1) segments investigation of human eye tissue. molecular mystery of Sinai and a member of the NYEE sun during last year’s eclipse for 21 technologies like OCT angiography and patient’s right eye was a small region For NYEE’s latest solar retinopathy circulation have remained largely “What we have to recognize is that For years, ophthalmologists have Neurosurgery. “This protocol is the best to the carotid artery in the neck, With her new lease on life, Imaging Is a Wisconsin and Stanford University—is by atmospheric turbulence. In the case vasculature using split-detection network, much earlier using motion of the choroid down to the capillary clinical team that examined the patient. seconds without proper protective en face OCT,” Dr. Deobhakta says. “That of hyporeflectivity, indicating the patient, a medical breakthrough unknown due to poor resolution and this part of macular degeneration A major finding from the team’s struggled with how to effectively reverse option we now have for saving the sight and finally to the entrance of the Ms. Ontala moved to Milwaukee, retinal disease through allowing researchers and clinicians of ocular applications, adaptive optics AOSLO allowed for quantification of contrast analysis for red blood cell level, and found that individuals with “We had never been able to see that eyewear. Four hours later, she noticed unique capability opens the door to presence of non-wavelength guiding able to reverse the permanent blind reproducibility of previous imaging is a systemic vascular disease, and hyperspectral imaging was that it arterial occlusion of the eye, an “eye of patients with central retinal artery ophthalmic artery in the brain, where where she has family, and has an unprecedented view of the retinal helps achieve cellular-level imaging lumen and wall thickness. Significantly, movement. coronary artery disease have a thinner high-resolution imaging level of precision before, because blurred vision, color distortion, and further research and investigations into photoreceptors, and disruption of the spot etched on the retina of her left techniques, including indocyanine macular choroid, something that could that patients are going to have to be detected underneath the RPE a very stroke,” which is as critical a medical Fig 2. Angiogram of a catheter being guided by an interventional radiologist into the distal occlusion.” the medicine was released. returned to full-time work with a Pivotal Part of NYEE’s microvascular structure and blood flow. by overcoming optical aberrations. they learned that this technique cervical internal carotid artery to administer tPA (22 mg) into the ophthalmic artery. imaging modalities like adaptive optics metamorphopsia, which were worse diseases we weren’t able to characterize photoreceptor structure with a few eye—making everyday activities green angiography and ultrasound. treated accordingly,” says Dr. Smith, distinct spectral signature for drusen, emergency as a stroke affecting other nonprofit educational company such as adaptive optics This is accomplished by measuring has potential for early detection “We intend to make the software be a biomarker for CAD, as well as for weren’t even available until recently in the left eye, her dominant eye. She before.” enlarged inner segments. In the left eye, like reading and TV-watching a Imaging of the choroid has improved identifying patients with increased risk who joined NYEE in September and drusen precursors, in the macula. parts of the brain. A long list of therapies For Ms. Ontala, the procedure meant While treatment of eye stroke with there. “I’m fortunate to have had an Adaptive optics, which produces the distortions of the wavefront of of diabetic retinopathy, as well as we’ve developed at NYEE a new and swept source optical to examine solar retinopathy. We’re also reported seeing a black spot in the the advanced imaging showed a large challenge—couldn’t come soon dramatically, however, with the 2017 from NYU Langone Medical “This has potentially major diagnostic tried in the past—usually aimed at transporting her emergently to another tPA is still being actively studied, experienced team of physicians that did images that are high resolution and the light reflected from the eye and accurate monitoring of progression and addition to our clinical care,” emphasizes of outer retinal disease. Rich History hopeful this kind of information will not center of her left eye. Three days later, Nowhere is that more evident than with area with ambiguous reflectivity due to enough. “At least we now have a much advent of spectral domain optical Center. “This means they should and prognostic import,” advises Dr. displacing the clot—were rarely she had come to the right place. NYEE “The key is getting patients on the Health System hospital, Mount Sinai neuroradiologists have reported everything they could to help me,” she noninvasive, is particularly well suited compensating for them by using a treatment response. Dr. Chui. “And that will help us to better coherence tomography solar retinopathy. While past studies abnormal and non-wavelength guiding better understanding of the reason be controlled with regard to their effective, and patients typically suffered offers a treatment available at only a operating table within the 12-hour West. Waiting for her in an operating impressive results in patients who acknowledges a year after her ordeal. for retinal imaging. The technology was special mirror that corrects or “adapts” monitor the progress of eye disease, only help us to better understand the retinal scanning began at NYEE’s David coherence tomography (SD-OCT) Multimodal advanced imaging, Smith, “because if we can identify early conducted after solar eclipses have photoreceptors, as well as sparse, behind her injury,” acknowledges Dr. cholesterol levels, blood pressure, permanent, devastating vision loss, handful of major medical centers around window of safety and efficacy, so that the room were members of the hospital’s were identified and treated early. “To say I’m happy with the results after (OCT), New York Eye and built into astronomical telescopes by to those distortions, essentially Dr. Chui’s work with adaptive optics has and allow clinicians to intercede at the condition, but lead to new therapies for E. Marrus Adaptive Optics Imaging and enhanced depth imaging SD- including autofluorescence imaging, warning signs in patients who might be traced the mechanism of injury to intact inner segments within the area of Deobhakta, “and that represents a and cardiac status, which to some beyond the level of legal blindness. As the country: the “Eye Attack Protocol” neuroradiologists can administer intra- neuroradiology team, who stand by “In developing this protocol, we were suffering an eye stroke is an obvious U.S. government scientists nearly 30 eliminating them. Adaptive optics produced improvements to another earliest possible stage to benefit solar retinopathy and other forms of Laboratory, using a combination OCT (EDI SD-OCT), according to Dr. also figured heavily in another study progressing to macular degeneration, Fig 1. (B). Abnormal electrocardiograms showing CAD. Ear Infirmary has been in photochemical toxicity, and localized photoreceptor disruption. huge step forward for patients.” extent takes it out of the eye clinic. Ms. Ontala was about to learn, however, for treating acute stroke of the eye. arterial tPA, which has worked 24/7 to treat patients who present aware of the growing numbers of understatement.” years ago to improve image resolution improves the optical transmission of mainstay of NYEE’s advanced imaging the patient.” photic injury to the retina.” of optical coherence tomography Smith. Further improvements are being designed to show the association we can start treatment sooner.” the forefront.

NYEE Diagnostic “For eye diseases where we really don’t understand the 1888 1957 1961 1966 1970 1983 1990 1992 1997 2002 2012 2015 2016 2018 underlying mechanism, imaging is a huge asset because it Edward G. Loring, New York City’s first Retina Early studies A seminal article, “The As a NYEE resident, Aran Robert Ritch, MD, joins First photo Dan Ning Hu, MD, Sheree A. Thomas O. Muldoon, 20 years ahead of their time, Richard Rosen, MD, Patricia Garcia, MD, Mark The study of retinal microvascular disease took a leap forward with the Richard Rosen, With the introduction of OCT angiography, the Building upon earlier work Imaging Advances: NYEE and expands introduction of adaptive optics. Richard Rosen, MD, and Yuen Ping Toco MD, and Yuen clinical utility of en face OCT became widely in adaptive optics, Richard gives us a constructive pathway forward. And consistent MD, enhances Service is formally established of laser Technique of Binocular Indirect Safir, MD, invented the first of cultured McCormick, PhD, and Robert MD, becomes Hathaway, PhD, and Rishard Weitz, BEng, (working with Adrian Podoleanu, the Helmholtz by Morton L. Rosenthal, MD. photocoagulation Ophthalmoscopy,” is published automated refractometer for glaucoma research, purified human Ritch, MD, developed the Chief of the Retina PhD, and George Dobre, PhD) turned the en face OCT into a high-resolution Chui, PhD (in collaboration with Alfredo Dubra and Joseph Carroll, PhD, at the Ping Toco Chui, recognized. By providing rapidly accessible Rosen, MD, Yuen Ping 198 Years of with our practice over the years, we continue to develop and Ophthalmoscope Dr. Rosenthal introduced at in rabbit retina by Morton L. Rosenthal, MD, and prescribing spectacles. 1982 popularizing use of high- iris pigment methodology for isolation Service. He was clinical tool by combining it with ICG angiography. This project was done in Medical College of Wisconsin) merged fluorescein imaging with adaptive optics PhD, introduced noninvasive capillary imaging, OCT angiography Toco Chui, PhD, and their with design NYEE techniques of indirect were conducted Seymour Fradin, MD. Illustrated A team of clinician-scientists resolution ultrasound epithelial (IPE) and culture of human uveal an early proponent collaboration with the University of Kent, which created the first en face OCT. visualization to reveal the internal fluid dynamics of retinal microaneurysms. quantitative opened the way for monitoring changes in patients collaborators in the Medical Innovation refine our imaging tools to complement the progress our 1992 features to ophthalmoscopy and fundus at Bell Labs by Dr. Fradin, the methodology at NYEE, Virginia Lubkin, MD, biomicroscopy (1994) as a clinical tool cells was melanocytes (UM). The first of fluorescein analysis of capillary with glaucoma , diabetic retinopathy, and macular College of Wisconsin added Background: researchers and clinicians are making in critical areas like 1862 for diagnosis of complex glaucomas, Richard Rosen, MD, Thomas O. Image of macular improve drawing for visualizing the by Seymour described for a 1971 Mort Gersten, Richard Koplin, 1987 taken at NYEE’s Ocular Cell Culture photo of cultured human angiography, laser, density using degeneration at a resolution previously available the normative data mapping Henry D. Noyes, MD, and clinical use of OCT (1995), paving Aran Safir, MD, (and Muldoon, MD, and David Buzawa, deviation mapping of gene therapy and breaking down ocular disease to its ergonomics retinal periphery, ushering Fradin, MD, and Morton L. Rosenthal, MD, retinal exam is NYEE’s Retina Diagnostic MD, and Dennis Gormley, MD, Lab, thanks to Dan Ning Hu, MD, Robert uveal melanocytes (UM) and vitrectomy, and helped 2007 2014 adaptive optics only with adaptive optics. Richard Rosen, MD, to OCTA imaging to enable Executive Director of the way to some of the most significant Leonard Flom, MD,) MEng (in partnership with Iris Taking OCT to the next dimension, Richard Rosen, MD, Patricia Garcia, MD, Dynamic Histopathology, introduced by Richard Rosen, MD, and Yuen nonperfused areas cellular components.” for the clinician. in a new era in (along with Charles Townes, MD, and Arthur still used Center for retinal photography invented corneal topography, Ritch, MD, and Sheree A. McCormick, was taken 12 days after the foster adoption of modern retinal scanning laser and Yuen Ping Toco Chui, PhD, introduced a instantaneous quantification NYEE takes the first advances in the understanding and invented iris recognition Medical) developed the first clinical Gennady Landa, MD, and Rishard Weitz, MD, integrated SLO microperimetry Ping Toco Chui, PhD, using adaptive optics serial imaging allowed overlaid with the modern retinal Leonard Schawlow). This would eventually today. and fluorescein angiography, and built the first corneal PhD, who were the first to develop the seeding of a UM isolated diagnostic and surgical technologies. ophthalmoscopy with fluorescein angiography. full spectrum of quantitative tools for precision of abnormalities of blood flow application of transscleral viewing superficial OCTA photographic image is established under the mapper, leading the way management of glaucoma. biometrics for unique and OCT/SLO 3-D topography. For the first time, clinicians had one physicians for the first time to study the retinal capillary microvascular assessment and follow-up of clinical microvascular surgery. become the mainstay treatment for diabetic methodology for isolation and culture of from the choroid of This provided unprecedented clinical to the retina. image. — Richard Rosen, MD, Director of Retina Service and of the retina in a live identification. and laser therapy for treatment of instrument that combined structural imaging with visual functional testing. remodeling in live patients. retinopathy. leadership of Thomas O. to precision corneal vision human IPE. a donor eye. measurements of microvascularity in the retina. disease, based upon their adaptive optics work. Ophthalmic Research, NYEE subject, a rabbit. Muldoon, MD. correction. retinal tears and detachments. › continued from page 9

0 2 4 6 8 10 NYEE Uses a Rare Retinal Transplant to Close a Patient’s Macular Hole A Clinical Trial Seeks to Boost Patient Satisfaction

and some of his colleagues do not believe that the transplanted By Making Intravitreal Injections Less Painful piece of retina itself is detecting light, the reattachment improves the function of the adjacent neurosensory retina by promoting its Joe Mauro dreaded at 6 hours and 24 hours. reattachment to the retinal pigment epithelium (RPE) to allow the his injections every While the group who received patient to see better. “The key to the surgery is really getting the month or two at a local a pressure patch after the transplant into the hole, and ensuring it doesn’t move by applying ophthalmologist’s office injection also showed lower the right pressure during the PFC silicon oil exchange,” says Dr. for diabetic retinopathy. “It pain scores, the data was Gentile, who has performed two autologous retinal transplants— pricked a little bit when I not found to be statistically among the very first cases in New York City. “This involves precise, got the needle, but the big different from those in the leading-edge surgery that’s intended only for patients who have problem was afterwards, control group. exhausted all other forms of treatment.” when it felt like I had a hot coal in my eye,” recalls the “What we found was an easy For Ms. Benjamin, a retired home health aide who has five grown 68-year-old Staten Island way to reduce the patient’s children and 12 grandchildren, the results were evident within days resident, who has type 2 pain after injection with Dr. Gentile examining Mary Benjamin after retinal transplant surgery. of the surgery. Her visual acuity improved to 20/200 in her left diabetes. “And I have a pretty literally just a single drop,” When 68-year-old Mary Benjamin came to Ronald Gentile, MD, at eye, enough to allow her to resume everyday activities that had good threshold for pain.” explains Richard Kaplan, MD, New York Eye and Ear Infirmary of Mount Sinai (NYEE), she had a The surgery, which took place in March 2017, began by harvesting previously been off limits. “The thing I notice most is that my vision a vitreoretinal surgery fellow macular hole that three surgeries elsewhere had failed to close. an autologous neurosensory free flap from the peripheral retina is now balanced the way it should be between both eyes,” she Intravitreal injections have at NYEE, who worked on the The retinal surgeon quickly recognized the severity of the case. to place over the macular hole and provide a type of plug for says, “which allows me to focus on and see things I couldn’t before revolutionized the treatment study with Dr. Gentile. “Our For one thing, Ms. Benjamin’s sight had deteriorated to the point closure. This flap, approximately 0.5 disc diameter larger than the my repair.” of retinal disease, from hope is that this procedure where merely walking down the block became hazardous. “After From left: Richard Kaplan, MD, a vitreoretinal surgery fellow at NYEE and Ronald macular opening, was cut using forceps and scissors. Dr. Gentile macular degeneration to will not only make patients the macular hole reopened, I could barely count the number of Gentile, MD, with patient Joe Mauro explaining the new procedure for eye injections. likens this part of the hour-long procedure to taking a biopsy of an Ms. Benjamin is hardly out of the woods, though. She has had diabetic retinopathy to other happier with their treatment, fingers in front of my left eye,” Ms. Benjamin recalls. “And the area of the eye that is disease-free, yet not being used for vision. other complications, including cataracts in both eyes and removal disease forms involving leaky blood vessels or the growth but result in better compliance and thus better outcomes.” drops I was taking just weren’t doing the job they were meant to.” A light laser around the edges of the area marked for grafting, of the silicone oil with gas injection, which required further of new ones. What has received far less attention from the along with diathermy to blood vessels at the edge, was then used surgery by Dr. Gentile nine months after the autologous retinal medical community, though, is the issue of patient satisfaction The pain management trial turned Mr. Mauro into a believer—and an On clinical examination, OCT imaging revealed that the macular by the surgeon to prevent future complications, including retinal transplant. with this breakthrough therapy—particularly as to how they NYEE patient. “It was amazing how, after getting a drop in the eye, hole registered nearly 800 microns, making standard closure detachment. Once the transplanted retinal tissue was placed react to the very thought and experience of receiving repeat I had no discomfort at all after the needle,” reports the retired New using the internal limiting membrane that was previously removed into and stretched over the macular hole, the eye was filled with While Dr. Gentile was candid in explaining to Ms. Benjamin the injections in the eye. Indeed, pain can persist for a few days York City police officer. “No one wants to get a needle in the eye, but impractical, by Dr. Gentile’s reckoning. Instead, he reached for perfluorocarbon (PFC) and silicon oil exchange to keep the uncertainties of a procedure still in its embryonic stage, she following treatment, and can disrupt and/or even diminish now I don’t really have a big problem with it.” a surgical technique that had only been performed a handful transplanted tissue firmly in place. says she was eager to proceed knowing what the future benefits patient compliance. of times in this country: autologous retinal transplantation. The might be. “There’s certainly some risk to trying anything new,” While not a standard procedure, NSAIDs like nepafenac are transplant is used to close the hole and reattach the normal Once the transplanted retina is in place, it adheres to the acknowledges Dr. Gentile, “but we now have an important new New York Eye and Ear Infirmary of Mount Sinai (NYEE) has often used by ophthalmologists to relieve discomfort following a retina around the hole that was detached because of it. “It’s only surrounding tissue through what is believed to be migration of glial procedure in our toolbox, and won’t be afraid to roll it out for become one of the first institutions to address this matter with wide range of procedures. The favorable findings of this patient applicable to the very small number of patients who have failed cells across the patch, which acts like stitching. While Dr. Gentile patients who previously had no good options.” a recent study focused on improving the patient experience satisfaction study make it more likely than ever that these agents will multiple procedures in attempting to close a very difficult macular and reducing pain from intravitreal injections. “When we enjoy an increasingly prominent role at NYEE and other ophthalmic question patients, they tell us their greatest fear, besides going centers. blind, is pain from the injection,” says Ronald Gentile, MD, Clinical Professor of Ophthalmology at NYEE, and the study’s OCT images of the left eye before and after transplant principal investigator. “So our goal became to put a procedure in place that could actually improve their experience and eliminate any discomfort from pain.” “When we question patients, they

The clinical trial, which began collecting data in June 2017, tell us their greatest fear, enrolled 60 patients who received intravitreal injections of bevacizumab, aflibercept, or triamcinolone acetonide. They besides going blind, were then randomized to receive post-injection one of three is pain treatments: a single drop of topical nepafenac 0.3 percent suspension, an NSAID; a pressure patch for two hours; or from (intravitreal injections).” a single drop of preservative-free tears (the control group). The results were extremely encouraging for investigators. —Ronald Gentile, MD They showed that the group receiving topical nepafenac had Fig 1. Left eye showing a 800 micron macular hole Fig 2. Left eye after autologous retinal transplant significantly lower pain scores than those in the control group

10 11 New Pediatric Ophthalmology Fellowship Program Is Broadening NYEE’s Patient Services

The growing integration of New York Eye and Ear Infirmary of Mount Sinai (NYEE) and Mount Sinai Health System is about to yield another dividend: a joint pediatric ophthalmology fellowship program accredited by the Association of University Professors of Ophthalmology Fellowship Compliance Committee (AUPO FCC). The AUPO FCC-compliant year-long program, which will start in July 2019, will add to both institutions’ nationally recognized roster of specialized training in the fields of cornea and refractive surgery, glaucoma, vitreoretinal surgery and uveitis.

“The Mount Sinai Hospital (MSH) and NYEE both have long histories of excellence in education, and the new pediatric fellowship will really complete our fellowship training programs,” says Douglas Fredrick, MD, newly named Deputy Chair for Education in the Department of Ophthalmology and Chief of Pediatric Ophthalmology for the Mount Sinai Health System. Because fellows take an active role in training residents, the new program will enable NYEE and Mount Sinai to jointly grow their pediatric ophthalmology and strabismus service lines by increasing the number of providers, adds Dr. Fredrick, who will lead that expansion along with creation of a comprehensive pediatric ophthalmology center. While the new pediatric fellowship will start modestly with a single fellow, Dr. fellows and attendings to provide pediatric-centered integrated “Our goal is to train highly Fredrick envisions the program soon taking under its wings three fellows— care to children with the broadest spectrum of ocular and vision- two domestic and one international—over the next five years. “International threatening conditions. fellows will return to their home countries and help improve the quality of qualified pediatric care for both developing and developed nations,” he explains. “It’s also my Under the new fellowship program, the network of training sites will hope that we’ll be able to establish closer relationships with departments of grow beyond NYEE and MSH to include Elmhurst Hospital in New ophthalmologists ophthalmology and training programs in those developing countries.” York City’s borough of Queens, giving fellows the chance to treat a spectrum of disorders akin to what might be found in developing to handle everything from Closer to home, the AUPO FCC-approved fellowship program will address countries, according to Dr. Frempong. “These fellows will be part a national shortage of pediatric ophthalmologists. “Our goal is to help fill of a multidisciplinary approach to treating patients who could have that gap by training highly qualified pediatric ophthalmologists to handle rare, complicated syndromes and complex eye diseases like orbital basic to very complex eye everything from basic to very complex eye disorders in children, as well tumors,” she notes. as strabismus in adults,” says Tamiesha Frempong, MD, who will serve as disorders in children as Director for the new joint fellowship program when it launches next summer. What will set the new pediatric ophthalmology fellowship program apart from others across the country is its unique combination of eye well as strabismus in adults.” While MSH does not currently train pediatric ophthalmology fellows, hospital and major academic medical center, stresses Erin Walsh, NYEE has a long tradition of excellence in orthoptic, strabismus, and MD. “Fellowship programs typically have access to one or the other, —Tamiesha Frempong, MD Erin Walsh, MD, with a NYEE pediatric pediatric ophthalmology education. With over 50 years of leadership of the but rarely do they have both of these resources at their fingertips,” ophthalmology fellow, Phillip Tenzel, Orthoptics service, Sara Shippman, CO, along with Co-Directors of the MD, performing a cover test for ocular she elaborates. “For fellows, this will translate into exposure to a wide Pediatric Ophthalmology and Strabismus division, Steven Rosenberg, MD, misalignment (top) and a retinoscopy range of pathology, as well as to attendings who can share a wealth of and Erin Walsh, MD, work as a team to supervise residents, sub-specialty exam (bottom). knowledge and experience.”

12 13 Paul A. Sidoti, MD, Site Chair of Ophthalmology at NYEE Louis R. Pasquale, MD, FARVO

A faculty leader at NYEE for more than 24 years, Dr. Sidoti previously served as Deputy Chair for An internationally renowned clinician and researcher into primary prevention strategies in open-angle Clinical Affairs at Mount Sinai Health System and has been instrumental in the growth of NYEE’s glaucomas, Dr. Pasquale joins the Department as Site Chair of Ophthalmology at The Mount Sinai Hospital national and international reputation as one of the top teaching hospitals for ophthalmology. and Mount Sinai Queens, as well as System Vice Chair for Translational Ophthalmology Research. In these He received his medical degree from the Albert Einstein College of Medicine. He completed his combined roles, he will seek to achieve excellence in clinical care delivery using the latest technologies for residency at NYEE and a clinical/research fellowship in glaucoma at the Doheny Eye Institute/ data acquisition and analysis, as well as integrate the department’s translational research efforts into the University of Southern California School of Medicine. larger global research network. Dr. Pasquale previously served as Professor of Ophthalmology at Harvard Medical School and Director of the Glaucoma Service at Massachusetts Eye and Ear. Appointees Promotions Richard B. Rosen, MD, Deputy Chair for Clinical Affairs at Mount Sinai Health System Douglas Fredrick, MD

An internationally renowned researcher and lecturer, Dr. Rosen joined the Department of An academic leader with an international reputation in the treatment of complex strabismus, pediatric Ophthalmology at NYEE in 1989. Under his leadership, NYEE established one of the most advanced cataracts, cortical visual impairment, and modalities to slow the progression of childhood myopia, Dr. Fredrick imaging centers in the country. As Deputy Chair for Clinical Affairs, Dr. Rosen will apply his problem- joins the Department as Deputy Chair for Education and System Chief of Pediatric Ophthalmology. He will solving skills to continue to improve clinical operations and patient care delivery. He will continue to serve work to build upon the Department’s national and international reputation as a premier teaching institution as Director of Ophthalmic Research and Director of the Retina Service/Retina Fellowship at NYEE. Dr. for residents and fellows, in addition to leading the expansion of pediatric ophthalmology services, including Rosen earned his MD from the University of Miami School of Medicine, and completed his ophthalmology the establishment of a comprehensive pediatric ophthalmology center. He previously served as Clinical residency and vitreoretinal fellowship at NYEE. Professor and Vice Chair of Education and Clinical Affairs in Ophthalmology at Stanford University.

Robert C. Della Rocca, MD, Chief of Oculoplastic and Reconstructive Valerie I. Elmalem, MD Surgery at Mount Sinai Health System Fellowship trained in both neuro-ophthalmology and in orbital and ophthalmic plastic surgery, Dr. Della Rocca is an international leader in complex cosmetic and reconstructive eyelid, midfacial, and orbital Dr. Elmalem joins the Department as Director of Neuro-Ophthalmology at Mount Sinai West. With surgery. A distinguished lecturer, editor, and author of five textbooks, Dr. Della Rocca is also a dedicated a special interest in surgical education of ophthalmology residents, Dr. Elmalem’s clinical focus teacher; over the years, he has mentored 35 fellows in U.S. and over 85 internationally. A resident graduate includes diagnosis and management of optic nerve and brain disorders affecting vision, and of NYEE, Dr. Della Rocca was instrumental in growing the Oculoplastic and Reconstructive Surgery division management of a wide range of eyelid and orbital conditions in adults and children. Recognized by for the past 35 years, ultimately serving as its Director. Dr. Della Rocca is also passionate about mission her peers as an outstanding ophthalmologist, Dr. Elmalem has been listed in Super Doctors® New work, traveling to 15 countries, in the past three decades, as a volunteer surgeon to care for patients from the York Rising Stars since 2015. She previously served as Director of Neuro-Ophthalmology at SUNY remote villages. Downstate Medical Center. News Faculty News Faculty David A. Della Rocca, MD, Director of Oculoplastic and Reconstructive Gareth Lema, MD, PhD Surgery at The Mount Sinai Hospital and Mount Sinai St. Luke’s Gareth Lema, MD, PhD joins the Department as Director of Quality, Safety, and Experience at The A specialist in reconstructive orbital and eyelid surgery with a busy clinical practice, Dr. Della Rocca Mount Sinai Hospital. A fellowship-trained retina specialist with a particular interest in diseases of the is committed to being a teacher of residents at NYEE, The Mount Sinai Hospital, and Mount Sinai St. retina and posterior uveitis, including diabetic retinopathy, macular degeneration, and ocular trauma, Luke’s. An author of many peer-reviewed articles and chapters, Dr. Della Rocca is a recipient of the Dr. Lema also holds a PhD in biophysics. He is leaving his positions as a Clinical Assistant Professor 2012 Achievement Award for teaching from the American Academy of Ophthalmology. After earning of Ophthalmology at the University at Buffalo Jacobs School of Medicine and Director of the Retina his medical degree from Creighton University School of Medicine, Dr. Della Rocca completed his Division of the Ira G. Ross Eye Institute. ophthalmology residency and fellowship in oculoplastic, reconstructive, and orbital surgery at NYEE.

Harsha S. Reddy, MD, Director of Oculoplastic and Reconstructive Surgery at NYEE and Physician Wellness Champion for Ophthalmology GME at Mount Sinai Health System

Dr. Reddy is an ophthalmic plastic surgeon specializing in correction of age-related changes in the eyelids and reconstruction after facial trauma and tumors. With a passion for teaching, research, and service, Dr. Reddy has written many peer reviewed articles, lectured at international scientific conferences, and led medical outreach in Nepal, Ethiopia, and India. He has received many teaching awards at NYEE and was a finalist for the 2014 Henry Bayliss Outstanding Thesis Award (ASOPRS). Dr. Reddy earned his medical degree at Harvard Medical School, completed an ophthalmology residency at the Doheny Eye Institute and an ASOPRS oculoplastic surgery fellowship at the University of Washington.

14 15

Icahn School of Medicine at Medical Directors Neuro-Ophthalmology Uveitis and Ocular Immunology Department of Ophthalmology at a Glance: New York Eye and Ear Infirmary of Mount Sinai Mount Sinai Departmental Mark Kupersmith, MD Douglas Jabs, MD, MBA Avnish Deobhakta, MD (NYEE) and The Mount Sinai Hospital (MSH) / Icahn School of Medicine at Mount Sinai Leadership System Chief, System Chief, Uveitis and Ocular Medical Director, NYEE - Neuro-Ophthalmology, Immunology, MSHS James C. Tsai, MD, MBA East 85th Street Oculoplastic MSHS President, NYEE 720+ 2017 STATISTICS* Stephanie Llop, MD System Chair, Department of Robin N. Ginsburg, MD NYEE Refractive Surgery Valerie Elmalem, MD Sophia Saleem, MD Other Ophthalmology, MSHS Medical Director, NYEE- 1,090+ Joel Mindel, MD No. 680+ East 102nd Street Cornea and External Residency Positions Louis R. Pasquale, MD Affiliated Leadership 33 Ocular Oncology Diseases Site Chair, Department of Gennady Landa, MD 6,290+ Paul Finger, MD Ebby Elahi, MD, MBA 11 Ophthalmology, MSH and MSQ Medical Director, NYEE- President, NYEE/MSH Pediatric Fellowship Positions System Vice Chair, Translational Williamsburg and Tribeca Ophthalmic Pathology Ophthalmology Alumni Ophthalmology 12 Ophthalmology Research, MSHS Jodi Sassoon, MD Society (Highest-ranked 1,870+ One of the largest ophthalmology Kira Manusis, MD Site Chair, Pathology, NYEE in NYC) in graduate medical education programs Medical Director, NYEE- Paul A. Sidoti, MD Robert Fischer, MD Ophthalmology in the country Midwood Site Chair, Department of Nada Farhat, MD Director of Ophthalmology, by 2018- 2019 24,700+ Ophthalmology, NYEE Alan Friedman, MD Elmhurst Hospital U.S. News & Paul A. Sidoti, MD Surgical Case System Chief, Glaucoma, MSHS Codrin Iacob, MD World Report Medical Director, NYEE- Volume by Funded Clinical Trials David Goldman, MD “Best Hospitals” 58 Douglas Fredrick, MD East 14th Street Oculoplastic and Medical Director, NYEE-West

in America Service* Deputy Chair for Education, MSHS Reconstructive Surgery Palm Beach Angie E. Wen, MD General System Chief, Pediatric Robert Della Rocca, MD Medical Director, NYEE- Ophthalmology Satellite Locations Ophthalmology and Strabismus, System Chief, Oculoplastic Michelle Rhee, MD Columbus Circle 3,940+ Retina 9 MSHS and Reconstructive Surgery, Associate Director of 5,100+ MSHS Ophthalmology, Elmhurst Douglas A. Jabs, MD, MBA Clinical Divisions at Hospital Deputy Chair for Research, MSHS Mount Sinai Health David Della Rocca, MD Glaucoma 203,300+ Director, Eye and Vision Research System Faculty Practices Monica Dweck, MD 4,900+ Institute, MSHS Valerie Elmalem, MD Outpatient Visits Cornea, External Diseases, * Includes Cataract Surgery Alexander Rabinovich, MD and Refractive Surgery * Combined 2017 numbers for NYEE and MSH Salvatore Loiacono, Jr. MPA Harsha Reddy, MD NYEE = New York Eye and Ear John Seedor, MD Deputy Chair for Finance and Infirmary of Mount Sinai Administration, MSHS System Chief, Cornea and Pediatric Ophthalmology MSHS = Mount Sinai Health System Main Campus Affiliated Faculty Vice President for Ophthalmology External Diseases, MSHS and Strabismus New York Eye and Ear MSH = The Mount Sinai Hospital 1 Practice Sites Services, NYEE Douglas Fredrick, MD Infirmary of Mount Sinai MSQ = Mount Sinai Queens 10 Mount Sinai Doctors David Ritterband, MD System Chief, Pediatric 310 East 14th Street Brooklyn Heights Richard B. Rosen, MD System Chief, Refractive Ophthalmology and New York, NY 10003 300 Cadman Plaza West Deputy Chair for Clinical Affairs, MSHS Surgery, MSHS Strabismus, MSHS Brooklyn, NY 11201 Satellite Locations Vice Chair and Director of Ophthalmic 2 NYEE - East 102nd Street 11 Mount Sinai Doctors Research, NYEE Sumayya Ahmad, MD Tamiesha Frempong, MD, 17 East 102nd Street Palm Beach Priti Batta, MD MPH New York, NY 10029 625 North Flagler Drive Christopher T. Spina, MS Anita Gupta, MD Edward Raab, MD West Palm Beach, FL 33401 3 NYEE - East 85th Street Senior Vice President and Chief Noga Harizman, MD Steven Rosenberg, MD 234 East 85th Street Operating Officer, NYEE Richard Koplin, MD Erin Walsh, MD Affiliated Ambulatory New York, NY 10028 Kira Manusis, MD Surgery Centers Angie Wen, MD 4 NYEE - Columbus Circle 12 Empire State Ambulatory Tamiesha Frempong, MD, MPH Primary Care 200 West 57th Street Surgery Center Vice Chair for Diversity and Inclusion, Ophthalmology/Optometry New York, NY 10019 3170 Webster Avenue MSHS Eye Trauma Karen Hendler-Goldberg, MD 5 NYEE - Tribeca Bronx, NY 10467 John Aljian, MD Bessie Abraham, OD Sandra K. Masur, PhD Ronald Gentile, MD Jared Hayashi, OD 77 Worth Street 13 North Queens Surgical Center New York, NY 10013 45-64 Francis Lewis Boulevard Vice Chair for Mentoring, MSHS Harsha Reddy, MD Vanessa Hernandez, OD Caitlin Morrison, OD 6 NYEE - Midwood Bayside, NY 11361 1630 East 15th Street Donna J. Gagliuso, MD Glaucoma Elena Schmidt, OD Brooklyn, NY 11229 AffiliatedAffiliated TeachingTeaching Residency Program Director, MSH Paul Sidoti, MD InstitutionsInstitutions System Chief, Glaucoma, Retina 7 NYEE - Williamsburg 14 JamesJames J.J. PetersPeters VAVA Anita Gupta, MD MSHS Nazanin Barzideh, MD 101 Broadway MedicalMedical CenterCenter Residency Program Director, NYEE Avnish Deobhakta, MD Brooklyn, NY 11249 130130 WestWest KingsbridgeKingsbridge RoadRoad Director, Comprehensive Nisha Chadha, MD Robin Ginsburg, MD Bronx,Bronx, NYNY 1046810468 8 NYEE - Mineola West Palm Beach, FL Westchester, NY Service, NYEE Donna Gagliuso, MD Meenakashi Gupta, MD 200 Old Country Road 15 NYCNYC Health+Hospitals/ElmhurstHealth+Hospitals/Elmhurst Noga Harizman, MD Gennady Landa, MD Mineola, NY 11501 79-01 Broadway 79-01 Broadway Paul S. Lee, MD Tsontcho Ianchulev, MD Jessica Lee, MD Queens,Queens, NYNY 1137311373 9 NYEE - Westchester Associate Residency Program Nathan Radcliffe, MD Gareth Lema, MD, PhD 90 South Ridge Street 16 MountMount SinaiSinai UnionUnion SquareSquare Director, MSH Robert Ritch, MD Richard Rosen, MD Rye Brook, NY 10573 1010 UnionUnion SquareSquare EastEast Chief of Ophthalmology, James J. Tania Tai, MD R. Theodore Smith, MD, PhD NewNew York,York, NYNY 1000310003 Peters VA Medical Center James Tsai, MD, MBA Kateki Vinod, MD 16 17 SAVE THE▼ DATE Department of 200 Ophthalmology Years www.NYEE.edu Anniversary SPECIALTY REPORT | FALL 2018 www.NYEE.edu Celebration

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Cover image: Slice of a central retina section showing all layers (ONL, INL, GCL). Red indicates rod photoreceptors, located in outer nuclear layer (ONL). Green indicates Müller glial cells, whose cell bodies are located in inner nuclear layer (INL), and their branches across all three layers. Dark blue indicates the nucleus of all cells in three layers (GCL).