2020 ANNUAL REPORT KECK SCHOOL OF MEDICINE OF USC DEPARTMENT OF OPHTHALMOLOGY MESSAGE FROM THE CHAIR
The USC Roski Eye Institute’s mission is to provide exceptional clinical care, train the future leaders
in ophthalmology, and develop novel therapies in the fight against blindness. As our team educates tomorrow’s medical leaders, we continue to be at the forefront of innovation through the integration Inof medicine2020, the andUSC science. Department of Ophthalmology ranked #1 among all ophthalmology departments in one of the top departments in U.S. News and World Report federal NIH Funding. The Department has been nationally ranked as Our dedicated team of clinicians,for 27scientists, consecutive staff, years.and trainees take an integrated multidisciplinary approach to provide exceptional patient care through innovative treatments and state-of-the-art diagnostic services. The USC Roski Eye Institute continues to offer treatments not widely available in the community, including the management of complex cornea, retina, glaucoma, neuro-ophthalmology, oculoplastic, and uveitis cases.
The LAC+USC Ophthalmology Residency Program is nationally ranked in the U.S. by Doximity. With the expansion of our residency, fellowship, and hands-on teaching programs, we continue to strengthen our educational mission. Notably, we are grateful to our exceptional alumni who volunteer their time at LAC+USC Medical Center to mentor the next generation of ophthalmologists.
This year, the ongoing COVID-19 crisis disrupted patient care, research and the educational curriculum. However, our residents and faculty rose to meet the challenge and are implementing the latest COVID-19 industry responses provided by the American Academy of Ophthalmology (AAO) in their work.
Eliminating blindness is far from impossible. When science, innovation, perseverance, and compassion come together, breakthroughs are made in the service of our patients. We thank you for all of your continued dedication and support of our mission and look forward to the year ahead as we strive to develop new treatments and therapies to preserve, protect and restore vision.
J. Martin Heur, MD, PhD Mark S. Humayun, MD, PhD Professor and Interim Chair Co-Director, USC Roski Eye Institute Corneal Laser Surgery Cornelius J. Pings Chair in Biomedical Sciences USCCharles Department C. Manger of III, Ophthalmology M.D. Chair in Keck Medicine of USC Director, USC Ginsburg Institute for Biomedical Therapeutics
2 eye.keckmedicine.org YOUR VISION IS OUR MISSION
PRESERVE PROTECT RESTORE The USC Roski Eye Institute The USC Roski Eye Institute The USC Roski Eye Institute diagnoses, treats and manages leads major research in the integrates and applies the most complex eye diagnosis of eye disease with emerging technologies to conditions, from in utero to advanced imaging technology develop new methods to
advanced age. to help prevent blindness. restore sight to the blind.
SPECIALIZED CARE for ADULTS & CHILDREN
The USC Roski Eye Institute treats the full spectrum of eye conditions - from the most common to the CATARACT most complex. OCULO-FACIAL PLASTIC SURGERY CORNEA & EXTERNAL DISEASES OPHTHALMIC MOLECULAR AND ▪ GLAUCOMA ▪ IMMUNOPATHOLOGY ▪ LASER VISION CORRECTION ▪ PEDIATRIC OPHTHALMOLOGY ▪ SPECIALTY CONTACT LENSES AND PROSE ▪ NEURO-OPHTHALMOLOGY AND ADULT ▪ UVEITIS AND OCULAR INFLAMMATION ▪ LOW VISION REHABILITATION ▪ RETINA, VITREOUS AND MACULAR DISEASES ▪ OCULAR ONCOLOGY ▪ & SURGERY STRABISMUS ▪ Advertising Supplement 3 ▪ of EyeNet Magazine USC DEPARTMENT OF OPHTHALMOLOGY #1 IN NIH RESEARCH FUNDING AMONG OPHTHALMOLOGY DEPARTMENTS FY 2019 Top NIH Prinicipal Investigators
#1 #23 #50 Arthur Toga, PhD Qifa Zhou, PhD Paul Thompson, PhD
#50 #55 #90 Gianluca Lazzi, PhD Mahnaz Shahidi, PhD Sarah Hamm-Alvarez, PhD
44 eye.keckmedicine.org *Source: Blue Ridge Institute for Medical Research eye.keckmedicine.org Dry Eye Center of Excellence
Creates a Tear BiorepositoryPatients for seeking Identifying care for dry eye at the Dry Eye Center already receive a thorough work-up Biomarkers for Subtypes ofaccording Dry to Eyethe recommendations of the DEWS
provide an excellent view of each patient’s II workshop. Together, these measurements
Withlevel ofthe aqueous patient’s deficiency, consent, themeibomian Dry Eye Centergland researchersdisease and ocularwill store surface the tears inflammation. generated during clinical work-up, as well as the clinical data, in
the tear biorepository. foundation for furthering the development The tear biorepository will create a solid Syndrome, testing its performance against of Cathepsin S as a biomarker for Sjögren’s Pictured: A patient has Schirmer tear test strips inserted in her lower eyelids to collect tears other subtypes of dry eye and correlation with Dry eye disease remains a challenging condition indifferent tear composition clinical parameters. in patients It withwill also different allow for ophthalmologists to treat, due to the lack underlyingresearchers conditions, to characterize varying new degrees alterations of of understanding of its root causes. There has furthermeibomian the understandinggland disease, aqueousof the different deficiency dry been a growing interest in identifying objective and other dry eye parameters. This will not only monitoringbiomarkers thethat progression can be used of as the diagnostic disease and tools for dry eye disease, and for objectively eye conditions but may also help identify new biomarkers and therapeutic targets. efficacy of treatments. The hope is that this will benefit a wide range In published studies, USC Roski Eye Institute of subsets of dry eye patients, paving the researchers, Drs. Sarah Hamm-Alvarez and Maria populationway for personalized at the USC medicine. Roski Eye Finally, Institute the will Edman, analyzed tears in Sjögren’s Syndrome deep characterization of the dry eye disease increasedpatients to activity identify of diagnostic the protease, biomarkers Cathepsin for the autoimmune disease. They learned that the allow for better design of clinical trials for dry eyeA longertreatments version performed at the clinic. S, was a potential biomarker for Sjögren’s of this story Syndrome. The next step was to find biomarkers originally appeared on our for additional subtypes of dry eye disease. This year, researchers from the USC Dry Eye website.
Scan the QR code Center of Excellence (whose members includes to read the full Drs. Hamm-Alvarez and Edman) received an story: IRB approval to create a tear biorepository for Advertising Supplement 5 identifying biomarkers for subtypes of dry eye. of EyeNet Magazine Patient Stories From Silhouttes to Sight: How a Keratoprosthesis Corrected One Patient’s Lifelong Struggle with Vision
Dr. Nguyen performed the procedure on Caldwell aby synthetic replacing prosthetic diseased tissuedevice from to the the center eye with of thea full-thickness graft so Caldwell’s transplant eye wouldgraft. She stay added clear if
thatthe surrounding day to place tissuea drainage failed. device In addition, to control Drs. Benjamin Xu and Brian Toy performed surgeries
TheCaldwell’s morning glaucoma. after surgery, Caldwell woke up at
apartment she’d lived in for a year and saw her home with the gift of sight. She ran around the Pictured: living room, kitchen, and TV for the first time. Roslymn Caldwell (right) with her MedicalShe woke transportation her caretaker droveand shouted, Caldwell “I to can her see!” ophthalmologist, Dr. Annie Nguyen 14 freeway toward Los Angeles, she saw freeway Ever since Roslymn Caldwell was born, she childhood advanced to keratoconus in adulthood signs,next check-up hills, and with the licenseDr. Nguyen. plates Driving of other down cars the had eye conditions. What began as a lazy eye in
and Caldwell was blind for all of her adult life. for the first time in decades. When she arrived at the USC Roski Eye Institute, Dr. Nguyen asked “My vision was blurry,” she said. “It wasn’t dark, who was with her. but gray. I could see the silhouette of your face, When she read the eye chart, she could see to the but not the details.” “No one,” Caldwell said. “I came here myself.” needed someone to drive her, read to her, and she only saw motion and couldn’t even see the Her condition destroyed her confidence. She 20/40 line the day after surgery. Before surgery, guide her around her apartment. Caldwell Sincechart. her surgery, Caldwell has retaken control optometristsunderwent several throughout cornea Southern transplants, California but her body rejected each. Ophthalmologists and of her life. She is in school and has rediscovered told her there was nothing they could do. “Iher recommend love of reading. USC to anyone with an eye One day, a blind agency suggested Caldwell visit the USC Roski Eye Institute. Caldwell problem because it’s such a blessing to me,” felt hopeless but went to a consultation Caldwell said. “Anyone who wants to see, come examinedwith Dr. Annie Caldwell’s Nguyen, eyes an and ophthalmologist recommended check them out.” awho keratoprosthesis, specializes in the a procedure cornea. Dr. only Nguyen offered
by a handful of academic medical institutions 6 eye.keckmedicine.org worldwide. Under Pressure: How Minimally Invasive Glaucoma Surgery Saved a Promising, Young Student's Eyesight
someDr. Brian changes Song, to a glaucomaNamita’s medications specialist at withthe the USC Roski Eye Institute. Dr. Song initially made
hope of avoiding surgery, but this only led to a Heminimal recommended improvement she undergo in her pressure. urgent surgery
He thought she was a good candidate for a newer,to lower minimally the pressure invasive and saveglaucoma her sight. surgery
(MIGS). The advantage being a lower risk of complications and an easier recovery.
Pictured (L to R): “Dr. Song was patient and informative," Namita Toy, and Namita Sarraf Interim Dean Dr. Narsing Rao, Dr. Brian said. "He referenced data that had been Namita Sarraf suffered episodes of redness, pain, published just weeks earlier in a medical journal, and light sensitivity in her left eye that seemed to indicating how he was also searching for the best way to treat his patients.” recur despite treatment by her ophthalmologist. Dr. Song performed a combined canaloplasty A busy graduate student trying to finish her afterand trabeculotomy surgery, the pressure through in a Namita’ssmall incision eye had to studies in bioengineering, Namita didn’t have open the natural drain of the eye. “The morning “Whentime for the this. pressure in my eye was really high, uveitisdropped has back not to recurred, normal levels.thanks Six to amonths new, simpler later, She was diagnosed with recurrent anterior not only is her pressure controlled, but her it felt like a balloon about to pop,” Namita said. treatment regimen. uveitis of her left eye. Her ophthalmologist treated her with anti-inflammatory steroid eye “I was very happy to find that the pressure in drops, but these caused glaucoma. After a year of my eye had decreased as expected, confirming Attreatment, the recommendation her condition of was a family not improving. friend, she that the surgery had solved the problem. I am so grateful for the care I received at USC and to be Rao, internationally renowned uveitis specialist ableA longer to focus version on my studies again.” andsought interim out the dean expert of the opinion Keck School of Dr. Narsingof Medicine of this story originally appeared on our pressure in her left eye, which was now twice the of USC. Dr. Rao was concerned about the rising website. Scan the QR code upper limit of normal. He knew vision loss could to read the full occur as a result of glaucoma damage. story:
That same week, Dr. Rao referred her to see Advertising Supplement 7 of EyeNet Magazine ACTIVE RESEARCH FUNDING -
DECEMBER 2020
Pictured:
Dr. Sarah Hamm-Alvarez in her lab. PRINCIPAL INVESTIGATOR PROJECT SOURCE
NIH/NCI Eyes Development of a Surrogate Liquid Biopsy from the Aqueous Humor in Retinoblastoma Jesse Berry, MD Wright Foundation Prospective Longitudinal Aqueous Humor Liquid Biopsy to Predict Treatment Jesse Berry, MD Melinda Chang, MD Response and Minimal Residual Disease in Retinoblastoma KTE Quantitative Visual Assessment in Children with Cortical/Cerebral Visual Impairment NIH/NEI (CVI) Using a Machine-Learning Model of Eye Tracking Data NIH/NCI David Cobrinik, MD, PhD Human Specific Signaling Circuitry in Cone Precursor Development David Cobrinik, MD, PhD Successive Responses to Oncogenic Aberrations in Retinoblastoma Genesis Charles Flowers, MD CIR-SIEU David Cobrinik, MD, PhD TranscriptomicProtection Effects of Copy Number Alterations in Pediatric Cancers St. Baldrick's PurchasingPhysiologic BreathElectrical Shields Fields for Direct Slit Lamp Optic Exams Nerve toRegeneration Enhance Patient and Provider USC Fight For Sight Kimberly Gokoffski, MD, PhD Kimberly Gokoffski, MD, PhD Measurement of Vascular Tortuosity in IIH by OCTA and Optos In vivo Application of Electrical Fields Directs Retinal Ganglion Cell Axon Regeneration NIH/NEI Kimberly Gokoffski, MD, PhD Electric Fields Collaborate with Cdc42 to Direct Optic Nerve Regeneration BFF NIH/NEI Kimberly Gokoffski, MD, PhD Protein-polymer Nanomedicine for Sjogren's Syndrome NIH/NEI Sarah Hamm-Alvarez, PhD Microtubule-Based Transport in Lacrimal Gland Function MJF Sarah Hamm-Alvarez, PhD USC Sarah Hamm-Alvarez, PhD Expansion of Tear Biomarker Studies in Parkinson's Disease Patient Cohorts NIH/NIA Sarah Hamm-Alvarez, PhD RNA-Seqdisease using on Tears: RT-QuIC Biomarker Discovery for Parkinson's Disease Development of a novel tear-based biomarker assay for diagnosis of Parkinson's Sarah Hamm-Alvarez, PhD Enhanced Preservation of Donor Corneas OneLegacy J. Martin Heur, MD, PhD Research to Prevent Blindness Unrestricted Grant RPB Mark Humayun, MD, PhD NIH/NEI J. Martin Heur, MD, PhD Mark Humayun, MD, PhD CIRM USCAge-related Roski Eye Macular K12 Clinician-Vision Degeneration Scientist Training Program (USC Roski Eye K12) Mark Humayun, MD, PhD EFRIPRPE-SF, CEE: polarized Engineered hESC-derived Retinal Epigenomics RPE Soluble Factors, as a Therapy for Early Stage Dry NSF Mark Humayun, MD, PhD NSF Mark Humayun, MD, PhD NIH/NEI EAGER: Engineered nano-scale barrier to prevent viral infections Mark Humayun, MD, PhD NSF Abiotic-Biotic Interfaces for Ophthalmology Symposium Xuejuan Jiang, PhD Cumulative Effects of Sickle Cell Trait on the Eye among Older African Americans NIH/NEI Microbubble-assisted Crispr/Cas9 Delivery in Retina for Photoreceptor Therapeutics
8 eye.keckmedicine.org Xuejuan Jiang, PhD NIH/NEI preschool children Amir Kashani, MD, PhD IntrauterineFunctional Imaging exposure in Hypoxic-Ischemicto tobacco smoke, RetinalDNA methylation, Disease and vision disorders in NIH/NEI Amir Kashani, MD, PhD NIH/NINDS Amir Kashani, MD, PhD NIH/NIA Imaging Cerebral and Retinal Microvasculature in Cerebral Small Vessel Disease Assessment of Retinal Capillary Density, Morphology and Function in Retinal Vascular Amir Kashani, MD, PhD Motor, Visual, and Olfactory Changes in Genetic Subtypes of Alzheimer’s Disease NIH/NEI Connectome-Derived Computational Models of Degenerated Retina for Retinal NIH/NEI DiseaseProsthetic Using Design Novel OCT Angiography Based Metrics Gianluca Lazzi, PhD, MBA NSF
Gianluca Lazzi, PhD, MBA EAGER: Bioelectronic Color Vision Structures in the Presence of Supraphysiological Electric Fields Predictive Modeling of Bioelectric Activity on Mammalian Multilayered Neuronal Gianluca Lazzi, PhD, MBA CRCNS: US-Spain Research Proposal: Computational Modeling of PNS NIH/NIBIB Stimulation GianlucaAaron Nagiel, Lazzi, MD, PhD, PhD MBA NIH/NIBIBUSC Aaron Nagiel, MD, PhD EDT Development and Maintenance of the Human Photoreceptor-bipolar Cell Synapse Aaron Nagiel, MD, PhD Hippo pathway inhibition for the treatment of geographic atrophy cell synapse Role of non-canonical Wnt signaling in the developing human photoreceptor-bipolar Aaron Nagiel, MD, PhD CHLARPB Retinal Organoids Development and Maintenance of the Photoreceptor-Bipolar Cell Synapse in Human Grace Richter, MD, MPH NIH/NEI Disease, and Ocular Anatomic Factors in African Americans Defining the Relationships of Retinal Microcirculation with Glaucoma, Systemic NIH/NEI Center Core Grant for Vision Research NIH/NEI Mahnaz Shahidi, PhD Imaging of Retinal Oxygenation and Metabolism In Vivo Molecular Imaging of Vascular Disease of the Retina NIH/NEI Mahnaz Shahidi, PhD NIH/NEI Mahnaz Shahidi, PhD Retinal vessel features as a marker of idiopathic intracranial hypertension treatment Mahnaz Shahidi, PhD Imagingresponse: of a Retinal secondary Oxygen analysis Metabolism of the idiopathic in Diabetic intracranial Retinopathy hypertension treatment trial NoelleMahnaz Stiles, Shahidi, PhD PhD NIH/NEI
John Whalen, PhD DOD Restoring- II Sight to the Blind: Neural Imaging with Retinal Prostheses Thermoreponsive Reversible Adhesive for Temporary Intervention of Ocular Trauma NIH/NEI Evaluate Patients with Primary Angle Closure Disease Development and Validation of Quantitative Anterior Segment OCT-based Methods to Benjamin Xu, MD, PhD NIH/NEI Damages VRC: A Stem Cell-Based Treatment Strategy for Laser-Induced Permanent Retinal Benjamin Xu, MD, PhD Anatomical Mechanisms for Development and Progression of Primary Angle Closure American Disease: A Cross-Sectional and Longitudinal Analysis Glaucoma Society Benjamin Xu, MD, PhD FFS USC Benjamin Xu, MD, PhD QuantitativeRisk Factors forOCT-based Primary Methods Angle Closure for Primary Disease Angle Closure Disease Development of Quantitative OCT-based Methods to Detect and Evaluate Biometric Benjamin Xu, MD, PhD Development of an Integrated Teleglaucoma Care Program for a Safety-Net Health American System Glaucoma Society
QifaBrandon Zhou, Wong, PhD MD Combined OCT/US/PAT System for Intravascular Imaging NIH/NHLBI NIH/NCI Qifa Zhou, PhD cancer Large aperture and wideband modular ultrasound arrays for the diagnosis of liver High-resolution Elastographic Assessment of the Optic Nerve Head NIH/NEI Qifa Zhou, PhD
Non-invasive Ultrasound Stimulated Retinal Prosthesis NIH/NEI Qifa Zhou, PhD
High-resolution High-Speed Photoacoustic and Ultrasound Imaging of Small Vessel NIH/NINDS Qifa Zhou, PhD Functions in Ischemic Stroke
• AGS (American Glaucoma Society) • BFF (BrightFocus Foundation) • CHLA (Children's Hospital Los Angeles) • CIRM (California Institute for Regenerative Medicine) • CIR-SIEU (Committee of Interns and Residents SEIU Healthcare) DoD (Department of Defense) • EDT (Edward N. & Della L. Thome Memorial Foundation) • FFS (Fight for Sight) • KTE (Knights Templar Eye Foundation) • MJF (Michael. J. Fox Foundation) • NCI (National Cancer Institute) • NEI (National Eye Institute) • NHLBI (National Heart, Lung and Blood Institute) • NIA (National Institute on Aging) • NIBIB (National Institute of Biomedical Imaging and Bioengineering) • NINDS (National Institute of Neurological Disorders and Stroke) • NSF (National Science Foundation) • OneLegacy (OneLegacy Foundation) • RPB (Research to Prevent Blindness) • St. Baldrick's (St. Baldrick's Foundation) • USC (University of Southern California) • Wright Foundation
Advertising Supplement 9 of EyeNet Magazine Research Progress Intrauterine Exposure to Cigarette Smoke, DNA Methylation, and Vision Disorders in Preschool Children
Intrauterine exposure to factors such as maternal smoking may affect the offspring's vision via epigenetic programming.
Vision disorders in early childhood, such as strabismus, amblyopia, and high hyperopia, can significantly impair the development of children's visual, motor, mechanismsand cognitive underlying functions. Maternalthese disorders smoking and during the effect pregnancy of maternal has been smoking consistently remain associated with several pediatric vision disorders. However, the biological
mostly unknown. Given the persistently high maternal smoking rates and emerging new sources of nicotine exposure (e.g., e-cigarettes), a better understanding of how intrauterine exposure to smoke/nicotine affects vision development is needed. Also, herthere team have been significant advances in identifying methylation changes in newborns in response to maternal smoking during pregnancy. These led Dr. Xuejuan Jiang and to hypothesize that methylation changes can alter vision development in the fetus, leading to vision disorders in early childhood. study nested within the Multiethnic Pediatric Eye Disease Study to test this Funded by the National Eye Institute, Dr. Jiang's team is conducting a case-control
hypothesis. They are retrieving neonatal dried blood spots collected by the California Biobank Program from these children at birth. Using these unique resources, Dr. Jiang and her team will perform genome-wide profiling of DNA methylation in newborns' blood and measure biomarkers of intrauterine exposure to smoke/nicotine. They will then evaluate how these neonatal biomarkers may predict the risk of developing strabismus, amblyopia, and hyperopia in children. They will also conduct a genome- wide search for methylation susceptibility loci for hyperopia. Findings from their investigation will contribute novel knowledge for a better understanding of the biological mechanisms involved in the development of pediatric vision disorders, and may generate novel targets for the prevention and treatment of these diseases. 10 eye.keckmedicine.org Minimally Invasive or Wearable, Adaptive, Systems for Stimulating and Controlling Neural Circuits in the Retina
Conceptual implementation of novel contact lens for retinal stimulation. The device is an “e-lens” to provide controlled electrical stimulation of the retina. Electrical stimulation of neural tissue is widely adopted in neuroengineering as an attempt to restore partial neural functions, usually lost due to diseases or traumatic neurostimulators and have resulted in very encouraging, and sometimes dramatic, partialinjuries. relief While to anlost increasing neural functions number – of such medical as a retinal conditions prosthesis have been – the treated limited with understanding of the complex processing in the central nervous system (CNS) istranslates nearly identical into sub-optimal in all cases, bioengineered including retinal devices, prosthetic: which fall currents short ofinjected being thethrough true biomimetic devices that researchers aspire to create. The premise in these implants electrodes meant to stimulate the surviving neural cells beneath them, thus bypassing Researchthe upstream in the diseased Department neural of circuitry. Ophthalmology at USC has resulted in fundamental contributions in the understanding of the alterations of retinal network signaling in prevalent retinal diseases, such as Retinitis Pigmentosa (RP), Age-Related Macular Degeneration (AMD), and Primary Open Angle Glaucoma (POAG), is working which spearheaded on a research on the potential role of induced electric fields to alter or slow down the contactprogression electrodes of these that diseases. do not Acover team or led damage by Dr. theGianluca cornea, Lazzi and are designed to wirelessly-powered contact lens electrical stimulator (“e-lens”), which includes simulations maximize electric current flow in the retina as determined through computational (pictured). Highly efficient wireless powering systems have been developed and novel electrical stimulation circuits and waveforms are being investigated to stimulate specific areas of the retina. Advertising Supplement 11 of EyeNet Magazine Wiring the Human Retina in Development and Disease: Insights from Human Retinal Organoids
Human retinal organoid section demonstrating the laminar organization of photoreceptors (blue), horizontal cells (red), and bipolar cells (green) along the outer plexiform layer. Inherited retinal diseases encompass a wide array of genetic disorders that can cause
These disorders affect approximately 1 in 2,000 individuals and can lead to severe and dysfunction and degeneration of the retina, the light-sensing tissue inside our eyes. there is accumulating evidence that dysfunction occurs at the site of communication permanent vision loss, usually beginning in childhood. In many of these disorders,
Nagiel's(or synapse) between photoreceptors, which convert light into electrical signals, and bipolar cells, which relay these signals to the brain via other cell types. Dr. Aaron laboratory aims to determine how human photoreceptors establish and maintain specific synaptic connections with bipolar cells and how this process goes awry in retinal disease.
To study this process in human tissue, Dr. Nagiel's lab utilizes retinal organoids, developmentwhich are “mini-retinas” to understand produced the fundamental from human processes stem cells that that guide can proper be made wiring from normal blood or skin cells. These retinal organoids are being analyzed during retinal
of photoreceptors and bipolar cells. These studies will be bolstered by access to organoids containing live fluorescent cell types and genetically engineered cell lines waysthat simulate to restore inherited neuronal retinal connections disease. in The disease lab's statesultimate following goal is tothe provide use of geneinsights into how specific connections are made between neurons of the retina and identify
therapy or stem cell-based therapy. 12 eye.keckmedicine.org Employing Big Data to Inform Health Systems Practice
Large volumes of health data are aggregated in insurance claims databases and electronic medical records. This information can be leveraged to study rare and orphan diseases for which it would be impractical to perform standard clinical trials. Furthermore, knowledge about real-world treatment patterns and costs associated with more common diseases can have has important employed public clinical health informatics implications. approaches to
A research group led by Dr. Brian Toy analyze big data to identify needs in caring for populations of patients with diabetic retinopathy, ocular inflammatory disease, angle-closure glaucoma, and idiopathic intracranial hypertension.
Employing a nationwide claims database comprising of over 65 million individuals, approaches,Dr. Toy's group including identified telemedicine gaps in screening and machine for diabetic learning, retinopathy to improve even preventive among insured adults with presumable access to care. This highlighted a need for innovative care for this sight-threatening disease. With the same database, Dr. Toy's group andhas characterizedmanagement ofthe uveitis, epidemiology thus preventing and risk visionfactors loss, underlying decreasing infectious cost and ocular inflammatory diseases. Clinical informatics has the potential to improve the diagnosis improving the quality of care for patients.
Advertising Supplement 13 of EyeNet Magazine Education and Training RESIDENCY PROGRAM
rotations at the USC Roski Eye Institute, training is also provided at Los Angeles County+USCEach year, hundreds Medical of Centerapplicants (LAC+USC) compete, Children’sfor seven positions. Hospital In Los addition Angeles to clinical(CHLA) , and the VA Downtown Los Angeles Medical Center
. With a total of 21 residents, we have positioned ourselves as one of the largest programs in the Western U.S. PROGRAM LEADERSHIP
J. Martin Heur, MD, PhD Charles Flowers Jr., MD Brandon Wong, MD Malvin Anders, MD Professor and Interim Chairman Program Director Associate Program Director Chief of Ophthalmology, LAC+USC Medical Center
• Our residency program maintains its large volume of clinical encounters, consistently excellent hands-on training and high research output within the resident body. Our residents have been in the top 5% of programs nationwide for the past eight consecutive years in total ophthalmologic surgeries and procedures performed. • Our residency continues to maintain one of the highest Accreditation Council of Graduate Medical Council (ACGME) resident survey results across all post-graduate programs at LAC+USC Medical Center. • Our AUPO-compliant fellowship programs continue to thrive, with fellows from across the nation choosing our institute to further their subspecialty training. • Our faculty are very involved in medical student education through lectures, workshops, hands-on teaching in the clinic and OR, and mentoring research projects. There is also a thriving ophthalmology student interest group that engages in several community outreach activities each year with faculty guidance, led by Dr. Jessica Chang, Director of Medical Student Education.
14 eye.keckmedicine.org 2020-2021 Graduating Residents
Charles DeBoer, William Gange, MD Hong-Uyen Hua, MD, Nicole Koulisis, MD MD, PhD Loyola University Co-Chief University of USC Chicago, IL University of Miami Massachusetts Los Angeles, CA Miami, FL Worcester, MA
Diana Lee, MD Jonathan Lu, MD Maggie Runner, MD, Georgetown UC Davis Co-Chief Washington, DC Davis, CA Emory University Atlanta, GA
2020-2021 Graduating Fellows
Mashal Akhter, MD Christine Bokman, MD Andres Gonzalez, MD Surgical Retina Oculoplastics Surgical Retina Northest Ohio Medical UCLA University of Florida University Los Angeles, CA Gainesville, FL Rootstown, OH
David Kay, MD Peter Lam, MD Glaucoma Cornea UT Health San Antonio LSU Shreveport San Antonio, TX Shreveport, LA Advertising Supplement 15 of EyeNet Magazine Grand Rounds Case Study “Up, Up, and Away!” HISTORY • Dilated fundus examination showed no evidence of intraocular CHALLENGING • 25-year-old male with no presenting with: progressively • Patient then initiated on EYE CARE cysts. worseningsignificant pastheadaches, medical nausea/ history vomiting, and acute altered mental albendazole 15mg/kg/day + • praziquantel 50mg/kg/day + 0.2 – EXAMstatus FINDINGS x1 day. 0.4mg/kg/day of dexamethasone. • PatientNeurocysticercosis remained inpatient (NCC) • In the ER, patient AAOx1 with antibodies returned positive.
• CT Head: Ventriculomegaly and a and then in rehabilitation for tachycardia and leukocytosis. PATIENTappropriate COURSE NCC treatment. of the Tectal plate, likely resulting 2.5 cm cystic lesion in the region • Patient returns four months trans-ependymal edema (cyst not after initial presentation with Sona Shah, MD in obstructive hydrocephalus with PGY-2 Ophthalmology • complaints of binocular diplopia. Resident studyclearly visible on initial imaging Since being in rehabilitation, • but can be seen below on a later (Figure 1). withpatient worsening has noted symptoms limited up-gaze of MRI Brain (Figure 2): Obstructive and persistent dysconjugate gaze, MANAGEMENThydrocephalus. OCULARdiplopia EXAMINATION x2 days. • Admitted to the ICU for urgent shunt placement, with an opening • • ExternalPupillary exam exam showed significant (Figure for: 3, light-near disassociation. Figurepressure 1 (below, left): elevated MRI Brain at w/ > and 30mmHg. w/out contrast after initial presentation, illustrating cystic lesion in the • 4th ventricle. •4) 4 mm ptosis bilaterally Figure 2 (below, right): MRI Brain w/ and w/out contrast on day of initial presentation, exhibiting Abduction: full and intact hydrocephalus. It was evident that this was not a typical • Adduction:bilaterally (ruling full and out intact a CNVI communicating hydrocephalus and that a mass effect palsy) Kimberly Gokoffski, was present, however the cysts were not clearly visible MD, PhD on imaging. slowed adduction saccades Assistant Professor of bilaterally w/out evidence of Clinical Ophthalmology
16 eye.keckmedicine.org Figure 3 (above): Extraocular muscle Figure 4 (above): Versions movements.
• Given treatment of NCC and control of not ruling out a partial nuclear third nerve (ruling out internuclear ophthalmoplegia, but surgical correction after approximately six • intracranial pressure (ICP), we would offer palsy) Right and left gaze: the adducting eye shoots months of recovery. • up, indicating inferior oblique overaction (indicating bilateral CN IV palsy) Up-gaze: cannot move eyes beyond midline DIAGNOSIS(indicating AND up-gaze DIFFERENTIAL palsy) • convergence retraction nystagmus, alternating Summary: Bilateral ptosis with upgaze palsy,
hypertropia and near light dissociation. Our patient displayed 30 degrees of excyclotorsion. With the Parks-Bielschowsky three-step test, there was suspicion for either a bilateral CNIV palsy versus skew deviation. Distinguishing deviationbetween the has two no relativerequires cyclotorsion testing for relative while CNIV Figure 5 (above): This illustration demonstrates the geographic cyclotorsion using a double Maddox rod: skew relationship of the posterior commissure to its surrounding structures. MLF = medial longitudinal fasciculus. INC = Interstitial nucleus of Cajal. ANATOMICALpalsy demonstrates DAMAGE relative UNDERLYING excyclotorsion. REFERENCES • Walsh DORSAL MIDBRAIN SYNDROME and Hoyt's clinical neuro-ophthalmology: The essentials include:Components of dorsal midbrain syndrome - Miller, N. R., Subramanian, P. S., & Patel, V. R. •(many Light-near of which dissociation: were present results in the from case damage at hand) . to the posterior commissure Philadelphia, PA: Lippincott Williams & Wilkins. 2016. - Sawhney, I. M. S., Singh,Journal G., ofLekhra, the Neurological O. P., Mathuriya, Sciences S. N.,, • Parihar, P. S., & Prabhakar, S. Uncommon presentations of rostral interstitial nucleus of the medial neurocysticercosis.- Hoehn ME, Calderwood J, O'Donnell T, Armstrong GT, Upgaze palsy: results from damage to the 154(1), 94-100. 1998. Journal of American Association for • Convergence-retraction nystagmus: results GajjarPediatric A. ChildrenOphthalmology with dorsal and Strabismus midbrain syndrome as a longitudinal fasciculus (riMLF) result of pineal tumors. , 21(1):34-8. 2017. one-and-a-half syndrome with associated contralesional from damage to the midbrain supranuclear - Mesraoua, B., Deleu, D., D'souza, A., Imam, Y. Z. B., & Melikyan, G. NeurocysticercosisJournal ofpresenting the Neurological as a vertical TREATMENTfibers in posterior AND PROGNOSIS commissure Sciences horizontal gaze paresis. • , 323(1-2), 250-253. 2012. Neurology, - Baloh, R. W., Furman, J. M., & Yee, R. D. Dorsal midbrain • FullManagement resolution of of dorsal symptoms midbrain is rare, syndrome and some is syndrome: clinical and oculographic findings. targeted at treating the underlying cause. 35(1), 54-54. 1985.Archives of Ophthalmology - Keane, J. R. Neuro-ophthalmologic signs and symptoms of cysticercosis. , 100(9), 1445- degree of persistent symptoms is expected. 1448. 1982. Advertising Supplement 17 of EyeNet Magazine As COVID-19 Disrupts Education, Ophthalmology Residents Adapt
are adapting within the drastically disrupted in the USC Department of Ophthalmology, learning environment due to the ongoing When Dr. Charles DeBoer, a third-year resident patients and physicians from COVID-19 droplet learned that barrier shields meant to protect InCOVID-19 addition, pandemic. residents are continuously implementing the latest COVID-19 industry transfer were nationally backordered, he spent his own time and personal resources to build PPE customized for ophthalmic exams. responses provided by the American Academy of ‘Stepping up infection control measures in theirOphthalmology patients’ health (AAO). histories, They are and strengthening have ophthalmology“I saw a barrier duringshield designthe novel in thecoronavirus paper, increasedtheir history in-depth taking provider-to-provider skills to learn more about discussions with their fellow residents, fellows, and thought the way they implemented infection outbreak: an experience from Hong Kong (2020)’ how to use new technology to provide telehealth and faculty. Furthermore, residents are learning control made sense,” said Dr. DeBoer. “So I copied it for our clinics and we refined the design.” In “Telehealthservices to meet allows patient us to performneeds. a quick external collaboration with co-resident Dr. Diana Lee and slittwo lamps, attending the microscopesphysicians, Dr. used DeBoer to look created into barrier shields out of polycarbonate sheets for doesexam not of a allow patient’s for a eye,” full assessment,said Dr. Hong-Uyen it can help Hua, a third year and co-chief resident. “While it patients’ eyes. physicians to examine a patient closely while patients avoid in-office visits for non-urgent Dr. DeBoer’s barrier shields now enable issues.”
still reducing the risk of infection for them both Dr. Hua elaborated that patients often call with at LAC+USC Medical Center (LAC+USC) and COVID-19eye problems have that called can withbe resolved concern over that the they Keck Medical Center (KMC) ophthalmology phone. Several patients who tested positive for 18 eye.keckmedicine.orgclinics. This is only one example of how residents In addition, the residency program’s education this situation, we ensure that the patient has are developing an eye infection, as well. “In All faculty lectures and Grand Rounds continue curriculum has quickly shifted to online learning. theno vision-threatening importance of social issues. distancing, We educate and make and counsel them on supportive care, emphasize Despiteto be conducted the disruption via Zoom. that COVID-19 has caused to the residents’ training, they share great pride sure they practice good hygiene. As a result, we minimize exposure for everyone.” that COVID-19 will permanently affect the in their colleagues’ resilience. “Too often likened ophthalmologySeveral residents landscape expressed and their that belief it has to war, this pandemic has heroic troops battling opened the door for telemedicine to play a more career,this microscopic, no healthcare insidious worker enemy imagined every we day,” would said Dr. Hua. “When we chose medicine as a
Awayfrequent from role clinic, in the residents field. are reading journal have to risk our own lives to save others. I am in articles to stay updated on their respective aawe career of all and of myvocation colleagues during on this the unprecedentedfrontline. I feel re-affirmed in my decision to choose medicine as fields and studying for their annual Ophthalmic pandemic.” Knowledge Assessment Program (OKAP) exams.
Advertising Supplement 19 of EyeNet Magazine LAC+USC Ophthalmology Alumni Spotlight: Dr. Charles Manger III
Resident Teaching Rounds were something to resident, I remember the Tuesday Morning
tofear. three Dr. Ryanhours would preparing lead themyself rounds for the and next he was a very serious, focused man. I’d spend two
morning’s rounds, because he’d call on the independenceresidents at random the program to ask questionsgave me to about evaluate the case. But what impacted me the most was the
and treat a significant number of patients at the Los Angeles County/USC Hospital. Senior residents and staff were available to assist if I had a question, but the program gave us Whatautonomy. was your most memorable experience of residency?
when an intern woke me to say a patient had arrivedIt was January with retina 1, 1980. symptoms I was on and call insisted and asleep
Dr. Charles Manger III graduated from the LAC+USC Medical Center Ophthalmology somethat I seecalls, him. I arranged I examined for thethe staffpatient’s at the eye Eye and CA,Program where in he 1980. has performedHe subsequently ~89,000 founded LASIK found he had a retinal detachment. After making the Saddleback Eye Center in Laguna Hills, made a generous donation to the USC Roski Institute to fix his detachment the next morning. surgeries since 1996. In 2007, Dr. Manger The patient became a neurologist and lives in III Endowed Chair in Corneal Laser Surgery, a itOrange empowered County me and to we make have decisions kept in touch regarding since. Eye Institute to establish the Charles C. Manger My residency experience was so vital because Ophthalmology’s interim department chair, chair currently held by the USC Department of Beforepatient care.you started residency, you went to Annapolis and served on a nuclear missile Dr. J. Martin Heur. submarine. Did those experiences shape your Manger recently donated his time to share approach to healthcare? howTo reflect the residency on his ophthalmology program prepared career, him Dr. for a The common thread through those experiences successful career and impart wisdom on the next is I learned you must find a purpose and then make a commitment. These places taught me Cangeneration you tell of us ophthalmologists. about your experience as a that you must be willing to work every waking resident at the Keck School of Medicine? hours a day and free weekends are not a given in hour of most days to fulfill your goals. Eight
When I started training, Dr. Steve Ryan and Dr. these endeavors. Ron Smith had just arrived at USC to establish 20 eye.keckmedicine.org a full-time academic program. As a first-year With those kinds of demands, what keeps you right career for me, it provided me with routines going?
WhatI apply advice to my practicewould you to this give day. to our residents toWhen them patients and let firstthem meet know with this me, is something they have fearI’ve who want to go into private practice? of the LASIK procedure. But my staff and I talk to do the surgery technically correct and it’s medicine are important to you, you must work been doing for 24 years. I tell them I’m going hardIf the and business communicate and entrepreneurship continually with aspects your of staff, so you are consistent with procedures LASIKgoing to makes improve a truly their positive vision. change A few hours in their after the procedure, they can’t believe the difference. operations,and instructions. while Youalso must managing stay involved the clinical from and a Whatquality advice of life. would you give to our residents distance and manage all aspects of your office and alumni? Consistent communication with patients and Whatsurgical inspired work on you your to patient. make such a transformational gift to our department? staff is key to an organized office environment. Manger was a Professor of Neurology at the myIt is practice, essential we not have to be 15-minute absorbed staff with rounds patient Before I was born, my grandfather, Charles care to the exclusion of those relationships. In USC allowedMedical Schoolme to pursue [1911-1918]. my dream I wanted of a career to handlewith the given doctors situations, and staff how every we workday.may handle We recognize both my grandfather’s work and that talk about the day before, the correct way to Inin medicineappreciation at 28 of yearsthe opportunities old. My wife thatCarol USC and Navy,those wheresituations rounds better are in held the everyfuture, morning upcoming providedmy daughter for ourLaurie family, have we degrees wanted from to help USC. other procedures, etc. The practice comes from the when in port. Although the Navy was not the people seeking a medical career.
At the chair installation for Dr. J. Martin Heur, MangerDr. Manger has gave always a guest stressed lecture to his and children was the importanceaccompanied of by getting his family. a good As education a father, Dr. and
pursuing the work that they love. His daughter Laurie Manger has a B.A. and Masters in Strategic Public Relations from USC, and today olderworks son as theCharles Director Manger of Marketing IV has degrees and Public from ClaremontRelations at McKenna the Saddleback and George Eye Center. Washington His University, and has worked as a software engineer for more than 10 years. His younger son Joey Manger has a B.A. from Chapman University, and is a commercial airline pilot.
When Dr. Manger is not leading a busy practice, he enjoys gardening at both his office and home. He has a special interest in palms and cycads. In addition, he spends 30-60 minutes every day on physical training and stretching exercises. Advertising Supplement 21 of EyeNet Magazine TRAINING the NEXT GENERATION at LAC+USC
environment seeing everything from trauma to complex neurologicalResidents at LAC+USCconditions Medical involving Center the eye engage to common in a rich eye learning ailments, ALUMNI56 VOLUNTARY BY THE NUMBERSFACULTY simultaneously manage the complex inpatient and emergency including diabetic retinopathy, cataracts, and glaucoma. They 15 DEPARTMENT CHAIRS
consult service for ophthalmology as well as run the busiest seen in the ophthalmology clinic daily with 8-10 surgeries also 279 RESIDENTS TRAINED outpatient clinic in the hospital. Between 250-350 patients are year residency with supreme experience and extraordinary skills 306 FELLOWS TRAINED being performed daily. Our residents come out of their three
prepared for any job or fellowship they desire.
22 eye.keckmedicine.org Notable Accolades & Achievements
Jesse Berry, MD Narsing Rao, MD National Research Mentoring Network International Gold Award of Chinese Scholar, National Institutes of Health Ophthalmological Society 2020 Featured in Living Legend Series, Indian Cheryl Craft, PhD Journal of Ophthalmology ARVO Foundation 2020 Distinguished Honoree Grace Richter, MD, MPH Paul Harris Fellow Award, Rotary J. Martin Heur, MD, PhD International Charles Manger III, MD, Chair in Corneal Laser Surgery Installation Paul Thompson, PhD Authored multiple papers in the last Mark Humayun, MD, PhD decade ranked in the top 1% by Institute of Electrical and Electronics citation for his field and year of Engineers (IEEE) Medal for publication Innovations in Healthcare Technology Arthur Toga, PhD Lecturer, Seventeenth Annual Carl M. Authored multiple papers in the last Franklin Lecture on Science and decade ranked in the top 1% Society by citation for his field and year of Retina Research Foundation’s Gertrude publication D. Pyron Award Sandy Zhang-Nunes, MD Gianluca Lazzi, PhD, MBA Top Doctor, Los Angeles Magazine Fellow of the National Academy of Inventors Qifa Zhou, PhD President-Elect of the IEEE Antennas and National Academy of Inventors Senior Propagation Society (APS), 2021 Member Andrew Moshfeghi, MD, MBA Hossein Ameri, MD, PhD; Candidate for Membership in Club Charles Flowers, MD; Jules Gonin Society Linda Lam MD, MBA; Karen Morgan, MD; and Narsing Rao, MD Top Doctors 2020, Pasadena Magazine
Annual Report Cover Image: This volumetric rendering shows the visual system fiber bundles, orbit, optic tract, and vascular system of the brain. Also visible, with reduced opacity, are the inferior fronto-occipital fiber bundles. Image credits: Jim Stanis and Arthur Toga. Data provided by data Yonggang Shi and Ryan Cabeen. Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute.
Advertising Supplement 23 of EyeNet Magazine USC DEPARTMENT OF OPHTHALMOLOGY #1 IN NIH RESEARCH FUNDING
AMONG OPHTHALMOLOGY DEPARTMENTS HOSPITAL FOR#12 OPHTHALMOLOGY FY 2019 IN THE NATION USC Roski Eye Institute
*Source: Blue Ridge Institute for Medical Research 287 PEER-REVIEWED PUBLICATIONS
HOSPITAL#18 IN THE NATION Keck Hospital of USC
The USC Roski Eye Institute and LAC+USC Medical Center see patients at the following locations:
Keck School of Medicine of USC USC Roski Eye Institute - USC Village FACEBOOK.COM/USCROSKIEYE Department of Ophthalmology USC Roski Eye Institute Suite 1720 INSTAGRAM.COM/USCEYE 1450 4th Floor Los835 Angeles,W. Jefferson CA 90089 Boulevard, TWITTER.COM/USCEYE Los Angeles, CA 90033 San Pablo Street, LINKEDIN.COM/COMPANY/USC-EYE-INSTITUTE Children’s(833) USC-EYES Hospital Los Angeles YOUTUBE.COM/USCEYEINSTITUTE USC(323) Roski 442-6335 Eye Institute- Arcadia The Vision Center 65 101 4650 Arcadia, CA 91006 Los Angeles, CA 90027 N. First Avenue, Suite Sunset Boulevard Give the gift of sight today USC(626) Roski 446-2122 Eye Institute- Pasadena (323) 660-2450 625 400 BE VISIONARY Pasadena, CA 91105 eye.keckmedicine.org/giving/For more information, please contact S. Fair Oaks Avenue, Suite Silviya Aleksiyenko, MPA Senior Director of Development (323) 442-6335
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