The Newsletter of the D epartment of Eyewitness FALL/WINTER 2010 #15

notes from the chair from institutions up to NIH. Are they effective, worth it, enforceable? How will they affect us? Will they constrain scientific advancement or Conflict of Interest: ensure impartiality and honesty in research? The Good, the Bad, As we try to sort through COI and the relationship between industry and academe, and the Ugly we want to do what is in the best interest of n previous issues we discussed change and our patients and the public good. We can I author Malcolm Gladwell’s concept of a probably recognize behavior that we think is “tipping point,” the moment when an idea accrues bad. We don’t want doctors being bribed to enough momentum to move it to the fore of our Joan W. Miller, MD administer a particular medication. We don’t Chief and Chair societal consciousness. Concerns about conflict of want pharmaceutical companies controlling interest (COI) between medical practitioners and researchers the educational content of our training programs or our and the pharmaceutical/medical device industry have now continuing education courses. However, many innovations reached this point. Rules are being promulgated at all levels, continues on page 6

Highlights from the 2010 Graduation and Annual/Alumni Meeting he 2010 Graduation began with the unveiling of T our most recent portrait of an ophthalmology giant: Dr. Evangelos S. Gragoudas. Anthony P. Adamis, MD, former Associate Professor of Ophthalmology and Director of Training, was on hand to recap Dr. Gragoudas’ long list of accomplishments, including proton beam therapy for ocular malignancies, early work on PDT and anti- drug development and testing, as well as the dozens of clinicians he has trained and mentored over 2010 Frederick A. Jakobiec and Mariana Mead Lecturer, the years. HMS alumnus Dimitri T. Azar, MD, currently Dimitri Azar, MD, Chair of the Department of Ophthalmology BA Field Professor of Ophthalmologic Research and Chair and Visual Sciences, University of Illinois at Chicago (l), of the Department of Ophthalmology and Visual Sciences, Deborah Langston, MD, FACS and Kathryn Colby, MD, PhD University of Illinois at Chicago, gave the Frederick A. having received the 2010 Joseph B. Martin Dean’s Leadership Jakobiec Lecture. Dr. Azar spoke on “Do Something of Value Award for the Advancement of Women. and Hold on to Your Values.” The Teacher of the Year Award was presented to Mark C. Kuperwaser, MD, Instructor in Dr. Azar was featured the following day as he delivered the Ophthalmology, based at Beth Israel/Deaconess Medical Mariana Mead Lecture at the 2010 “Update on Ophthal­ Center. Sandra Rocio Montezuma, MD received the Fellow mology” didactic program. His lecture, “Theoretical and of the Year Award. Joan W. Miller, MD, was recognized for continues on page 4 I n the Spotlight

Anne B. Fulton, MD, Promoted to Professor of Ophthalmology In this issue: r. Anne B. Fulton, MD, is one of the members Notes from the Chair...... 1 D of the Department of Ophthalmology to be Highlights from the 2010 promoted most recently to Professor of Ophthalmology Graduation and Annual/Alumni at Harvard Medical School. Dr. Fulton is a graduate of Meeting...... 1 Tufts University School of Medicine. She completed an Anne B. Fulton, MD, Promoted to internship at Grady Memorial Hospital in Atlanta and a Professor of Ophthalmology . . . 2 residency at Yale School of Medicine. First Biennial AMD Symposium Dr. Fulton is a world authority in pediatric retinal and Spurs Lively Discussion, Debate . .3 visual development, with a focus in retinal degenerations Alumni Giving Society ...... 5 and genetic disorders. Her clinical practice and research News from All Over...... 8 Anne B. Fulton, MD laboratory are based at Children’s Hospital Boston, where she has been on staff since completing her residency at Yale in 1976. Her work has provided a solid foundation for discovering the molecular and Published three times a year: cellular bases for a wide range of disorders that afflict pediatric patients. Joan W. Miller, MD, Editor Judy Gibian, Staff Writer Her work seeks to elucidate the development of fundamental processes in infants’ Suzanne Ward, Staff Writer retinal photoreceptors and post-receptor . Funded by the National Institute of Health, her recent research in Retinopathy of Prematurity (ROP) has explored the hypothesis that the growing photoreceptors’ escalating demands for energy and oxygen contribute to the retinal hypoxia that leads to clinical ROP. Additionally, the photoreceptors are damaged if their oxygen needs are not met. Using non- invasive assessment techniques such as electroretinography (ERG) in babies with Dr. Fulton’s work in or without ROP, Dr. Fulton showed that rod sensitivity could predict vascular “understanding retinal outcome at a later age. These observations physiology in children is were confirmed in animal models of ROP, and suggest that rod dysfunction unparalleled in the world, T ake a look at the may have a causative role in the vascular and the level of clinical Mass Eye and Ear website problems of ROP. These studies establish expertise she and her team where you’ll find a newly designed the immature photoreceptors as potential offer her patients is equally and structured powerhouse of pharmacological targets, and offer promise information right at your fingertips. of very early intervention in the treatment peerless. Visitors are encouraged to peruse of ROP. ” —Dr. David G. Hunter, MD, PhD the site and let us know about items or information they would In honor of her promotion, Dr. David G. like to see included. Check out Hunter, MD, PhD, Ophthalmologist-in-Chief at Children’s Hospital Boston and www.masseyeandear.org and let Vice Chair for Ophthalmology Promotions and Reappointments at HMS, lauded us know what you think. Dr. Fulton’s outstanding contributions to advancing retinal science and vision care in www.masseyeandear.org the pediatric arena. “Dr. Fulton’s work in understanding retinal physiology in children is unparalleled in the world, and the level of clinical expertise she and her team offer her patients is equally peerless.” The Pediatric Retinal Degeneration Service in the Department of Ophthalmology at Children’s Hospital Boston was established nearly 30 years ago under the leadership of Dr. Fulton. Today, the Service offers unique depth of expertise and attracts patients from around the world. Equipped with advanced pediatric electrophysiology and psychophysical capability, the service provides comprehensive assessment and management of retinal and visual disorders in infants and children. We look forward to Dr. Fulton’s continuing contributions and extend warmest congratulations to her on recognition well-earned. n

2 Eyewitness First Biennial AMD O phthalmology Symposium Spurs in the News

Lively Discussion, The Mass. Eye and Ear Infirmary ranked 4th in Ophthalmology Debate among the nation’s 4,852 hospitals diverse and distinguished group in the 2010-11 U.S. News and World A of clinicians and researchers from Report magazine’s “America’s Best around the world enjoyed a stimulating Hospitals” annual survey. two days of active discussion at the first international AMD symposium In the 2010 Ophthalmology Times’ hosted by the HMS Department of peer-rated survey, MEEI/Harvard Ophthalmology. The symposium, University’s ranking for overall which also included leaders from related “Best Programs” climbed a notch disciplines outside ophthalmology, to 5th place and retained the featured an interactive format to discuss number 3 spot for “Best Research current areas and future avenues in AMD Programs.” research. Topics included genetics, RPE/ Bruch’s membrane/choriocapillaris, Make your voice heard in inflammation, stem cells and tissue Alan Bird, MD emeritus professor at London Ophthalmology Times’ next survey engineering, imaging, animal models, University and honorary consultant at (summer, 2011). Just 328 physician Moorfields Eye Hospital, London, lectures at subscribers completed the on-line and neurodegenerative disease. the AMD Symposium on the “Pathogenesis Discussion panels were purposefully long, of AMD.” Dr. Bird is a leading expert on the survey that determined this year’s and the audience truly engaged faculty in treatment of retinal vascular disease and rankings. If you don’t subscribe genetic and degenerative retinal disorders. to Ophthalmology Times, then stimulating discussion. consider signing up at their Post-symposium feedback was highly positive. website: www.modernmedicine. Attendees commented on the great selection com/modernmedicine/ of speakers and moderators for the event, and Ophthalmology/home/40207. If you’re already a subscriber, your the lively and active discussions during panel vote can make a difference! sessions. Kudos from attendee, Nicolas G. Bazan, MD, The HMS Department of PhD, Professor and Director, Ophthalmology’s residency Center of Excellence, Louisiana State training program, led by John I. University Health Sciences Center, Ernest C. Loewenstein, MD, residency and Yvette C. Villere Endowed Chair for program director and Carolyn E. Bruce Ksander, PhD, HMS Associate Retinal Degenerative Diseases, captures some Kloek, MD, Associate Program Professor of Ophthalmology, Schepens of the enthusiasm generated at the meeting, Director, was prominently Eye Research Institute, at the AMD “…Without a doubt, it was the best AMD featured in the Ophthalmology Times’ September 1st, 2010 symposium. meeting I have ever attended. I left there with issue. The article emphasizes a wealth of knowledge on the excellent research taking place in this area. Also, I was the Department’s “fundamental very pleased that we had ample time for extended group discussions of the different commitment … to develop contributions presented. The meeting was a major success thanks to the committee’s residents into first-class clinicians efforts and thoughtfulness.” and well-rounded academicians.” The article highlights several “This meeting was a great platform to engage colleagues from all over the U.S. and key factors that contribute to the abroad, and an opportunity to collaborate with some of the best minds in AMD depth and breadth of the program, research,” noted famed angiogenesis scientist, Dr. Anthony P. Adamis. “Having including: MEE’s dedicated, speakers on hand from related disciplines added to the depth of discussions and 24-hour emergency eye facility gave this meeting a very unique flavor. In every respect, it was a great experience.” offering residents unprecedented “on-the-job” training; a new and We look forward to organizing another exciting event in 2012. n improved, hands-on learning curriculum; and advanced, Organizing Committee Co-Chairs for the inaugural event were Patricia A. D’Amore, PhD, computer-based simulation Professor of Ophthalmology and Pathology; Ivana K. Kim, MD, Assistant Professor training tools. of Ophthalmology; and Joan W. Miller, MD, Henry Willard Williams Professor of Ophthalmology and Chair of the Department of Ophthalmology.

FALL/WINTER 2010 #15 3 Annual Meeting, continued from page 1

Clockwise from above left: , MD and Anthony Adamis, MD (r), watch as Dr. Gragoudas officially unveils his portrait. n 2010 HMS Distinguished Alumnus, Stanley Chang, MD, Columbia University College of Physicians and Surgeons (l) and Joseph Rizzo, III, MD, HMS Conference Co-Chair. n Carolyn Kloek, MD (l), Nicole Benitah, MD graduating clinical fellow (retina), John Loewenstein, MD, and Joan Miller, MD. n 2010 HMS Department of Ophthalmology residents and fellow graduates pose with faculty.

Practical Applications of Corneal Asphericity Optimization and the American Board of Ophthalmology and a board member Wavefront-Guided Excimer Laser Surgery,” drew a large and of Prevent Blindness America. His research is designed to enthusiastic crowd. enhance understanding of the delivery of effective healthcare, from the laboratory to patients’ homes, and to improve the care Stanley Chang, MD, presented the first “Distinguished that patients receive, including new methods of accessing care Alumni” lecture on “OCT Management in the Management of by interested parties. A key focus is to understand policy and Vitreoretinal Interface Disorders.” Dr. Chang was a resident in financial factors that influence how care is provided. Dr. Lee ophthalmology at Mass. Eye and Ear from 1976-78. Following presented a lecture on “Asking Questions—or Learning to See retinal fellowship training at Bascom Palmer Eye Institute, the Forest Amidst all the Trees.” Miami, he joined the faculty at Cornell University Medical College where he was appointed professor in 1994. Since 1996, Winners of the awards for best Clinical Poster were HMS Dr. Chang has served as the Edward Harkness Professor of ophthalmology residents, Anthony B. Daniels, MD for Ophthalmology and Chair of Ophthalmology at Columbia his poster titled “Genotype-Phenotype Correlations in the University Medical Center. He has made contributions in Bardet-Biedl Syndrome,” and Rebecca C. Stacy, MD, PhD, the field of Vitreoretinal surgery through the introduction of with a poster on “Histopathological Characterization of perfluoropropane gas, perfluorocarbon liquids, and panoramic Retro-Keratoprosthetic Membranes in the Boston Type 1 viewing systems. He first recognized the occurrence of open Keratoprosthesis.” Winners of the awards for best Research angle following vitrectomy. Poster were Bharathi Govindarajan, PhD, Schepens Eye Research Institute, for her poster titled: “Purification of Our second 2010 Distinguished Alumnus was Paul P. Lee, a Protein Secreted by Non-encapsulated Streptococcus MD, JD, James Pitzer Gills III, MD and Joy Gills Professor of Pneumoniae that Induces MUC16 Shedding in Human Ophthalmology at Duke University School of Medicine and Corneal Epithelial Cells,” and Xiao-Hong Wen, PhD, Howe Vice-Chairman of the Department of Ophthalmology. Dr. Laboratory, Mass Eye and Ear for his poster on, “A Role for Lee received his medical degree from , Guanylyl Cyclase Activating Protein 1 in Setting the Size of the completed residency at Johns Hopkins’ Wilmer Eye Institute, Single Photon Response.” n and a glaucoma fellowship at Mass Eye and Ear. He also holds a law degree from Columbia University. Dr. Lee is a member of

4 Eyewitness Alumni Giving Society Stephen R. Deppermann, M.D. of HMS Ophthalmology @ Mass Eye and Ear Donald J. Doughman, M.D. Our alumni know first-hand that supporting the vital work of our students Aaron M. Fay, M.D. and faculty in the HMS Department of Ophthalmology helps drive continued Gary Neal Foulks, M.D. Saravut S. Fung, M.D. achievement across all areas of education, research and patient care. Since we Edward J. Galbavy, M.D., Ph.D. launched the Alumni Giving Society last December, nearly 100 generous alumni Dasa V. Gangadhar, M.D. have joined the Society which recognizes individuals who make annual gifts of Matthew F. Gardiner, M.D. $1,000 or more within the fiscal year (October 1–September 30). You may designate Alexander R. Gaudio, M.D. Michael W. Gaynon, M.D. and your gift in any way you choose or support one of our numerous programs. Members Susan Ryu, M.D. are invited to Department events throughout the year and are recognized in this C. Mitchell Gilbert, M.D. newsletter and Mass. Eye and Ear publications. Melanie R. Graham, M.D. and Kenneth B. Graham, M.D. Your philanthropy does matter. Help us continue a culture of excellence by planting Scott H. Greenstein, M.D. the seeds of possibility today. To learn more about the Alumni Giving Society and the Jack V. Greiner, D.O., Ph.D. programs supported, please contact Melissa Paul at [email protected] Cynthia L. Grosskreutz, M.D., Ph.D. Peter S. Hersh, M.D. or call 617-573-4168. Gifts are tax-deductible. Our sincerest thanks to the following Ula V. Jurkunas, M.D. Society members: Ivana K. Kim, M.D. Stella K. Kim, M.D. Visionary – Gifts of $10,000 or more Rosa Y. Kim, M.D. Drs. Ernest and Ellen Kornmehl Mark B. Abelson, M.D. Gilbert H. Kliman, M.D. Vera O. Kowal, M.D. Shelby R. Wilkes, M.D., MBA and Jeffrey C. Lamkin, M.D. Peter R. Laibson, M.D. Jettie M. Burnett, M.D. Michael A. Lemp, M.D. Eeva-Liisa Martola, M.D. Evangelos S. Gragoudas, M.D. Simmons Lessell, M.D. W. Wynn McMullen, M.D. Mark S. Hughes, M.D. and Byron S. Lingeman, M.D. Anthony B. Nesburn, M.D. Delia N. Sang, M.D. John I. Loewenstein, M.D. Louis R. Pasquale, M.D. Kenneth R. Kenyon, M.D. Robert A. Lytle, M.D. Victor L. Perez, M.D. Joan W. Miller, M.D. Ben B. Mahan, M.D. Tuyet-Mai M. Phan, M.D. Richard J. Simmons, M.D. Shizuo Mukai, M.D. Roberto Pineda, II, M.D. Janey Wiggs, M.D., Ph.D. and Anwar Shah, M.D. Jonathan D. Primack, M.D. Robert J. D’Amato, M.D., Ph.D. Vinh Tran, M.D. John W. Reed, M.D. Innovator – Gifts of $5,000-$9,999 Robert G. Webster, Jr., M.D. Chandrappa S. Reshmi, M.D. Anonymous Lucy H. Y. Young, M.D., Ph.D. Joseph F. Rizzo, III, M.D. Anthony P. Adamis, M.D. Friend – Gifts of $1,000-$2,499 Perry Rosenthal, M.D. Dimitri Azar, M.D. and Nathalie Azar, M.D. Charles K. Beyer-Machule, M.D. Oliver D. Schein, M.D., M.P.H. John C. Barber, M.D. William P. Boger, III, M.D. Tueng T. Shen, M.D., Ph.D. Thaddeus P. Dryja, M.D. Sheila Borboli-Gerogiannis, M.D. Bradford J. Shingleton, M.D. Michael E. Hettinger, M.D. Jill M. Brody, M.D. C. Eric Shrader, M.D. Mahnaz Nouri, M.D. John M. Carroll, M.D. Stephen U. Stechschulte, M.D. Michael D. Wagoner, M.D. Annabelle Ching-Ang, M.D. and Roger F. Steinert, M.D. Pioneer – Gifts of $2,500-$4,999 Robert T. Ang, M.D. Rhoads E. Stevens, M.D. Stanley Chang, M.D. Wing Chu, M.D. Jonathan H. Talamo, M.D. Michael Chang, M.D. Joseph B. Ciolino, M.D. Felipe I. Tolentino, M.D. M. , M.D., M.P.H., M.Sc. Elisabeth J. Cohen, M.D. Kazuo Tsubota, M.D. Claes H. Dohlman, M.D. Kathryn A. Colby, M.D. Ira J. Udell, M.D. C. Stephen Foster, M.D. Paul R. Cotran, M.D. Demetrios Vavvas, M.D. B. Thomas Hutchinson, M.D. Donald J. D’Amico, M.D. and Stuart R. Winthrop, M.D. Kimberly C. Sippel, M.D.

N ew Report Aims to “Tell the Story” of HMS Department of Ophthalmology The HMS Department of Ophthalmology is preparing a comprehensive report on the department’s numerous accomplishments, key milestones and extraordinary growth during the past several years. Frontiers in Vision Science is meant to inform, educate and engage a variety of audiences on the outstanding work we do in our three-fold mission of clinical care, medical education, and research. The report showcases the efforts of our renowned faculty and their field-defining contributions to ophthalmology and vision science, and spotlights how our growing collaborations with affiliates and partners across the global ophthalmic community are positioning us to fight blinding eye disease on a more robust scale. Targeted publication date of Frontiers in Vision Science is January, 2011. The report will be distributed to a national audience, and will be available in PDF format on the MEEI website.

FALL/WINTER 2010 #15 5 Notes from the Chair, continued from page 1 have come about through effective collaborations between As COI has come into the spotlight, studies reveal that attitudes academia and industry, and we don’t want to lose those among medical professionals about COI may not yet be in opportunities. Dr. was a pioneer in this area, synch with the growing societal/political concern. Korenstein collaborating with numerous pharmaceutical companies in the and colleagues2 explored attitudes of physicians from all US and beyond, including Abbott, Entremed, and specialties toward gifts from and interactions with pharmacy others. Although some questioned this approach, it is impos­ and medical device companies. They found that physicians sible to deny the positive outcomes of these collaborations, “continue to hold positive attitudes toward marketing-oriented including the development of numerous anti-angiogenic drugs activities…” and suggest that “Changes in medical culture and the funding of a broad range of research at Children’s and physician education focused on surgeons and trainees Hospital’s Vascular Laboratories. may align physician attitudes with current Within ophthalmology, industry/academia As COI has come into the policy trends.” Physicians tend to believe collaboration was an important factor in the that their practice patterns are not influenced development of new treatments for macular spotlight, studies reveal by marketing activities and gifts. However degeneration and , that attitudes among data has shown otherwise, and companies including (Visudyne)® medical professionals pursue these strategies because they are and the anti-VEGF drugs Macugen®, effective. In addition, the whole patient- Lucentis® and Avastin®. Federal funding about COI may not yet be physician relationship is built on trust, and agencies were not supportive of this work, in synch with the growing if concern over inappropriate influence by and most pharmaceutical companies had not societal/political concern. pharmaceutical and device companies erodes recognized ophthalmology, especially retinal that trust, then patient care is compromised. disease, as a market worth developing. It was Zinner et al3 surveyed scientists and really only through the passion and persistence of the Harvard administrators at NIH and found that the Institute’s 2005 angiogenesis researchers, including Drs. Tony Adamis, Evan ethics rules did what they were supposed to do—limited Gragoudas, Patricia D’Amore, Lloyd Aiello and myself, that relationships with industry while maintaining NIH researchers’ these avenues were pursued and resulted in new treatments and associations with external scientific and professional vision improvement for patients. organizations. However, the rules negatively affected personnel morale and the perceived progress of research. A 2009 report from the Institute of Medicine of the U.S. National Academies1 lays out many of the concerns about The influence on trainees is of particular concern to many. potential conflict of interest between medicine and both While there has been some preliminary work in ophthal­ pharmacia and the medical devices industry. The report mology programs to assess the behavior and attitudes towards defines conflict of interest as “circumstances that create a risk pharmaceutical promotions, the field is more advanced in that professional judgments or actions regarding a primary other specialties. Sah and Loewenstein4 surveyed residents interest will be unduly influenced by a secondary interest.” The in pediatrics and in family medicine to determine whether report goes on to note that the “central goal of COI policies in reminding residents of the sacrifices they made to become medicine is to protect the integrity of professional judgment and physicians influenced their attitudes regarding gifts from to preserve public trust.” Note that this is a proactive goal—to industry. Hardships experienced by physicians in training encourage ethical behavior and preclude conflict rather than results in the expectation of delayed gratification that may to try to remediate bias or mistrust after it occurs. Examples of or may not be realized in terms of compensation. Training COI may include: involves grueling hours during long years of training, stressful work life; pressures on home/family life and often leaves new n Physicians failing to disclose substantial payments from drug physicians with substantial debt from their education. These companies. n factors seem to influence newly trained physicians’ willingness Investigators not publishing negative results from industry- to accept gifts. Sah and Loewenstein tested this hypothesis sponsored clinical trials or delaying publication for a by measuring responses with and without reminders of the significant time. “sacrifices” and found that reminders influenced respondents’ n Academic researchers being listed on publications, even willingness to accept gifts from industry by providing them a though they were not involved in data collection/analysis rationale and justification. Indeed, reminding trainees of their and after early drafts are written by individuals employed by sacrifices resulted in gifts from industry being evaluated as industry. more acceptable. Wang and Adelman5 surveyed ophthalmology n Professional societies that develop clinical practice guidelines residents to evaluate their behavior and attitudes toward choosing not to disclose their industry funding or reveal COI pharmaceutical promotions. Prescribing practices appeared to of experts who draft such guidelines.

6 Eyewitness be influenced by receiving information or drug samples; and on a searchable, publicly available website on the DPH portal although half of the respondents acknowledged knowing about beginning sometime in 2011. Meanwhile, the Physician guidelines or policies, only 28% reported having received COI Payments Sunshine Provisions in the new federal health care training. On a more positive note, an April, 2010 article in reform law will give the US Department of Health and Human Archives of Internal Medicine revealed broad support within the Services authority to establish, starting in 2013, a national health care community, including trainees, for transparency in system for reporting payment and other “transfers of value” to relationships with industry and full disclosure of same.6 physicians and teaching hospitals from manufacturers of drugs, devices, biological, or medical supplies.8 In April, 2010 the Council of Medical Specialty Societies, which includes the Policies on conflict of Our professional societies, regulating AAO among its members, released its own agencies, grantors, even the industries Code for Interactions with Companies.7 It interest are a fact whose themselves are pro­mulgating policies sets forth 10 principles in four key areas, time has come; the old designed to modify conduct to avoid COI. a) conflict of interest, b) financial disclosures, paradigm no longer holds. Right now, many professionals don’t like it. c) independent program development, What should our attitude be? First, read up and d) independent leadership. New Far better for medical on the issue and proposed regulations from policies at Harvard Medical School, with professionals ourselves your institution, employer and professional implementation beginning in January to take an active part in societies like the AAO. Second, get involved. 2011, restrict research interaction with devising COI policies and Policies on conflict of interest are a fact pharmaceutical and medical device whose time has come; the old paradigm manufacturers. Among the provisions is a procedures than to have no longer holds. Far better for medical ban on faculty accepting personal gifts; a cap them handed down to us professionals ourselves to take an active part of $10K for compensation provided to an by politicians, theorists, in devising COI policies and procedures individual researcher for work on technology than to have them handed down to us owned or licensed by a given company; and other policy makers. by politicians, theorists, and other policy and a prohibition on speakers’ bureaus or makers. We want to maintain the positive speaking engagements where faculty are paid to give a speech advantages of collaboration and philanthropy, especially in prepared by a company in advance. Harvard has a history of educational grants and research, while holding ourselves free strict policies regarding interactions with industry and conflict from possible bias. We must treasure and ensure the public’s of interest, although the new policy goes somewhat further. trust. No one can do it better than we can. n At Harvard, the challenge comes with implementation, since Harvard Medical School has approximately 8000 full time 1  Conflict of Interest in , Education, and Practice. Lo, Bernard and Marilyn J. Field, Eds. The National Academies Press, faculty, with most employed by the affiliated hospitals and Washington, DC. institutions, and over 3000 part-time faculty, many of whom 2  Korenstein D, Keyhani S, Ross JS. Physician attitudes toward industry: are in private practice. Physicians and researchers at Harvard a view across the specialties. Arch Surg. 2010 Jun;145(6):577. and beyond, face the challenge of understanding the policies 3  Zinner DE, Desroches CM, Bristol SJ, Clarridge B, Campbell EG. and determining how they apply, since in most cases there Tightening Conflict-of-Interest Policies: The Impact of 2005 Rules at will be overlap between hospital, medical school, professional the NIH. Acad Med 2010 Sep 16 [Epub ahead of print]. society, state and federal policies. 4  Sah, S and G Loewenstein. Effect of reminders of personal sacrifice and suggested rationalizations on residents’ self-reported willingness to State and federal governments are passing legislation to increase accept gifts: a randomized trial. JAMA. 2010 Sep 15;304(11):1233-5. disclosure requirements and transparency. In Massachusetts 5  Wang Y and RA Adelman. A study of interactions between the Office of Health and Human Services implemented a pharmaceutical representatives and ophthalmology trainees. Am J Pharmaceutical and Medical Device Manufacturers Code Ophthalmol. 2009 Oct;148:(4):619-622.e3. Epub 2009 Jul 1. 6 of Conduct and its disclosure requirements (www.mass.gov/  Campbell EG. Public disclosure of conflict of interest: moving the debate forward. Arch Int Med 2010 Apr 26;170(8):667. dph/pharmamed). This regulation requires manufacturers, 7  Available at: www.cmss.org/coseforinteractions.aspx. beginning July 1, 2010, to disclose payments made to 8  Harris S. New Conflict of Interest Rules Help Spur Financial Disclosures “covered recipients,” defined as any person authorized to Online. AAMC Reporter: June 2010. www.aamc.org/newsroom/ prescribe, dispense or purchase prescription drugs, biologics, reporter/june10/conflict.htm or medical devices. The disclosed information will be posted

The opinions in this article are solely those of the author and do not reflect any HMS or Mass Eye and Ear institutional policy. To comment, write to [email protected].

FALL/WINTER 2010 #15 7 News from All Over

Gil Grand, MD, Professor Ophthalmology of Clinical Ophthalmology and Visual Sciences at Grand Rounds Washington University A cademic Year ’10-11 School of Medicine supervises retina Grand Rounds are held every fellow, Dr. David Pan, Thursday from 8:00-9:00 AM in as he practices surgical Meltzer Auditorium, 3rd Floor, MEE. techniques using an Eyesi Continuing Medical Education virtual reality simulator. credit is available. A monthly list Observing is Marshall Dial, is posted on the MEE website at VP of Sales from VR Magic, www.masseyeandear.org. the company that developed Eyesi. Training S pecial Grand Rounds Speakers took place during MEE’s new Vitreoretinal Course December 2, 2010: Neuroscience for first-year retina fellows. Grand Rounds (MGH Etherdome): John I. Loewenstein, MD January 20, 2011: Ivana K. Kim, MD March 10, 2011: Joseph F. Rizzo, III March 14, 2011: Boston Ophthalmic Eliot L. Berson, MD, William F. MD Pathology Lecture Series, Retina, Chatlos Professor of Ophthalmology March 31, 2011: Reza Dana, MD, MSc, Tatyana Milman, MD, New Jersey and Director of the Berman-Gund MPH Medical School Laboratory for the Study of Retinal Degenerations at Mass. Eye and Ear, June 9, 2011: Dean Eliott, MD (Joins May 7-8, 2011: Annual Harvard was named the 2010 recipient of The HMS Ophthalmology faculty at MEE in Intensive Cataract Surgical Training Award of Merit in Retina Research late 2010) Course for Second-Year Residents from The Retina Society. May 16, 2011: Boston Ophthalmic Pedram Hamrah, MD, Assistant Pathology Lecture Series, Upcoming Events Professor in Ophthalmology was Phakomatoses and Optic Nerve, The Department of Ophthalmology at awarded nearly $230K from Alcon Hans E. Grossniklaus, MD, Emory Mass. Eye and Ear sponsors a range Research, Ltd for a Confocal Medical School of special lectures and courses. For Microscopy project. He also won a further information, please consult the June 16, 2011: Department of $20,000 grant from Fight for Sight for Ophthalmology Education section at Ophthalmology Residents and his Imaging Alloimmunity project. www.masseyeandear.org. Fellows Graduation Ivana K. Kim, MD, Assistant Professor December 8, 2010: Pediatric June 17, 2011: Department of of Ophthalmology, received a new Ophthalmology Visiting Professor Ophthalmology 2011 Annual and 2-year R21 (exploratory/developmental Lecture Series, Children’s Hospital Alumni Meeting research) award totaling almost Boston, William V. Good, MD, Smith- $226,000 from the National Cancer July 22-23, 2011: Annual Harvard Kettlewell Eye Research Institute Institute to study “Oncogene Mutation Medical School Department of Profiling in Uveal Melanoma.” December 17-18, 2010: Paul A. Ophthalmology Fellows’ Course in Chandler Visiting Professorship: Vitreoretinal Surgery Four HMS Ophthalmology faculty Resident Case Presentations, Monte D. are the recipients of the latest round Mills, MD, University of Pennsylvania of Harvard Catalyst Grants. Lucy Q. Shen, MD and Louis R. Pasquale, MD February 3-4, 2011: Cornea Service Awards, Grants & of the Glaucoma service received a Visiting Professors, Jayne S. Weiss, grant for clinical research on OCT MD, Detroit Medical Center Other Honors and glaucoma, in collaboration with Joan W. Miller, MD, Ophthalmology February 23, 2011: Ephraim Friedman radiologist Andy Tsai, MD, from Department Chief and Chair, won the Lecture, Frank G. Holz, MD University Children’s Hospital Boston. Dean M. 2010 Suzanne Verroneau-Troutman Eye Hospital, Bonn, Germany Cestari, MD, Neuro-Ophthalmology Award from Women in Ophthalmology. service is collaborating with Dong February 25, 2011: Harvard Visiting The award was presented during the Feng Chen, MD, PhD, SERI to work on Professorship and Residents’ Course, AAO meeting in Chicago, October, in vivo imaging in a mouse model of Topic: Advances in Detection and 2010. optic nerve and retinal injury. Treatment of Ocular Infections, Todd P. Lloyd P. Aiello, MD, PhD, Professor Margolis, MD, PhD, UCSF Medical MEEI’s Retina and Cornea services, of Ophthalmology, was granted a Center under the guidance of Fellowship Lew R. Wasserman Merit Award from Directors Mukai Shizuo, MD and March 10-11, 2011: Cornea Service Research to Prevent Blindness. James Chodosh, MD, MPH, have won Visiting Professors, Penny A. Asbell, Allergan Horizon Grants to support MD, The Mount Sinai Medical Center

8 Eyewitness the research work of their fellows. P ersonnel Changes The awards fund clinical research in Staff Updates Kip Connor, PhD, Instructor in the diagnostic or pharmacological C ongratulations to the following Ophthalmology and Mien Hoang, PhD, treatment of glaucoma, corneal and Instructor in Ophthalmology, both staff on their HMS promotions/ retinal diseases. joined the Angiogenesis Lab in the appointments: Roberto Pineda, II, MD, Assistant Howe Laboratory at Mass Eye and Ear. L loyd P. Aiello, MD, PhD, Beetham Professor of Ophthalmology, received Eye Institute/Joslin, Professor of Leo T. Chylack, Jr., MD, Clinical a $15,000 grant from Alcon Research, Ophthalmology Professor of Ophthalmology, retired Ltd for the Aberrometers Study on August 1, 2010. Dr. Chylack received Project. Dong Feng Chen, MD, PhD, Schepens his MD from Harvard Medical School Eye Research Institute, Associate Houman David Hemmati, MD, PhD, in 1964, and completed a fellowship Professor of Ophthalmology clinical fellow in the Cornea Service, in lens biochemistry in 1970 at the has been selected the 2010-11 Alcon Michael S. Gilmore, PhD, Professor of Howe Laboratory of Ophthalmology, Research Scholar. Ophthalmology, Mass Eye and Ear, was where he was mentored by Jin H. formally named as the first incumbent Kinoshita, PhD and David G. , MD, PhD, has been of the Sir William Osler Professor of Cogan, MD, both pioneers in lens awarded one of the most prestigious Ophthalmology at HMS research. He went on to complete his recognitions that a biomedical scientist residency in Ophthalmology at the can achieve: the 2010 Lasker-DeBakey Evangelos S. Gragoudas, MD, Massachusetts Eye & Ear Infirmary Clinical Medical Research Award. Professor of Ophthalmology, Mass Eye in 1971. From 1971-1997, he served Dr. Ferrara was a collaborator in the and Ear, was formally named as the as Chief, Division of Ophthalmology vital angiogenesis research undertaken first incumbent of the Charles Edward at Brigham & Women’s Hospital at HMS in the last two decades, Whitten Professor of Ophthalmology and, since 1993, Director, Center for leading to the anti-VEGF therapies at HMS Ophthalmic Research, Brigham and that have revolutionized care of wet David G. Hunter, MD, PhD, Children’s Women’s Hospital. Dr. Chylak has been AMD. We extend to him our heartiest a wonderful asset to the Department congratulations. Hospital Boston, Professor of Ophthalmology and HMS. We wish him the best. Ula V. Jurkunas, MD, has received Ali Hafezi-Moghadam, MD, PhD, left approval from PACT (Production Richard H. Masland, PhD, Professor of Ophthalmology, Mass Eye and Ear, was Mass Eye and Ear this summer for Assistance for Cellular Therapies) other opportunities. for support in the manufacture of formally named the David Glendenning cultivated corneal and oral epithelial Cogan Professor of Ophthalmology at Margaret M. DeAngelis, PhD, left Mass stem cells for . HMS Eye and Ear this summer for a position Dr. Jurkunas, in conjunction with Demetrios G. Vavvas, MD, PhD, Mass at University of Utah. Reza Dana, MD, PhD, MPH is Eye and Ear, Assistant Professor of collaborating with researchers from Ophthalmology Harvard’s Immune Disease Institute and the Dana Farber Cancer Institute. R eaching out to Ilene K. Gipson, PhD, FARVO, is the community: the newest Leadership Committee MEEI Glaucoma member of ARVO’s Women in Eye and Service Manager Vision Research (WEAVR). WEAVR and Ophthalmic was established to further develop and Technician, strengthen the career path of women Carolyn Shea (l), in eye and vision research. Dr. Gipson conducts tests is the founding chair of Women’s Eye of visual acuity Health.org, an advocacy and outreach during a vision screening at Camp organization aimed at preventing/ Harbor View on reducing eye disease in women and Long Island in their families. Boston. MEEI staff HMS faculty Bonnie A. Henderson, MD, Leslie Dennis and Tiffany Tran assist. Deborah S. Jacobs, MD and Louis R. Pasquale, MD were presented with Secretariat Awards from the American Academy of Ophthalmology at the Academy’s 2010 Joint Meeting in Chicago in October. The awards recognize “significant contributions” to the Academy and to the profession of Ophthalmology.

FALL/WINTER 2010 #15 9 Dr. Danielle of common and important neuro- Ledoux, MD, ophthalmic disorders. Course Director Children’s Hospital Joseph F. Rizzo, III MD, describes Boston (l) performs the program’s unique format as strabismus surgery “traditional medicine played out in on a pediatric front of a live audience.” Cases were patient during a presented to a distinguished panel mission trip to of six senior neuro-ophthalmologists Guatemala in 2010. who discussed and diagnosed them in Surgical technician, Rita Robillard, real time. assists. Clinical, Assessment and Intervention Updates in Neurorehabilitation, November 19th-20th, 8:00am to 6:00pm, The Inn at Longwood, Fenway Room, Boston, MA. Please join faculty and researchers from and around the world for a two-day course on novel technologies in Neurorehabilitation. The course Service Education Updates is designed for rehabilitation L ucy Q. Shen, MD, Instructor in A new and innovative educational professionals (physiatrists, Ophthalmology, and David S. event designed exclusively for first- neurologists, psychiatrists, PTs, Walton, MD, Clinical Professor year Vitreoretinal fellows debuted OTs, and neuroscientists) who wish of Ophthalmology, both recently in July with the first annual HMS/ to learn more about the technology presented public information lectures MEEI Vitreoretinal Course for First- applied in Neurorehabilitation sponsored by the New England chapter Year Retina Fellows. Developed research. Online participation is of the Glaucoma Foundation. On and directed by Residency Program offered. Course Directors: Felipe Saturday, October 23, the foundation Director, John I. Loewenstein, MD Fregni, MD, PhD, MPH, Director, sponsored Tatjana Jakobs, PhD, and Demetrios G. Vavvas, MD, PhD, Laboratory of Neuromodulation, Instructor in Ophthalmology, who this unique and comprehensive one- Spaulding Rehabilitation Hospital, lectured on current research in day workshop, modeled after MEEI’s Assistant Professor of Neurology, glaucoma. nationally-renowned cataract surgery Harvard Medical School, and Lotfi B. course, covers the theory and practice Assistant Professor Roberto Merabet, OD, PhD, FAAO, Associate of Vitreoretinal surgery. Participants Pineda, II, MD, flew on an ORBIS Director, Vision Rehabilitation joined a distinguished group of mission to Malaysia this past sum­ Service, Mass. Eye and Ear Infirmary, faculty in lectures, video, wet labs mer. Dr. Pineda is also one of six new Assistant Professor in Ophthalmology, and a surgical simulation laboratory members to join the International Harvard Medical School. For outfitted with five EyeSi simulators. Advisory Committee of Tissue Banks more information, please contact The intensive, one-day workshop International (TBI). The committee Jennifer Schadler at 617-573-2195, drew 40 first-year Vitreoretinal fellows assists in providing strategic oversight or [email protected]. Or visit from across the US and provided for TBI’s international programs, such www.neuromodulationlab.org and a low 2:1 student-teacher ratio. as identifying areas of the world that click on courses/events for details. Dr. Loewenstein describes this newest could most benefit from TBI eye and educational venue as “…simply an The Tear Film & Ocular Surface Society tissue banking programs. amazing opportunity for participants (TFOS) is a non-profit organization For the fifth year in a row, pediatric to learn directly from some of the most created to advance the research, ophthalmologist Danielle M. Ledoux, eminent faculty in the world and, in a literacy, and educational aspects of MD, participated as part of a surgical short time, add immeasurably to their the scientific field of the tear film and mission trip to Hermano Pedro fund of knowledge and surgical skills.” ocular surface. Recently, under the Hospital in Antigua, Guatemala. Next year’s course is scheduled for direction of Co-founder and President, July 22-23 and will host an even larger David A. Sullivan, PhD (Schepens Mass. Eye and Ear and Children’s cohort. Eye Research Institute), TFOS hosted Hospital Ophthalmology Foundation its 6th International Conference on teamed up recently to provide A highly successful repeat of the the Tear Film and Ocular Surface: pediatric vision screenings to more biennial Neuro-Ophthalmology Fall Basic Science and Clinical Relevance than 100 children at the Neighborhood Festival was held in October and drew (September 2010; Florence, Italy; 600+ House Charter School in Dorchester. an enthusiastic audience of more than participants), sponsored a Regulatory The school is home to 400 children of 100 neurologists and ophthalmologists Experts’ Meeting entitled “Global diverse backgrounds. from around the country. Through a Treatments for Dry Eye Syndrome: mix of lectures, case presentations and An Unmet Need (September 2010; Q&A, the one-and-a-half day program Florence, 210 attendees), organized provided a comprehensive overview International Workshops on on the diagnosis and management

10 Eyewitness Meibomian Gland Dysfunction and Dry Dr. Steve Charles, Eye Syndromes, which have generated renowned major reports and a worldwide Vitreoretinal surgeon consensus on the definition, diagnosis and Clinical Professor and treatment of these diseases, and of Ophthalmology oversaw the awarding of numerous at the University of Young Investigator Travel Awards. Tennessee Health TFOS has also sponsored, and Science Center, promoted the growth and recognition was among the distinguished faculty of the peer-reviewed journal, The participating in the Ocular Surface, which now has the 3rd HMS/MEEI first highest impact factor of all ophthalmic annual Vitreoretinal journals. TFOS has approximately Course held in July. 600 members, and another ~3,400 interested basic scientists, clinicians and industry representatives from over 80 countries. For information about problems. This work was published 1972-73. Dr. Braconier is survived by TFOS, please visit www.tearfilm.org. in an article by Medill Reports, his wife, Virginia Strauss Braconier, Northwestern University, Evanston, two children and three grandchildren. IL entitled, “Screenings Target HMS alumnus, William R. Green, Mass Eye and Ear Undetected Vision Problems that MD, a world-renowned pathologist— Could Lead to Blindness.” Dr. Palmer ophthalmologist and former head Space Renovations is in private practice in Chicago and of the eye pathology laboratory of Construction is underway for a new Glenview, IL. the Wilmer Eye Institute at Johns oculoplastics clinic on the tenth floor During its 60th anniversary celebration Hopkins Hospital, died July 5 at his of the main building, including 5 in October, Schepens Eye Research Ruxton, MD home. He was 76. In examination rooms, two procedure Institute honored Tatsuo Hirose, MD the early 60’s, Dr. Green worked at rooms and administrative offices for with its 2010 Distinguished Alumni MEEI’s Howe Laboratory and was the faculty, with estimated completion Award. Dr. Hirose, a Clinical Professor a research fellow at The Retina in April, 2011. Once the move is of Ophthalmology at HMS, came to Foundation (later renamed the complete, major renovations will the US in 1969 where he completed Schepens Eye Research Institute). ensue on the first floor clinic area, a fellowship in electrophysiology at During his career, he authored more with a net result of approximately 15 Cornell Medical Center; a Vitreoretinal than 700 medical papers and received additional ophthalmology examination fellowship at the Schepens Eye numerous national awards, including rooms. Also planned for 2011 is a Research Institute (at the time the the Greatest Living Ophthalmologist renovation and expansion of Neuro Retina Foundation); and a clinical Millennium Award and the American Ophthalmology’s space on the ninth fellowship in the Retina Service at the Academy of Ophthalmology’s Lifetime floor of the main building. Massachusetts Eye and Ear Infirmary. Achievement Award. He is survived Dr. Hirose is world renowned for by two sons, a sister and three his expertise in the human retina, granddaughters. Alumni News and especially for his treatment of N icholas J. Volpe, MD, HMS advanced Retinopathy of Prematurity, C orrection: Resident in Ophthalmology 1988- complicated retinal detachments and The Eyewitness staff extends its most 1991, Chief Resident, 1992-1993, and Stickler Syndrome. sincere apologies to Lotfi Merabet, MEE Neuro-ophthalmology Fellow, OD, PhD, FAAO, whose name we Harry E. Braconier, MD (HMS residency 1991-1992 has been appointed the misspelled in the Staff Updates section alumnus 1943-45) passed away at Tarry Professor and Chair of the of our last newsletter, #14. Department of Ophthalmology at his home in Weston, MA in August, Northwestern University Feinberg 2010, at age 100. Dr. Braconier’s School of Medicine and Northwestern ophthalmology practice spanned six Memorial Hospital, together known as decades; he saw his last patient in Northwestern Medicine. 2003 at the age of 93. A committed Have a program or course to and enduring friend of the Boston publicize? We would be happy David J. Palmer, MD, Mass Eye and ophthalmology community, he enjoyed Ear Glaucoma Fellow, 1984-85, Clinical his HMS teaching opportunities and to list it in the newsletter and at Assistant Professor, Northwestern was involved with the planning of the the department’s web page site University Feinberg School of Mass Eye and Ear tower from 1969-73. on eCommons. Contact us at Medicine, Chicago, is participating in He contributed generously and was [email protected]. a national initiative to target greater a member of the Reynolds Society eye health in the Hispanic population, for many years. He was also active in which has a high prevalence of the New England Ophthalmological potentially correctible vision-related Society and served as its president in

FALL/WINTER 2010 #15 11 FIRST-CLASS MAIL The Newsletter of the Harvard Medical School US POSTAGE D epartment of Ophthalmology PAID PERMIT NO. 51711 Eyewitness BOSTON, MA

243 Charles Street, Boston, MA 02114

SAVE THE Hra va d Department of Ophthalmology DATES! Special Lectures

December 17-18, 2010 Paul A. Chandler Visiting Professorship: Resident Case Presentations Monte D. Mills, MD Associate Professor of Clinical Ophthalmology University of Pennsylvania

February 23, 2011 Ephraim Friedman Lecture Frank G. Holz, MD Chairman and Professor of the Department of Ophthalmology University of Bonn, Germany

February 25, 2011 Harvard Visiting Professorship and Residents’ Course Topic: Advances in Detection and Treatment of Ocular Infections Todd P. Margolis, MD, PhD Professor of Ophthalmology University of California, San Francisco