A publication of The Edward S. Harkness Eye Institute and the Department of Ophthalmology in the College of Physicians and Surgeons

Spring/Summer 2006 Saving the Sight of Diabetics It was a "happy coincidence" that brought George Bresnick, M.D., M.P.A. and his wife, Geraldine "Geri" Hendriksen to Columbia to collaborate on a new commu- nity diabetic retinopathy telemedicine screening program.

Dr. Bresnick, former chairman of ophthalmology at the universities of Rochester and Wisconsin, and Ms. Hen- driksen, a successful community health professional, are the founders of Vision for All, Inc., a not-for-profit estab- lished in 1996 with the goal of providing affordable eye care to high-risk, elderly and medically underserved indi- viduals. The couple first piloted a free eye care program in inner-city Rochester, later expanding their efforts to C. Manley Michael Chiang, M.D., M.A. and con’t. page 12 George Bresnick, M.D., M.P.A.

Apprehending the IN THIS ISSUE... View from the Chair...... 2 Silent Thief A Treasured Gift to Vision ...... 3 Glaucoma, a silent and insidious thief of vision, Basic Science Course...... 4 occurs when the retinal ganglion cell bodies of the optic Faculty Spotlight...... 6 nerve begin to die, leading to slow but progressive loss of vision. According to Research to Prevent Blindness, glau- New Fellows ...... 8 coma is one of the leading causes of irreversible blindness Visionaries & Luminaries ...... 10 con’t. page 17 In Memoriam...... 19 BOARD OF ADVISORS Department of Ophthalmology View from the Chair Louis V. Gerstner, Jr., Chairman William Acquavella Rand Araskog Dear Friends, Dr. Endré Balazs Shirlee Brown Vision is one of the most precious Robert L. Burch III gifts of life. For many diseases of the Howard L. Clark, Jr. eye, early diagnosis is the best defense Abraham E. Cohen Joseph C. Connors against unnecessary vision loss. E. Virgil Conway Alan K. Docter With this issue of Viewpoint, we are Gloria and Louis Flanzer excited to report on several research and Joel Hoffman screening initiatives designed to diagnose T. C. Hsu Florence and Herbert Irving and safeguard vision in vulnerable popu- Helen and Martin Kimmel lations. Dr. George Bresnick and his wife C. Manley Dr. Henry Kissinger Geri Hendriksen, founders of Vision for Stanley Chang, M.D. Ambassador John L. Loeb, Jr. John Manice All, are partnering with Dr. Michael Chiang to create a new dia- Barbara Margolis betic retinopathy screening program using telemedicine for the Bjorg and Stephen Ollendorff Washington Heights community. Dr. James Tsai is pioneering a Homer McK. Rees novel technological device for early detection of glaucoma that is John Robinson James Shinn ready to enter Phase 2 clinical trials. Dr. Rando Allikmets' team William Spier has discovered yet another gene related to age-related macular Miranda Wong Tang degeneration (AMD). Richard Woolworth Dukes Wooters Our "Vision for the Future" — a $50 million capital campaign for IN MEMORIAM the Department — is well underway, thanks to the leadership of Dorothy Eweson Seymour Milstein our co-chairmen, Howard L. Clark, Jr., Shirlee Brown and Homer Candace VanAlen McK. Rees. We thrive on the generosity of dear friends and current MEDICAL ADVISORS and former patients. Your campaign gifts will support research Rando Allikmets, Ph.D. programs, faculty development and state-of-the-art facilities. Gaetano Barile, M.D. Richard Braunstein, M.D. Additionally, we thank you for your considerable support of the Stanley Chang, M.D. Department of Ophthalmology's Annual Fund. John Espy, M.D. John Flynn, M.D. We are especially grateful for the opportunity to work toward pre- William Schiff, M.D. serving the gift of vision for so many, and extend sincere thanks Harold Spalter, M.D. Janet Sparrow, Ph.D. for your dedication and commitment to our work in advancing B. Dobli Srinivasan, M.D., Ph.D. ophthalmology and vision care. James Tsai, M.D. Stephen Trokel, M.D. With best wishes to you and yours, VIEWPOINT Editor-in-Chief Jane E. Heffner Writing & Design Stanley Chang, M.D. Kathleen Hickey Boyd K.K. Tse and Ku Teh Ying Professor Photography Edward S. Harkness Professor Charles E. Manley Chairman, Department of Ophthalmology 3 A Treasured Gift to Vision

"A sighted eye is a gift," says B. Dobli tic, while I spent Srinivasan, M.D., Ph.D., Director of Ambula- two years of post- tory Eye Care at the Harkness Eye Institute. doctoral training," Dr. Srinivasan has dedicated his career to Dr. Bito explains. protecting sight, one of life's most precious "Then we each gifts. After more than four decades at the re t u r n e d t o Harkness Eye Institute in research, clinical Columbia, Dobli practice and now directing residents in the in clinical work ITT Eye Clinic, he plans to retire in June to and I in basic southern California with his wife, Sheila, to research. Those enjoy warmer weather and family nearby. were heady years after Sputnik, Dr. Srinivasan's multi-faceted career as a sci- when science was entist, physician and faculty member at held in especially Columbia began with pre-medicine studies high regard." at Bard College in the late 1950s, where he met Laszlo Bito, Ph.D. (the retired Columbia Prasad Kulkarni, scientist perhaps best known for developing Ph.D., now a pro- C. Manley Xalatan for the treatment of glaucoma). As fessor of ophthal- B. Dobli Srinivasan, M.D., Dr. Bito tells the story, George Smelser, Ph.D., mology at the Ph.D. Professor of Anatomy at Columbia and University of Louisville, recalls, "I first met Director of Ophthalmology Research, came Dobli in 1976 when I joined Dr. Ken Eakins' to Bard to give a lecture on the eye. Both men lab as a post-doctoral fellow at the Harkness were impressed and intrigued, and it was this Eye Institute. Dobli and I each had NIH initial exposure to ophthalmology that grants and worked together to investigate spurred the young Srinivasan to pursue a eicosanoids and prostaglandins and their position as a research assistant in George involvement in ocular inflammation. Smelser's laboratory in the Ophthalmology Together we had a lot of fun and I learned Department. Laszlo Bito joined that labo- from him the insight and importance of ratory shortly thereafter, and both basic research and its implications for clinical enrolled in the graduate program in Cell research. We also consulted as a team and Physiology and Biophysics. were instrumental in the development of anti-inflammatory drugs like diclofenac and "Dobli pursued both the M.D. and Ph.D. flurbiprofen for use in the eye." degrees, while I stayed with the Ph.D. pro- gram. After our graduations, Dobli com- Dr. Srinivasan agrees. "I had a great time pleted two years of military service in the doing research for almost 25 years, from Coast Guard, including a trip to the Antarc- con’t. page 15 4 Basic Science Course Draws International Residents and Experts

Despite New York's short days and "Since 1941, the Columbia University cold weather, Winter Intersession at the Department of Ophthalmology has offered Harkness Eye Institute is anything but dull. the Basic Science Course in Ophthalmology. During their break from clinical practice, 26 Originally intended primarily for residents, it talented medical residents from the New York has proven valuable to the broader visual sci- metropolitan region and as far away as Den- ences community," explains Dr. Tsang. "The mark, Jamaica, Kuwait, Portugal and Sweden Harkness Eye Institute's mission is a syner- filled the Flanzer Auditorium and surround- gistic triangle that combines education of the ing classrooms and laboratories to partici- world's future leaders in ophthalmology with pate in the annual Basic Science Course in unparalleled patient care and cutting-edge Ophthalmology (BSCO). vision research. This course fulfills that mis- sion perfectly." Organized by Stephen Tsang, M.D., Ph.D. and coordinated by Levin Santos, the BSCO Participants receive intensive instruction is an intense and fascinating four-week from a stellar international faculty of more course designed to immerse participants in than 80 clinicians and scientists. The rigor- the fundamentals of ophthalmic science and ous course schedule runs Monday through their application to patient care. Saturday during the four weeks of the course, and includes more than one hundred lecture hours, plus labo- ratory studies in ocular anatomy and histology, two days of training in orbital dissection and two days of instruction in retinoscopy and refraction. Partic- ipants also C. Manley perform cataract L to R: Stanley Chang, M.D.; Graham E. Holder, Ph.D.; Robert Braunstein, M.D.; surgery and lens Stephen Tsang, M.D., Ph.D.; Alan C. Bird, M.D.; Lucian Del Priore, M.D., Ph.D.; implantation on Gaetano Barile, M.D. 5

Basic Science Course (con’t.) pig eyes during a one-day session in the "Phaco wet lab" under faculty guidance. The curriculum and faculty are selected by Columbia scientists and clinicians, including John T. Flynn, M.D., Jan P. Koniarek, Ph.D., James C. Tsai, M.D., Joseph Walrath, M.D., and the late Basil V. Worgul, Ph.D. [See In Memoriam, page 19.] "This course was truly an exceptional experi- ence that encompasses much more than the exposure to didactic teaching," remarks

Suzanna Airiani, M.D., a Harkness Eye Insti- C. Manley tute resident who participated in this year's L to R: BSCO Faculty member Irene Maumenee, course. "The first few months of my training M.D., Marcus Kivitalo, M.D. of Ornskoldsvik, involved mastering basic ophthalmic skills Sweden, and Stephen Tsang, M.D., Ph.D. at the and clinical examinations. This course aug- course graduation ceremony. mented that training with intensive instruc- tion in the basic sciences underlying oph- "The curriculum incorporates current thalmic practice and research." She adds, understanding and knowledge within a "The orbital dissection training was a mar- clinically relevant framework," explains velous hands-on opportunity to interact with Dr. Airiani. "The curriculum provided a and learn from top eye center experts." firm and experiential grounding in the fundamentals, plus additional emphasis on In addition to the many Columbia faculty molecular and clinical genetics, cellular who offered their expertise, this year's invited biology, epidemiology, pharmacology, faculty included Professor Alan C. Bird refractive and cataract surgery and clinical and Sir Stewart Duke-Elder Professor testing modalities." She concludes, "This Anthony T. Moore, both from University course was excellent preparation for the College London; Graham E. Holder, mandatory ophthalmic knowledge assess- Ph.D., Director of Electrodiagnosic Depart- ment program, and the opportunity to ment at Moorfields Eye Hospital in London; sharpen my knowledge of basic science Robert Nussenblatt, M.D.,Director of with such esteemed faculty has been Immunology at the National Eye Institute invaluable." (NEI), National Institutes of Health (NIH); and Joseph L. Demer, M.D., Ph.D., The website for the Basic Science Course in Chief, Comprehensive Ophthalmology Divi- Ophthalmology can be found at: sion at the Jules Stein Eye Institute, UCLA. http://www.cumc.columbia.edu/dept/eye/edu- cation/edu_bsc.html. 6 Spotlight: Takayuki Nagasaki, Ph.D.

How does the cornea maintain its trans- parency and health? That is the question that Takayuki Nagasaki, Ph.D., is trying to answer. Dr. Nagasaki, Assistant Professor of Oph- thalmic Science (in Ophthalmology) and Director of the Anterior Segment Biology Laboratory at Columbia, is investigating how the cornea and the conjunctiva maintain tissue and mass to achieve a state of healthy equilibrium known as "homeostasis." "Our research is aimed toward understanding the physiology of the surface of the eye at a molecular and cellular level with the goal of providing better management of injuries and C. Manley diseases of the cornea and the conjunctiva. Takayuki Nagasaki, Ph.D. The knowledge gained from this basic science research will also improve keratorefractive also thin and transparent, is a mucous mem- surgery such as PRK and LASIK," Dr. brane that lubricates the eye, beginning at the Nagasaki explains. outer edge of the cornea and extending to cover the sclera (the white of the eye) and the The cornea is the eye's window — the trans- inside of the eyelids. parent dome-shaped refracting surface at the front of the eye that provides two-thirds of Although the cornea and conjunctiva are the eye's focusing power. The conjunctiva, adjacent tissues, their individual epithelial stem cells (the cells responsible for regenera- tion and wound healing) behave very differ- ently. In the cornea, epithelial stem cells are concentrated in the limbus, the border between the cornea and the sclera. These cells divide and migrate toward the center of the cornea at a rate of 30 micrometers per day. In the conjunctiva, epithelial cells are distrib- uted uniformly and divide, but do not move.

"Ocular surface homeostasis involves three parameters — cell movement, cell division and cell loss. We know that continuous

National Eye Institute, NIH movement of the epithelial stem cells is 7

Spotlight: Takayuki Nagasaki, Ph.D. (con’t.) essential to the cornea's ability to stay trans- parent," Dr. Nagasaki asserts. He uses a tech- nique called in vivo time lapse fluorescence microscopy to track the progression of the stem cells in the eyes of mice. These "trans- genic" mice are genetically engineered and bred so that the cells of interest will be fluo- rescent and readily traceable under the microscope. By creating a time lapse sequence, Dr. Nagasaki can observe individ- ual epithelial stem cell movement in a living animal, tracking the rate and direction of movement over the course of several months. In mice, this movement from limbus to cornea center takes approximately eight T. Nagasaki T. weeks; in humans, more than six months. Top left: A live image of a normal mouse eye "Every single cell on the corneal surface is viewed from the apex, genetically modified to moving centripetally," Dr. Nagasaki contin- show fluorescent cells. Radial stripes become ues. "It appears that many of them die off on visible because some epithelial cells are bright their way to the center. We are trying to while others are dim, showing the texture of the iris. Corneal epithelial cells move from the understand why the movement from limbus limbus to the central cornea. The central bright to cornea center happens. At the same time, spot is due to the fluorescence of lens cells, we are looking at why the stem cells in the which is mostly blocked by the pigmented iris, conjunctiva do not move." He points out that but not at the pupil. the cornea and conjunctiva are continuous structures without much of a defined bound- Top right: A normal eye viewed from the side ary between the two. In addition to tracking shows both cornea (top half) and conjunctiva (bottom half), separated by the limbus (where the stem cell movement, Dr. Nagasaki is corneal epithelial stem cells are located, but researching why and how the corneal stem not conjunctival epithelial stem cells). Radial cells move to the central cornea, rather than stripes in the cornea originate at the limbus. to the conjunctiva. The conjunctiva has arbitrary patterns without any stripes. "By studying this process in the normal eye, we gain insight into the eye's natural Bottom: An abnormal eye from the apex (left) regenerative and wound healing abilities," and from the side (right). In this experimentally notes Dr. Nagasaki. "This will help us to generated disease condition there are no better understand what is going wrong in stripes in the cornea. A cornea like this will usually the diseased eye." D become vascularized and lose transparency. 8 New Fellows Join Department

Howard Fine, M.D., from Parsippany, NJ, Surgeons in Ireland, and holds a master's is a Vitreoretinal Clinical Fellow. He holds degree in medical science from University undergraduate degrees in chemical engineer- College Dublin. As part of his Ph.D. in oph- ing and biology from the Massachusetts thalmology from University College London, Institute of Technology, a graduate degree in Dr. Keegan researched methods of retinal cell health sciences in clinical trials from Duke transplantation. Dr. Keegan has also held vit- University and earned his medical degree reoretinal sur- from Harvard Medical School. He completed gery and medical his residency at Wilmer Eye Institute at Johns retina fellow- Hopkins University and participated in Phase 1 ships at Moor- and 2 clinical trials related to uveitis in the fields Eye Hospi- Clinical Research Training Program of the tal in London National Eye Institute. under Professor Alan C. Bird and "I am excited to have other top experts. joined the team at Colum- bia as a retina fellow "I came to under the leadership of Columbia to

Dr. Stanley Chang, Dr. C. Manley work with Dr. Chang and his Lawrence Yannuzzi and David Keegan, M.D., Ph.D. the outstanding retina team — it truly faculty," Dr. Fine states. "I is a privilege and that is not an overstate- find this to be an exhila- ment," says Dr. Keegan. "I feel very fortu- rating time to be entering nate to have the opportunity to see differ-

C. Manley the field as we are learning ent approaches to the spectrum of vitreo- retinal diseases." Howard Fine, M.D. to treat previously blind- ing diseases and will Natalia Elkin, M.D.,a native New Yorker,is increasingly be able to preserve and restore a Clinical Fellow in Glaucoma. She earned a sight for our patients." B.A. from New York University summa cum Dublin native David Keegan, M.D., laude and her M.D. from SUNY Downstate Ph.D. is a Vitreoretinal Clinical Fellow. He Medical Center in Brooklyn. First a resident received his M.D. from the Royal College of in internal medicine at Long Island Jewish 9

New Fellows Join Department (con’t.)

Medical Center, she pleted her ophthalmology residency at the completed another New York Eye & Ear Infirmary. residency in ophthalmol- ogy at Montefiore Med- Dr. Manusis works with Dr. Richard Braun- ical Center and served as stein and his colleagues, performing refrac- Chief Resident during tive and anterior segment surgery and serv- her final year. ing as a supervising and attending physician for Dr. Elkin works closely in residents. clinical and surgical practice with Drs. James Born in Thailand, Tsai, Max Forbes, Lama Lookjan Riansuwan, C. Manley Al-Aswad and Rajendra M.D. is a Research Fellow Natalia Elkin, M.D. K. Bansal. She is also in Glaucoma. She earned actively involved in the Department's free her medical degree and glaucoma screenings in the community. completed her residency in ophthalmology at the Kira Manusis, M.D. , another New York Faculty of Medicine Siri- C. Manley native, is a Clinical Fellow in Anterior Seg- raj Hospital of Mahidol Lookjan ment. Dr. Manu- University in Bangkok. Riansuwan, M.D. sis earned a B.S. Certified by the Board of de g r e e f r o m Ophthalmology in Thailand, Dr. Riansuwan Brooklyn Col- has practiced at the Somdej Prapinkloa Naval lege summa cum Hospital in Bangkok and lectured on basic laude and her ophthalmology for nurses. M.D. from New York University Dr. Riansuwan's personal interest in glau- School of Medi- coma stems from the fact that East Asians cine. Following suffer the world's highest rate of blindness an internship in from primary angle closure glaucoma. She medicine at works with Columbia glaucoma physicians

Cabrini Medical C. Manley and scientists with the goal of returning to Thailand to better serve her patients there. D Center, she com- Kira Manusis, M.D. 10 Allikmets' Team Discovers Second AMD Gene Rando Allikmets, Ph.D., Director of the Molecular Genetics Laboratory, has reported the results of a new study that is being pub- lished in Nature Genetics that shows that two genes — Factor H and Factor B — play a role in nearly three-quarters of all AMD cases. Faculty News The study, which included a genetic analysis of 1,300 people, showed decisively that while Jorge Fischbarg, M.D., Ph.D., the Laszlo Factor H [see Viewpoint Fall 2005] inhibits Z. Bito Professor of Physiology and Cellular immune response to infection, Factor B, a Biophysics (in Ophthalmology) and Director complementary gene, acts as an activator. of Membrane Biology Laboratory, is the Both genes have protective and risk-increas- editor of a book titled, "The Biology of ing variants, meaning that a protective Factor the Eye," published by Elsevier. B variation can protect against AMD, even if one carries a risk-increasing variant of Factor John T. Flynn, M.D., H, and vice versa. Still, 74% of the study's sub- Vice Chairman of the jects with AMD had either the Factor H or the Department of Ophthal- Factor B risk variant (or both), but no protec- mology and Chief of Pedi- tive variants of either gene. atric Ophthalmology, received the Marshall M. "These findings are significant because they Parks Medal from The absolutely confirm the roles of these two Foundation of the genes and, consequently, the central role of a American Associa- specific immune response pathway, in the tion for Pediatric development of AMD. We confirmed this Ophthalmology and association not just statistically and geneti- Strabismus. This medal C. Manley cally but, most importantly, pinpointed the is conferred on those who John T. Flynn, M.D. biological origin of the disease," added Dr. have made extraordinary Allikmets. "In just a few short years, we've gone contributions to the field and to the care of from knowing very little about what causes children and adults with strabismus. AMD to knowing quite a lot. We now have clear targets for early therapeutic intervention." D Max Forbes, M.D., Professor Emeritus and the former head of the Glaucoma Special thanks to Elizabeth Streich of CUMC's Division, was awarded the American Office of External Affairs. 11 Promotions

Rando Allikmets, Ph.D.,received tenure as Associate Professor of Ophthalmic Science (in Ophthalmology and Pathology & Cell Biology).

Rajendra Bansal, M.D.,promoted to Associate Clinical Professor of Ophthalmology. Glaucoma Society's President's Award for Lucian Del Priore, M.D., Ph.D.,received his scientific achievement tenure as Professor of Clinical and continued service to Ophthalmology. the Glaucoma Society and the field of ophthalmol- George Florakis, M.D., promoted to ogy. The fourth recipient Clinical Professor of Ophthalmology. of the award, Dr. Forbes is a founding member of the Song Eun Lee, Ph.D., promoted to Society. Associate Research Scientist. James C. Tsai, M.D., Director of the Glaucoma Eli Marcovici, M.D., promoted to Assistant C. Manley Max Forbes, M.D. Division, was recently Clinical Professor of Ophthalmology. named to the Board of Directors of The Glaucoma Foundation, Takayuki Nagasaki, Ph.D., promoted to the premiere not-for-profit organization Assistant Professor of Ophthalmic Science dedicated to fighting glaucoma through its (in Ophthalmology). research support and patient outreach. "It is an absolute gift to have Jim on our board," Richard Silverstein, M.D., Ph.D., promoted says Scott Christensen, the Foundation's to Assistant Clinical Professor of President and CEO. The Glaucoma Founda- Ophthalmology. tion, which recently celebrated its 20th anniversary, is based in lower Manhattan, R. Theodore Smith, M.D., Ph.D., promoted with chapters in Chicago, Dallas/Fort Worth to Associate Clinical Professor of and Long Island. Ophthalmology (in Biomedical Engineering). Stephen L. Trokel, M.D., Vice Chairman of the Department of Ophthalmology and Li Wu, M.D., M.Sc., promoted to Senior con’t. page 16 Staff Associate. 12

Saving the Sight of Diabetics (con’t. from page 1)

Boston, the numerous studies have shown that fewer West Indies than half of diabetic patients actually do so. and Mexico. "George and Geri brought their proposal to "Last fall I our doorstep at exactly the right time. We contacted Dr. had been considering how to implement a James Tsai for diabetic retinopathy screening program after advice on seeing so many cases of advanced retinopathy establishing a in the clinic," confirms Dr. Chang. "Simulta-

National Eye Institute, NIH glaucoma pro- neously, Dr. Michael Chiang's success with Fundus photograph of a gram on the the Retinopathy of Prematurity telemedicine normal retina. island of Nevis study has proven the viability and effective- in the West ness of telemedicine as a screening tool [see Indies," notes Dr. Bresnick. "As we talked fur- 2005 Fall/Winter Viewpoint]. We are excited ther, the discussion turned to our program to by the potential of combining the power screen for diabetic retinopathy in Mexico. Dr. of telemedicine with the effectiveness of Tsai immediately saw the potential for Vision for All's community outreach in Columbia and set the wheels in motion Washington Heights." by bringing Dr. Stanley Chang into the conversation." The Harkness Eye Institute already provides low-cost and free vision care to the largely Diabetic retinopathy is the leading cause of Hispanic Washington Heights population blindness in working-age Americans, even through the ITT Eye Clinic. Yet the challenge though it is highly treatable by laser when lies in reaching diabetic patients who may caught in time. Retinal blood vessels are par- not be aware of the Eye Clinic's services, or ticularly sensitive to cellular damage from even that their vision is at risk. high blood sugar; in fact, nearly all Type 1 diabetic patients and over 60% of Type 2 dia- "Although many of the community's diabetes betic patients will develop retinopathy within patients are having their diabetes monitored the first 20 years of onset. The American at New York-Presbyterian Hospital medical Academy of Ophthalmology and the Ameri- clinics several times per year, roughly 60% of can Diabetes Association strongly recom- the patients are not obtaining the necessary mend that diabetic patients obtain annual retina exams at the Eye Clinic. Sadly, many ophthalmology examinations for early detec- do not come to us until the situation is dire, tion and treatment of retinopathy, yet when the retinopathy is advanced and the 13

Saving the Sight of Diabetics (con’t.) vision is already severely compromised," retina photo- states Dr. Bresnick. "In order to treat diabetic graphs devel- patients with laser most effectively, the oped at the patients must be seen before the retinopathy University of has progressed to an advanced stage. This Wisconsin in requires regular retinal examinations, as the early 1970s severe retinopathy can develop without any where Dr. visual symptoms until serious bleeding Bresnick was a occurs in the eye. Since so many patients fail member of the National Eye Institute, NIH to come to the Eye Clinic for preventive care, research team. Proliferative retinopathy, an the most effective way to preserve their vision advanced form of diabetic is to bring the eye screening to them." Dr. Bresnick retinopathy, occurs when feels fortunate abnormal new blood vessels Michael Chiang, M.D., M.A., Assistant Pro- to have partic- and scar tissue form on the surface of the retina. fessor of Ophthalmology and Biomedical ipated in that Informatics, is leading the operational early research. "We conducted a series of col- aspects of the two-year project for Colum- laborative clinical trials supported by the bia's ophthalmology and biomedical infor- National Eye Institute that decisively showed matics departments, with the goal of proving the effectiveness of laser treatment in pre- the efficacy of telemedicine diagnosis for dia- serving vision for diabetic patients with pro- betic retinopathy screening. Telemedicine liferative diabetic retinopathy or macular diagnosis of diabetic retinopathy involves edema," he explains. obtaining digital photographs of patients' retinas during a standard visit with their pri- Dr. Bresnick continues, "A crucial part of mary care physician, and then transmitting these studies involved developing standard- those images via the Internet to a remote ized and reproducible methods to record and screening center for reading and grading by grade the severity of the retinopathy in each trained experts. All that is necessary is a will- patient. The stereo-retinal photographic ing patient, a standard ophthalmic fundus technique and grading system developed at camera operated by a qualified technician, a the University of Wisconsin has become rec- computer and an Internet connection. ognized as the 'gold standard' for diabetic Experts anywhere in the world can make an retinopathy evaluation." Dr. Chiang agrees, accurate assessment based solely on the reti- emphasizing that this grading protocol is at nal photographs, thanks to the universally the very core of the telemedicine diabetic accepted standards for reading and grading con’t. page 14 14

Saving the Sight of Diabetics (con’t. from page 13)

retinopathy screening study at Columbia. can we implement this system within existing Without universally accepted grading stan- medical workflows? Will it be economically dards, reliable remote diagnosis simply self-sustaining? Access to a high-volume would not be possible. patient population and a strong research infrastructure makes Columbia the perfect Thanks to generous funding from the Russell real world environment in which to conduct Berrie Foundation, approximately 3,000 dia- this study and address these questions." betic patients will be screened annually for diabetic retinopathy at community medical Simultaneously, through Vision for All, Dr. clinics operated by the Ambulatory Care Bresnick and Ms. Hendriksen are building Networks Corporation (ACNC) at Columbia the community networks necessary to reach University Medical Center. The resulting diabetic individuals in Washington Heights retina photographs will be uploaded via the who are not receiving regular medical care or Internet to Inoveon, a telemedicine company whose eyes are not yet being monitored. based in Oklahoma City with a reading "Geri and I are working with various organi- center in Nashville, where trained experts zations to offer initial screenings and retina will read, grade and provide the results to exams in conjunction with diabetes educa- patients' primary care physicians. In turn, the tion at various community sites. We then physicians will refer their patients to the Eye facilitate appointments and visits to an oph- Clinic to ensure that they receive appropriate thalmologist for appropriate eye care. But ophthalmic treatment. making sure the patient actually makes the trip to the Eye Clinic for follow-up care is one "We have two main goals for the project. The of the hardest things to do. There are a first is to detect potentially blinding disor- number of educational and socioeconomic ders in the high-risk diabetic population and barriers," observes Dr. Bresnick, noting that steer those patients toward treatment in time fear and financial worries top the list. to save their vision," states Dr. Chiang. "The second is to look at several research questions Dr. Chiang is optimistic. "The Columbia related to the main outcomes of the study, ophthalmology clinic has a longstanding such as, will the availability of a telemedicine commitment to working with the public, and screening system within a primary care set- never turns away someone in need of treat- ting increase the likelihood that diabetics will ment due to lack of ability to pay. This is the have their eyes examined? Can telemedicine driving force behind the telemedicine dia- provided in this setting improve our ability betic retinopathy screening program that we to diagnose this treatable disease? How well are all working to implement." D 15

A Treasured Gift to Vision (con’t. from page 3) graduate school onward. Those were the hal- Araskog. "He always talks with fervor about cyon days of research." After pursuing the fact that a sighted eye is a gift to be research for many years, he started in clinical treated with the greatest of care. This belief practice under the mentorship of A. Gerard expands beyond his professionalism and DeVoe, M.D., the oph- toward his genuine con- thalmology department cern for the individual chair during the 1960s. and what being able to see means to a lifetime. He Dr. DeVoe reminisces, "I has had a major impact enjoyed working with Dr. on my life." Srinivasan during his clinical days. He is a won- Dr. Srinivasan became derful person, straightfor- involved on a volunteer ward and honest, basis with the Eye Clinic extremely conscientious. that serves the Washing- He is a fine surgeon and ton Heights community has a gentle manner with during Dr. DeVoe's patients. I could always tenure. In 1990, under the count on him to do what- K. H. Boyd chairmanship of Anthony ever needed to be done. I Dr. Srinivasan examines a patient in Donn, M.D., Dr. Srini- don't think you'll find the ITT Eye Clinic vasan accepted the Eye anyone more loyal to the Clinic directorship, and Eye Institute." with it, the responsibility for treating 21,000 patients annually, as well as teaching and Dr. DeVoe introduced Dr. Srinivasan to Rand supervising nine to ten residents each year. Araskog, the now-retired chairman and chief executive officer of ITT Corporation and a "One of the best decisions I ever made was to founding member of the Department's ask Dr. Srinivasan to become the director of Board of Advisors. Over the years, they have the Eye Clinic," states Dr. Donn. "Prior to developed a special bond, and Mr. Araskog that, the clinic had been run on a volunteer credits Dr. Srinivasan with preserving his basis by the attending physicians. Putting vision. In fact, Mr. Araskog and his wife Dobli in charge of supervising residents established the A. Gerard DeVoe-B. Dobli brought the quality of the residency program Srinivasan Directorship of Ambulatory Eye to a new level." Care in 2004 to honor both doctors. "Dr. Srinivasan's kindness and humility con- Dr. Srinivasan clearly enjoys mentoring his stantly show through in his work. He really residents. "I get a big kick out of learning deserves the adjective 'selfless,'" reflects Mr. con’t. page 16 16

Faculty News (con’t. from page 11)

Director of Columbia Vision Correction, Stephen Tsang, M.D., Ph.D., Assis- delivered the keynote lecture at the Ameri- tant Professor of Ophthalmology, has can Society for Laser Medicine and been selected by the Association for Surgery's (ASLMS) 26th Annual Meeting Research in Vision and Ophthalmol- in Boston in April. Dr. Trokel is the first ogy (ARVO) to receive its inaugural ophthalmologist to recognize the signifi- ARVO/Alcon Early Clinician Scientist cance of the excimer laser in corneal Research Award. He will present his win- refractive surgery. In 1999, he was nomi- ning paper at the ARVO Annual Meeting nated by over 30,000 of his peers as one of in late April. D the twentieth century's most influential ophthalmologists.

A Treasured Gift to Vision (con’t. from page 15)

from them. They keep me going! It is gratify- tionately known, is respected and loved by all ing to see them blossom; by their third year, of his students and patients and has achieved they are superb ophthalmologists." a fatherly status in the eyes of his residents and colleagues. He is a veritable institution within Amilia Schrier, M.D., who has taught resi- this medical center and will not be forgotten." dents in the clinic with Dr. Srinivasan since 1998, will become the new DeVoe-Srinivasan Reflecting on his career, Dr. Srinivasan says, Director of Ambulatory Care and assume "I have thoroughly enjoyed my career at responsibility for the ITT Eye Clinic when Columbia — the research, the clinical work, Dr. Srinivasan retires at the end of June. She the residents, my colleagues. I feel very lucky says, "Dr. Srinivasan is a physician's physi- to have had so many wonderful opportuni- cian; his knowledge, judgment and contribu- ties." He plans to continue his involvement in tions are second to none. There is not a day ophthalmology and public health, albeit on a that goes by that he is not called upon to offer more relaxed level. his opinion and recommendations on chal- lenging cases. His self-assurance gives all of "Dr. Srinivasan has been a pillar of this depart- us — colleagues, attending physicians and ment," states Dr. Stanley Chang. "His steadfast residents — the confidence to perform and dedication to teaching residents and medical be the best that we can be." students, and strong commitment to serving the community has set a high standard for Eric Wolf, M.D., Chief Resident in the ITT scholarly activity over for four decades. We Eye Clinic, concurs. "Dr. Srini, as he is affec- wish him a happy and healthy retirement!" D 17

Apprehending the Silent Thief (con’t. from page 1) in the United States, affecting some 2.2 million Americans, with as many as 2 million more not yet diagnosed.

Although elevated pressure within the eye has long been considered a tell-tale symptom of glaucoma, recent research has shown that one in three glaucoma cases occur in persons with normal intraocular pressure. This alarming statistic has led James C. Tsai, M.D., Director of the Glaucoma Division at V. Zemon V. Columbia, and his mentor, Max Forbes, Vance Zemon, Ph.D. demonstrates the icVEP M.D., former glaucoma division director, to redouble their efforts in pursuit of a multi- stable or getting worse? What we're trying to dimensional approach to apprehending the do is develop new treatments and technolo- "silent thief." gies that are more sensitive and specific to the early detection and worsening of glaucoma, "There are three facets to our clinical and and the Harkness Eye Institute has developed research efforts in the Glaucoma Division. a highly accurate and sensitive prototype The first involves implementing aggressive device to do just that." glaucoma screening outreach with funding from the Friends of the Congressional Glau- Drs. Tsai and Forbes have partnered with coma Caucus Foundation and other organi- Vance Zemon, Ph.D. of Yeshiva University zations to detect and begin treating the dis- and George Hu, Ph.D. of Synabridge Corpo- ease earlier, before significant vision loss ration to develop the "isolated check visual occurs [see Viewpoint Spring 2005]. The evoked potential" instrument (icVEP), a fast second is basic science research, both to and highly accurate glaucoma screening tool understand retinal ganglion cell loss and to that measures electrical activity in the brain discover new compounds or drugs with in response to visual stimuli. Columbia was potential neuroprotective and neuroregener- the only center for the initial clinical trials ative effects," explains Dr. Tsai [see Viewpoint funded by the National Institutes of Health Fall 2005]. "The third is translational research (NIH), and achieved a 94% accuracy rate in and goes hand in hand with the basic science separating glaucoma patients from the con- neuroprotection research. How do you trol group in Phase 1. Columbia is one of demonstrate that a person's glaucoma is con’t. page 18 18

Apprehending the Silent Thief (con’t. from page 17)

three collaborating institutions in Phase 2, sion for perception of dark objects on a which will test the efficacy and safety of the lighter background. The icVEP measures the technology in a broader context. strength of electrical currents generated by the magnocellular pathway and The hypothesis behind the then a signal-to-noise ratio is icVEP is that glaucoma computed. If the result is patients with 20/20 visual greater than 1, then there is a acuity do not have the same true response in the brain. visual function as those with- However, if a response is not out glaucoma and 20/20 visual found, the pathway is dis- acuity. By measuring the rupted, indicating possible responses in select visual path- glaucomatous damage."

ways and applying complex Zemon V. statistical algorithms, Drs. Tsai The ”check” pattern used The icVEP device is a special- and Zemon can quickly screen with the icVEP ized computer combined with a for glaucoma and also detect carefully calibrated monitor. further visual decline — something that cur- Input is received from two electrodes placed rent screening methods cannot do. The on the scalp of the subject — one over the icVEP concept builds on the success of visual cortex of the brain and the other over Columbia's expertise in multifocal VEP pio- a neutral reference point on the top of the neered by Columbia's Vivienne Greenstein, head. Once connected, the electrodes meas- Ph.D. and Don Hood, Ph.D. ure EEG brainwaves while the subject looks at an array of bright or dark isolated squares "A number of ganglion cell subpopulations on the monitor. The "check" patterns appear exist in the retina, and we believe that these and disappear during the testing, which subpopulations represent parallel pathways involves the modulation of peak contrast for the transmission of visual information to over the course of eight two-second stimulus the brain. One of these pathways — the mag- presentations per eye. nocellular pathway — is known to be sensi- tive to low contrast and high frequency of Dr. George Hu, a former student of Dr. stimulation and it is thought to be affected Zemon, is the principal investigator on the early in glaucoma," explains Dr. Zemon. "The NIH study and the engineer who designed magnocellular pathway has an ON-cell divi- the icVEP instrument. "George is the genius sion for brightness perception, such as white behind the icVEP. He has invented an effi- on a black background, and an OFF-cell divi- cient machine that collects data rapidly, 19 In Memoriam: Basil V. Worgul, Ph.D.

The Department of Ophthalmology mourns the loss of Basil Vladimir Worgul, Ph.D., who died of a heart attack at his home in Edgewater, NJ, on January 19, 2006 at the age of 58. He joined Columbia in 1974 and became a full professor in the departments of ophthalmology and radiology in 1990. He was also a director of the Ukrainian/Ameri- can Chernobyl Ocular Study. He studied the effects of radiation on the eyes of some Basil V. Worgul, Ph.D. 12,000 clean-up workers exposed to radia- tion following the disaster. neutrons and HZE particles were in produc- "Dr. Worgul's most important contributions ing cataracts, even at low doses. After Dr. came early in his career through his research Merriam retired, Basil became the number collaborations with the esteemed ophthal- one expert on radiation-induced cataracts in mologist, George Merriam, M.D.," observes the United States." Eric J. Hall, Ph.D., Director for the Center of "Basil Worgul made significant contributions Radiological Research at Columbia. "They to our understanding of cataract formation made recommendations to NASA before the after radiation exposure," states Dr. Stanley lunar missions about radiation protection, Chang. "We will miss his brilliance and con- and were the first to show how very effective stant quest for new information." D

Apprehending the Silent Thief (con’t.) rejects false information and automatically routine screening device within a primary computes the signal-to-noise ratio to gener- care setting." ate objective results," says Dr. Zemon with Dr. Tsai agrees. "If our clinical trials continue pride. "Unlike others studying VEP, we have to be as successful as they already have been, synchronized data collection with the stimu- the icVEP has the potential to revolutionize lus, meaning that we can obtain much glaucoma detection for millions of people, as cleaner signals from the brain and therefore well as provide a reliable way to test new drug achieve more reliable results. Yet the simplic- treatments. This is very exciting technology. ity of the instrument ensures that any physi- We are really accomplishing our translational cians' assistant can be trained to use it as a research goals." D The Department of Ophthalmology & The Edward S. Harkness Eye Institute at COLUMBIA UNIVERSITY MEDICAL CENTER 635 West 165th Street New York, NY 10032-3797

Charitable Gift Annuities: The Best of Both Worlds

A Charitable Gift Annuity (CGA) is a simple table and financial goals and demonstrates form of gift that will pay you and/or some- the advantages you can receive through one you choose a guaranteed fixed annual establishing a CGA at Columbia University income for your lifetime. In addition, you Medical Center. They may include: will receive a generous charitable income tax deduction and a reduction in gift and estate D A guaranteed annual income for your life- taxes. Best of all, your gift will support excel- time; lence in education and training, basic D An income tax deduction; research and patient care in the Department of Ophthalmology. D A reduction in capital gains tax if you use appreciated securities to fund your gift; We would be pleased to prepare a personal- ized illustration that reflects your own chari- D A reduction in gift and estate taxes.

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