OPHTHALMOL OG Y JOURNAL - Memorial Hermann...Dr. Gene Kim received his medical degree at the...

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R O P H T H A L M O L O G Y

M E M O R I A L H E R M A N N

J O U R N A LA P U B L I C AT I O N F RO M M E M O R I A L H E R M A N N-T E X A S M E D I C A L C E N T E R A N D U T H E A LT H M E D I C A L S C H O O L

M E M O R I A L H E R M A N N - T E X A S M E D I C A L C E N T E R

In ThIs Issue

Making the Impossible Possible

FeaTures

An Eye to the Future: Robert Cizik Eye Clinic and Ruiz Department of Ophthalmology Expansion Offers Patients Comprehensive Subspecialty Care

Diagnosis and Management of Ocular Malignancies

Randy Whitesides: A Floridian Travels to Houston for World-class Care

Amy Truong: Successful Treatment Inspires a Young Woman to Study Nursing

Brendan Diffley: Meticulous Surgery Saves a Young Trauma Patient’s Vision

research

On the Clinical and Research Utility of Confocal Microscopy

news oF noTe

Dr. Bhavani Iyer Awarded SightFirst Grant to Help Patients with Low Vision

Six UTHealth Medical School Ophthalmologists Named Among Houstonia Magazine’s Top Doctors

Moran Pediatric Eye Clinic Celebrates Grand Opening

The Ophthalmology Basic Science Course: 45 Years of Residency Training

In The MedIa

selecTed PublIcaTIons

absTracTs

book chaPTers

lecTureshIPs

PresenTaTIons

honors and awards

GranTs

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01O P H T H A L M O L O G Y J O U R N A L

Making the Impossible PossibleIt’s been said that nothing is impossible for those with the courage to try. Over the last

three years, the Robert Cizik Eye Clinic and Ruiz Department of Ophthalmology and Visual Science have doubled in size and expertise; affiliated physicians now offer diagnosis and treatment within all subspecialties of ophthalmology. An experienced multidisciplinary team provides the highest level of care, with an across-the-board track record of quality outcomes. Using highly advanced technology, they perform complex procedures that preserve sight and improve vision. In this issue, you’ll read about the experiences of three patients who benefited from the clinical excellence of affiliated faculty.

In 2014, we welcomed two new faculty members: Stella Kim, M.D., who joined us after 12 years at The University of Texas MD Anderson Cancer Center and is internationally recog-nized for her work in ocular graft versus host disease, and Alla Kukuyev, M.D., director of the uveitis service, who is the only provider in Texas with dual fellowship training in vitreoretinal surgery as well as uveitis and ocular inflammatory disease. The two physicians complete the department’s subspecialty services and ensure that we are fully equipped to meet the needs of the hospital, medical school and community.

In this issue Dr. Kim, Amy Schefler, M.D., and ophthalmic plastic and reconstructive sur-geon Margaret Phillips, M.D., address our capabilities to treat ocular malignancies, including conjunctival melanoma, uveal melanoma and retinoblastoma. Children’s Memorial Hermann Hospital is the only center in the south-central United States routinely offering intra-arterial chemotherapy and intravitreal chemotherapy for the treatment of retinoblastoma, which requires a large multispecialty team.

To be trusted with the most precious of senses is the highest compliment. We extend our thanks to Randy Whitesides, Brendan Diffley and his parents Kathy Perry and Shane Diffley, and Amy Truong for sharing their personal stories of courage in the face of potential vision loss. Mr. Whitesides found his way to us from South Florida after suffering loss of vision due to long-term uveitis. Twelve-year-old Brendan Diffley arrived through the Emergency Center after shooting himself in the eye with a pencil while playing with a makeshift paper crossbow. Ms. Truong underwent an emergent corneal transplant after developing a difficult-to-treat fungal infection following LASIK surgery at another institution.

Congratulations to the members of our department who were singled out for recognition in Houstonia magazine’s 2014 listing of Top Doctors in Houston. We’re proud of their clinical accomplishments, commitment to teaching and research productivity.

As always, we’re grateful for the ongoing support of UTHealth President Giuseppe Colasurdo, M.D., Memorial Hermann-TMC CEO Craig Cordola and Children’s Memorial Hermann Hospital CEO Susie Distefano. Their support, along with that of the Hermann Eye Fund, the Memorial Hermann Foundation, Research to Prevent Blindness and the National Eye Institute, has given us the opportunity to dream big and achieve our goals.

Sincerely,

ROBERT M. FELDMAN, M.D.

Distinguished Professor and ChairmanRuiz Department of Ophthalmology and Visual ScienceUTHealth Medical School

“OVER THE LAST THREE YEARS,

THE ROBERT CIZIK EYE CLINIC

AND RUIZ DEPARTMENT OF

OPHTHALMOLOGY AND VISUAL

SCIENCE HAVE DOUBLED IN

SIZE AND EXPERTISE, OFFERING

DIAGNOSIS AND TREATMENT

WITHIN ALL SUBSPECIALTIES

OF OPHTHALMOLOGY.”

02 M E M O R I A L H E R M A N N - T E X A S M E D I C A L C E N T E R

An Eye to the Future:Robert Cizik Eye Clinic and Ruiz Department of Ophthalmology Expansion

Offers Patients Comprehensive Subspecialty Care

ver the last three years, the Robert Cizik Eye Clinic and Ruiz Department of Ophthalmology and Visual

Science at UTHealth Medical School have doubled in size. With the addition of Stella Kim, M.D., to the cornea and external disease service and ocular oncol-ogy service and Alla Kukuyev, M.D., as chief of the uveitis service, the depart-ment now covers all subspecialties within ophthalmology.

STELLA KIM, M.D. Clinical ProfessorRuiz Department of Ophthalmology andVisual ScienceUTHealth Medical School

Dr. Kim, a clinical professor of oph-thalmology, joined the cornea/external disease and ocular oncology services in July 2014. After receiving her bachelor’s in biochemistry from Louisiana State University in Baton Rouge, she spent the next 10 years at Harvard Medical School, where she received her medical degree and completed two research fel-lowships as a Karin Grunebaum Cancer Fellow and the Howard Hughes Medical Institute Medical Student Fellow, a medical internship at Mount Auburn Hospital and her ophthalmology resi-dency at Massachusetts Eye and Ear Infirmary. For her cornea fellowship, she spent one year as a Heed Fellow at the Moran Eye Center at the University of Utah.

After her training, Dr. Kim joined The University of Texas MD Anderson Cancer Center. For more than 12 years, she served as a faculty member at MD Anderson with a clinical focus in ocular surface diseases in cancer patients, conjunctival tumors, ocular surface reconstructions and complex cataract sur-gery. She is internationally recognized for her work in ocular graft versus host dis-ease (GVHD). Dr. Kim joined the Robert Cizik Eye Clinic and the Ruiz Department of Ophthalmology and Visual Sciences to provide care for patients with corneal and external diseases, in particular with severe ocular surface diseases, conjunc-tival/cornea tumors and GVHD, as well as cataract and other corneal disorders.

ALLA KUKUYEV, M.D. Assistant ProfessorRuiz Department of Ophthalmology andVisual ScienceUTHealth Medical School

Dr. Kukuyev, assistant professor of oph-thalmology, joined the retina service of the Robert Cizik Eye Clinic and the Ruiz Department of Ophthalmology and Visual Science at UTHealth Medical School in September 2014, and is chief of the uveitis service.

She received her combined B.S./M.D. degree from the University of Akron and Northeast Ohio Medical University and completed her residency in ophthalmol-ogy at the Havener Eye Institute at the Ohio State University Medical Center. She completed fellowship training in uveitis and ocular inflammatory diseases at the Jules Stein Eye Institute at the University of California, Los Angeles, and then completed additional fellowship train-ing in vitreoretinal surgery at Retina and Vitreous of Texas. Dr. Kukuyev is the only provider in the state of Texas with dual fel-lowship training in vitreoretinal surgery as well as uveitis and ocular inflammatory disease. She is certified by the American Board of Ophthalmology and holds mem-berships in the American Academy of Ophthalmology, the American Society

“WE’RE PROUD OF OUR TEAM OF AFFILIATED SUBSPECIALISTS AND

THE EXPERTISE THEY BRING TO HOUSTON AND THE SURROUNDING

REGION. IN ADDITION TO CLINICAL ACCOMPLISHMENTS, THEY HAVE

INCREASED OUR RESEARCH PRODUCTIVITY.”

B C P RJ F S L D O A W U M T I H

F E A T U R E S


of Retina Specialists and the Houston Ophthalmological Society. Her clinical interests include medical and surgical management of diabetic retinopathy; retinal detachment; macular hole; epiret-inal membrane; retinal vascular diseases; endophthalmitis; uveitis associated with autoimmune diseases, including juvenile idiopathic arthritis and sarcoidosis; and white dot syndromes and inflammation secondary to infectious diseases includ-ing AIDS, tuberculosis, toxoplasmosis and herpetic infections of the eye.

Preceding Drs. Kim and Kukuyev in the expansion at Memorial Hermann-Texas Medical Center and UTHealth Medical School are Lauren Blieden, M.D., Gene Kim, M.D., Kartik Kumar, M.D., and

Grace Lindhorst, M.D., who joined the department in 2012, and Margaret E. Phillips, M.D., Karina Richani Reverol, M.D., and Ore-ofe Adesina, M.D., who were recruited in 2013. Ocular oncolo-gist and retinoblastoma specialist Amy Schefler, M.D., now provides care through Cizik Eye Clinic.

LAUREN BLIEDEN, M.D. Assistant ProfessorRuiz Department of Ophthalmology and Visual ScienceUTHealth Medical School

Dr. Blieden received her medical degree at Baylor College of Medicine in Houston and completed her residency in ophthal-mology at the same institution, followed by a fellowship in glaucoma at Bascom Palmer Eye Institute in Miami. An assis-tant professor of ophthalmology, she is board certified by the American Board of Ophthalmology, with clinical and research

interests that focus on pediatric glaucoma and surgical outcomes. As part of her prac-tice, Dr. Blieden is active in the Childhood Glaucoma Research Network (CGRN), an international organization comprised of clinicians and scientists who specialize in the treatment of children with glaucoma.

GENE KIM, M.D. Assistant ProfessorRuiz Department of Ophthalmology and Visual ScienceUTHealth Medical School

Dr. Gene Kim received his medical degree at the University of Pittsburgh and com-pleted his residency in ophthalmology at Emory University, followed by a fellow-ship in cornea, ocular surface disease and refractive surgery from the John A. Moran Eye Center in Salt Lake City. An assistant professor of ophthalmology, Dr. Kim performs cataract surgery, corneal trans-plantation and LASIK and PRK vision

Glaucoma specialist Nicholas Bell, M.D., and

corneal disease specialist Nan Wang, M.D., Ph.D.,

examine a patient using the confocal microscope

for anterior segment corneal imaging.


Blepharoplasty” and “Transcanalicular Laser Dacryocystorhinostomy,” in the third edition of Smith and Nesi’s Ophthalmic Plastic and Reconstructive Surgery, published in 2012.

ORE-OFE ADESINA, M.D.Assistant Professor, Neuro-Ophthalmology SectionRuiz Department of Ophthalmology and Visual ScienceUTHealth Medical School

Ore-ofe Adesina, M.D., joined the department from the University of Utah Moran Eye Center, where he completed a fellowship in neuro-ophthalmology with an additional preceptorship in oculoplastics. He received his medical degree at the University of Oklahoma College of Medicine in Oklahoma City, followed by a residency at the University of Oklahoma/Dean McGee Eye Institute in the same city. He is certified by the National Board of Medical Examiners and is board eligible by the American Board of Ophthalmology. Dr. Adesina is a clinical assistant professor in the Ruiz Department of Ophthalmology and Visual Science.

AMY SCHEFLER, M.D. Assistant ProfessorRuiz Department of Ophthalmology and Visual ScienceUTHealth Medical School

Dr. Amy Schefler received her medi-cal degree at Weill Medical College of Cornell University in New York City, with honors in research. After finish-ing her residency at Bascom Palmer Eye Institute and the University of Miami, she completed a clinical and research fel-lowship in ocular oncology and a clinical fellowship in vitreoretinal diseases and surgery at the same institution. She was chief resident and co-director of ocular trauma at Bascom Palmer Eye Institute from 2009 to 2010. From 2010 to 2012, she served on the Institute’s faculty as an assistant professor of clinical ophthal-mology with a secondary appointment in radiation oncology.

with numerous other awards. An assis-tant professor of ophthalmology, Dr. Lindhorst directs a satellite clinic in Katy, Texas.

MARGARET PHILLIPS, M.D.Assistant ProfessorRuiz Department of Ophthalmology and Visual ScienceUTHealth Medical School

Among the 2013 recruits is Margaret E. Phillips, M.D., an ophthalmic plastic and reconstructive surgeon and clini-cal assistant professor of ophthalmol-ogy, who received her medical degree at the University of Alabama School of Medicine in Birmingham, followed by a residency in ophthalmology at the University of Maryland Department of Ophthalmology and Visual Sciences in Baltimore. A diplomat of the American Board of Ophthalmology, she completed a two-year fellowship in ophthalmic plas-tic and reconstructive surgery at the University of Tennessee in Memphis and at Vanderbilt University in Nashville. She was inducted into Alpha Omega Alpha Honor Medical Society in 2006.

KARINA RICHANI REVEROL, M.D.Assistant ProfessorRuiz Department of Ophthalmology and Visual ScienceUTHealth Medical School

After receiving her medical degree summa cum laude at the Universidad del Zulia in Maracaibo, Venezuela, Dr. Karina Richani Reverol completed transitional residency training at Sinai Grace Hospital-Detroit Medical Center. She then completed a residency in oph-thalmology at Kresge Eye Institute in Detroit, where she served as chief resident. She completed her fellow-ship training in oculoplastic surgery at Consultants in Ophthalmic and Facial Plastic Surgery in Southfield, Michigan. An ophthalmic plastic and reconstruc-tive surgeon and a clinical assistant pro-fessor of ophthalmology, Dr. Richani is coauthor of two chapters, “Lower Eyelid

correction surgery. He has a special inter-est in artificial corneal transplantation and performs keratoprosthesis surgery for severely damaged corneas. His research interests focus on corneal imaging using confocal microscopy and anterior seg-ment optical coherence tomography.

KARTIK KUMAR, M.D. Assistant ProfessorRuiz Department of Ophthalmology and Visual ScienceUTHealth Medical School

A vital addition to the pediatric ophthal-mologic service at Children’s Memorial Hermann Hospital, Dr. Kartik Kumar joined the ophthalmology team after completing a fellowship in pediatric ophthalmology at the Children’s National Medical Center in Washington, D.C. He received his medical degree at The University of Texas Southwestern Medical School in Dallas, followed by a residency in ophthalmology at the University of Kansas Medical Center, where he was chief resident. An assistant professor, Dr. Kumar’s clinical interests include all areas of pediatric ophthalmology, includ-ing amblyopia, strabismus, eyelid ptosis and cataracts. His research interests include visual development, amblyopia and the treatment of strabismus.

GRACE LINDHORST, M.D. Assistant ProfessorRuiz Department of Ophthalmology and Visual ScienceUTHealth Medical School

Dr. Lindhorst was recruited from the South Texas Veteran’s Healthcare Administration in San Antonio, where she was chief of the ophthalmology depart-ment. She received her medical degree from The University of Texas Health Science Center at San Antonio School of Medicine, followed by a residency in the department of Ophthalmology at the same institution, where she served as chief resident. She was inducted into the Alpha Omega Alpha Honor Medical Society in 2002 and has been recognized

F E A T U R E S


Dr. Schefler has received numerous honors and awards, and has authored numerous articles in peer-reviewed jour-nals. She provides state-of-the-art care for intraocular tumors in both adults and chil-dren. Dr. Schefler, along with the Memorial Hermann Mischer Neuroscience Institute at the Texas Medical Center, has initiated a retinoblastoma program that offers intra-arterial chemotherapy, the first treatment of its kind in Texas and the only center pro-viding the treatment in the south-central United States.

With the addition of new faculty members, the Ruiz Department of Ophthalmology and Visual Science has also expanded into new space. Nearly two years ago, the department began offering general and pediatric ophthalmology at the UT Physicians’ health center serving the Cinco Ranch and Katy areas, a prac-tice that provides care for patients of all ages in a convenient west Houston loca-tion. Clinic director Dr. Grace Lindhorst is joined on a part-time basis by Drs. Kumar and Phillips.

The new Moran Pediatric Eye Clinic held its grand opening in May 2014 in 3,000 square feet of newly built-out space on the 19th floor of the Memorial Hermann Medical Plaza, one floor above the Robert Cizik Eye Clinic at Memorial Hermann-Texas Medical Center. The clinic was made possible by a generous gift from the W.H. and Louise Moran Foundation in Houston. In addition to the clinic, the new space houses the offices of pediatric oph-thalmologists Helen A. Mintz-Hittner, M.D., the Alfred W. Lasher III Professor of Ophthalmology at UTHealth Medical School, and Dr. Kumar.

New equipment has also expanded the Cizik Eye Clinic’s capabilities. Ophthalmologists now have the use of a confocal microscope for anterior seg-ment corneal imaging, a femtosecond laser for cataract surgery, a state of the art Centurion® phaco machine, an ocular endoscope for use in trauma cases and a second retinal camera.

“We’re proud of our team of affiliated subspecialists and the expertise they bring to Houston and the surrounding region,” says Robert M. Feldman, M.D., chief of ophthalmology at Memorial Hermann-TMC and clinical profes-sor and chair of the Ruiz Department of Ophthalmology and Visual Science. “In addition to clinical accomplish-ments, they have increased our research

productivity. All this has been made pos-sible through the continued support of Memorial Hermann-TMC, Children’s Memorial Hermann Hospital, the Hermann Eye Fund, the Memorial Hermann Foundation, Research to Prevent Blindness and the National Eye Institute. We’re grateful to have the opportunity to continue to do challeng-ing work that benefits our community and the patients who travel great dis-tances for expert care.”

Robert Cizik Eye Clinic Services

Adult

• Cornea, External Disease, Anterior Segment and Refractive Surgery

• Comprehensive Ophthalmology

• Glaucoma

• Low Vision and Visual Rehabilitation Services

• Neuro-ophthalmology

• Oculoplastic, Facial Reconstruction and Rejuvenation Surgery

• Medical and Surgical Retina

• Ocular Oncology

• Adult Strabismus

• Uveitis

• Vitreoretinal Surgery

Pediatric

• Comprehensive Pediatric Ophthalmology and Strabismus

• Cornea Anterior Segment and Refractive Surgery

• Glaucoma

• Neuro-ophthalmology

• Ocular Oncology

• Oculoplastic and Facial Reconstruction

• Retinopathy of Prematurity (ROP)

• Uveitis

• Vitreoretinal Surgery

“OPHTHALMOLOGISTS NOW HAVE THE USE OF A CONFOCAL

MICROSCOPE FOR ANTERIOR SEGMENT CORNEAL IMAGING, A

FEMTOSECOND LASER FOR CATARACT SURGERY, A STATE OF THE

ART CENTURION PHACO MACHINE, AN OCULAR ENDOSCOPE FOR

USE IN TRAUMA CASES AND A SECOND RETINAL CAMERA.”


Ongoing Clinical Trials

Clinical research is the basis of modern medicine: the day-to-day decisions phy-sicians make are based on the evidence published as a result of quality long-term research.

“The National institutes of Health and the National Eye Institute (NEI) have always been the primary finan-cial power advancing major biomedical research,” says Lauren Blieden, M.D., a clinical assistant professor of oph-thalmology and medical director of the Ruiz Department of Ophthalmology and Visual Science Clinical Trials Unit. “With current national funding levels for biomedical research at an all-time low, clinical research in ophthalmology has been significantly impacted. The NEI’s funding for the 2014 fiscal year was cut $36 million from the previous year, which equates to about 90 new research studies. We’re grateful that private foun-dations, such as the Hermann Eye Fund and Research to Prevent Blindness, have softened the blow during these tough financial times.”

The following trials are among many under way at the Robert Cizik Eye Clinic and the Ruiz Department of Ophthalmology and Visual Science:

• African Descent and Glaucoma Evalu-ation Study (ADAGES) III: Contri-bution of Genotype to Glaucoma Phenotype in African-Americans

• Pediatric Cataract Surgery Outcomes Study

• Clinical Study of the ARTISAN® Apha-kia Lens in Children

• Glasses versus Observation for Moder-ate Hyperopia in Young Children

• Primary Enucleation/Evisceration Study

• A Comparison of Gonioscopic Examination using the Spaeth System versus Swept Source Spectral Domain Anterior Segment Optical Coherence Tomography Imaging of the Anterior Chamber Angle

• Examiner Handedness and the Effects on Intraocular Pressure Readings Using the Tono-Pen XL

• Ahmed versus Baerveldt Comparison Study

• Characterizing Pathologic Changes in the Iridocorneal Angle and Trabecular Meshwork Using Anterior Segment Optical Coherence Tomography

• A Pilot Study to Assess the Safety and Efficacy of Intraoperative Topi-cal Mitomycin C and Bevacizumab (Avastin®) to Bare Sclera in Pterygium Surgery

• Robison D. Harley, M.D., CGRN Inter-national Pediatric Glaucoma Registry

• International Pilot Survey of Child-hood Glaucoma

• Evaluating the Efficacy of Fenestra-tions in Tube Shunt Implants During the Early Postoperative Period

• Characterizing the Trabecular Mesh-work Shadow with Anterior Segment Optical Coherence Tomography

• CT Imaging in the Detection of Open Globe Injuries

• Multifocal Intraocular Lens Simula-tion Study

• Trabecular-Iris Circumference Volume in Normal Open Angle Eyes Using Swept Source Fourier Domain Optical Coherence Tomography

• Recurrence Following Intravitreal Bevacizumab Monotherapy for Zone I, Stage 3+ Retinopathy of Prematurity

Clinical research creates new knowledge that leads

to advances in surgery, improvements in patient

care and ultimately, better outcomes.

F E A T U R E S


Diagnosis and Management of Ocular Malignancies

ancer of the eye is a devastat-ing diagnosis, putting individu-als at risk of losing one of the five traditionally recognized

senses – vision, an essential part of how we interact with the world – and also of losing their lives. With the addition of ocular oncologist and cornea and exter-nal disease specialist Stella Kim, M.D., and ocular oncologist and retina special-ist Amy Schefler, M.D., both of whom are affiliated with Memorial Hermann-Texas Medical Center and on the faculty of UTHealth Medical School, the Ruiz Department of Ophthalmology and Visual Science now provides patients with oncology expertise from the front to the back of the eye.

STELLA KIM, M.D. Clinical ProfessorRuiz Department of Ophthalmology andVisual ScienceUTHealth Medical School

AMY SCHEFLER, M.D. Assistant ProfessorRuiz Department of Ophthalmology and Visual ScienceUTHealth Medical School

“Primary malignancies of the ocular surface, such as conjunctival melanoma and squamous cell carcinomas, are infre-quent diagnoses, even among eye cancers,

which are rare in general,” says Dr. Kim, who is internationally recognized for her work in ocular graft versus host disease and has focused her practice on ocular surface diseases and cancers of the eye for more than 13 years. “Conjunctival melanoma, for example, accounts for only about 2 percent of all ocular malig-nancies. Because the Robert Cizik Eye Clinic is a referral center, we treat more cases of conjunctival malignancy than the average practice. Ocular cancers can be difficult to manage, and early diagno-sis and meticulous care are critical to an optimal outcome – from pre-surgical eval-uation and precise surgical approach, to adjuvant topical chemotherapy and long-term follow-up.”

An aggressive tumor, conjunctival mela-noma originates de novo in approximately 5 percent of cases, from pre-existing con-junctival primary acquired melanosis in 75 percent, and from nevi in 20 percent of cases, according to the American Association of Ophthalmology (AAO). The AAO reports the overall tumor-related mortality rate for conjunctival melanoma at approximately 25 percent. Treatment usually involves surgical removal of the tumor, radiation therapy when appropriate and topical chemother-apy as an adjunct treatment.

“Management of conjunctival mela-noma is complex,” says Dr. Kim, who considers working with patients with ocular cancers a unique privilege. “Vision is intricately linked with quality of life, and ocular cancers underscore the need for a multidisciplinary approach that considers the whole patient, not just the disease of the eye. That is our philosophy of care.”

Melanoma of the uveal tract, although rare, is the most common primary intraoc-ular malignancy in adults. Approximately 2,000 new cases of uveal melanoma are diagnosed per year in the United States. They can arise in the anterior or the pos-terior uveal tract, with most originating in the choroid. The iris is the least common site of origin, with the best prognosis.

“PATIENTS ARE REFERRED TO US FROM ACROSS THE COUNTRY WHEN

THEIR LOCAL DOCTORS FIND AN UNUSUAL MASS AND ARE UNABLE TO

REACH A DIAGNOSIS. IN DIAGNOSTICALLY CHALLENGING CASES,

SUCH AS THOSE IN WHICH THE VIEW OF THE TUMOR IS BLOCKED BY

BLOOD, WE USE SOPHISTICATED RETINAL INSTRUMENTATION FOR

BIOPSY AND GENERALLY ARE ABLE TO MAKE A DEFINITIVE DIAGNOSIS

WITH A MINIMALLY INVASIVE PROCEDURE.”



“The uveal melanoma service at Robert Cizik Eye Clinic provides top-notch ophthalmic care including all types of advanced treatment, as well as sophis-ticated fine-needle aspiration biopsies with pathology confirmation,” says Dr. Schefler, a renowned specialist in tumors of the eye in children and adults. “Patients are referred to us from across the country when their local doctors find an unusual mass and are unable to reach a diagnosis. In diagnostically challenging cases, such as those in which the view of the tumor is blocked by blood, we use sophisti-cated retinal instrumentation for biopsy and generally are able to make a defini-tive diagnosis with a minimally invasive procedure.”

In many cases, however, uveal mela-noma is diagnosed without a biopsy. “We

have the capability to characterize the tumor using sophisticated testing tech-niques including ultrasound, ophthalmic photos, ophthalmic fluorescein angiogra-phy and optical coherence tomography, which offers a magnified view of the retina,” Dr. Schefler says.

By the time choroidal and ciliary body melanomas are diagnosed, they typically range in size from 2 to 12 millimeters high and from 5 to 18 millimeters wide. “Although the overall size of the tumor is small – often smaller than a jelly bean – the impact on the eye is significant because its structures are so delicate,” she says.

Most patients with uveal melanoma are asymptomatic; the tumor usually is discovered during a routine examina-tion. Melanomas are thought to arise

Example of treated retinoblastoma in a 40-year old

patient with radiation retinopathy.

F E A T U R E S


from pre-existing nevi that are benign in appearance initially and then transform into true cancers. The transformation can occur slowly or rapidly, which means it can occur in a patient who has had an eye exam with a benign-appearing nevus a few years before the cancer diagnosis. Some of these cancers are in the ciliary body or anterior choroid, and are difficult to detect during a routine exam without the use of specialized equipment.

Commonly used treatments for uveal melanoma include plaque therapy, in which tiny beads composed of radioactive isotopes are custom chosen and designed for the patient based on the size, shape and configuration of the tumor. The seeds are placed in a bottle cap-shaped implant backed in gold to protect healthy surrounding tissue. The radiation patch is surgically inserted onto the outside surface of the eye, where it remains for several days. Dr. Schefler’s team has seen nearly 100 percent local tumor con-trol with no tumor recurrences in the eye using this treatment.

She is also known for her innova-tive approach to the treatment of retinoblastoma, the most common pri-mary intraocular cancer in children. With only 250 to 350 new cases of reti-noblastoma per year in the United States and about 8,000 new cases annually in the world, few specialists are trained to treat the condition.

“Retinoblastoma generally develops in children from birth to 5 years of age, can be hereditary or occur spontane-ously, and may involve one or both eyes,” she says. “Treatments are complex and include chemotherapy – intra-arterial, intravitreal, systemic/intravenous or periocular – laser, cryotherapy, radiation and enucleation.”

Dr. Schefler performed the first intra-arterial chemotherapy treatment for retinoblastoma in Texas, and Children’s Memorial Hermann Hospital is the only hospital in the south-central United States routinely offering intra-arterial chemo-therapy and intravitreal chemotherapy for the treatment of retinoblastoma. The treat-ment requires a large multispecialty team that involves close collaboration between ocular oncology, endovascular neurosur-gery and medical neuro-oncology.

“Having the capability to inject che-motherapy directly into the arteries that feed the eye eliminates the side effects of systemic chemotherapy and maximizes the therapeutic dose to the eye,” says Dr. Schefler, who also specializes in the treatment of Coats’ disease, persistent fetal vasculature, medulloepithelioma, iris and ciliary body tumors, leukemia and lymphoma, and vascular tumors. “The technique is very new and a paradigm shift in the treatment of retinoblastoma. There are very few centers in the United States with the expertise that we have.”

To deliver the treatment, Dr. Schefler collaborates with endovascular neurosur-geon Mark Dannenbaum, M.D., an expert in cerebrovascular surgery and neuroin-terventional techniques and an assistant professor of neurosurgery at UTHealth Medical School. Dr. Dannenbaum places a microcatheter into the ophthalmic artery using a neuroendovascular tech-nique, then infuses a high concentration of chemotherapy directly into the tumor bed, eliminating the side effects of sys-temic chemotherapy and maximizing the dose to the eye.

“This is exciting and groundbreaking clinical work,” she says. “We’re providing a cure for this treatable type of cancer and saving eyes and lives.”

Treating Adnexal Eye Cancers

Skin cancers of the eyelid account for 5 to 10 percent of all skin cancers. These include basal cell carcinomas, squamous cell carcinomas and rarely, melanomas.

“Basal cell carcinomas are by far the most common skin cancer on the eyelid,” says Margaret E. Phillips, M.D., chief of ophthalmic plastic and reconstructive surgery at the Robert Cizik Eye Clinic and the Ruiz Department of Ophthalmology and Visual Science. “The gold standard for treatment remains surgical excision with confirmation of clear margins to decrease the risk of recurrence. In select cases, basal cell carcinomas are amenable to topical treatment with imiquimod, an immune response modifier.”

For eyelid margin malignancies, the approach to reconstruction is determined by the degree of margin involvement. If less than 30 percent is involved after excision and cleared margins, the lid can be closed directly with the release of the lateral canthus. If 30 to 50 percent of the eyelid margin is involved, a myocutaneous flap is needed to reconstruct the eyelid. When greater than 50 percent of the eyelid margin is involved, a combination of flaps and grafts is required to reconstruct the lid’s full thickness.

“If the excised malignancy involves the non-marginal eyelid or canthi, skin flaps from surrounding areas can be used to close the defects,” Dr. Phillips says. “A skin graft is also an option. The approach to reconstruction is best determined on a case-by-case basis, depending on the size, location and shape of the surgical defect.”

“THERE ARE VERY FEW CENTERS IN THE UNITED STATES

WITH THE EXPERTISE THAT WE HAVE”


Randy Whitesides: A Floridian Travels to Houston for World-class Care

y the time Randy Whitesides made it to the office of interna-tionally recognized glaucoma expert Robert M. Feldman,

M.D., the Floridian had lost the vision in his right eye. After contracting a bac-terial infection in Mexico 30 years ago, he developed reactive arthritis, an auto-immune condition in which the joints become painful and swollen. One mani-festation of the condition is uveitis, which Whitesides has had since 1984.

ROBERT FELDMAN, M.D.Distinguished Professor and ChairmanRuiz Department of Ophthalmology and Visual ScienceUTHealth Medical School

“Like all autoimmune diseases, reactive arthritis is triggered by environ-mental factors, including stress,” says Whitesides, founder and CEO of Neptune Boat Lifts in Fort Lauderdale, Florida. “My uveitis comes and goes and eventu-ally became this thing in my life that I just dealt with. At first I had it once or twice a year for four to six weeks. Eventually, I was getting it five to 10 times a year. You follow the treatment protocol – steroid eye drops – but a few days after I started the steroids, my intraocular pressure (IOP) would spike in response. I used other eye drops to reduce the pressure, but over time I became extremely sensitive to the steroids. I’d be fine one day, then the next day my IOP would shoot up to 50 or 60, which can cause blindness in a few hours.”

From his home in Key Largo, Whitesides called his local ophthalmolo-gist when he developed another case of uveitis in the winter of 2013. “He was out of town so I self-medicated until he got back,” he says. “My IOP spiked and I lost vision in my right eye in a matter of a day. After this, my ophthalmologist told me my condition was out of his league and

recommended I go to one of the big eye clinics. I’d been treated at Bascom Palmer in Miami, so I scheduled an appointment at the Cleveland Clinic in Weston. In the interim I had a second, much more severe episode of uveitis and woke up almost totally blind. A friend drove me up to Weston, where they admitted me through the ER. I was treated by their team and released. Over the next month my uveitis started to improve.”

During the recovery period, Whitesides could only see shapes. An associate of his who had undergone corneal transplants at the Robert Cizik Eye Clinic in Houston suggested he call Dr. Feldman, who directs the clinic and is chief of ophthalmology at Memorial Hermann-Texas Medical Center and clinical professor and chair of the department of Ophthalmology at UTHealth Medical School.

“I said, ‘Yeah, yeah, yeah, I’ll call’ but I put it off,” Whitesides says. “So my asso-ciate called Dr. Feldman and gave him my number. When he heard about my case, he called me at home. I was really impressed that he took the time to call me. We spent almost an hour on the phone that night going through my treatment history. He told me he had a really good team and sug-gested I come to Houston when I felt well enough to travel. ‘We’ll put you through

a battery of tests,’ he said. ‘You’re getting really good treatment, but they may have overlooked something.’”

At the end of 2013, Whitesides saw uve-itis specialist Alla Kukuyev, M.D., and Dr. Feldman. “The autoimmune suppressant Randy was taking was no guarantee that he wouldn’t have another episode of uve-itis,” Dr. Feldman says. “Every time he had uveitis and a reaction to steroids with a sudden increase in intraocular pressure, he was at risk of losing more eyesight. We recommended tube-shunt surgery to pre-serve the vision he had.”

Whitesides flew home to Florida to think it over. The next day he called to schedule his surgery. On a Tuesday in December 2013 Dr. Feldman placed a tube-shunt in his left eye, followed by one in his right eye on Thursday. On Friday, he flew home.

Dr. Feldman consulted with his local ophthalmologist in follow-up. “Randy’s story describes how we work with patients and their physicians. Patients come here for expert care, and when they return home, we become a resource to their local ophthalmologists.”

After 30 years of experience with oph-thalmologists, Whitesides is discerning about the care he receives. “Everyone at the Cizik Eye Clinic was great,” he says. “I give them a 10-plus for an amazingly positive experience.”


Uveitis can be caused by autoimmune disorders, as in

the case of Randy Whitesides, or by infection or expo-

sure to toxins. In many cases, the cause is unknown.

F E A T U R E S


Amy Truong: Successful Treatment Inspires a Young Woman to Study Nursing

hree days after she had LASIK surgery at another institu-tion, 19-year-old Amy Truong noticed a white spot in her

right eye. When a three-week course of antibiotics failed to resolve the issue, her eye surgeon referred her to cornea and external disease specialist Gene Kim, M.D., at the Robert Cizik Eye Clinic.

Using the clinic’s confocal micro-scope, Dr. Kim took high-resolution images without sacrificing any tissue from Truong’s cornea. Twenty minutes later, he knew she had a fungal infection. “We prescribed antifungal eye drops and an oral medication for a few days, but because the fungus had been there for three weeks prior to treatment, it damaged and eventually perforated the cornea,” he says. “We had to do an urgent corneal transplant on a Friday evening.”

Therapeutic corneal transplants are fre-quently done in cases of fungi or parasites,

which are difficult to treat. “If one of the three medications we have available doesn’t work and the fungus spreads to other parts of the eye, the patient is at risk of losing the eye. Rather than waiting until no options are available, we remove the infection while it is still contained within the cornea.”

Following the transplant, Truong had issues with transplant rejection. To coun-ter the rejection, Dr. Kim prescribed a medium dose of steroids. “We were light on the steroids because the medication can cause the fungus and infection to

worsen. We want to remove all the fungus – if there’s even a small amount left, it will spread. So we have to find a good balance, which makes post-infection transplants difficult to manage. If you prescribe ste-roids to prevent rejection, the medication can cause the original problem to worsen. We watched her very closely and saw her often to find the right balance.”

Truong says getting rid of the infection was “such a relief. The surgery and recov-ery were nothing compared to dealing with the infection, which left me feeling emotionally unstable for a very long time.”

In September 2014, a year after Truong’s surgery, Dr. Kim removed the 16 sutures of her cornea transplant. Today, she’s 20 and fungus free. She’s also working through core courses at Lone Star College, with plans to complete her associate degree in nursing and go on to UTHealth School of Nursing for her B.S.N. Her eye looks normal and is doing well.

“Dr. Kim is literally my hero,” she says. “He knows how to care for people physi-cally and emotionally. I felt I had had such bad luck, but then was so blessed to meet him. He was always honest and straight-forward with me. I never once felt lost when I was with him.”

“USING THE CLINIC’S CONFOCAL MICROSCOPE, DR. KIM TOOK HIGH-

RESOLUTION IMAGES WITHOUT SACRIFICING ANY TISSUE FROM TRUONG’S

CORNEA. TWENTY MINUTES LATER, HE KNEW SHE HAD A FUNGAL INFECTION.”


Fungus that spreads beyond the cornea puts the

patient at risk of losing the eye.


Brendan Diffley: Meticulous Surgery Saves a Young Trauma Patient’s Vision

n New Year’s Eve 2012 Brendan Diffley’s father, Shane Diffley, and his step-mother, Jennifer Diffley,

drove the 12-year-old to nearby Memorial Hermann Katy Hospital after he shot himself in the eye with a pencil while fash-ioning a makeshift paper crossbow using online directions. He was transferred to Memorial Hermann-Texas Medical Center, where cornea and external dis-ease specialist Gene Kim, M.D., was on call for ophthalmic trauma.

GENE KIM, M.D. Assistant ProfessorRuiz Department of Ophthalmology and Visual ScienceUTHealth Medical School

“The front of Brendan’s eye was splayed open and bleeding, with an L-shaped cut in the cornea,” says Dr. Kim, a clinical assistant professor in the Ruiz Department of Ophthalmology and Visual Science at UTHealth Medical School. “We rushed him to the OR.”

In the hospital’s first surgery of 2013, Dr. Kim closed the open globe injury with

eight sutures and re-inflated the eye using balanced salt solution. Brendan went home with his mother, Kathy Perry, on the day of surgery, wearing a patch over his eye.

While he recovered well, the aftermath of the injury left Brendan with scars on his cornea, an irregular astigmatism that could not be corrected with glasses or soft contacts, and a traumatic cataract.

“Repairing a lacerated cornea is like putting the pieces of a puzzle together: it’s never going to be as smooth as it was originally,” Dr. Kim says. “We were able to put it back together neatly, but where there were sutures, he had astigmatism. Because his astigmatism was perfectly aligned, when we removed the cataract six months after the initial surgery, we were

able to implant an intraocular toric lens to correct the astigmatism.”

Dr. Kim says he recognizes that implanting a toric lens in trauma cases is considered risky. “I debated it for a long time, but given Brendan’s active lifestyle and low likelihood of tolerating a con-tact lens, I decided to place the special toric lens inside the eye. We performed meticulous surgery to get around some of the internal scarring and also had some luck. I’ve had a lot of experience doing trauma and complicated cases. The more experience you have, the better feel you

have of what will work. I was fortunate to be right in Brendan’s case.”Over a year and a half, Brendan went from having a badly cut cornea and collapsed eyeball to 20/30 vision without correction. “He has a bit of scar tissue on the capsule holding his intraocular lens, which causes slight distortion in his vision, but we can correct that in a five-minute laser procedure to remove the opacified tissue. He was very lucky that most of his injuries were to the front half of his eyeball. When injuries affect the back half, there’s very little we can do to save the eye.”

A talented athlete, Brendan rides dirt bikes and is an avid water skier and year-round swimmer who competes in tri-athlons. “When he first had the surgery, he couldn’t even see the big E on the eye chart,” his mother says. “But that was just the beginning, and his eye healed well. Dr. Kim is an incredible surgeon. We were blessed to have him. They do amazing things to save eyes these days.”

“WE PERFORMED METICULOUS SURGERY TO GET AROUND SOME OF

THE INTERNAL SCARRING AND ALSO HAD SOME LUCK. I’VE HAD A LOT

OF EXPERIENCE DOING TRAUMA AND COMPLICATED CASES. THE MORE

EXPERIENCE YOU HAVE, THE BETTER FEEL YOU HAVE OF WHAT WILL WORK.

I WAS FORTUNATE TO BE RIGHT IN BRENDAN’S CASE.”


Brendan Diffley, an active 14 year old, after

swim practice.

F E A T U R E S


On the Clinical and Research Utility of

Confocal Microscopy n 2013, Gene Kim, M.D., was the runner-up in the New Producer category of the American Society of Cataract and Refractory Surgery

Film Festival. His entry, a 7:43-minute video entitled the Clinical Utility of In Vivo Confocal Microscopy for Diagnosing Corneal Pathology, showed how extraor-dinary high-resolution images of cor-neal anatomy can be useful in clinical diagnosis.

“Although the equipment itself is bulky and ergonomically difficult to use in the clinical setting, corneal confocal micros-copy (CCM) can be used to distinguish fungal and acanthamoebal infections,1 both of which are difficult to culture,“ says Dr. Kim, a cornea and external dis-ease subspecialist at the Robert Cizik Eye Clinic and clinical assistant professor in the Ruiz Department of Ophthalmology and Visual Science at UTHealth Medical School. “Using CCM we can gain vital information and make a diagnosis during the office visit without having to remove any tissue from the eye and without the time lag involved in sending specimens to the lab.”

Dr. Kim, the author of a number of peer-reviewed publications on corneal confocal microscopy, has been engaged in research focused on increasing its everyday use in clinic. He is co-author of an article pub-lished in the Journal of the Peripheral Nerve System in 2013 concluding that corneal confocal microscopy is “a rapid, well-tolerated and reproducible method for assessing corneal innervation.”2 The clinical trial involved 11 healthy partici-pants who underwent CCM sampling of five standardized locations in the left eye and one centrally located in the right eye.

A second study was designed to evaluate

the reproducibility of in vivo confocal microscopy for quantitative corneal nerve analysis in different corneal locations. CCM was performed on 10 healthy partic-ipants with a mean age of 31.3 ± 2.8 years, who were imaged in five locations in the right eye at two time points about a month apart. In results published in the August 2013 issue of Cornea, Dr. Kim and his colleagues determined that while single confocal images have poor reliability for any of four corneal nerve measurements – corneal nerve fiber length, corneal nerve fiber density, corneal nerve branch density and tortuosity – averaging five images from different locations improved reproducibility, making it essential for obtaining clinically meaningful data.3

Dr. Kim is currently applying data gath-ered using the microscope to attempt to develop new treatments for ocular sur-face diseases, such as chronic dry eyes, neurotrophic keratopathy and limbal stem cell deficiency. “We hope to utilize the technology to better analyze the cor-neal nerves and ocular surface with the hope that we can eventually treat many of these diseases that do not have a definitive

cure,” he says. “We’re engaged in early collaboration with the basic science sec-tion of the Ophthalmology department to see if it is possible to regenerate new ocular surface tissue. Being able to ana-lyze the differences between the normal and synthetic ocular surface tissue on the microscopic level using CCM will be essential to eventually finding a cure.”

To view Dr. Kim’s short film, visit ascrs2013.conferencefilms.com and search “Gene Kim.”

1 Refer to the article “Amy Truong: Successful

Treatment Inspires a Young Woman to Study

Nursing” on page 11 in this issue of the

Memorial Hermann Ophthalmology Journal.

2 Smith AG, Kim G, Porzio M, Allen B, Koach M,

Mifflin M, Digre K, Keung BM, Singleton JR.

Corneal confocal microscopy is efficient, well-

tolerated, and reproducible. J Peripher Nerv

Syst. 2013 Mar;18(1):54-8.

3 Kim G, Singleton JR, Mifflin MD, Digre

KB, Porzio MT, Smith AG. Assessing the

Reproducibility of Quantitative In Vivo Confocal

Microscopy of Corneal Nerves in Different

Corneal Locations. Cornea. 2013 Aug 22. [Epub

ahead of print]


CCM can quickly and accurately distinguish fungal

infections from those caused by bacteria.

R E S E A R C H


ophthalmology and a fellowship at the same institution. A clinical profes-sor, she holds the Stephen A. Lasher Professorship in the Ruiz Department of Ophthalmology and Visual Science. Dr. Kellaway focuses her clinical practice on treatment of the retina, specifically in patients with diabetes and trauma, and general ophthalmology. In addition to her clinical practice, she is director of the residency program and an advocate for medical and premedical students.

NICHOLAS P. BELL, M.D. Associate ProfessorRuiz Department of Ophthalmology and Visual ScienceUTHealth Medical School

Dr. Nicholas P. Bell focuses his practice on the medical and surgical management of glaucoma; his research findings have been published in numerous ophthal-mic journals. He graduated from the University of Miami School of Medicine and completed his residency and fellow-ship at Baylor College of Medicine. A clinical associate professor in the Ruiz Department of Ophthalmology and Visual Science and director of glaucoma services at Cizik Eye Clinic, he currently serves as chief of ophthalmology at Lyndon B. Johnson General Hospital in Houston and as the glaucoma fellowship program director within the department. Dr. Bell is active in the training of UTHealth medi-cal students, ophthalmology residents and glaucoma fellows. He is the A.G. McNeese, Jr. Professor in Ophthalmology at UTHealth Medical School.

GARVIN H. DAVIS, M.D. Assistant ProfessorRuiz Department of Ophthalmology andVisual ScienceUTHealth Medical School

A clinical assistant professor of vitreo-retinal diseases and surgery, Dr. Garvin Davis graduated from Johns Hopkins School of Medicine and completed his residency at Wills Eye Hospital at Jefferson University in Philadelphia,

Hospital will be the two low vision centers in Houston where education programs and support services will be offered.

Dr. Iyer plans to establish low vision device loaner libraries at both locations, benefiting people who need to be trained on the devices or who may want to try them out before buying them.

Six UTHealth Medical School Ophthalmologists Named Among Houstonia Magazine’s Top Doctors

Robert M. Feldman, M.D., Judianne Kellaway, M.D., FACS, Nicholas P. Bell, M.D., Garvin H. Davis, M.D., David A. Lee, M.D., and Nan Wang, M.D., Ph.D., were named to Houstonia magazine’s 2014 listing of Top Doctors in Houston.

ROBERT FELDMAN, M.D.Distinguished Professor and ChairmanRuiz Department of Ophthalmology and Visual ScienceUTHealth Medical School

Dr. Feldman, clinical professor and chair of the Ruiz Department of Ophthalmology and Visual Science at UTHealth Medical School, specializes in the medical and surgical treatment of glaucoma, including congenital and pediatric glaucoma. After receiving his medical degree at Chicago Medical School, he completed his residency at the University of California, San Diego, and a fellowship at Baylor College of Medicine in Houston. A reviewer for several journals, Dr. Feldman has authored or co-authored more than 250 journal articles and made presentations worldwide. He holds the Richard S. Ruiz Distinguished University Chair in Ophthalmology.

JUDIANNE KELLAWAY, M.D.Clinical Professor and Stephen A. Lasher ProfessorshipRuiz Department of Ophthalmology andVisual Science, UTHealth Medical School

After receiving her medical degree at UTHealth Medical School, Dr. Judianne Kellaway completed her residency in

News of NoteDr. Bhavani Iyer Awarded SightFirst Grant to Help Patients with Low Vision

BHAVANI IYER, O.D., FAAODirector of the Center for Visual Rehabilitation at the Robert Cizik Eye Clinic at Memorial Hermann-Texas Medical Center and director of Low Vision Services for the Harris Health System

Low vision specialist Bhavani Iyer, O.D., FAAO, was awarded a three-year $164,645 grant to help Harris County residents with vision problems that cannot be corrected with glasses, medi-cation or surgery.

Dr. Iyer received the grant from the Lions Club International Foundation, which promotes SightFirst grants to build comprehensive eye care systems to fight the major causes of blindness and care for blind or visually impaired people. In addition to this award, the first of its kind in Texas and the third largest in the coun-try, Dr. Iyer’s project received $20,000 in funding from local sources.

With the grant, Dr. Iyer will develop the Harris County Low Vision Project, which will promote outreach programs, educa-tion and training for the visually impaired population around the county, a prob-lem that affects approximately 3 million people nationwide according to 2010 sta-tistics from the National Eye Institute. By 2050, that number is expected to increase to about 9 million.

The project will provide training for patients with low vision through support groups, education programs and loaner devices, such as miniature telescopes attached to eyeglasses or held by hand, filters that screen out blue light and glare, magnifiers and strong electronic readers, among other things.

The Center for Visual Rehabilitation at the Robert Cizik Eye Clinic at UTHealth Medical School and Memorial Hermann-Texas Medical Center, and Harris County Health System’s Lyndon B. Johnson


followed by fellowships in public health in ophthalmology at the Dana Center for Preventive Ophthalmology, Wilmer Eye Institute in Baltimore, and in vitreoreti-nal surgery and diseases at Baylor College of Medicine. Dr. Davis also holds a mas-ter’s in public health from Johns Hopkins School of Public Health.

DAVID A. LEE, M.D. Clinical ProfessorRuiz Department of Ophthalmology andVisual ScienceUTHealth Medical School

Dr. David Lee is internationally recog-nized for his expertise in the diagnosis and treatment of glaucoma. He received his medical degree from Boston University School of Medicine, followed by residency at Mayo Graduate School of Medicine in Rochester, Minnesota, and a fellowship at Massachusetts Eye and Ear Infirmary at Harvard Medical School. A clinical professor in the Ophthalmology depart-ment, Dr. Lee serves as an examiner for the American Board of Ophthalmology. His recognitions include the American Academy of Ophthalmology’s Honor and Senior Honor Awards and listing among The Best Doctors in America since 1986. He holds four patents and has published seven books and more than 200 scientific articles in peer-reviewed journals.

NAN WANG, M.D., PH.D. Clinical Associate ProfessorRuiz Department of Ophthalmology andVisual ScienceUTHealth Medical School

Dr. Nan Wang specializes in the medi-cal and surgical treatment of corneal and anterior segment eye diseases. Her expertise includes all types of corneal transplantation, cataract surgery and vision correction surgery. A clinical associate professor of ophthalmology, Dr. Wang has extensive research experience and a strong research interest in biochem-ical and biophysical properties of the eye. She received her medical degree and doc-torate in biochemistry at Baylor College

of Medicine, and completed her residency and a fellowship at the same institution. She is director of the cornea and anterior segment section at the Cizik Eye Clinic. Fluent in Mandarin, she is active in Houston’s Chinese community where she participates in public education activities about eye disease and proper eye care. She is the Walker and Ruth Sterling Professor in Ophthalmology at UTHealth Medical School.

Moran Pediatric Eye Clinic Celebrates Grand Opening

The new Moran Pediatric Eye Clinic held its grand opening in May 2014 in 3,000 square feet of newly built-out space on the 19th floor of the Memorial Hermann Medical Plaza, one floor above the Robert Cizik Eye Clinic at Memorial Hermann-Texas Medical Center. The clinic was made

possible by a generous gift from the W. H. and Louise Moran Foundation in Houston.

In addition to the clinic, the space houses the offices of pediatric ophthal-mologists Helen A. Mintz-Hittner, M.D., the Alfred W. Lasher III Professor of Ophthalmology in the Ruiz Department of Ophthalmology and Visual Science at UTHealth Medical School, and Kartik Kumar, M.D., a clinical assistant profes-sor in the department.

Physicians see cases ranging from blocked tear ducts, styes and chalazions to retinopathy of prematurity. Amblyopia and pediatric cataracts are also treated, along with vision screenings and treat-ment of common pediatric eye conditions.

To schedule an appointment, call 713.559.5200.

The colorful waiting area and an exam room in the

Moran Pediatric Eye Clinic.


The Ophthalmology Basic Science Course: 45 Years of Residency Training

Because ophthalmology is treated as a subspecialty of surgery in medical school, ophthalmology residents begin their training program with only a basic knowledge of their chosen specialty. At UTHealth Medical School, they spend part of their first year of residency in the Basic Science Course in Ophthalmology, created in 1969 by the Ruiz Department of Ophthalmology and Visual Science.

Residents from across North American attend the course, which covers basic and surgical anatomy, embryology, electrophysiology and ultrasound, pedi-atric ophthalmology, biochemistry, low vision, optics, contact lenses, refraction, genetics, pathology, immunology, retina, glaucoma, visual fields, external disease, orbit and oculoplastics and neuro-oph-thalmology. It prepares residents for the Ophthalmic Knowledge Assessment Program (OKAP®) exam, a 250-item multiple-choice test designed to measure the ophthalmic knowledge of residents, relative to their peers, to facilitate the ongoing assessment of resident progress and program effectiveness.

Lectures, which emphasize the applica-tion of basic scientific principles to clinical situations, are presented by ophthalmolo-gists from UTHealth Medical School and from other ophthalmology programs around the country. Designed primarily for residents in training, the course is also available as a refresher for practitioners and as a general information course in oph-thalmology for allied health professionals.

Correction

Margaret E. Phillips, M.D., is a fellow in training of the American Society of Ophthalmic Plastic and Reconstructive Surgeons. In the last issue of the Memorial Hermann Ophthalmology Journal we erroneously reported that Dr. Phillips is a member of the ASOPRS.

In the MediaCosmetic Contacts Too Scary for Halloween. Gene Kim, M.D., clinical assistant professor, appeared on CW 39 to discuss the hazards of using cosmetic contacts lenses as part of Halloween costumes. The inexpensive lenses put people at risk of infection, ulceration, long-lasting vision loss and even blind-ness. October 7, 2014.

Winning the War Against Aging.Wrinkle fillers have dramatically changed the war against aging over the past 20 years. While a facelift is an effective solu-tion to wrinkles, people are now pursu-ing less-invasive alternatives. Karina Richani, M.D., a clinical assistant pro-fessor who specializes in oculoplastics and facial surgery, was interviewed on Univision 45 discussing wrinkles and fill-ers. September 27, 2014. UTHealth’s Dr. Bhavani Iyer Awarded SightFirst Grant to Help Patients with Low Vision. Low vision specialist Bhavani Iyer, O.D., FAAO, received a three-year $164,645 grant to help Harris County residents with vision problems that cannot be corrected with eyeglasses, medication or surgery. News coverage appeared on the BioNews Texas website. July 18, 2014.

Selected PublicationsAdesina OO, Stagg BC, Digre KB, Katz

BJ, Quigley EP, Palmer CA, Warner JE. Optic neuropathy caused by Propionibacterium acnes pachymen-ingitis. J Neuroophthalmol. 2014 Sep;34(3):264-7.

Geloneck MM, Chuang AZ, Clark WL, Hunt MG, Norman AA, Packwood EA, Tawansy KA, Mintz-Hittner HA on behalf of the BEAT-ROP Cooperative Group. Refractive outcomes following bevacizumab monotherapy compared with conventional laser treatment: A randomized clinical trial. JAMA Ophthalmol. 2014;132:1327-33.

Joos ZP, Adesina OO, Katz BJ. Posterior ischemic optic neuropathy in the setting of posterior reversible enceph-alopathy syndrome and hypertensive emergency. J Neuroophthalmol. 2014 Jun;34(2):151-2.

Kumar K. Monocular Elevator Deficiency. International Ophthalmology Clinics. 2014;54(3):89-93.

Li H, Chuang AZ, O’Brien J. Regulation of photoreceptor gap junction phos-phorylation by adenosine in zebrafish retina. Vis Neurosci. 2014;31(3): 237-43.

Marshak DW, Mills SL. Short-wavelength cone-opponent retinal ganglion cells in mammals. Vis Neurosci. 2014;21:167-175.

Mao CA, Li H, Zhang Z, Kiyama T, Panda S, Hattar S, Ribelayga C, Mills SL, Wang S. T-box Transcription Regulator Tbr2 Is Essential for the Formation and Maintenance of Opn4/Melanopsin-Expressing Intrinsically Photosensitive Retinal Ganglion Cells. J Neurosci. 2014;34:13083-95.

McDonnell JF, Kumar K. Competencies in Pediatric Ophthalmology, New Retina MD. 2014 May.

Mills SL, Tian LM, Hoshi H, Whitaker, CM. Massey SC. Three Distinct Blue-Green Color Pathways in a Mammalian Retina. J Neurosci. 2014;34:1760–8.


O’Brien J. The ever-changing elec-trical synapse. Current Opinion in Neurobiology. 2014;29:64-72.

Pruet CM, Feldman RM, Kim G. Re: Topical tetracaine used for 24 hours is safe and rated highly effective by patients for the treatment of pain caused by corneal abrasions: a dou-ble-blind, randomized clinical trial. Academic Emergency Medicine. 2014;21(9):1062-3.

Rigi M, Blieden LS, Nguyen D, Chuang AZ, Baker LA, Bell NP, Lee DA, Mankiewicz KA, Feldman RM. Trabecular-iris circumference volume in open angle eyes using swept-source Fourier domain anterior segment optical coherence tomography. J Ophthalmol. 2014; 2014:590978.

Sáles CS, Margeta M, Hsu L, Fu T, Tsui JY, Kwon YH, Chan V, Law S, Kahook MY, Fang A, Kass M, Girgis N, Chen T, Tsai JC, Feldman RM, Francis B, Lin SC, Singh K. Prevalence of glaucoma-tous disease in young Chinese adults: A pilot study. J Clin Exp Ophthalmol. 2014;5(2):331.

AbstractsCrowell EL, Gold ME, Chuang A, Baker

L, Feldman RM, Bell NP, Blieden LS. Characterizing angle landmarks with anterior segment optical coherence tomography. Invest Ophthalmol Vis Sci. 2014;55: E-Abstract 929.

Fortepiani L, Pyarali M, Akimov NP, Zhang Z, Ribelayga CP, Rentería RC. Evidence of decreased dopa-mine receptor-mediated control of gap junction coupling in the inner nuclear layer of the diabetic Ins2Akita mouse retina. The FASEB Journal. 2014;28(S1):1129.1.

Gross J, Baker L, Chuang A, Blieden LS, Bell NP, Feldman RM. Comparing the effect of laser peripheral iridotomy to lens extraction on anterior seg-ment morphology in narrow angle eyes using anterior segment optical coherence tomography (ASOCT). Invest Ophthalmol Vis Sci. 2014;55: E-Abstract 6122.

Jin N, Ribelayga CP. Melatonin modulates rod photoreceptor electrical coupling in the mouse retina. Invest Ophthalmol Vis Sci. 2014;55: E-abstract 5006.

Mao C-A, Li H, Zhang Z, Kiyama T, Panda S, Hattar S, Ribelayga C, Mills S, Wang SW. Regulation of ipRGCs by Tbr2. Journal of Vision. 2013;13(15): E-abstract P6.

Minnal VR, Chuang A, Baker L, Blieden LS, Bell NP, Feldman RM. Evaluating the effect of laser peripheral iri-dotomy on iridotrabecular contact in eyes with primary angle closure. Invest Ophthalmol Vis Sci. 2014;55: E-Abstract 4837.

Rentería RC, Akimov NP, Zhang Z, Ribelayga CP, Pyarali M, Fortepiani L. Evidence of decreased dopamine receptor-mediated control of gap junc-tion coupling in the inner nuclear layer of the diabetic Ins2Akita mouse retina. Invest Ophthalmol Vis Sci. 2014;55: E-abstract 1067.

Ribelayga CP, Zhang Z, Vidal A, Zimmerman R. A circadian clock in melanopsin-expressing intrinsically photosensitive retinal ganglion cells is required for normal visual function. Invest Ophthalmol Vis Sci. 2014;55: E-abstract 1234.

Ribelayga C, Jin N, Chuang AZ, Zhang Z. Circadian clock and dopamine con-trol of rod photoreceptor electrical coupling in mouse retina. Journal of Vision. 2013;13(15): E-abstract P7.

Rigi M, Nguyen D, Blieden LS, Bell NP, Baker L, Chuang A, Feldman RM. Trabecular-iris circumference volume in normal open angle eyes using swept source Fourier domain anterior seg-ment optical coherence tomography. Invest Ophthalmol Vis Sci. 2014;55: E-Abstract 930.

Zhang Z, Vidal A, Zimmerman R, Ribelayga CP. A circadian clock in the retina is required for normal reti-nal development and visual function. Invest Ophthalmol Vis Sci. 2014;55: E-abstract 5004.

Book Chapters O’Brien J. Regulation of electrical synap-

tic plasticity in the retina by G-protein coupled receptors. In: G protein Signaling Mechanisms in the Retina. Eds. K.A. Martemyanov and A.P. Sampath. Springer Life Science (New York). 2014;143-169.

LectureshipsFeldman RM. MIGS or MEGS: Is the Hype

for Real? Dr. Guillermo Picó Santiago Lecture at the 45th Annual Meeting of the Puerto Rico Ophthalmology Society, May 24, 2014, San Juan, Puerto Rico.

Feldman RM. Angle Closure: A Bigger Problem Than You Think. 49th Annual C. S. O’Brien Professorship at the 36th Annual Tulane Alumni Day, June 6, 2014, Tulane University Health Sciences Center, Department of Ophthalmology, New Orleans, La.


PresentationsAnderson J, Chuang AZ, Blieden LS,

Feldman RM, Bell NP. Long-term efficacy of iridoplasty in plateau iris. Poster presentation at the American Glaucoma Society 24th Annual Meeting. Feb. 27-March 2, 2014, Washington, D.C.

Feldman RM. Case Presentation: Chronic Angle Closure, Surgery Day Section 2/Symposium 1—ASCRS/AGS: Surgical Management of Chronic Angle Closure; Long-Acting Drug Treatments AKA Drug Delivery, Symposium 4—New Glaucoma Medications in the Works; Co-Moderator, Surgery Day Section 2/Symposium 1—Surgical Management of Chronic Angle Closure. Invited pre-sentations at the American Glaucoma Society 24th Annual Meeting, Feb. 27-March 2, 2014, Washington, D.C.

Feldman RM. Chronic Angle Closure: Can Imaging Improve Our Practice?; Long-Acting Drug Treatments AKA Drug Delivery. Invited lectures at the 45th Annual Meeting of the Puerto Rico Ophthalmology Society, May 24, 2014, San Juan, Puerto Rico.

Feldman RM. Surgical Management of Chronic Angle Closure: When should I perform laser surgery (LPI, Iridoplasty, or ECP?), Joint ASCRS/AGS Symposium: Surgical Management of Chronic Angle Closure; Case Presentation: Chronic Angle Closure, Video Case Presentations: Complications and a Ray of Hope; Co-Moderator, Joint ASCRS/AGS Symposium: Surgical Management of Chronic Angle Closure. Invited pre-sentations at ASCRS Glaucoma Day at the 2014 American Society for Cataract and Refractive Surgery and American Society of Ophthalmic Administrators Annual Symposium and Congress, April 25, 2014, Boston, Mass.

Fortepiani L, Pyarali M, Akimov NP, Zhang Z, Ribelayga CP, Rentería RC. Evidence of decreased dopamine recep-tor-mediated control of gap junction coupling in the inner nuclear layer of the diabetic Ins2Akita mouse retina. Annual Meeting of Experimental Biology, April 26-30, 2014, San Diego, Calif.

Fuller T, Feldman RM, Baker L, Chuang AZ, Blieden LS, Bell NP. Optimal number of scans for calculating anterior angle measurements and iris volume. Poster presented at the American Glaucoma Society 24th Annual Meeting. Feb. 27-March 2, 2014, Washington, D.C.

Gross J, Mai K-B T, Feldman RM, Blieden LS. AS-OCT: A novel diagnostic tool in the diagnosis and management of cyclodialysis clefts. Poster presented at the American Glaucoma Society 24th Annual Meeting. Feb. 27-March 2, 2014, Washington, D.C.

Hittner H. Retinopathy of Prematurity: The Basics; Update on Current Treatment Possibilities. Invited lecture at the 13th National Neonatal Nurses Conference. Sept. 10, 2013, Las Vegas, Nev.

Hittner H. Bevacizumab for Retinopathy of Prematurity: An Update. Invited lec-ture at the OMIC International Summit on Clinical Pharmacy and Dispensing. Nov. 18, 2013, San Antonio.

Hittner H. Results Following Avastin® Use for Retinopathy of Prematurity: Be Delighted… But Vigilant. Invited lecture at the 10th Annual Highlights Newborn Intensive Care Conference, Jan. 17, 2014, Houston.

Hittner H. Bevacizumab (Avastin®) Use for Typical Stage 3+ or Aggressive Posterior Retinopathy of Prematurity. Course pre-sentation at the World Ophthalmology Congress. April 3, 2014, Tokyo, Japan.

Hittner H. Recent Advances in Retinopathy of Prematurity. Invited lecture at the 6th Texas Perinatal Association Meeting. April 25, 2014, El Paso, Texas.

Hittner H. Use of Intravitreal Bevacizumab for Stage 3+ ROP or Aggressive ROP. Grand Rounds at Idaho Falls Hospital, June 19, 2014, Idaho Falls, Idaho.

Hittner H. Avastin® and Other Medications in Development to Treat Retinopathy of Prematurity. Invited presentation at the American Academy of Pediatrics: Section on Perinatal Pediatrics. Oct. 12, 2014, San Diego, Calif.

Hittner H. Retinopathy of Prematurity—Treatment Indications and Long-term Considerations. Invited speaker at the 5th Congress of the European Academy of Paediatric Societies. Oct. 20, 2014, Barcelona, Spain.

Hittner H. Retinopathy of Prematurity—Pathophysiology and Epidemiology; Retinopathy of Prematurity—Peripheral Retinal Ablation versus Vascular Endothelial Growth Factor Inhibition. Invited speaker at the Annual Symposium: 34 Years of Advances and Controversies in Neonatal Medicine. Vanderbilt University School of Medicine Division of Neonatology, Nov. 13-14, 2014, Nashville, Tenn.

Jin N, Ribelayga CP. Melatonin modu-lates rod photoreceptor electrical coupling in the mouse retina. Invited presentation at the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO). May 4-8, 2014, Orlando, Fla.


Jin N, Ribelayga CP. Rod photoreceptor coupling is controlled by a circa-dian clock and dopamine in mouse retina. Invited presentation at the Neuroscience Research Center 20th Annual Neuroscience Poster Session, Baylor College of Medicine/William M. Rice University/UTHealth Medical School Neuroscience Research Center, Dec. 8, 2013, Houston.

Jin N, Ribelayga CP. Melatonin modu-lates rod photoreceptor electrical coupling in the mouse retina. Invited presentation at the Gordon Research Conference “Pineal Cell Biology: Pineal Melatonin: Comparative Approaches to Human Health and Disease,” January 19-24, 2014, Galveston, Texas.

Jin N, Ribelayga CP. Melatonin modu-lates rod photoreceptor electrical coupling in the mouse retina. Invited presentation at the Federation of American Societies for Experimental Biology (FASEB) Summer Research Conference on Retinal Physiology and Visual Processing, June 22-27, 2014, Saxtons River, Vt.

Mao C, Li H, Zhang Z, Kiyama T, Panda S, Hattar S, Ribelayga CP, Mills SL, Wang SW. Regulation of ipRGCs by Tbr2. Invited presentation at the ARVO/ISOCB Ocular Cell Biology Conference, September 3-6, 2013, Keble College, Oxford, UK.

Mao C, Li H, Zhang Z, Kiyama T, Panda S, Hattar S, Ribelayga CP, Mills SL, Wang SW. Regulation of ipRGCs by Tbr2. Invited presentation at the Annual Meeting of the Optical Society of America, October 4-6, 2013, Houston.

Mao C, Li H, Zhang Z, Kiyama T, Panda S, Hattar S, Ribelayga CP, Mills SL, Wang SW. T-box transcription regula-tor Tbr2 is essential for the formation and maintenance of Opn4/melatonin-expressing intrinsically photosensitive retinal ganglion cells. Invited presenta-tion at the Gordon Research Conference “Pineal Cell Biology: Pineal Melatonin: Comparative Approaches to Human Health and Disease,” January 19-24, 2014, Galveston, Texas.

Minnal V, Blieden LS, Bell NP, Baker L, Chuang AZ, Feldman RM. Evaluating the effect of lens extraction with anterior segment optical coherence tomography in narrow angle eyes. Poster presentation at the American Glaucoma Society 24th Annual Meeting; Feb. 27-March 2, 2014, Washington, D.C.

O’Brien J, Zhang Z, Chuang AZ, Blackburn M, Wang SW, Ribelayga CP, Li H. Conserved molecular mech-anisms control photoreceptor gap junctional coupling. Invited presen-tation at the Federation of American Societies for Experimental Biology (FASEB) Summer Research Conference “Retinal Physiology and Visual Processing,” June 22-27, 2014, Saxtons River, Vt.

Rentería RC, Akimov NP, Zhang Z, Ribelayga CP, Pyarali M, Fortepiani L. Evidence of decreased dopamine receptor-mediated control of gap junction coupling in the inner nuclear layer of the diabetic Ins2Akita mouse retina. Invited presentation at the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO), May 4-8, 2014, Orlando, Fla.

Ribelayga CP. Dissecting the circadian system in the mammalian retina, one cell-type and one clock pathway at a time. “Hot Topics” paper session. Gordon Research Conference “Pineal Cell Biology: Pineal Melatonin: Comparative Approaches to Human Health and Disease,” January 22, 2014, Galveston, Texas.

Ribelayga CP, Zhang Z, Vidal A, Zimmerman R. A circadian clock in melanopsin-expressing intrinsi-cally photosensitive retinal ganglion cells is required for normal visual function. Invited presentation at the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO), May 4-8, 2014, Orlando, Fla.

Ribelayga C, Jin N, Chuang AZ, Zhang Z. Circadian clock and dopamine control of rod photoreceptor electrical cou-pling in mouse retina. Annual Meeting of the Optical Society of America, October 4-6, 2013, Houston.

Ribelayga CP, Zhang Z, Vidal A, Zimmerman R. A circadian clock in melanopsin-expressing intrinsically photosensitive retinal ganglion cells is required for normal visual func-tion. Gordon Research Conference “Pineal Cell Biology: Pineal Melatonin: Comparative Approaches to Human Health and Disease,” January 19-24, 2014, Galveston, Texas.

Ribelayga CP. How circadian clocks opti-mize retinal circuits for day and night vision. University of Strasbourg. June 10, 2014, Strasbourg, France.

Ribelayga CP. A circadian clock and dopa-mine control rod electrical coupling in mouse retina.


Federation of American Societies for Experimental Biology (FASEB) Summer Research Conference “Retinal Neurobiology and Visual Processing,” June 25, 2014, Saxtons River, Vt.

Zhang Z, Vidal A, Zimmerman R, Ribelayga CP. A circadian clock in the retina is required for normal reti-nal development and visual function. Paper presentation at Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO), May 4-8, 2014, Orlando, Fla.

Zhang Z, Ribelayga C. Circadian clocks are essential for normal reti-nal development and visual function. Neuroscience Research Center 20th Annual Neuroscience Poster Session, Baylor College of Medicine/William M. Rice University/UTHealth Medical School Neuroscience Research Center, December 8, 2013, Houston.

Zhang Z, Vidal A, Zimmerman R, Ribelayga CP. A circadian clock in the retina is required for normal retinal development and visual func-tion. Invited presentation at the Gordon Research Conference “Pineal Cell Biology: Pineal Melatonin: Comparative Approaches to Human Health and Disease,” Jan. 19-24, 2014, Galveston, Texas.

Honors and AwardsChristophe Ribelayga, Ph.D., has been awarded the Certificate of Appreciation for Outstanding Performance and Lasting Contribution to Problem-based Learning from the UTHealth Medical School in Houston. He also received a travel award from the Federation of the American Societies for Experimental

Biology (FASEB) Summer Research Conference “Retinal Neurobiology and Visual Processing” held in Saxtons River, Vermont, in June 2014. Dr. Ribelayga is a member of the Communications Working Group of the Association for Research in Ophthalmology and Vision.

GrantsRobert M. Feldman, M.D.Site principal investigator for African Descent and Glaucoma Evaluation Study (ADAGES) III: Contribution of Genotype to Glaucoma Phenotype in African-Americans; NEI-5R01EY023704; August 2014 to present. Sub-investigators: Nicholas Bell, M.D., and Lauren Blieden, M.D.

David A. Lee, M.D.Principal investigator for EYEGUARD C: A Randomized, Double-masked, Placebo-controlled Study of the Safety and Efficacy of Gevokizumab in the Treatment of Subjects with Non-infectious Intermediate, Posterior or Pan-uveitis Currently Controlled with Systemic Treatment; XOMA; February 2014 to present. Sub-investigators: Nicholas Bell, M.D., Lauren Blieden, M.D., Robert Feldman, M.D., Garvin Davis, M.D., and Alla Kukuyev, M.D.

Principal investigator for EYEGUARD A: A Randomized, Double-masked, Placebo-controlled Study of the Safety and Efficacy of Gevokizumab in the Treatment of Active Non-infectious Intermediate, Posterior or Pan-uveitis; XOMA; February 2014 to present. Sub-investigators: Nicholas Bell, M.D., Lauren Blieden, M.D., Robert Feldman, M.D., Garvin Davis, M.D., and Alla Kukuyev, M.D.

Bhavani Iyer, O.D., FAAOLions Club International Foundation SightFirst Grant, Harris County Low Vision Project

Steve Mills, Ph.D.Principal investigator of Blue-green Pathways in the Mammalian Retina; NEI-2R01EY10121; 2014-2019.

Steve Massey, Ph.D.Principal investigator of Neurotransmitter Mechanisms in the Mammalian Retina; NEI-2R01EY006515, 2014-2018.

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