sign in sign up
<<
Home , Alon Harris, Eye surgery, SUNY Eye Institute

SUNY Downstate Medical Center Department of

Experts in Care

Pioneers in Research

Leaders in Academics

Phone (718) 270-1714 • Fax (718) 270-2972 • http://www.downstate.edu/ophthalmology members rotate among the sites. This approach has permitted us to keep faculty fully occupied and challenged while extending the benefits of their special abilities to patients at several institutions. Additionally, we have purchased advanced diagnostic technologies in all areas, allowing for the management of complex disease. In 2010, we added additional faculty in and who will work at both Downstate in Chairman’s the faculty practice, and at Kings County Center with residents. Our faculty, plus our improved facilities and expanded clinical offerings, have, indeed, dramatically increased demand for ophthalmology services. At our largest clinical affiliate, Kings County Hospital, outpatient visits Message have increased significantly year after year over the last decade, and leadership has provided a wonderful opportunity for growth of our service in both the and the operating room. We relocated to a modern 9,500 square feet Eye Clinic in Kings County in 2006 due to continued growth of the service, which now provides EMR, networked digital image analysis at the work station, simulated training, and a minor procedure room in this state-of-the-art facility.

We have similarly expanded the faculty practice facility at Downstate, known as The Midwood Eye Center, located conveniently on Nostrand Avenue near the junction of Flatbush Avenue. This impressive facility boasts 16 exam rooms in addition to multiple other diagnostic and treatment areas.

Our eye research program has vastly grown in the basic science area. Long known for excellence in clinical research, we now are deeply committed to the study of various eye diseases at the cellular level, and our PhD scientists are working feverishly to find cures for . With many basic and clinical studies currently The Department of Ophthalmology at SUNY Downstate Medical Center has a well-established history of underway, I am proud to have led this significant expansion of research at Downstate, along with my Director accomplishment as an educator of . The program's reputation as a center of research excellence of Research, William Brunken, PhD, one of the world’s authorities on retinal extracellular matrix proteins. has blossomed in the last few years, and our clinical service provides state-of-the-art care to residents of the Brooklyn community. We currently have funding in addition to extramural grant support to help with our research endeavors. Ophthalmology residents and medical students have been fully integrated into our research program In assessing the potential of our ophthalmology program in Brooklyn, a comparison is instructive. SUNY and actively participate in all phases of our studies. Furthermore, we have been leaders in the conception and Downstate's catchment area contains a population of approximately 685,000—roughly equal to that of the formation of the SUNY Eye Institute, a statewide consortium of many of the top eye researchers across the state city of Boston. In 1996, the residents of Boston were served by 250 practicing ophthalmologists; in contrast, from SUNY’s four academic medical centers and SUNY , which allows us to cross-train and teach, SUNY Downstate's catchment area had only eight. This paucity of ophthalmologists had historically motivated collaborate on projects, and at the same time share important resources. many Brooklynites to turn to physicians for eye care, as evidenced by the fact that 30 to 40 percent of ophthalmology patients treated in Manhattan lived in Brooklyn. This trend has stopped as our faculty Many other details of our program—and their positive results—are described in the report that follows. Suffice practice now boasts 18 UOC (University Ophthalmic Consultants) doctors who span all disciplines within it to say that our diverse and expert faculty, plus our improved facilities and expanded clinical and research ophthalmology and provide the most advanced care for the most complicated disease states. offerings, have dramatically increased demand for ophthalmology services in Brooklyn. We are poised to meet the challenge and serve as leaders in the field. These facts point to both an opportunity and an urgent need. The goals we have attained have promoted Brook- lyn as a desirable practice environment for faculty physicians and residents-in-training. We have enthusiastically committed ourselves to providing desperately needed care for the many community residents with , of diabetes, and other disorders that are potentially blinding or that otherwise diminish their quality of life. Our faculty and residents come from all over the United States and we are fortunate to have many grad- Douglas R. lazzaRo, MD, FaCs, Faao uates of the program involved in many aspects of the teaching program after completing their training. Professor and Chairman The Richard C. Troutman, MD, Distinguished Chair in Ophthalmology and Ophthalmic Microsurgery The department has been fortunate to win support and funding from the SUNY Downstate leadership and our affiliated clinical practice sites. This, in turn, has allowed for the recruitment of first-rate faculty. Single individuals are made responsible for each of six subspecialty programs networkwide, and many faculty

SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology Leaders in Eye Care SUNY Eye Institute www.sunyeye.org The State University of Downstate Medical Center has a rich tradition in , research and clinical care, dating back to 1860 when Long Island College Hospital became the first in the United Groundbreaking Research, Novel Insights, Unlimited Possibilities States to include bedside teaching in the curriculum.

The Division of Ophthalmology was formally instituted in 1873. Today, the Department of Ophthalmology employs In August 2009, the academic health science centers, responding to a faculty-generated initiative, formed the SUNY state-of-the-art procedures to provide both adult and pediatric patients with the best possible care for a broad range Eye Institute (SEI), a state-wide consortium of vision researchers from all four academic medical universities in the of ocular disorders. SUNY system (Downstate, Upstate, Stony Brook and Buffalo) and the SUNY College of Optometry. This group of investigators represents over 45 laboratories making great strides against blinding diseases. Through the SEI we provide statewide leadership in translational vision research.

The SEI Brooklyn is an integral part of the consortium. We are particularly focused on those disorders that affect patients in our culturally diverse community. These include glaucoma, age-related , , , retinopathy of prematurity, and congenital and acquired refractive disorders.

Our multi-investigator research teams are made up of clinical and basic researchers from the Departments of Ophthalmology and Cell Biology. We have extensive collaborations across the state, the nation, even worldwide.

We provide research training opportunities for undergraduate, graduate and medical students. Moreover, all ophthalmology residents are required to complete one research project.

Our research staff is supported by federal grants from the National Eye Institute and from private foundations includ- ing the Foundation Fighting Blindness, Research to Prevent Blindness, and the E. Matilda Ziegler Foundation.

Basic and Clinical Research Collaboration Collaborative teams of basic and clinical scientists are working hard to advance our understanding of eye disease. The Department of Ophthalmology has a long and distinguished history of research contributions in the field of ophthal- mology. Current faculty continues that tradition as they employ cutting-edge technology in research projects that enhance I Dr. William Brunken's group is interested in the role article in Archives of Ophthalmology demonstrates our understanding of the structure, function and disorders of the eye and . A particular focus of current of laminins in eye development and disease. Their re- retinal thinning in persons with Parkinson's disease. research is the determination of the etiology, pathophysiology and treatment of eye diseases across ethnic boundaries. cent paper, published in Investigative Ophthalmology Dr. Bodis-Wollner is funded by the Michael J. Fox & Visual Science, shows that disruptions of laminins Foundation for Parkinson’s Research. Vision researchers at SUNY Downstate Medical Center are a multidisciplinary group of cell, molecular and developmental can cause congenital retinal disease. Dr. Brunken is biologists, as well as clinical scientists. We join research efforts across departmental boundaries—ophthalmology, cell funded by the NEI. I biology, and —forming a cohesive collaboration that addresses the clinical needs of Brooklyn, Dr. Brahim Chaqour has teamed up with clinicians Queens and Staten Island. Our investigators include faculty, residents, and medical and graduate students who meet to address the role of extracellular matrix molecules regularly to discuss their work as well as that of others. I Dr. John Danias was awarded a new grant of $500,000 in regulating vascular development. Their paper, from the National Eye Institute to study steroid-induced published in , details how components Our outstanding facilities for basic science and clinical research and treatment all feature modern, state-of-the-art equip- glaucoma. Long-term steroid treatment can provoke of the ECM lead to blood vessel remodeling. Dr. ment. At Downstate there are a number of dedicated eye research laboratories in addition to other labs, where eye and glaucoma, and Dr. Danias, along with Dr. Oscar Candia Chaqour is funded by the NEI. other areas of cell biology research are being conducted simultaneously. A new animal facility is under construction at of Mount Sinai Medical School, is studying the molecu- Downstate and will be opening shortly. The very significant expansion of vision research conducted on campus has led lar and genetic changes caused by steroid use in the eye I Dr. Douglas Lazzaro and Dr. William Brunken have to National Eye Institute funding and other public and private funding. to better understand how to avoid these complications. teamed up to study the role of the extracellular matrix in corneal disease and repair. Their recent presentation Our large residency training program and faculty practice gives us the ability to examine a very diverse group of patients I at the International Association for Research in Vision exhibiting the entire spectrum of eye disease. This allows us to perform clinical studies and, in addition, should give us Dr. Ivan Bodis-Wollner heads a team of neurologists, and Ophthalmology demonstrated that laminins and an unprecedented opportunity to bring translational science to future clinical applications. ophthalmologists and basic scientists studying the retinal effects of Parkinson's Disease. Their recent netrins regulate corneal epithelial proliferation.

2 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 3 Staff Dry Eye Service Kichiemon Asoma, MD – UHB, LICH Michael Ehrenhaus, MD – UHB, LICH More than six million Americans suffer from dry , and Himani Goyal, MD – Bay Ridge the number of symptomatic individuals is increasing as our Douglas Lazzaro, MD – Bay Ridge, LICH population ages. For the dry eye patient, early evaluation Bradley Phillips, MD – UHB and treatment is important to prevent ocular surface damage before it occurs, as well as to relieve patient discomfort. Typically, lid function, lacrimal system function and the conjunctival surfaces all play a role in the development of , External Disease, dry eye conditions. Successful treatment depends on com- and Refractive plete evaluation of the patient and potential treatment modalities based on the specific etiology identified. Ocular Service lubricants are the mainstays of , but punctal occlusion, University Ophthalmic Consultants provides subspecialty repositioning of the or, occasionally, conjunctival consultation, treatment and surgery in cornea, external transplants may be indicated. disease and at both University Hospital Because a patient's work or lifestyle can exacerbate dry of Brooklyn and Long Island College Hospital. eye symptoms, our experts often prescribe a daily regimen Consultations are offered for patients with conjunctival specifically tailored to control his or her condition. scarring diseases, including chemical burns and Steven Contact Us Clinical Services Johnson Syndrome; corneal stromal dystrophies and For further information, or to make a referral or schedule degenerations; corneal endothelial disorders; herpetic an appointment, please call: disease (HSV, VZV); corneal ulcers; ocular trauma; and sicca (KCS), or dry eyes. University Hospital of Brooklyn (718) 270-1714 Long Island College Hospital (718) 780-1530 Set your sights high. Comprehensive Consultative Testing Bay Ridge (718) 748-1334 We do. Ophthalmology Ancillary corneal testing is available either in conjunction Physician Staff with a consult visit or by specific appointment. Test results Kichiemon Asoma, MD – UHB, LICH I Comprehensive Ophthalmology The University Ophthalmic Consultant's comprehensive are interpreted by the service's director. Tests offered include Michael Ehrenhaus, MD – UHB, LICH ophthalmologists can diagnose and treat most ocular computerized video ; endothelial cell Himani Goyal, MD – Bay Ridge I Cornea and External Disease Service disorders. When more advanced diagnosis or treatment is counts; corneal pachymetry; pneumotonometry; and anterior Douglas Lazzaro, MD – Bay Ridge, LICH I Corneal Refractive Surgery / Laser Vision Surgery / indicated, they will refer patients to one of UOC's outstanding segment photography. Surgeons perform PRK, LASIK, Intacs, Intac Implants subspecialists. and cataract procedures. The Consultative Service's board-certified physicians I Contact Services perform a complete range of examinations, with appropriate Contact Us Glaucoma Service I Dry Eye Service diagnostic tests, and treat conditions such as , infec- For further information, or to make a referral or schedule Several ethnic groups in the Brooklyn community suffer tious and allergic , and . Our compre- an appointment, please call: a high incidence of various forms of glaucoma. The UOC I Glaucoma Service hensive physicians screen for diabetic retinopathy and also University Hospital of Brooklyn (718) 270-1714 Glaucoma Service offers state-of-the-art technology to detect I Neuro-Ophthalmology Service perform anterior segment surgery, such as cataract extractions. Long Island College Hospital (718) 780-1530 glaucoma-related diseases, and its dedicated, culturally sen- Referring physicians are sent expedited consult letters so Bay Ridge (718) 748-1334 sitive physicians offer a wide range of treatment modalities. I Oculoplastics / Orbital Service necessary treatments can begin without delay. Glaucoma management and free community screenings are Physician Staff I Retina Service important aspects of our service. Contact Us Kichiemon Asoma, MD – UHB, LICH Extensive patient evaluation is required for the effective I & Service For further information, or to make a referral or schedule Michael Ehrenhaus, MD – UHB, LICH treatment and management of glaucoma in its many forms. an appointment, please call: Himani Goyal, MD – Bay Ridge I Ocular Imaging Service A full range of highly advanced medical tests is available to Douglas Lazzaro, MD – Bay Ridge, LICH University Hospital of Brooklyn (718) 270-1714 patients through UOC's Ocular Imaging Service and Ocular I Long Island College Hospital (718) 780-1530 Blood Flow Service. Precise measurement of ocular blood Bay Ridge (718) 748-1334 flow is particularly important to the accurate evaluation of

4 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 5 normal tension glaucoma. This test also allows clinicians Contact Us Retina Service Service physicians evaluate and treat children with: to gauge the effects of therapy on blood flow to the eye. For further information, or to make a referral or schedule • Congenital or early-onset nystagmus Management of high-risk glaucoma is among our ser- an appointment, please call: The UOC Retina Service offers comprehensive medical and • Congenital or genetic ocular abnormalities surgical management for a large variety of retinal conditions vice's specialties. Potential treatments include filtering Long Island College Hospital (718) 780-1530 • Systemic syndromes, metabolic disorders or chromosomal surgery with antifibrotics, placement of aqueous drainage University Hospital of Brooklyn (718) 270-1714 which include diabetic retinopathy, macular degeneration, abnormalities, including: shunts, and various combined procedures. Many treatments epiretinal membranes, macular holes, , I Juvenile rheumatoid arthritis Physician Staff are performed in collaboration with the UOC Cornea and proliferative vitreoretinopathy, non-diabetic vascular diseases, I Galactosemia Retina Service. Bradley Phillips, MD – UHB and AIDS-related . I Diabetes mellitus The Glaucoma Service also offers a multidisciplinary Lekha Gopal, MD – LICH The service maintains a fully-equipped retina surgical I Marfan's syndrome approach to anterior segment reconstruction. Services are suite and an operating room equipped to manage all retinal I Down's syndrome available by appointment, and urgent consultations are surgical conditions. All instruments are state-of-the-art and I Retinopathy of prematurity always available. Oculoplastics / Service fully up to date with the latest technology. I Ocular or periocular /inflammation I Congenital or hemangiomas Contact Us The Oculoplastics/Orbital Service evaluates and treats Diagnostic Testing I Poor vision or delayed attainment of vision For further information, or to make a referral or schedule patients at both University Hospital of Brooklyn and The Retina Service is equipped to provide: I Congenital or childhood cataracts an appointment, please call: Long Island College Hospital. Expedited consultations I Strabismus (eye misalignment) • Spectral domain optical coherence tomography (SDOCT) Long Island College Hospital (718) 780-1530 are available when necessary. I Stereo University Hospital of Brooklyn (718) 270-1714 The service has particular expertise in thyroid ophthal- • mopathy and traumatic orbital fractures, and our surgeons • Digital Service physicians are also available for optical or surgical Physician Staff also treat a wide range of other conditions. Commonly • ICG angiography correction of eye misalignment and double vision in adults John Danias, MD, PhD – LICH performed include lid and orbital oculoplastic • B-scan ultrasonography with a history of childhood strabismus, thyroid eye disease/ Jeffrey Freedman, MD, PhD – UHB procedures for tumors, and inflammatory condi- • Heidelberg retinal tomography/flowmeter Grave's disease, myasthenia gravis, nerve palsies, or a history Shobit Rastogi, MD – UHB, LICH tions. Following a comprehensive evaluation, required cor- Heidelberg retinal angiography of ocular trauma. Wayne Scott, MD – UHB, LICH • rective procedures are performed in a timely way. As soon as it is medically appropriate, patients are returned to the Contact Us Contact Us care of their referring physician. For further information, or to make a referral or schedule For further information, or to make a referral or schedule Neuro-Ophthalmology Service Operating facilities of the Oculoplastics/Orbit Service an appointment, please call: an appointment, please call: support a broad range of eyelid and orbital surgeries. The Long Island College Hospital (718) 780-1530 Long Island College Hospital (718) 780-1530 SUNY Downstate has a long-standing reputation for expertise majority of lid surgeries are performed under local anesthe- University Hospital of Brooklyn (718) 270-1714 University Hospital of Brooklyn (718) 270-1714 in the evaluation and treatment of neuro-ophthalmic diseases, sia in the minor surgery suite of either University Hospital the ocular manifestations of neurological diseases, and defects or Long Island College Hospital. Unless medically indicated, Physician Staff Physician Staff in the neurosensory system. Patients who are candidates for no pre-testing is needed for such procedures. More complex Kenneth Olumba, MD – UHB, LICH James Deutsch, MD – LICH evaluation include those with suspected , optic surgery is performed in a standard operating suite under Eric Shrier, MD – UHB, LICH Ashima Kumar, MD – UHB, LICH nerve tumors, chiasmal lesions, unexplained visual loss, dis- monitored or general . Except in rare circumstances, orders of perception, and other neurological maladies. UOC patients are discharged on the day of surgery. neuro-ophthalmology evaluations include the use of state-of- the-art imaging to pinpoint the location and characteristic Contact Us Pediatric Ophthalmology and Ocular Imaging Service features of suspected lesions. For further information, or to make a referral or schedule Strabismus Service The Ocular Imaging Service aids in the diagnosis of a wide Diagnosis and treatment is provided by an expert team an appointment, please call: range of ocular disorders by providing physicians with of neuro-ophthalmologists, many of whom were fellowship- Long Island College Hospital (718) 780-1530 The Pediatric Ophthalmology and Strabismus Service spe- comprehensive, highly detailed images of structures within trained by Arthur H. Wolintz, MD, Distinguished Teaching University Hospital of Brooklyn (718) 270-1714 cializes in the medical and surgical treatment of eye muscle the eye. Sophisticated ocular images typically are used to Professor of the State University of New York and former misalignment in children and adults. In addition, this service formulate a more effective treatment plan. Ocular imaging Chairman of Ophthalmology at Downstate Medical Center. Physician Staff provides comprehensive care for all ocular disorders in is also used to detect plateau syndrome or a partially Monica Dweck, MD – UHB, LICH children, including the treatment of amblyopia, tear duct dislocated lens. Roman Shinder, MD – UHB, LICH obstruction, ocular infections, pediatric cataracts, and eye At the referring physician's request, UOC ocular imaging problems associated with arthritis, genetic disorders, pre- test reports can include a complete evaluation by a UOC con- mature birth or neurologic disease. sultant, or images can be submitted to the referring physician without interpretation.

6 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 7 Available Tests UBM can also be used to determine if an angle is To Schedule a Test Practice Locations occludable after (in plateau iris syndrome). • Visual Field Testing – Frequency Doubling Perimetry Tests should be scheduled through University Hospital of Biomicroscopy has proven increasingly useful for defin- (FDT) has been shown to be the most sensitive test for • Brooklyn or Long Island College Hospital (see contact SUNY Downstate Medical Center ing anterior segment in patients with complex detecting the initial defects caused by glaucoma. In addi- information below). On the day of the test, referred patients University Hospital of Brooklyn disease. Ultrasound biomicroscopy is available for imag- 450 Clarkson Avenue, Box 58 tion, both conventional automated visual field testing must bring with them a completed request form. Forms will ing pathologic structure and physiologic abnormalities in Brooklyn, NY 11203 and blue-on-yellow (SWAP) visual field testing are be faxed to referring physician offices upon request. the anterior segment with a resolution of 50 microns. Phone (718) 270-1714 available. SWAP (short wave automated perimetry) test- ing demonstrates visual field loss as many as five years • Uses include identification and location of intraocular Midwood earlier than conventional testing, and it is more sensitive lens haptics, location of glaucoma drainage tubes, vitre- Contact Us SUNY Downstate Eye Center in detecting advancing visual field changes. Screening, ous strands, determining the integrity of scleral wounds, For further information, or to make a referral or schedule 2171 Nostrand Avenue @ Flatbush full threshold, 24-3, 30-2, and customized testing are and locating inadvertent filtration blebs and cyclodialysis an appointment, please call: Brooklyn, NY 11210 Phone (718) 270-1714 available upon request. clefts. Using biomicroscopy to evaluate these and many Long Island College Hospital (718) 780-1530 other abnormalities allows the implementation of more University Hospital of Brooklyn (718) 270-1714 optical Coherence Topography – Measurement • exact modalities. of retinal lesions and thicknesses are profiled by this Long Island College Hospital state-of-the-art imaging system. • Corneal Topography – Corneal topography with the Othmer Building Tomey instrument can be highly useful in managing Urgent Care Center 339 Hicks Street, 4th Floor Nerve Fiber layer Measurement – Measurement of Brooklyn, NY 11201 • patients with and regular and irregular astig- nerve fiber layer thickness is performed with the NFA/ Emergency eye care is available from 8:00 am to 6:00 pm in Phone (718) 780-1530 matism, as well as in a host of other corneal conditions. GDx scanning laser polarimeter, as well as with Heidel- the ophthalmology departments of both University Hospital • Confocal and specular Biomicroscopy – These modali- of Brooklyn and Long Island College Hospital. berg retinal tomography (HRT). Testing is completed in Bay Ridge seconds and may document changes in nerve fiber layer ties are used to evaluate all layers of the cornea and can In addition, emergency eye care is available 24 hours 7901 4th Avenue be used to study corneal dystrophies and anterior segment a day through the Department of Ophthalmology's Urgent thickness in very early disease, as well as in advanced Brooklyn, NY 11209 optic atrophy with extensive cupping or pallor. This test dysgenesis. It also is a useful aid in preoperative evalua- Care Center, also at both Long Island College Hospital and Phone (718) 748-1334 is useful in glaucoma suspects, as well as in patients with tion of patients scheduled for cataract and other surgical University Hospital of Brooklyn. documented glaucoma and other causes of . procedures and can aid in the diagnosis of complicated Patients presenting at either location will be seen initially dilation is not necessary. The HRT unit provides a corneal infectious disease. by an ophthalmology resident who is in direct consultation Brooklyn Heights measurement of the nerve fiber layer as well as an analy- with an on-call ophthalmology attending physician. 110 Remsen Street • anterior segment Photography – This photography Brooklyn, NY 11201 sis of topography. permits evaluation of lid position, external conjunctival Referring Physician Contact Phone (718) 855-8700 lesions and other anterior segment disorders. Gonio- • Disc Topography - oCT and Heidelberg Retinal The ophthalmologists of non-referred patients are called Tomography – Computerized c:d ratio, rim area and cup photography is also available. by the resident/attending at the time of the patient visit. For 142 Joralemon Street area for comparison to a normative database and future referred patients, referring physicians will also be notified of Brooklyn, NY 11201 • Fluorescein angiography – Digital fluorescein angio- Phone (718) 596-6800 self-comparative analysis. This instrument is currently graphy is performed by a certified ophthalmic photographer. patient results the same evening of the patient's emergency considered the most reliable available for disc analysis. It is useful in the diagnosis and management of a host visit, if possible. If not, they will be contacted the following morning. It also measures nerve fiber layer thickness. of iris and retinal disorders. Digital angiography allows Manhattan for instant viewing of the images obtained as well as the 229 East 79th Street • Corneal Pachymetry – Studies have shown that abnor- Contact Information New York, NY 10075 mal corneal thickness can lead to a false high or low ability to transmit the images instantly via the internet. Patients or their physicians may request urgent eye care at Phone (212) 288-0905 reading as well as independent high • Indocyanine green (ICg) angiography – ICG angiog- either location by calling (718) 780-2600, 24 hours a day, risk factor for progressive disease. Using appropriate raphy is useful in the diagnosis and management of sub- 7 days a week, including all holidays. nomograms, corneal thickness measurements can be used retinal disorders, including choroidal neovascularization, Laser Vision Correction Center urgent Eye Care, university Hospital of Brooklyn to obtain a closer approximation of the true intraocular SUNY Downstate at Bay Ridge which are poorly imaged with conventional angiography. 445 Lenox Road, Box 58 pressure. 699 92nd Street • Fundus and Disc Photography – Photography of the Brooklyn, NY 11203 Brooklyn, NY 11228 • ultrasound Biomicroscopy – Ultrasound biomicroscopy optic nerve, nerve fiber layer, posterior pole and retinal (718) 270-1714 Phone (718) 748-1334 (UBM) to evaluate the chamber angle without medication periphery is useful in the documentation and follow-up urgent Eye Care Center at long Island College Hospital in a dark versus light room is the methodology of choice of a variety of ocular disorders. Othmer Building, 4th Floor, 339 Hicks Street for determining if an angle is physiologically occludable. Brooklyn, NY 11201

8 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 9 Laser Vision Correction Center

A brand new, state-of-the-art laser center has been established due to the generosity of Dr. Richard C. Troutman and his wife, Dr. Suzanne Véronneau. Dr. Troutman has left a long-lasting imprint on the field of ophthalmic micro- surgery that continues today.

The Laser Vision Correction Center is located at SUNY Downstate at Bay Ridge. We offer both LASIK and PRK procedures. For appointments call 718-748-1334.

Dr. Troutman celebrating his birthday with his wife Dr. Suzanne Véronneau- Troutman on May 16, 2008

Dr. Troutman is a member and past officer of many ophthalmic specialty societies, including the prestigious American Ophthalmological Society, founded in 1864. In 1978, when his wife Dr. Suzanne Véronneau-Troutman was admitted as the 8th woman member, they became the first couple in the history of the society.

The Troutman Chair in Ophthalmology

Dr. Richard Troutman headed the Department of Ophthalmology at Downstate from 1955 to 1983. In 2002, The Richard C. Troutman Distinguished Chair in Ophthalmology and Ophthalmic Microsurgery was initiated at SUNY Downstate Medical Center with a $1 million gift from the Microsurgical Research Foundation. The endowment was completed by 2005 with an additional $1 million. The Chair honors the foundation's legendary founder, Dr. Richard C. Troutman, a worldwide leader in ophthalmic microsurgery and one of the innovators in the design of the ophthalmic microscope.

VISX STAR S4 System with WaveScan Richard C. Troutman, MD, Distinguished Chair in Ophthalmology WaveScan technology captures unique imperfections in each individual’s vision that could not have been measured before. This new level of measurement provides 25 times more precision than measurements using standard methods and Ophthalmic Microsurgery Endowment Fund for glasses and contact lenses. WaveScan technology produces a detailed map of the eye—much like a fingerprint, no To contribute to the Richard C. Troutman, MD, Distinguished Chair in Ophthalmology and Ophthalmic Microsurgery Endow- two are alike—and translates this information into a set of CustomVue treatment instructions for the laser. WaveScan ment Fund, please call Downstate's Department of Institutional Advancement and Philanthropy at 718-270-4418. transfers these digital treatment instructions to the laser, providing a new level of precision and accuracy. If you prefer, you may also donate online at: http://www.downstate.edu/giving/ways.html

10 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 11 Dr. Richard C. Troutman is a worldwide leader in ophthalmic Achievements of Dr. Troutman microsurgery and one of the innovators in the design of the ophthalmic microscope.

In June of 1955, Dr. Troutman was appointed as the first They also developed specialized microsurgical instruments, nylon that significantly improved corneal wound closure, Barraquer, Dr. Troutman and Dr. Swinger reported their Professor and Head of the Division of Ophthalmology at the in particular, a new suture material, 8-0 virgin silk armed but was unknown outside their institution. Dr. Troutman early results which would lead to safer, more effective newly opened SUNY Downstate Medical Center. He had with a 5mm Grieshaber needle, which was far superior to subsequently made 10-0 nylon universally available through refractive surgical techniques. With Dr. Miles Friedlander, completed his residency in Ophthalmology at CUMC (New those being used in the US at the time. Dr. Troutman imme- the Ethicon Suture Division of J&J, as chair of the AAO they formed the ISRS (International Society of Refractive York Hospital Cornell Medical Center) under John McLean diately incorporated this for his surgery and advocated the Suture Committee in the United States. Surgery) which has become the primary forum for this in 1951. Until his appointment, he was Instructor to Resi- same to many of his colleagues. specialty and is the first international specialty to be recog- dents at MEETH (Manhattan Eye Ear and Throat Hospital) In 1967, Dr. Troutman developed, in nized by the AAO and included in its annual program. and served as Assistant Professor of Ophthalmology at In 1962, Dr. Troutman, with the CUMC. It was at that time he began his pioneering develop- conjunction with the Weck Surgical Keeler Instrument Company, At SUNY Downstate, Dr. Troutman's ments in ophthalmic microsurgery by modifying a Zeiss Company, the first ceiling-mounted otologic microscope for use in anterior segment surgery. Division of Ophthalmology post- developed and used the first zoom ophthalmic surgical micro- He soon realized that before the better visualization through graduate training program was one the microscope could be utilized effectively, extensive remote-controlled, motorized, scope that incorporated remotely of the first in the United States to changes in instrumentation, needles and suture materials, zoom-magnification microscope controlled focusing and centering, as well as in the microscope itself, would have to be made for ophthalmic microsurgery. routinely teach microsurgery of the before its full potential could be realized. planetary tilting and multi-focal eye to its residents. His first priority, however, was the development of the That same year, Dr. Barraquer discovered alphachy- illumination. Contemporary surgical new division. Fortunately, the National Institutes of Health motrypsin, an enzyme that facilitated the intracapsular microscopes that incorporate Dr. Dr. Troutman has authored or co-authored 7 textbooks, (NIH) had recently inaugurated its Ophthalmology Training extraction of cataract, and sent some to Dr. Troutman to try. many book chapters and more than 150 scientific publica- Grant program that provided support for Dr. Robert Jampel Suitably impressed, he convinced the AAO to sponsor a Troutman's concepts continue to tions, many of which detail his interests and innovations in and Dr. Bernard Schwartz with their specialty training in national trial of its safety and efficacy, based at SUNY, and be the instruments of choice for microsurgical techniques and instrumentation for anterior strabismus and glaucoma, both of whom joined the full- that resulted in its worldwide acceptance. This technique segment surgery. In recognition of his pioneering advances, time faculty. The further addition of specialized part-time went unchallenged until extracapsular extraction and phaco- ophthalmic microsurgery. he has been recognized with numerous awards, citations and faculty made possible this specialty-based training program, emulsification (for which Dr. Troutman chaired a similar named lectureships. He is a member and past officer of one of the first of its kind in the country, with 12 residents trial for the AAO in 1975) became the procedures of choice Inert in tissue and elastic, 10-0 nylon suture could hold many ophthalmic specialty societies, including the presti- and 4 fellows. This group of residents and fellows were for . These studies and the Courses in Micro- the cornea firmly in apposition for months, allowing first gious American Ophthalmological Society, founded in 1864. the first trained to use the microscope for their anterior surgery held at SUNY and at the AAO, and taught by our intention healing which prevented the optical changes in the In 1978, when his wife Dr. Suzanne Véronneau-Troutman segment surgery. residents, faculty and foreign guests, put our program “on cornea from tissue displacement. Using Dr. Troutman’s was admitted as the 8th woman member, they became the the map.” corneal wedge resection it was possible for the first time to first couple in the history of the society. correct severe post keratoplasty, and for lesser In 1957, Dr. Troutman designed Meanwhile, Dr. Troutman continued his development of degrees with his corneal relaxing incisions (1975), the first surgical microscopes, introducing the first motorized zoom In 2000, Dr. Troutman received the and had constructed at Downstate effective, reproducible refractive keratoplasty procedures. microscope (Keeler) in 1962 and his ceiling mounted micro- Lifetime Achievement Award from the the first hydraulic, chair-supported scope with XYZ translation and focusing and planetary tilt It was at the first IOMSG meeting that Dr. Troutman American Academy of Ophthalmology ophthalmic surgical microscope for (Weck) in 1967, concepts that continue to be used in con- met José Barraquer. Because of their mutual interests in temporary surgical microscopes by many specialties. refractive keratoplasty, they developed a close relationship for “many years of distinguished use in the operating suite. that would lead Dr. Troutman to perform the first lamellar In 1966, to further the development of ophthalmic micro- refractive surgeries outside Colombia, keratophakia and service to the society." He is one surgery, with Gûnther Mackensen and Heinrich Harms of Two years later, in 1957, Dr. Troutman invited Dr. in 1977, after he and his Corneal Fellow the Universität Tübingen in Germany he formed the of the first seven ophthalmologists Joaquin Barraquer, who was travelling in Latin America Dr. Casimir Swinger were trained in the technique by Dr. IOMSG (International Ophthalmic Surgery Study Group). to have received this award from demonstrating his surgery, to SUNY. He, too, was using a Barraquer in Bogotá. Two years later, at a meeting of the In 1963 they had introduced him to 10-0 monofilament microscope that he had developed with his brother José. New Orleans Academy of Ophthalmology featuring Dr. the AAO.

12 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 13 The department currently provides a three-year post- ships are established in graduate training program for 21 residents, with seven the first year of residency new candidates accepted each year. Residents benefit training. Other special from the wisdom of a large, expert faculty with a deep program features include Residency Program commitment to teaching, and they have the opportunity to an rotation at work with the latest Memorial Sloan-Kettering diagnostic and thera- and small group eye peutic equipment. The pathology teaching sessions. organized teaching Particularly popular with program consists of residents is the surgical approximately 350 course, with outstanding hours of didactic practice opportunities under expert faculty guidance. lectures per residency, Strengths of the overall residency program, they say, include covering all subspe- the extensive exposure to trauma cases it provides, and its cialty areas within well-structured rotations through programs at the various Dr. Douglas Lazzaro and Dr. Justin Gutman confer about a cornea patient ophthalmology. On affiliated beginning in the first year. This gets resi- one afternoon a week, dents off to a positive start through experience with a variety residents leave the clinic areas and report to Downstate for of patients and . Another outstanding aspect of an afternoon of grand rounds case presentations followed the SUNY Downstate education program, according to resi- by didactics. Special program features include a one-week dents and fellows, is the opportunity it affords them to work course in San Antonio for first year residents and a one- and learn in state-of-the-art facilities, where the most sophis- week Wills Review course for second-year residents, while ticated equipment permits conducting the most advanced third year residents attend an approved course of their procedures. They also praise the dynamism of the faculty choice. In addition, all residents attend a weekly, three-hour and the program’s emphasis on research accomplishment. cooperative course collaboratively sponsored by several Approximately 96 percent of the program’s graduate major New York City-based residency training programs. residents pass their boards on the first attempt, and many The SUNY Downstate program offers outstanding training who have sought fellowships have obtained prestigious in surgery, with in-house courses for strabismus, glaucoma ones throughout the US. Some graduates who have decided surgery, and cataract techniques. All residents to remain in Brooklyn to practice are discovering a vast, easily exceed the minimum surgical requirements set by the barely tapped market for professional eye care. There has Accreditation Commission been a marked increase in the quality of applicants for for Graduate Medical residency program openings over the last decade, apparently Education (ACGME). It attracted by the department’s growing reputation nationally. is expected that the senior At its most recent review by the ACGME in 2009, the de- residents will all perform partment received a full four-year accreditation. more than 120 cataract cases. A comparable experience is I Largest residency program in the New York gained in ocular trauma, City area. , retinal I Most diverse patient population in the surgery and laser surgery. nation. The program includes I Eight residency training sites. monthly faculty grand rounds, Dr. Gabriel Schaab and Dr. Josh Glatman examine a retina patient often with visiting professors, I Experienced, diverse faculty. updating residents and faculty on developing trends and I techniques in ophthalmology, in addition to the weekly High surgical volume. resident grand rounds. I Wide breadth of pathology. All residents must execute a research project, and mentor- I Over 100,000 patients seen annually. Opposite: Dr. James Deutsch and Dr. Melanie Sobel examine a pediatric patient

14 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 15 Residents and Fellows

Graduates 2009 Fellowship PL3 Class 2011-2012 Medical School Attended Dr. Habeeb Ahmed Cornea - University of Southern California Dr. Sara Ferri SUNY Buffalo Dr. Kichiemon Asoma Cornea - University of Texas Southwestern Medical Center Dr. Sara Hanson Boston University School of Dr. Carl Danzig Retina - University of Texas Southwestern Medical Center Dr. Amy Kulak University of Miami School of Medicine Dr. Majida Gaffar Pediatric Ophthalmology - Children's National Medical Center, Washington Dr. Akil Pascal SUNY Downstate Dr. Adam Jacobowitz - Johns Hopkins College of Medicine Dr. Gabriel Schaab Rush Medical College Dr. Na Ma Neuro-Ophthalmology/Plastics - Kingsbrook/SUNY Downstate Dr. Melanie Sobel Drexel College of Medicine Dr. Preeti Poley Retina - University of Nebraska Dr. Kirk Sturridge Glaucoma - University of Iowa

PL2 Class 2011-2012 Medical School Attended Dr. Cindy Calderon SUNY Stony Brook Graduates 2010 Fellowship Dr. Justin Gutman SUNY Upstate Dr. Rodney Coe Retina - University of Pittsburgh Dr. David Mostafavi University of Medicine and of New Jersey Dr. Gennifer Greebal Pediatric Ophthalmology - Children's National Medical Center, Washington Dr. Chirantan Mukhopadhyay University of Wisconsin School of Medicine Dr. Sheetal Patel Cornea - Cornell Medical Center Dr. Sherry Narang Drexel College of Medicine Dr. Allison Rand Cornea - Mount Sinai Medical Center Dr. David Rand University of Miami School of Medicine Dr. Marjorie Rico Oculoplastics - Dr. Janet Neigel Dr. Isaac Reich SUNY Downstate Dr. Brandon Rodriguez Cornea - Cornell Medical Center Dr. Shetal Shah SUNY Downstate Dr. Jeremy Shaw Medical Retina - Duke University Medical Center

PL1 Class 2011-2012 Medical School Attended Graduates 2011 Fellowship Dr. Matthew Gorski Jefferson College of Medicine Dr. Ramanath Bhandari Retina - University of Colorado Dr. Jason Moss Stanford College of Medicine Dr. John Frisbee Retina - The Ochsner Foundation Dr. Renelle Pointdujour SUNY Downstate Dr. Andrew Greenberg Glaucoma - NY Eye and Ear Infirmary Dr. Allison Rizzuti SUNY Downstate Dr. Alex Karvelishvili Retina - Valley Retina Institute Texas Dr. Jordan Spindle Texas A & M College of Medicine Dr. Margaret Liu Cornea - Johns Hopkins School of Medicine Dr. Adam Thode Jefferson College of Medicine Dr. Monika Singh Private Practice Dr. Frank Tsai Temple College of Medicine Dr. Beatrice Whitaker Private Practice Dr. Lauren Yeager Pediatric Ophthalmology - Children's National Medical Center, Washington

16 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 17 Annual Symposium Held in Atlantic City www.eyecurrentconcepts.org

The Department of Ophthalmology is committed to the The two-day January symposium has taken place at The June one-day meeting occurs in Brooklyn as part of educational needs of the community ophthalmologist. To Caesars Atlantic City in New Jersey the past four years and the annual Alumni Meeting and is held on the first or second that end, a comprehensive Visiting Clinical Lecture series has attracted attendees from seven states. It takes place on a Thursday of the month. Past and future CME events can be takes place along with a Research Lecture series as a com- Friday and Saturday, generally around the second weekend viewed at www.eyecurrentconcepts.org. ponent of the Thursday Grand Rounds Series. of the month. This scientific and social venue has become an In addition to this widely popular activity, there are two excellent place for returning attendees each year, many of large symposia each year that bring together some of the whom have commented that this is “the best CME event I world’s top clinical scientists to share their knowledge on have attended in my career.” their particular specialty. The meetings cover a very wide area of ophthalmology and focus on the diagnostic testing and emerging for eye disease.

The 2-day symposium has taken Cornea Presenters 2011 place at Caesars Atlantic City the Left to right: Drs. Sadeer Hannush, C. Stephen Foster, past four years and attracted Douglas Lazzaro, David Hardten attendees from seven states.

2011 Current Concepts of Ophthalmology Drs. Himani Goyal, Sara Ferri, Peggy Liu and Anika Michael

Dr. Sonia Yoo of the Bascom Palmer Eye Institute of the University of Miami School of Medicine presented at our June 2009 CME meeting

Retina/Oculoplastics Presenters 2011 Glaucoma Presenters 2011 2011 Current Concepts of Ophthalmology Left to right: Drs. JP Dunn, Peter Kaiser, Douglas Lazzaro, Left to right: Drs. Jeffrey Liebmann, Douglas Lazzaro, Drs. Sheetal Shah and Cindy Calderon Roman Shinder, Dan Gombos, Lee Jampol L. Jay Katz, Shobit Rastogi, Malik Kahook, John Danias

18 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 19 2010 Current Concepts of Ophthalmology 2010 Current Concepts of Ophthalmology Drs. Lekha Gopal and Kenneth Olumba Dr. Aruoriwo Oboh-Weilke of Georgetown University School of Medicine

2010 Current Concepts of Ophthalmology Left to right: Drs. Shobit Rastogi, Rand Allingham, John Danias, Jeffrey Freedman, Douglas Lazzaro, Gregory L. Skuta

AAO 2010 Drs. Ashima Kumar and Howard Liu “I had the pleasure of participating in SUNY Downstate’s Current Concepts in Ophthalmology meeting in Atlantic City in January 2010 and was highly impressed with the outstanding reputation and quality of the invited speakers, the clinical rele- vance of the superb presentations, the wonderful setting, and Dr. Douglas Lazzaro’s remarkable hospitality and organizational skills as the course director. This is truly one of the country’s outstanding continuing medical education experiences.”

— Gregory L. Skuta, MD President and Chief Executive Officer Dean McGee Eye Institute Edward L. Gaylord Professor and Chair Department of Ophthalmology University of Oklahoma College of Medicine 2010 Current Concepts of Ophthalmology 2010 Current Concepts of Ophthalmology Left to right: Drs. Robert Nussenblatt, Carl Regillo, Left to right: Drs. Roy Rubinfeld, Angie Wen, Douglas Lazzaro, Steve Charles, Scott Cousins, Eric Shrier, Douglas Lazzaro David Tse, Geoffrey Gladstone, Monica Dweck

20 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 21 The SUNY Downstate Department of Ophthalmology is proud to present our 2011 Visiting Speaker Lecture Series, a forum for renowned clinicians and researchers to present their latest findings. Continuing Medical Education These lectures will feature advances in many areas of clinical ophthalmology and ophthalmic research, presented by noted clinical and basic scientists from throughout the world. Ample opportunity will be provided for questions and answers. Most programs will be held in Lecture Hall 1A, SUNY Downstate Medical Center, in the afternoon. For your convenience, there is valet parking at the main entrance of University Hospital of Brooklyn, 445 Lenox Road. Please join us for these insights into ophthalmic research and the promises they hold for patient care. No registration is required.

lecture series Course Directors

Douglas R. lazzaro, MD, FaCs, Faao Professor and Chair of Ophthalmology Richard C. Troutman, MD, Distinguished Chair In Ophthalmology and Ophthalmic Microsurgery Chief of Service: UHB, KCHC

William J. Brunken, Bs, PhD Department of Ophthalmology Director of Ophthalmic Research Professor of Ophthalmology and Cell Biology Visiting Speaker Lecture Series

22 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 23 Scott M. Goldstein, MD December 8, 2011 June 23, 2011 VISITING SPEAKER CLINICAL Clinical Assistant Professor 2:00-3:15 PM, Lecture Hall 1A Terete Borras, PhD Wills Eye Institute Professor, Ophthalmology LECTuRE SERIES 2011 Thomas Jefferson School of Medicine Paul D. Langer, MD Assistant Professor University of North Carolina Glaucoma Models and Treatment Jayne S. Weiss, MD Institute of Ophthalmology and Visual Science January 13, 2011 Professor and Chairman, Ophthalmology Chief, Division of Ophthalmic Plastic & Reconstructive Surgery 2:00-4:00 PM, Lecture Hall 1A Louisiana State University School of Medicine University of Medicine and Dentistry of New Jersey July 28, 2011 Orbital Floor Fractures Jeanine K. Suchecki, MD Thomas White, PhD Associate Professor of Ophthalmology June 23, 2011 Associate Professor University of Connecticut School of Medicine January 6-7, 2012 and Biophysics 2:00-4:30 PM, Lecture Hall 1A Contact Lenses Caesars Atlantic City Meeting SUNY Stony Brook Sohan Singh Hayreh, MD, MS, PhD, FRCS, FRCOphth, DSc Connexins and Cell Signaling in the Lens Professor Emeritus of Ophthalmology Full details on www.eyecurrentconcepts.org April 7, 2011 Director, Ocular Vascular Clinic 2:00-4:00 PM, Lecture Hall 1A Department of Ophthalmology & Visual Sciences August 25, 2011 George Spaeth, MD University of Iowa College of Medicine Mark Rosenblatt, MD, PhD Professor of Ophthalmology Lecture 1 – CRVO Pearls Assistant Professor, Weill Cornell Medical Center Jefferson University School of Medicine Lecture 2 – GCA Pearls VISITING SPEAKER RESEARCH Wound Healing in Cornea Compassionate Care of the Glaucoma Patient Lecture 3 – ARMD Pearls LECTuRE SERIES 2011 September 22, 2011 August 4, 2011 April 7, 2011 Janet R. Sparrow, PhD 4:00-5:00 PM, Lecture Hall 1A 2:00-4:00 PM, Lecture Hall 1A All research talks will be held 3:00-4:00 PM Associate Professor of Ophthalmic Science and Anatomy and Cell Biology Aruoriwo Oboh-Weilke, MD Kenneth Rosenthal, MD in Lecture Hall 1A. Columbia University Medical Center Assistant Professor of Ophthalmology Associate Professor of Ophthalmology University of Utah Medical Center RPE Cell Death Georgetown University School of Medicine February 3, 2011 The Value of a Systemic Workup: A Series of 3 Case Reports Lecture 1 – Cataract Surgical Pearls Lecture 2 – Innovative Eye Surgical Procedures Ross Cagan, PhD October 27, 2011 Professor, Dept. of Developmental and Regenerative Biology May 19, 2011 Associate Dean, Graduate School of Biological Sciences John R. Heckenlively, MD Paul R. Lichter Professor of Ophthalmic Genetics 2:00-4:00 PM, Lecture Hall 1A October 13, 2011 Mount Sinai School of Medicine Developmental Mechanisms and Disease Therapeutics: Professor, Ophthalmology and Visual Sciences Michael S. Ip, MD 2:00-4:00 PM, Lecture Hall 1A A View from the Fly Eye Director, Center for Retinal and Macular Degeneration Associate Professor of Ophthalmology Leonard B. Nelson, MD University of Michigan Kellogg Eye Center University of Wisconsin School of Medicine Associate Professor of Pediatrics and Ophthalmology Retinal Degeneration: A Tale of Mice and Men Retina 1 & Retina 2 Jefferson University Medical Center February 24, 2011 Co-Director Pediatric Ophthalmology, Wills Eye Institute Craig Evinger, PhD December 1, 2011 June 2, 2011 Lecture 1 – Misconceptions in Pediatric Ophthalmology Professor, Neurobiology & Behavior and Ophthalmology Annual Alumni Meeting Lecture 2 – The Odyssey of Where We Are in Congenital ET SUNY Stony Brook Simon W. M. John, PhD Neurobiology of Blepharospasm Investigator , Howard Hughes Medical Institute 8:00 AM-4:00 PM, LICH Avram Auditorium Senior Staff Scientist, The Jackson Laboratory November 2-3, 2011 Research Assistant Professor in Ophthalmology Brandon Ayres, MD March 24, 2011 Assistant Surgeon, Cornea Service Grant T. Liu, MD Tufts University School of Medicine Wills Eye Institute Professor of Neurology Marion Gordon, PhD Mechanistic Insights to Glaucoma Provided by University of Pennsylvania School of Medicine Associate Professor of Pharmacology & Toxicology Experimental Mouse Genetics Neil M. Bressler, MD November 2, 2011, Troutman Library Ernest Mario School of Rutgers University Pathobiology of Collagen and EMMPRIN in Cornea The James P. Gills Professor of Ophthalmology Pediatric Optic Neuropathies 5:30-6:00 PM Chief of Retina Division, Wilmer Eye Institute November 3, 2011, Lecture Hall 1A Johns Hopkins School of Medicine May 26, 2011 Chiasmal Disorders 2:00-2:45 PM Steven J. Gedde, MD Swelling 3:15-4:00 PM Ching-Hwa Sung, PhD The entire CME lecture series Professor of Ophthalmology Professor, Ophthalmology Bascom Palmer Eye Institute Weill Medical College of Cornell University can be viewed on our website University of Miami Miller School of Medicine Retinal Pigment Epithelium and Retinal Disease www.downstate.edu/ophthalmology

24 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 25 Retinopathy ReseaRch to save sight and lives

The retina, the light-sensitive inner layer of the eye, is an area of great scientific significance. Not only does it enable vision, it is an extension of the brain. The retina is composed of neural tissue, much like that larger organ from which it emerges during fetal development. as a result, research into the workings of the retina has a great impact on medical science’s understanding of and treatment of dysfunctions in the brain, as well as in the retina itself.

Douglas Lazzaro, MD, chairman of SUNY Downstate’s De- diabetic retinopathy. Daniel Rosenbaum, partment of Ophthalmology, says “the retina is an area where MD, chairman of Downstate’s Department there’s tremendous new research activity going on,” of Neurology, uses the retina as a model for much of it featured here. understanding what happens to brain cells dur- Downstate now has a director of ophthalmic research, ing strokes. And Ivan Bodis-Wollner, MD, William J. Brunken, PhD, whose investigations into retinal pro- DSc, director of the Parkinson’s Disease and teins called laminins and netrins may one day help restore sight Related Disorders, Center of Excellence of the to the visually impaired. Brahim Chaqour, PhD, investigates the National Parkinson Foundation, explores how molecular underpinnings of diabetic retinopathy, a microvascu- changes in the retina both signal and lar disease that is one of the leading causes of blindness in the influence the development of Parkinson’s disease. United States, all in an effort to develop treatments that may “The research we’re doing at Downstate is leading to new one day prevent the disease. understandings of retinal diseases and the nervous system,” Gladys Teitelman, PhD, a diabetes researcher who has con- Dr. Lazzaro says. “Most importantly, we’re creating potential centrated mostly on the regeneration of insulin-producing pan- new avenues of treatment.” creatic beta cells, has widened her investigations to also include Reprinted from Downstate Research: Profiles In Innovation, 2008, an annual publication of the Office of Institutional Advancement & Philanthropy. 26 SUNY Downstate Department of Ophthalmology Reprinted with publisher's permission. SUNY Downstate Department of Ophthalmology 27 The Exquisite Beauty of ocular architecture

illiam J. Brunken, PhD, is “stabilize synapses,” the junctions keenly interested in the between brain cells across which W architecture of the eye’s neural communication takes place, Dr. light-sensitive inner layer, the retina. Brunken says. FIG 1 “As an undergraduate,” says Dr. The connections between the light- Brunken, an associate professor of sensitive cells in the retina and the Fig 1. A section of the mouse retina stained with fluorescent protein markers. Support cells, Müller glia (green), span the whole retina and adhere to the retinal basement mem- anatomy and cell biology, ophthalmol- cells that convey visual signals to the brane (red line at bottom of the figures). The adhesion points are yellow. Some genetic ogy, and neurology, “I got hooked on brain are held together by laminins, deletions of laminins (B and D but not C) cause alterations in Müller cell and, secondarily, the retina’s elegantly organized struc- “which are the chief organizers of one in retinal anatomy. ture. Its columnar organization is very of the retina’s, and one of the body’s, carefully constructed, with a gorgeous most important structures: the base- FIG 2 symmetry to it.” ment membrane.” Dr. Brunken, director of SUNY In a series of papers published in Fig 2. The development of retinal blood supply is dependent on Downstate’s division of ophthalmic Neuron and the Journal of Neuro- laminin synthesis. Blood vessels spread over the normal retina research, explores the molecular may even help restore vision to those science, Dr. Brunken and his group (left side, overview) forming three different capillary networks at the surface, in the middle, and deep within the retina. In animals signals that create, maintain, and some- whose retinal problems have resulted were the first to demonstrate the with laminin gene deletions (right column) the development of times deform and destroy that in blindness. presence of native laminins in the blood vessels is altered dramatically. The entire surface of the retina structure. Dr. Brunken has spent much of his central nervous system. is not covered with blood vessels (overview) and the branching of all three levels of the capillaries are disrupted. These effects mimic His investigations into proteins recent career studying two specific reti- Basement membranes in the retina, a human disease called retinopathy of prematurity, a blinding dis- found in the retina’s extracellular nal proteins, laminins and netrins, and elsewhere, serve as platforms order found in some premature children. FIG 3 matrix, the biological scaffolding that which he describes as guidance mole- onto which cells attach themselves. Fig 3. Blood vessels are underdeveloped in lamin mutants. binds its cells together, may lead to cules. “They tell cells where to go and They also orient tissue development, treatment breakthroughs for a number how to function when they get there,” “telling cells what is top and what is of ocular diseases. These include dia- he explains. bottom, and therefore how cells should rare but complex diseases that involve netrin-4, regulates axon guidance membranes of molecules—we can use betic retinopathy, age-related macular Without laminins and netrins, organize themselves,” Dr. Brunken the eye along with other bodily sys- in the retina. those pieces for drug development.” degeneration, and retinopathy of pre- retinal development is disrupted and notes. “These properties make them tems. These diseases include Pierson “Netrin-4 helps bundle axons in Dr. Brunken’s investigations may maturity, a vision-loss problem associ- vision itself may well be impossible. critical for retinal development. If the syndrome, Merosin-dependent muscu- the retina together, enabling communi- also lead to a new way of treating ated with premature birth. His research Moreover, laminins and netrins basement membrane doesn’t form lar dystrophy, and Herlitz junctional cation between the retina and the rest vision loss from retinal defects. “Given properly, then the attachment of cells is epidermolysis bullosa. of the brain’s visual apparatus,” Dr. that laminins and netrins are guidance irregular and the retina’s columnar Dr. Brunken has created a mouse Brunken says. Perhaps most impor- molecules and stabilize synapses,” Dr. organization, and its ability to transmit model in which two laminin genes tantly, netrin-4 regulates the branching Brunken explains, “we hope we can in- visual signals, is lost.” have been removed. These mice have Dr. Brunken’s lab has identified all the symptoms of eye-brain- Dr. Brunken’s investigations may also lead to a four of the approximately forty laminin muscle disease, a complex neurodevel- new way of treating vision loss from retinal defects. variants that are active in retinal tissue. opmental disorder. Mutations in one of the genes Of particular interest to Dr. “The hope would be to fool neurons into thinking a that produces the laminin beta-2 Brunken is the role netrins play in the protein, a gene called LAMB2, retina’s organizing structure. “A netrin silicon chip is a photoreceptor.” “completely disrupts vascularization of is nothing more than a small piece of a the retina during fetal development,” laminin,” he explains. “Laminins are of the retina’s deepest capillaries. corporate them into a microchip-based Dr. Brunken notes. “What results is a cross-shaped molecules and netrins are Understanding the basic functions neuroprosthesis that would promote a very altered pattern of vascularization, the ends of the arms of the cross.” of these proteins may lead to new treat- kind of synapse between the prosthesis much like one sees in children with Working with Manuel Koch, PhD, ments for a number of eye diseases, Dr. and the retina. The hope would be to retinopathy of prematurity, where in- of the University of Cologne, in Brunken says. “If we can separate out fool neurons into thinking a silicon K flammation and, eventually, the death Germany, Dr. Brunken’s lab discovered the cell-binding domains—the parts chip is a photoreceptor.” of retinal tissue, disrupts the visual field.” that a novel type of netrin, called that interact with receptors on cell Members of Dr. Brunken’s lab (from left to right): Aarti Kuver, PhD student; Zeng-Xiu Liu, MSc, research associ- Other laminin mutations lead to ate; Dr. Brunken; Germán Pinzón-Duarte, MD, research associate; Gopalan Gnanaguru, PhD student. Reprinted from Downstate Research: Profiles In Innovation, 2008, an annual publication of the Office of Institutional Advancement & Philanthropy. Reprinted with publisher's permission. 28 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 29 Doc Focuses on Seeing 10 times more likely to develop it that most patients won't be able themselves. Doctors are working to spot themselves. hard to identify the genes that cause If you have high intraocular glaucoma. "It's a complex genetic pressure, ask your doctor how inheritance." says Danias. "We know problematic it is: "Can you give me an glaucoma clearly some of the genes that cause open estimate of what my risk for develop- angle glaucoma, but they only cause ing glaucoma is?" If your doctor thinks 2% to 3% of the overall cases." you are at higher risk, ask how often you should be screened. of their care, including diagnosis, Dr. John Danias recommends regular eye check- management and surgery. signs and symptoms ups—and more as you move into your 60s. Patients with angle closure What you can do: The big story glaucoma are at risk of pressure that allow the fluid to get out of the within their eyes increasing abruptly eye," says Danias. The success rate is July is Glaucoma Awareness Know your over a short period of time. "The wall very high, about 80 % . Month. So to spotlight the illness, of the eye actually becomes distended For angle closure glaucoma, family history we "check up" with Dr. Danias, who's from all the pressure," says Danias. the primary treatment is called laser been providing care to New York's own Because glaucoma has a genetic “Patients feel a lot of pain." The onset iridotomy, in which lasers are used to Governor Paterson since his angle component, if your relatives have of angle closure glaucoma can occur create a passageway for the exit of fluid closure attack in May. suffered from the disease, your risk over the course of minutes or hours. from the eye. This procedure is 10 times higher. Ask about your The pain can be severe enough to cause can be used preemptively for patients family's history, and be prepared to Who's at risk headaches, vomiting and blurry vision. at risk of the disease, and has an explain it to your doctor. Glaucoma is a disease that affects Patients are usually aware that some- extremely high success rate of 95 % . In the optic nerve in the back of the eye, thing is wrong, and that the source of a small percentage of cases, when the see a specialist leading to loss of peripheral vision and the problem is in the eye. disease is severe and laser iridotomy sometimes the complete loss of vision. Unfortunately, open angle glau- fails, the next step is an open If you have any of the risk It is often associated with high pressure coma often doesn't show any surgery done manually by the doctor factors, then get the opinion of a inside the eye. symptoms until the disease is quite far to open a new passageway. glaucoma specialist. Check the There are two main forms of advanced. "It's almost asymptomatic," American Academy of Ophthalmology glaucoma, open angle glaucoma and says Danias, and "people go for years Research website (www.aao.org), which allows closed angle glaucoma. "They're differ- with the disease without noticing. you to search for eye doctors by their ent diseases," says Danias. "They both Then they notice problems with their breakthroughs subspecialty and your zip code. damage the nerve at the back peripheral vision.” At Downstate, Danias's lab has of the eye, but the pathology of "Glaucoma is not something we been investigating the role of inflam- get frequent checkups the diseases is different." Open angle know how to prevent," says Danias. mation in causing glaucoma. "Our Danias recommends that anyone glaucoma is more insidious, and "Glaucoma is a chronic disease. We work indicates that the immune over 40 get an eye exam every two closed angle glaucoma is more don't have a cure but it's something we system may be involved," says Danias. or three years (more often if they're dramatic in its presentation. can control." If glaucoma is caught "There might be some sort of misregu- having problems). After 60, people Nearsighted people have a higher early enough, doctors can usually lation of what we call the innate immu- should get checked every year. risk of developing open angle prevent vision loss, or at least slow nity (a nonadaptive system that protects Screening consists of a general eye glaucoma, while farsighted people are down the process. Treatment usually us from viruses and bacteria), that gets exam, the "eye puff" exam, and often more likely to develop closed angle. consists of some combination of drops, activated somehow in glaucoma and drops to dilate the eyes so the doctor For both forms of glaucoma, laser surgery and open surgery. causes damage." Dr Danias is now can see the back of the eye. "It's not age is one of the most important risk The treatment for open angle glau- working on gene therapy as a potential a painful process," says Danias, "and factors. The disease is almost always coma usually starts with medication in new avenue of treatment for glaucoma. the expense is covered by insurance." diagnosed in people after the age of 60. the form of drops. "This treatment is About 1% of the population aged trying to lower the pressure inside the Questions for between 50 and 65 has glaucoma; eye," explains Danias. "The lower the Know your numbers up to 5% of the total population of pressure inside the eye, the lower the your doctor Ask for a reading of your intra- The specialist people in their 70s and older have chance of damage." A good first question to ask your ocular pressure, and keep a log yourself. It's just one number per visit, Dr. John Danias, Professor of Ophthalmology and Cell Biology glaucoma. Patients with diabetes For patients who can't tolerate doctor is "Do I have any of the risk and Danias says the log "can be helpful Co-Director, Glaucoma Service, SUNY Downstate Medical Center are also at higher risk of developing drops, there is the option of laser factors for glaucoma?" While Danias glaucoma. therapy, a 10 - to 15-minute procedure spelled out the major risk factors, there if you're traveling around or you have Director, Glaucoma Service, Long Island College Hospital K Genes play a big part in done in the office. "The doctor uses the are some others—like corneal thick- to change doctors." A glaucoma specialist for the past 10 years, SUNY Downstate’s Dr. John Danias glaucoma—so much so that people laser to stimulate the cells in the eye ness—that are more complicated and with a family history of glaucoma are (formerly at Mount Sinai Medical Center) helps glaucoma patients with every part Reprinted from NY Daily News, July 16, 2008. Article by Katie Charles. Reprinted with publisher's permission.

30 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 31 An Eye Into FIG 1 FIG 2 parkinson’s Disease

ike many illnesses affecting the nervous system, Parkin- l son’s disease is difficult not only to treat but also to monitor. Fig 1. The OCT of the retina of a healthy subject (46 years of age). The bottom Fig 2. The OCT of the retina of a Parkinson’s disease patient (50 years of age). New evidence suggests that the de- of the picture represents the outer layers of the eye; the top, the inner layers. The valleys—top center—represent the loss of neurons in the inner retina, generative motor disorder begins in the The dip, or “valley,” in the center is normal: retinal neurons are pushed to the including the nerve cells which transmit visual information to the brain. side to allow light to penetrate to the outer layers, where photo-receptors are peripheral nervous system and then located. works its way to the central nervous system—most importantly, to the brain. Once established there, this disease can cause a host of neurological problems: In the last several years, Dr. Bodis- cover the impacts of potential neuro- degeneration. tremors, motor impairment, communi- Wollner has employed a new imaging protective treatments on the brain’s Dr. Bodis-Wollner notes, “OCT cations difficulties, and mental technology called Optical Coherence dopaminergic pathways and, thus, on should be able to help quite a lot in our disturbances. Tomography (OCT) to detect micro- disease progression,” Dr. Bodis-Woll- quest for neuroprotective agents— Visual problems were not thought scopic changes in the retina. Says Dr. ner explains. With the detailed counts agents that can stop the dying-off of to be part of Parkinson’s disease, how- Bodis-Wollner, “the ability to image of retinal dopaminergic cells and infor- dopaminergic cells.” And with that, ever. From the time the illness was first the retina may revolutionize the mation on retinal thinning that ad- help stop the progression of Parkinson’s disease itself. K described in the early 1800s, until more process of evaluating and monitoring vanced OCT equipment can provide, than 150 years later, the loss of visual the neuronal changes that occur in researchers may be able to assess much acuity and the difficulty in distinguish- Parkinson’s disease.” more quickly and accurately whether a ing contrast many Parkinson’s patients Using OCT, he has been among the new treatment has arrested neuronal experience were attributed to other first to measure the of individu- causes, such as aging, cataracts als with Parkinson’s disease. Often, and glaucoma. they are 15 to 20 percent thinner than But in the late 1970s, Ivan Bodis- normal. “This loss may be a major rea- son why Parkinson’s patients have Wollner, MD, DSc, professor of neurol- difficulty distinguishing an image out dopaminergic cells, dopamine-sen- trouble detecting contrast,” Dr. Bodis- ogy and ophthalmology and director of from its background. sitive cells are deprived of dopamine,” Wollner says. “And we’ve learned University Hospital’s Parkinson’s Dis- Importantly, as part of that re- he notes, “and are no longer able to that the area of the retina affected in ease and Related Disorders Center, one search, he showed that vision changes make very important decisions that Parkinson’s may impair visual cogni- of the National Parkinson Foundation’s in tandem with neurological function- relate to vision and to motor tion,” the ability to respond to and Centers of Excellence, showed that ing. “When a patient doesn’t move execution.” categorize visual images. Parkinson’s disease itself can have a well,” Dr. Bodis-Wollner explains, “he In the late 1990s, intrigued by the Dr. Bodis-Wollner looks forward negative impact on vision. doesn’t see well.” role dopaminergic cells play in the to furthering this research by acquiring In 1978, using electrophysiology— Motor problems in Parkinson’s vision of Parkinson’s patients, Dr. the latest generation OCT equipment. brain-wave monitoring through exter- disease are caused by the death of Bodis-Wollner developed a quantita- “With these machines, we hope to be nally applied electrodes—he was the neurons that secrete and process an tive description of the relationship be- able to specify dopaminergic cells, in first to document delayed visual pro- important neurotransmitter called tween the retina’s dopaminergic and addition to measuring the retina’s cessing in the brains of individuals with dopamine. Dr. Bodis-Wollner’s dopamine-sensitive cells. A major ad- thickness,” he notes. Giving re- Parkinson’s disease. Following that, he research established that the death of vance in the Parkinson’s disease field, searchers access to cell counts could used the method again, this time these neurons, called “dopaminergic” the model has been used to predict the dramatically alter the course of clinical discovering among Parkinson’s patients cells, is also responsible for Parkin- retina’s response to new and existing trials for new Parkinson’s treatments. deficits in contrast-sensitivity— son’s-related visual problems. “With- Parkinson’s treatments. Until recently, “investigators have had to rely on clinical observations and Dr. Bodis-Wollner with M. Asim Javaid, MD, postdoctoral research fellow, and Sofya L. Glazman, MD, coordinator, “The ability to image the retina may revolutionize the process of evaluating wait a minimum of 18 months to dis- Parkinson’s Disease and Related Disorders Center of Excellence of the National Parkinson’s Foundation.

and monitoring the neuronal changes that occur in Parkinson’s disease.” Reprinted from Downstate Research: Profiles In Innovation, 2008, an annual publication of the Office of Institutional Advancement & Philanthropy. Reprinted with publisher's permission.

32 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 33 Decoding Diabetic development, initiate the weakening of the process of vasculogenesis involved healthy retinal blood vessels and promote in diabetic retinopathy.” the formation of new, leaky ones. Another of his important discover- On a fundamental level, Dr. ies is a protein called MMP-2. “In the Retinopathy Chaqour is interested in the ways that normal retina,” Dr. Chaqour explains, cellular environment affects cell behav- “there’s almost no MMP-2. But in ior. In the hyperglycemic milieu of the diabetic animals, CYR61 and CTGF diabetic retina, the pericytes, the induce expression of MMP-2.” The etween 12,000 and 24,000 technique called scatter laser surgery and the role of anti-angiogenic smooth muscle cells forming the outer protein destroys the extracellular Americans go blind each can, when administered early, improve factors, which lead to the destruction of layer of capillaries, begin to die. That matrix, the biological scaffolding that year as a result of diabetic the vision of people with diabetic pre-existing blood vessels and the process further deprives the retinal tis- stabilizes and connects cells. “This B sues of oxygen. Dr. Chaqour and his further degrades the pericytes.” retinopathy. retinopathy. But the procedure has formation of new blood vessel Diabetic retinopathy usually devel- limitations. Often, it can lead to the branches. colleagues discovered that when this Dr. Chaqour is using these discov- ops over several years and has its ori- loss of peripheral vision, and, because “A better understanding at the mo- oxygen deprivation occurs, two long- eries to develop pharmacological treat- gins in the body’s poor control of blood new blood vessels continue to grow, lecular level will help us learn how to dormant genes, CYR61 and CTGF, ments that may derail diabetic sugar levels. At the onset, the tiny the procedure must be repeated. control the process, both in the early from the family Dr. Chaqour has iden- retinopathy, even in the absence of tight blood vessels in the retina begin to To develop better treatments for and later stages of the disease,” tified begin to express themselves in blood sugar control. “We’re trying,” he swell and leak. Next, some of these this vision-impairing disease, Brahim he says. the retina. Their proteins accumulate in promoted by the CYR61 protein as says, “to put together recombinant vessels close off. Then, as more of Chaqour, PhD, an assistant professor of Dr. Chaqour has made great the space surrounding blood vessel well. Until recently, scientists believed peptides that will interrupt the growth them are blocked, the retina sends mo- anatomy and cell biology at SUNY progress towards this goal. He has cells, further exacerbating pericyte that angiogenesis—the branching off of of abnormal blood vessels and allow lecular signals that initiate a frenzied Downstate, is decoding the molecular identified a “small family of genes” death. new blood vessels from existing healthy retinal activity to occur.” formation of new and fragile blood ves- processes that underlie diabetic that, in the presence of hyperglycemia That’s not the only role CYR61 ones—was the only blood vessel- Already, Dr. Chaqour and his col- sels. In the advanced stages, called pro- retinopathy. “My goal is to understand (high blood sugar levels), plays a cru- and CTGF play in diabetic retinopathy. formation mechanism involved in the leagues developed several compounds, liferative retinopathy, these weakened a number of mechanisms that affect cial role in all phases of diabetic During the most advanced stage of di- disease. In fact, “scientists believed still unnamed, that block the destruct- vessels invade the vitreous gel that fills blood vessel growth and degeneration,” retinopathy. Working in tissue culture abetic retinopathy, their over-expres- the eye; when they leak, severe vision he says. These include the role of an- and with laboratory animals, he has sion contributes to the uncontrolled Dr. Chaqour has identified a “small family of proliferation of new, leaky blood loss or blindness results. giogenic factors, which lead to the pro- documented how these genes, normally genes,” that in the presence of hyperglycemia, To date, a high-tech vision-saving liferation of new blood vessel branches, active only during embryonic and fetal vessels, Dr. Chaqour has concluded. “The proteins these genes express even cause blood vessels to grow into the plays a critical role in all phases of diabetic eye’s vitreous gel, which, under normal retinopathy. conditions, is completely free of blood vessels. There’s no control mechanism vasculogenesis took place only during tive action of MMP-2. “That’s not in these newly activated genes that embryonic development and then enough to stop diabetic retinopathy, allows them to stop.” stopped altogether,” he says. By expos- yet,” Dr. Chaqour says. “But it’s a start. Dr. Chaquour’s lab discovered that ing stem cells to CYR61 in tissue One day, we may discover a pharmaco- vasculogenesis, the creation of entirely culture, Dr. Chaqour and his colleagues logical treatment that enables patients new blood vessels from stem cells, is demonstrated “this protein promotes to avoid the current surgical one.” K

IMAGE 1 IMAGE 2 IMAGE 3

Image 1: A well-organized and functional network of blood vessels in the retina of an adult rat. Image 2: A disorganized and dysfunctional network of blood vessels in the retina of an adult diabetic rat. Image 3: An extensive degradation of blood vessels in the retina of a diabetic rat. Diabetes activates specific proteases responsible for the destruction of retinal vessels during diabetes.

Members of Dr. Chaqour’s lab (from left to right): Jorge Espinoza, PhD student; Dr. Chaqour; Haibo Liu, PhD postdoctoral fellow; and Hunter College interns Michelle Reprinted from Downstate Research: Profiles In Innovation, 2008, an annual publication of the Office of Institutional Advancement & Philanthropy. Lee and Tyesha Williams. Reprinted with publisher's permission.

34 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 35 research scientist Mamdouh Kedees, PhD. can be life altering. than viruses will facilitate a treatment’s Restraining abnormal Dr. Teitelman is a diabetes “Because CTGF is involved in so entrance into involved cells, since researcher whose primary focus is the many important biological processes, viruses enter cells through receptors on regeneration of insulin-producing it’s not a good target for a systemic the cells’ surfaces. During this process, Blood Vessel Growth in the Retina B-cells in the pancreas. Yet she finds therapy,” observes Ms. Winkler. “But viruses’ relatively large size can hinder this new avenue of diabetes research the eye is encapsulated, which means their entrance. “SiRNA, on the other and “the possibility that we might be we can block the action of CTGF in the hand,” Dr. Teitelman says, “is small able to intervene in diabetic eye without concern for the treatment’s enough to enter the cell simply through retinopathy” compelling. impact on the rest of the body.” diffusion,” by the natural movement of n the United States, almost 21 glycemia, set off a years-long reaction But what if unrestrained blood One promising focus involves Working first in tissue culture and then molecules in the body. million people—7 percent of the that results in the formation of new, vessel growth, called proliferative proteins belonging to the CCN family, in diabetic laboratory rats, Dr. Teitel- Dr. Teitelman is hopeful the team’s I population—are diabetic. Of these fragile blood vessels that grow along retinopathy, could be kept in check including connective tissue growth man and her team have developed research will result in an effective treat- 21 million, an estimated 40 to 45 the retina and into the eye’s clear with a recombinant molecule factor (CTGF), cystein-rich protein recombinant molecules that bind to ment for what is becoming, in the percent will eventually suffer from vitreous gel. Ideally, people with dia- administered by injection or through (CYR61), and nephroblastoma overex- CTGF and prohibit its production. In United States and around the world, an diabetic retinopathy, the leading cause betes can slow or even halt the advance eye drops? pressed gene (NOV), which play a role their first experiment, the team used a increasingly common illness. “With the of blindness among American adults. of diabetic retinopathy by keeping their That’s the possibility being inves- in new blood vessel formulation and bioengineered virus that reduced CTGF first sign of diabetic retinopathy—the Diabetic retinopathy has its origins blood sugar levels under tight control. tigated by Gladys Teitelman, PhD, appear to be involved in the initiation expression by 70 percent in cells in cul- presence of leaky blood vessels, in poor control of blood sugar levels. In Such control, however, is difficult to professor of anatomy and cell biology, of retinopathy’s pathological changes. ture. Now, Dr. Teitelman’s lab is using for instance—we may be able to the eye, high levels of circulating blood achieve for the large majority of and the two members of her lab, Dr. Teitelman and her team are a small interfering RNA (siRNA) to intervene and prevent further compli- sugar, a condition called hyper- people with diabetes. graduate student Jennifer Winkler and specifically focusing on the action of accomplish the same task in laboratory cations of the disease,” she explains. CTGF. “We’re making progress in un- rats with induced diabetes. Of course, Dr. Teitelman notes, derstanding how we might be able to “One of siRNA’s benefits is that “glycemic control is always important interrupt its destructive action in the it’s very small — about a tenth the size in preventing diabetic retinopathy. But eye,” she says. of the virus we engineered,” says Dr. given how hard that is to achieve, Under normal conditions, CTGF is Kedees. The smaller size means any we must also pursue research that involved in a host of healthy biological treatment that involves siRNAs will be can lead to effective, minimally processes that include wound healing, less likely to provoke immune or invasive treatments.” K cell division and nerve conduction. In inflammatory responses. the diabetic eye, however, its action Moreover, using siRNAs rather

When blood vessels of the retina are infused with a red dye, leakage of the dye is found in the retinas of diabetic rats, but not in te retinas of rats with normal blood glucose levels. Arrow indicates area of leakage in the diabetic retina.

Reprint from Downstate Research: Profiles In Innovation, 2008, an annual publication of the Office of Institutional Advancement & Philanthropy. Reprinted with publisher's permission. 36 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 37 glaucoma implantation Research Dr. Freedman continues to teach part-time at University Hospital of Brooklyn while also conducting a private prac- tice. His current research projects include studies to identify Started at Downstate in the 1970s the most effective anti-fibrosis medications to improve out- comes following glaucoma surgery, as well as efforts to de- fine factors contributing to the development of glaucoma in individuals who have undergone corneal transplantation.

Dr. Freedman serves as chairperson of the Glaucoma Implant Session of Dr. Freedman helped pioneer the World Glaucoma Congress which the use of implantable devices occurs every two years. for the treatment of glaucoma, Glaucoma implant devices offer a treatment and this remains a primary Dr. Freedman was the Chairperson for the Glaucoma option for advanced and complicated glau- Implant Session at the highly-acclaimed World Congress coma. They are particularly well suited for focus of his clinical practice of Ophthalmology in Australia 2002, and was also invited to chair the session at the World Congress of Ophthalmology uveitic glaucoma, failed , and research. in Singapore in 2008 but had to decline due to health reasons. neovascular glaucoma, and some selected He was chairperson at the IGS (International Glaucoma Symposium), which is now the World Glaucoma Congress, primary glaucoma cases. in Prague 2001, Barcelona 2003, Cape Town 2005, Athens 2007, Singapore 2008, Boston 2009, and now in Paris 2011. He has had virtually the same faculty at all of these meetings. A new Molteno implant with Freedman modifications is currently in development and Implants now serve as part of the expected for use in late 2011 or early 2012. Dr. Jeffrey Freedman, an expert in glaucoma and corneal supra-Tenon's capsule placement of surgical armamentarium that the disease, and former director of the glaucoma subspecialty program, has played an important role in the Department a single-plate Molteno implant glaucoma surgeon can consider as of Ophthalmology. During an impressive career spanning The supra-Tenons implantation of the Molteno implant a management option. almost four decades, Dr. Freedman has made a number of was developed by Dr. Freedman and first published by him notable contributions in the field of ophthalmology. in the British Journal of Ophthalmology in 2007.

Molteno glaucoma Implant Ex-PREss Dr. Freedman has published over 70 articles in peer-reviewed journals. The Molteno Glaucoma Implant, which is the prototype Following are some recent book chapters he has authored. of all long tube implants in use today, was first introduced glaucoma shunt implantation The use of the Ex-PRESS shunt under a scleral flap was into the United States by Dr. Freedman in 1975, and im- 1) Ophthalmic Surgery, Fourth Edition, Spaeth 2010 planted into a patient at SUNY Downstate at that time. It first performed in the USA by Dr. Freedman in 2003. was Dr. Freedman’s work with the FDA that allowed for the 2) Management of Bleb Fibrosis. Glaucoma Complications. AAO 2010 subsequent use of glaucoma implants by other surgeons in the United States. Glaucoma implants have changed 3) Glaucoma Surgical Management, Saunders 2009 Dr. Freedman described the use of a patch graft over the long tube implants, which is now standard practice for these the way we manage complicated 4) “Drainage Implants” in Ophthalmology, Mosby. 3rd Ed 2009 implants. This procedure was first done at SUNY Downstate by Dr. Freedman in 1985. glaucoma cases.

38 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 39 Recent Publications

Case Report: spontaneous stenotrophomonas Maltophilia in a Diabetic Patient. Holifield K, gene Expression Changes in areas of Focal loss of Retinal ganglion Cells in the Retina of DBa/2J Mice. lazzaro DR. Eye Contact Lens. 2011. In Press. Panagis L, Zhao X, Ge Y, Ren L, Mittag TW, Danias J. Invest Ophthalmol Vis Sci. 2010 Apr;51(4):2024-34.

Beta-Blockade affects simulator scores. Pointdujour R, Ahmad H, liu M, smith E, lazzaro DR. The Matricellular Protein Cysteine-Rich Protein 61 (CCN1/Cyr61) Enhances Physiological adaptation Ophthalmology. 2011. In Press. of Retinal Vessels and Reduces Pathological Neovascularization associated with Ischemic Retinopathy. Hasan A, Pokeza N, Shaw L, Lee HS, lazzaro D, Chintala H, Rosenbaum D, Grant MB, Chaqour B. J Biol Chem. 2011 Mar 18;286(11):9542-54. Epub. 2011 Jan 6. Peters anomaly: Review of the literature. Bhandari R, Ferri s, Whittaker B, liu M, lazzaro DR. Cornea. 2011 March 28. survey of orbital Tumors at a Comprehensive Cancer Center in the united states. Roman shinder, M.D., Nagham Al-Zubidi, M.D., Bita Esmaeli, M.D. Head & Neck. March 2010, 1-7. Current Concepts in the Treatment of Pigmentosa. Musarella Ma and MacDonald IM. Journal Ophthalmology. 2011, Article ID 75347, 8 pgs. Defective Formation of the Inner limiting Membrane in laminin B2 and Y3-Null Mice Produces Retinal Dysplasia. Pinzón-Duarte G, Daly G, Li YN, Koch M, Brunken WJ. Invest Ophthalmol Vis Sci. 2010 Bone Invasion by adenoid Cystic Carcinoma of the lacrimal gland: Preoperative Imaging assessment Mar;51(3):1773-82. and surgical Considerations. Michelle D. Williams, M.D., Nagham Al-Zubidi, M.D., J. Matthew Debnam, M.D., Roman shinder, M.D., Franco DeMonte, M.D., and Bita Esmaeli, M.D. Ophthal Plast Reconstr Surg. 2010. Vol. 26, No. 6. Repair of Necrotizing in ulcerative Colitis with Processed Pericardium and a Prokera amniotic Membrane graft. lazzaro DR. Eye Contact Lens. 2010 Jan;36(1):60-1. Trypan Blue . smith EF, Desai RU, Schrier A, Enriquez B, Purewal BK. Ophthalmology. 2010 Jul;117(7):1462-1462.e1. genetic Deletion of laminin Isoforms B2 and Y3 Induces a Reduction of Kir4.1 and aquaporin-4 Expression and Function in the Retina. Petra G. Hirrllinger, Thomas Pannicke, Ulrike Winkler, Thomas Claudepierre, Shweta Varshney, Christine Schulze, Andreas Reichenbach, William J. Brunken and Johannes a Role for Complement in glaucoma. Ren L, Danias J. Adv Exp Med Biol. 2010;703:95-104. Hirrlinger. Plosone.org: January 2011, Vol. 6 Issue 1 (e16106).

Intraoperative Floppy Iris syndrome. Panagis L, Basile M., Friedman AH, Danias J. Arch Ophthalmology. In Vitro Cytotoxic Effects of Benzalkonium Chloride on adenovirus. lazzaro DR, Abulawi K, Hajee ME. 2010;128(11):1437-1441. Eye Contact Lens. 2009 Nov;35(6):329-32.

Journal of ocular Pharmacology and Therapeutics (Can Intraocular lenses Deliver antibiotics Inner Retinal layer Thinning in Parkinson Disease. Hajee ME, March WF, lazzaro DR, Wolintz aH, Intracamerally?) Shaw J, smith EF, Desai RU, Enriquez B, and Schrier A. J Ocul Pharmacol Ther. shrier EM, Glazman S, Bodis-Wollner Ig. Arch Ophthalmol. 2009 Jun;127(6):737-41. 2010 Dec;26(6):587-9.

Elevated levels of Transforming growth Factor B and Prostaglandin E2 in aqueous surgery for What is New after 40 Years of glaucoma Implants. Freedman J. J Glaucoma. 2010 Oct-Nov;19(8):504-8. glaucoma. Jeffrey Freedman M.D., David Goddard. Can J Ophthal. 2008. Vol. 43, No.3.

Morphologic Changes in the outflow Pathways of Bovine Eyes Treated with Corticosteroids. Tektas OY, Hammer CM, Danias J, Candia O, Gerometta R, Podos SM, Lutjen-Drecoll E. Invest Ophthalmol Vis Sci. 2010 Aug;51(8):4060-6. Epub. 2010 Mar 17.

Repair of limbal Dermoid With Excision and Placement of a Circumlimbal Pericardial graft. Douglas R. lazzaro, M.D., and Rodney Coe, M.D. Eye & Contact Lens. Volume 36, July, 2010:228-229.

40 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 41 Our Faculty

Kichiemon asoma, MD Marcus s. Edelstein, MD, PhD Douglas R. lazzaro, MD, FaCs, Faao shobit Rastogi, MD Clinical Assistant Professor of Ophthalmology Clinical Associate Professor of Ophthalmology Professor and Chair of Ophthalmology Assistant Professor of Ophthalmology Areas of Expertise: Areas of Expertise: Richard C. Troutman, MD, Distinguished Chair in Ophthalmology and Co-Director, Glaucoma Service Cornea & Anterior Segment • Cataract Surgery • General Ophthalmology • Clinical Optics • Laser Theory Ophthalmic Microsurgery Areas of Expertise: Corneal Transplantation • Refractive and LASIK Surgery • Refractive Surgery • Ophthalmic Infections Chief of Service: UHB, KCHC Glaucoma • Cataracts • Comprehensive Ophthalmology Comprehensive Ophthalmology Areas of Expertise: Michael P. Ehrenhaus, MD Comprehensive Ophthalmology • Ophthalmic Surgery • • Frank scalia, PhD Ivan Bodis-Wollner, MD, Dsc Assistant Professor of Ophthalmology LASIK Surgery • Corneal Transplants Professor, Cell Biology and Ophthalmology Professor of Neurology and Ophthalmology Director, Cornea, External Disease & Refractive Surgery Area of Expertise: Director, Parkinson's Disease Center of Excellence Areas of Expertise: E. Clifford lazzaro, MD Optic Nerve Regeneration Areas of Expertise: Intralasik • Intacs • Cataract Surgery • Corneal Transplant Surgery • Associate Professor of Clinical Ophthalmology Clinical Neurology • • Anterior Segment Reconstruction Retired Chair of Ophthalmology, Lutheran Medical Center Wayne scott, MD Movement Disorders • Parkinson's Disease Areas of Expertise: Assistant Professor of Ophthalmology Jeffrey Freedman, MD, PhD Comprehensive Ophthalmology • External Disease • Areas of Expertise: William J. Brunken, Bs, PhD Clinical Professor of Ophthalmology Neuro-Ophthalmology • Ocular Pathology • Optics Advanced Glaucoma and Cataract Surgery • Director of Ophthalmic Research Areas of Expertise: Management of All Forms of Glaucoma Professor of Ophthalmology and Cell Biology Glaucoma • Corneal Disease • Implantable Devices for the Howard liu, MD Areas of Expertise: Treatment of Glaucoma Assistant Professor of Ophthalmology osher sebrow, MD Retinal Angiogenesis • Extracellular Matrix • Laminins of the Eye Director Cornea, Kings County Hospital Center Clinical Assistant Professor of Ophthalmology anthony girardi, MD, FaCs Areas of Expertise: Director, Division of Ophthalmology, Brookdale Hospital Brahim Chaqour, PhD Clinical Assistant Professor of Ophthalmology Comprehensive Ophthalmology • Ophthalmic Surgery Areas of Expertise: Associate Professor of Cell Biology Director, Division of Ophthalmology, Coney Island Hospital Contact Lenses • Surface Ablation to Correct Refractive Errors Areas of Expertise: Areas of Expertise: lois M. McNally, MD, FaCs, Faao, FCaP Retinal Angiogenesis • ROP • CCN Proteins Comprehensive Ophthalmology • Sutureless Cataract Surgery • Associate Professor of Ophthalmology Roman shinder, MD Implantation Areas of Expertise: Assistant Professor of Ophthalmology John Danias, MD, PhD Ophthalmic Pathology • Ocular Oncology Areas of Expertise: Professor of Ophthalmology and Cell Biology Josh glatman, MD General Oculoplastics • Thyroid Ophthalmopathy • Co-Director of the Glaucoma Service Clinical Assistant Professor of Ophthalmology Maria Musarella, MD Orbital Wall Fractures • Orbital Tumors • Cosmetic Eye Surgery Director, Glaucoma Service, LICH Areas of Expertise: Professor of Ophthalmology Areas of Expertise: Diagnosis and Management of Retinal and Vitreous Disorders • Areas of Expertise: Eric shrier, Do Glaucoma • Glaucomatous Neurodegeneration • Gene Therapy Advanced Vitreo-Retinal Surgery Pediatric Ophthalmology • Ocular Genetics Assistant Professor of Ophthalmology Director, Retina Service James a. Deutsch, MD lekha gopal, MD Kenneth olumba, MD Areas of Expertise: Assistant Professor of Ophthalmology Clinical Assistant Professor of Ophthalmology Clinical Assistant Professor of Ophthalmology Diseases of the Posterior Segment (Vitreous, Retina and Macula) Areas of Expertise: Areas of Expertise: Areas of Expertise: Pediatric & Adult Strabismus • Pediatric Cataracts • Comprehensive Ophthalmology • Neuro-Ophthalmology Diabetic Retinopathy • Retinal Detachment • Ocular Trauma • Edward F. smith, MD Pediatric Eye Surgery • Amblyopia • Cataract Surgery Macular Degeneration Clinical Associate Professor of Ophthalmology Himani goyal, MD Associate Chief of Ophthalmology & Director, Brooklyn VA Monica Dweck, MD Clinical Assistant Professor of Ophthalmology Bradley Phillips, MD Areas of Expertise: Assistant Professor of Ophthalmology Areas of Expertise: Assistant Professor of Ophthalmology General Ophthalmology • Anterior Segment Surgery • Director of Oculoplastics Cornea & Anterior Segment • Cataract Surgery • Corneal Transplantation • Areas of Expertise: for Cataracts • Vice Chair & Program Director, Residency Program Refractive and LASIK Surgery • Comprehensive Ophthalmology Neuro-Ophthalmology • Refractive Surgery • Areas of Expertise: Small-Incision Cataract Surgery arthur H. Wolintz, MD Thyroid Ophthalmopathy • Orbital Wall Fractures • ashima V. Kumar, MD Former Chair and Distinguished Teaching Professor of Ophthalmology Orbital Tumors • Dry Eye • Lid Lacerations Assistant Professor of Ophthalmology Baljeet Purewal, MD Director, Neuro-Ophthalmology Service (Clinical Affiliates) Director of Pediatric Ophthalmology & Strabismus Assistant Professor of Ophthalmology Areas of Expertise: Areas of Expertise: Areas of Expertise: Optic Neuritis • GCA • Cranial Nerve Palsies • Headache Pediatric Ophthalmology • Cosmetic Oculoplastics • Ophthalmic Plastic & Reconstructive Surgery

42 SUNY Downstate Department of Ophthalmology SUNY Downstate Department of Ophthalmology 43 Dr. Ramanath Bhandari with Attending Baljeet Purewal, MD Drs. William Brunken and Brahim Chaqour at ARVO 2010

Dr. Douglas Lazzaro, Professor Eberhart Zrenner, MD, and Dr. William Brunken 2010 Pfizer Visiting Professorship Awarded to SuNY Downstate Department of Ophthalmology

Drs. Harry Flynn, Douglas Lazzaro and Joel Schuman at June 2010 Alumni Meeting at SuNY Downstate Drs. Sara Ferri, E. Clifford Lazzaro and Baljeet Purewal

Dr. Sara Hanson in OR with Attending Dr. Kenneth Olumba Drs. Douglas Lazzaro and Monica Dweck with the 2011 Graduating Class

44 SUNY Downstate Department of Ophthalmology Copyright © 2011 SUNY Downstate Department of Ophthalomology. All Rights Reserved. SUNY Downstate Department of Ophthalmology 45 SUNY DOWNSTATE MEDICAL CENTER DEPARTMENT OF OPHTHALMOLOGY

PRESENTS CURRENTCURRENT CONCEPTSCONCEPTS ININ OPHTHALMOLOGYOPHTHALMOLOGY January 6-7, 2012

Caesars Atlantic City, New Jersey

Visiting Faculty

Anthony J. Aldave, MD Michael Kazim, MD Miguel N. Burnier, MD, PhD Alex V. Levin, MD, MHSc Donald J. D’Amico, MD William F. Mieler, MD Lt. Col. Sheri DeMartelaere, MD Jonathan Myers, MD Steven L. Galetta, MD Alan Sugar, MD Professor Joel Sugar, MD Bonnie An Henderson, MD

For Complete Information or to Register Online, go to www.eyecurrentconcepts.org

Course limited to 300 attendees Earn up to 11 CME category 1 credits • Course fee $299.00 Hotel rooms limited - Call (800) 345-7253 and mention “SUNY Downstate” Questions about the meeting? Call Beatrice Pierre (718) 245-5460

COURSE DIRECTOR: Douglas R. Lazzaro, MD Professor and Chairman, Department of Ophthalmology