McGill University Department of

McGILL OPHTHALMOLOGY CLINICAL DAY 2017

Medical and Surgical Retina

Intercontinental Hotel 360, rue St. Antoine West Montreal,

Friday, June 2, 2017

Organizing Committee: Hady Saheb, MD, MPH, Chair, McGill Clinical Day Jill Rothberg, Senior Administrative Coordinator Scientific Committee: Leonard A. Levin, MD, PhD, FRCSC, Chair, McGill Department of Ophthalmology Mahshad Darvish, MDCM, MBA, FRCSC John Galic, MD, FRCSC

Événement durable McGill McGill Sustainable Event Bronze Certification

Cette activité s'adresse aux médecins ophtalmologistes, résidents en ophtalmologie, et étudiants en médecine.

La présente activité est une activité de formation collective agréée (section 1) au sens que lui donne le programme de Maintien du certificat (MDC) du Collège royal des médecins et chirurgiens du , approuvée par la direction du Développement professionnel continu (DDPC) de la Fédération des médecins spécialistes du Québec.

Vous pouvez déclarer un maximum de 7,80 heures pour l’activité globale. Les crédits sont calculés automatiquement dans MAINPORT. Une participation à cette activité donne droit à une attestation de présence. Les participants doivent réclamer un nombre d’heures conforme à la durée de leur participation.

En vertu d'une entente conclue entre le Collège royal des médecins et chirurgiens du Canada et l'American Medical Association (AMA), les médecins peuvent convertir les crédits obtenus au titre du programme de MDC du Collège royal en crédits de catégorie 1 de l'AMA PRAMC. Vous trouverez l'information sur le processus de conversion des crédits du programme de MDC du Collège royal en crédits de l'AMA à l’adresse www.ama-assn.org/go/internationalcme

Cette activité de formation est admissible aux allocations de ressourcement prévues à l’annexe 44.

DEPARTMENT OF OPHTHALMOLOGY McGILL UNIVERSITY CLINICAL DAY PROGRAMME

Friday, June 2, 2017 Intercontinental Hotel, 2nd floor, Sarah Bernhardt Room Montréal, Québec

7:00 – 8:00 a.m. Registration and Breakfast 8:00 - 8:05 a.m. Introduction, Department Chair Dr. Leonard A. Levin Professor and Chair, Department of Ophthalmology Riva and Thomas O. Hecht Family Chair in Ophthalmology McGill University 8:05 – 8:10 a.m. Introduction, McGill Clinical Day Chair Dr. Hady Saheb Assistant Professor, McGill University

IMAGING Moderator: Dr. John Galic 8:10 - 8:25 a.m. Do We Still Need Fluorescein Angiography? Dr. Julius Gomolin Associate Professor, McGill University 8:25 – 8:35 a.m. Wide Field Angiography: What We Are Missing Dr. David Lederer Affiliate Member, McGill University Clinical Associate, Eye Health MD 8:35 – 8:45 a.m. A New Understanding Of The Vitreoretinal Interface Dr. John Chen Associate Professor, McGill University 8:45 – 8:55 a.m. Present Day Role Of Electroretinography (ERG) Prof. Pierre Lachapelle Professor, McGill University 8:55 - 9:15 a.m. Discussion 9:15 – 9:45 a.m. THE DARIO LORENZETTI LECTURE: “The Future Of Imaging: What’s On The Horizon” Dr. SriniVas Sadda Stephen J. Ryan – Arnold and Mabel Beckman Endowed Chair Professor of Ophthalmology, Doheny Eye Institute University of California - Los Angeles 9:45 – 10:00 a.m. Discussion 10:00 – 10:20 a.m. Three Atypical Imaging Cases Presentations by residents Drs. Jeb Ong, Christian El-Haddad, Alexandre Plouznikoff Panel: Drs. David Lederer, Cynthia Qian, SriniVas Sadda

10:20 – 10:30 a.m. Primer On Genetic Investigations Dr. Cynthia Qian Assistant Professor, Adult and Pediatric Vitreoretinal Surgery and Diseases, University of Montreal 10:30 – 10:35 a.m. Discussion 10:35 – 10:55 a.m. Break

AMD Moderator: Dr. John Chen 10:55 – 11:25 a.m. THE SEAN MURPHY LECTURE "Solving AMD: Moving Forward By Stepping Back" Dr. Jayakrishna Ambati DuPont Guerry, III, Professor of Ophthalmology Vice Chair for Research, Department of Ophthalmology University of Virginia 11:25 – 11:30 a.m. Discussion 11:30 – 11:40 a.m. Risks Of Prolonged Injections Dr. Alain Grégoire Associate Professor, Université de Sherbrooke 11:40 – 11:50 a.m. AMD Mimickers Dr. Amer Omar Consultant Ophthalmologist - Medical Retina, Montreal 11:50 a.m. - 12:00 AREDS Update p.m. Dr. Jesia Hasan Professeure adjointe de clinique, Département d’ophtalmologie, Université de Montréal; Adjunct Professor, McGill University 12:00 – 12:15 p.m. Panel and audience discussion: Your Patient Needs Anti-VEGF Injections: What Should Be The First-line Treatment? Panel: Drs. Jayakrishna Ambati, Jesia Hasan, Julius Gomolin, Michael Quigley 12:15 – 12:45 p.m. A Molecular Road To A Therapy For Dry AMD Dr. Jayakrishna Ambati 12:45 – 1:00 p.m. Discussion 1:00 – 1:45 p.m. Lunch

DIABETES Moderator: Dr. Michael Quigley 1:45 – 1:55 p.m. 101 Dr. Jean-François Yale Professor, Department of , McGill University Division of Endocrinology & Metabolism 1:55 – 2:05 p.m. Diabetic Macular Edema: Where Do I Start? Dr. Danny Gauthier Professeur adjoint de clinique, Université de Montréal

2:05 – 2:15 p.m. Macular Laser: Re-emergence Or Demise? Dr. Michael Quigley Assistant Professor, McGill University 2:15 – 2:25 p.m. Protocol S: A Profound Shift In The Treatment Of Proliferative ? Dr. Ghassan Cordahi Professeur adjoint de clinique, Université de Montréal 2:25 – 2:40 p.m. Discussion 2:40 – 2:50 p.m. Diabetic Retinopathy Screening In Quebec Dr. Leonard A. Levin 2:50 – 3:10 p.m. Re-engineering The Screening And Staging Of Diabetic Retinopathy Dr. SriniVas Sadda 3:10 – 3:20 p.m. Discussion 3:20 – 3:40 p.m. Break

SURGERY Moderator: Dr. Michael Kapusta 3:40 – 3:55 p.m. Latest Surgical Technology Dr. Renaud Duval Professeur adjoint de clinique, Université de Montréal 3:55 – 4:05 p.m. Endoscopic Vitrectomy Dr. Natàlia Vilà Vitreoretinal Surgery Fellow - McGill University 4:05 – 4:15 p.m. Macular Holes: Expanding Options Dr. John Galic Associate Professor, McGill University 4:15 – 4:25 p.m. Discussion 4:25 – 4:35 p.m. Scleral Fixated IOLs Dr. Mahshad Darvish Assistant Professor, McGill University 4:35 – 4:45 p.m. Approach To Endophthalmitis Dr. Michael Kapusta Associate Professor, McGill University 4:45 – 4:55 p.m. Retinal Implants Dr. Flavio Rezende Chief of Retina Service, Associate Professor, Department of Ophthalmology, University of Montreal 4:55 – 5:00 p.m. Discussion 5:00 – 5:10 p.m. Splash!: Update On Hydroxychloroquine (Plaquenil) Toxicity Screening Dr. Razek Coussa Resident, McGill University Floaterectomy: Coming To A Clinic Near You Dr. Errol Chan Vitreoretinal Surgery Fellow - McGill University 5:10 – 5:15 p.m. Closing Remarks

LEARNING OBJECTIVES FOR THE McGILL OPHTHALMOLOGY CLINICAL DAY June 2, 2017 Hotel Intercontinental, Montréal, Québec

At the end of the program, participants will be able to:

. Compare different methods of retinal angiography and their role in clinical practice

. Assess possible mimickers of Age-Related

. Contrast traditional and novel treatment approaches diabetic retinopathy and macular edema

. Build on current approaches of surgical management of retinal pathologies

. Discuss the impact of recent developments in imaging, angiography and intravitreal injections could have on their practice

La Journée Clinique du Département d’ophtalmologie de McGill a été élaborée conjointement avec l’Association des médecins ophtalmologistes du Québec de manière à respecter les principes d’intégrité, d’objectivité et d’équilibre scientifiques.

Dr. Jayakrishna Ambati

DuPont Guerry, III, Professor of Ophthalmology Vice Chair for Research, Department of Ophthalmology Founding Director, Center for Advanced Vision Science University of Virginia

Fellow, National Academy of Inventors NIH Director's Pioneer Awardee

Dr. Jayakrishna Ambati is a vitreoretinal surgeon whose laboratory studies angiogenesis and cell death in age-related macular degeneration (AMD). He was trained as an electrical engineer at The Johns Hopkins University and, after graduating with an M.D. (magna cum laude) from SUNY Health Science Center at Brooklyn, completed ophthalmology residency at the University of Rochester and clinical and research retina fellowships at the Massachusetts Eye and Ear Infirmary of Harvard Medical School. His laboratory has reported numerous seminal advances in ocular vascular biology and immunology in journals such as Nature, Science, Cell, Nature Medicine, New England Journal of Medicine, Journal of Clinical Investigation, Proceedings of the National Academy of Sciences, and eLife. He pioneered the concept that AMD is an inflammatory disease that is driven by perturbations in innate immunity. His foundational contributions have led to fundamental conceptual advances that are on the cusp of improving the diagnosis and treatment of this disease.

He has been elected to the National Academy of Inventors, and was the first ophthalmologist to win the NIH Director’s Pioneer Award, Doris Duke Distinguished Clinical Scientist Award, Burroughs Wellcome Fund Clinical Scientist Award in Translational Research, Ellison Foundation Senior Scholar in Aging Award, and Harrington Discovery Institute Scholar-Innovator Award. He was elected as a Fellow of the American Association for the Advancement of Science, The American Society for Clinical Investigation and was the first ophthalmologist to be elected to The Association of American . He also won the ARVO Cogan Award and Carl Camras Translational Research Award, Roger Johnson Memorial Award for Macular Degeneration Research, Prix Soubrane, Junius Kuhnt Medal, Chanchlani Global Vision Research Award, and ASRS Presidents’ Young Investigator Award. RPB awarded him its Senior Scientific Investigator Award, Wasserman Merit Award, and -Scientist Award.

Dr. Ambati serves on the Editorial Boards of IOVS and Ophthalmic Research, is an Associate Editor of Ophthalmology and of Translational Vision Science & Technology, and is listed in “Best Doctors in America.”

Dr. SriniVas R. Sadda

President and Chief Scientific Officer Stephen J. Ryan – Arnold and Mabel Beckman Endowed Chair Doheny Eye Institute Professor of Ophthalmology

University of California – Los Angeles

Dr. SriniVas R. Sadda is the President and Chief Scientific Officer of the Doheny Eye Institute, the Stephen J. Ryan – Arnold and Mabel Beckman Endowed Chair, and Professor of Ophthalmology at the University of California – Los Angeles (UCLA) Geffen School of Medicine. He received his medical degree from The Johns Hopkins University in Baltimore, Maryland. After an internship at the William Beaumont Hospital in Royal Oak, Michigan, he returned to Johns Hopkins University and the Wilmer Eye Institute in Baltimore for an ophthalmology residency as well as neuro-ophthalmology and medical retina fellowships.

Dr Sadda’s major research interests include quantitative, automated retinal image analysis; retinal substructure assessments; advanced retinal imaging technologies; genotype-phenotype correlative studies; and vision restoration technologies (e.g, stem cells). In pursuit of these interests, Dr. Sadda is or has been the Principal Investigator on more than 30 trials, including phase III studies of ranibizumab, preservative-free triamcinolone acetonide, and a dexamethasone posterior segment drug delivery system. He has more than 310 publications in peer-reviewed journals and over 250 published abstracts. He authored the first edition of the textbook Emerging Technologies in Retinal Disease, as well as 13 book chapters. As an invited lecturer, he has given more than 250 presentations around the country and the world. Dr. Sadda also serves as an editorial board member of Ophthalmic Surgery, Lasers & Imaging, Retina, and Ophthalmology. He is also an editor of the 5th edition of the Ryan’s Retina textbook. In addition, he serves as an ad hoc scientific referee for Investigative Ophthalmology and Visual Science, Archives of Ophthalmology, American Journal of Ophthalmology, Experimental Eye Research, and the Center for Scientific Review at the National Institutes of Health.

Among Dr. Sadda’s awards and honors are a Research to Prevent Blindness Physician-Scientist Award, a Senior Honor Award from the American Society of Retina Specialists, an Achievement Award, a Secretariat Award and a Senior Achievement Award from the American Academy of Ophthalmology, John H. Zumberge Research and Innovation Award, and the Macula Society Young Investigator Award. He has been named to the Best Doctors of America list for several consecutive years. Biography of Dr. Sean Murphy (1924 - 2017)

A 1943 graduate of Harvard, Dr. Murphy received his possible, to offer them GFT positions on their return. medical degree from McGill in 1947. From 1952 to Supporting departmental research, he emphasized 1955 he served in the Royal Canadian Air Force, the importance of having basic scientists in the where he was in charge of ophthalmological department. He also helped develop a strong McGill services. Then in 1955 he joined the McGill Ocular Pathology unit with Drs. Mourad Khalil, Department of Ophthalmology and the staff of the Esmond Gordon and Seymour Brownstein, and RVH. For eighteen years thereafter he saw encouraged the development of the Low Vision consultations from the MNI and taught neuro- Clinic. He participated in the meetings of the Cogan ophthalmology, at the same time gradually Ophthalmic History Society and the American Osler furthering his practice of retinal surgery. Society.

In 1970 Dr. Murphy was appointed Ophthalmologist- Realizing that ophthalmology was under-valued in in-Chief at the RVH, and Professor and Chairman of hospitals and universities across Canada, Dr. Murphy the McGill Department of Ophthalmology. In 1975, accepted several administrative positions outside of the Dean, Dr. Samuel O. Friedman, gave him a McGill and its teaching hospitals. He became mandate to unify the department and create a President of the Canadian Ophthalmological Society, harmonious relationship between the four hospital President of the Association des médecins departments. This was no easy matter as the ophtalmologistes du Québec, and for two years was Chairman had virtually no authority over the hospital Chief Examiner of the Royal College. He was departments. awarded the Order of Canada in 1976, the medal of the Canadian Ophthalmological Society in 1987, and His first initiative was to form a McGill departmental in 2007 received the society’s Lifetime Achievement Executive Committee. The four hospital chiefs were Award. In 1989 the Department of Ophthalmology invited to be members. They were Dr. Dario established an annual lecture in his honour. Lorenzetti (MGH), Dr. John Little (MCH), Dr. Joel Rosen (JGH), and Dr. Murphy (RVH). The Executive He established the annual Clinical and Scientific Day Committee met regularly, once a month, and among in 1978 with the help of Dr. Bruce Jackson. It the many subjects discussed were: residents, continues to the present day. Dr. Murphy believed medical students, teaching, staff GFTs, recruitment, strongly in community activities and for ten years subspecialization, research, fund raising, space, was President of the Montreal Museum of Fine Arts, amalgamation, and the development of centers of which involved being an active fundraiser for the excellence. museum, a position which frequently helped in the search for funds for academic ophthalmology. McGill The Executive Committee proved to be successful in and the hospitals often did not provide sufficient cementing better interhospital relations. Its creation funds for research as well as the resident program, was an important step in assuring the future with the result that funding became a priority. Dr. development of the department. Dr. Murphy Murphy retired as Ophthalmologist-in-Chief at the promoted the training and recruitment of RVH and Chairman of the McGill Department of subspecialists and geographic full-time staff. He felt Ophthalmology in 1986. it was a priority to send graduating residents away for further specialized training and, wherever

Excerpt from ‘History of McGill Department of Ophthalmology’, Sean B. Murphy, 1990

Postscript: In 1991 Dr. Murphy was appointed Interim Chairman of the McGill Department until 1993 and was subsequently appointed Emeritus Professor. In retirement, Dr. Murphy continued to paint, and in 2000 had a solo exhibition of his watercolours and in 2010 wrote and self-published “Dare to Draw.” He passed away in Montreal on March 16, 2017. SEAN B. MURPHY LECTURES 1989 -

2017 Jayakrishna Ambati, MD, Retina 2001 Bruce Jackson, MD, Cornea/External Disease University of Virginia University of Ottawa Eye Institute, Ottawa

2016 Bonnie Henderson, MD, Cornea 2000 Jean Deschênes, MD, Uveitis, Cornea/External Tufts University School of Medicine Disease Department of Ophthalmology, McGill 2015 Todd Margolis, MD, PhD, Uveitis University Washington University School of Medicine, USA 1999 Lanning Kline, MD, Neuro-Ophthalmology 2014 Richard K. Parrish II, MD, Glaucoma Birmingham, Alabama Bascom Palmer Eye Institute, Miami, Florida, USA 1998 Rubens Belfort, MD, Cornea/External Disease Sao Paulo, Brazil 2013 Emily Chew, MD, Retina National Institutes of Health (NIH), Bethesda, 1997 Raymond Leblanc, MD, Glaucoma Maryland, USA Halifax, Nova Scotia

2012 George B. Bartley, MD, Oculoplastics 1996 Frederick Jakobiec, MD, Ophthalmic Mayo Clinic in Florida, Rochester, Minnesota, Oncology/Ophthalmic Pathology USA Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 2011 Harry A. Quigley, MD, Glaucoma Wilmer Ophthalmological Institute, John 1995 Duncan Anderson, MD, Neuro-Ophthalmology Hopkins University School of Medicine, Vancouver, British Columbia Baltimore, MD 1994 Lorenz E. Zimmerman, MD, Ophthalmic 2010 Sohan Hayreh, MD, Neuro-Ophthalmology Pathology University of Iowa, USA Armed Forces Institute of Pathology, Washington, D.C. 2009 Warren Hill, MD, East Valley Ophthalmology, Mesa, Arizona 1993 Howard Tanenbaum, MD, Vitreoretinal Albany, 2008 Dr. Nabil Saheb, Glaucoma Department of Ophthalmology, McGill 1992 Mark Abelson, MD, Cornea/External University Disease/Optics/Refraction Boston, Massachusetts 2007 Neil Miller, MD, Neuro-Ophthalmology , Baltimore, Maryland 1991 Elliott B. Werner, MD, Glaucoma Philadelphia, Pennsylvania 2006 Bryan Arthurs, MD, Oculoplastics Department of Ophthalmology, McGill 1990 E.R. Simpson, MD, Ocular Oncology University Toronto, Ontario

2005 Stanley Chang, MD, Retina 1989 Brian Yonge, MD Columbia University, New York, N.Y. Mayo Clinic, Rochester, Minnesota

2004 John T. Flynn, MD, Pediatric Ophthalmology/Strabismus Harkness Eye Institute, New York, N.Y.

2003 Alain Rousseau, MD, Retina/Ocular Pathology Laval University, Quebec City

2002 Jerry Shields, MD, Ophthalmic Oncology/Retina Vitreous Will’s Eye Institute, Philadelphia, Pennsylvania

Biography of Dr. Dario Lorenzetti (1936 - 1994)

Dr. Lorenzetti graduated in medicine from McGill in Drs. Bruce Jackson and Joel Rosen. The group was 1960. He then completed the Ophthalmology trying to obtain greater subspecialty amalgamation residency program at the MGH, followed by a between the hospitals, and met for external disease fellowship in external disease with Dr. Herbert clinics regularly in the different hospitals, where Kaufman at the University of Florida, Gainsville. In patients were examined and discussed. 1967, Dr. Lorenzetti returned to the MGH, and was appointed a GFT ophthalmologist. As Chairman of the Postgraduate Committee, he organizing the residents’ rotations and their As a researcher, teacher, and physician, Dr. Thursday morning lectures. The teaching offered in Lorenzetti’s contributions to the MGH and McGill the lectures was of high quality and given roughly in Ophthalmology were important. For example, in the parallel with the American Academy of 1960s, little ophthalmological research was being Ophthalmology schedule of subjects. These sessions conducted, either at McGill or at its teaching were instituted in the early 1970s and attended by hospitals. However, one exception to this situation all the residents. Their attendance was mandatory was the work being pursued by Dr. Lorenzetti. After and they were excused from all other duties to arriving at the MGH, he continued his studies in attend. At the conclusion of a series of lectures on a external disease, worked with several Fellows, and given subject area, and after discussion with the supervised corneal research. His research work, teachers involved, a distinguished visiting professor supported by grants, was important, as it signaled in that field was invited to spend time with the the later advent of clinical scientists and furthered residents and give a lecture to the whole the research projects and initiatives previously department. Most frequently these speakers came begun by Dr. Peter Davis at the RVH. from the , Canada, and occasionally other countries. Organizing this far-flung training He was a valued member of the departmental program in four hospitals was complex. However, Dr. executive committee, and could be counted on to Lorenzetti always had everything in good order and come up with better ways of doing things. In his submitted on time. Besides being a good organizer administrative functions, Dr. Lorenzetti was an and administrator of medical matters, Dr. Lorenzetti excellent and reliable administrator; one could was also renowned for organizing and participating always count on him. If he said he would do it, it was in festive occasions - especially senior resident done. Indeed his administrative and organizing skills dinners and more informal events. were reflected in his heavy involvement with the MGH project to secure new facilities for the Dr. Lorenzetti was friendly, well-liked, and his warm hospital’s ophthalmology department and clinic on hearted support of residents and staff was noticed the 6th floor of Livingston Hall. and appreciated by all. He looked after his staff’s interests admirably, often seeking improved funding Beyond his research and teaching duties, as well as and always supporting them. He presented his his official administrative functions, Dr. Lorenzetti points of view to others with clarity and conviction. held a number of additional university and non- Always logical, and a skilled debater, he fought hard university positions. In 1980 he was appointed Chief for what he believed. Understandably, both the Examiner for the Royal College of Physicians and hospital and university community were greatly Surgeons. In addition, an interest in medical saddened by his premature death in 1994 as were education led to his chairing the Canadian his friends and numerous patients. In his honour, the Ophthalmological Society’s Continuing Medical Canadian Ophthalmological Society launched the Education Committee for several years. Also in the annual Dario Lorenzetti Lecture. Similarly, the McGill late 1980s, Dr. Lorenzetti was a member of the Department of Ophthalmology also established an external disease group, composed of himself and annual lecture in memory of Dr. Lorenzetti.

Excerpt from ‘History of McGill Department of Ophthalmology’, Sean B. Murphy, 1990. DARIO W.C. LORENZETTI LECTURES 1996 –

2017 SriniVas Sadda, M.D. Doheny Eye Institute, University of California – Los Angeles

2016 Warren Hill, M.D., F.A.C.S. East Valley Ophthalmology, Mesa, AZ

2015 Christopher J. Rapuano, M.D. Wills Eye Institute, Philadelphia, PA

2013 John G. Flanagan, Ph.D. Vision Science, University of California, Berkeley, CA

2012 Rando Allikmets, Ph.D. Columbia University, New York, NY

2011 Austin Roorda, M.D. University of California, Berkeley, CA

2009 Debra A. Goldstein, M.D. McGill University

2008 Miguel N. Burnier Jr., M.D., Ph.D. McGill University

2007 Peter J. Savino, M.D. Wills Eye Hospital, Philadelphia, PA

2006 James J. Augsburger, M.D. University of Cincinnati College of Medicine, Cincinnati, OH

2005 J. William Harbour, M.D. Bascom Palmer Eye Institute, University of Miami Health System, Miami, FL

2004 Arthur B. Leith, M.D. McGill University

2003 Stephen M. Drance, M.D. University of British Columbia, Vancouver, BC

2002 Alan F. Cruess, M.D. Dalhousie University, Halifax, NS

2001 Donald S. Minckler, M.D. University of California, Irvine, CA

2000 Richard K. Parrish, M.D. Bascom Palmer Eye Institute, University of Miami Health System, Miami, FL

1999 Kenneth R. Kenyon, M.D. New England Eye Centre, Boston, MA

1998 Nabil E. Saheb, M.D. McGill University

1997 Ramon L. Font, M.D. Baylor College of Medicine, Houston, TX

1996 David J. Apple, M.D Medical University of South Carolina, Charleston, SC

The Department of Ophthalmology, McGill University has gratefully received educational grants from the following organizations:

Gold sponsor

Alcon Canada

Bayer

Silver sponsor

Abbott Medical Optics

Allergan

Association des médecins ophtalmologistes du Québec (AMOQ)

Novartis Canada

Bronze sponsor

Bausch & Lomb (a division of Valeant)

Shire