OphthalmologyUpdate EMR - Cleveland Clinic

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EMR

Dear Colleagues,Welcome to a very special edition of Cleveland Clinic Cole Eye Institute’s Ophthalmology Update. This issue delivers to you our perspective on the undeniable assimilation of electronic medical records (EMR) into the practice of ophthalmology.

In these pages, we provide you with a 360-degree view of what the integration of EMR means to our area of medicine. As a leading academic eye center, Cole Eye Institute is taking a national leadership role in adapting the technology advantages of EMR into improved clinical workflows, faster and easier documentation, and ultimately a better patient experience. Our practice has seen these benefits of this new system each and every day.

We’ve collected the perspectives of staff across our practice to bring you a closer look at the far-reaching implications of EMR. Some of those perspectives include:

• A view from our community practices, about connecting a smaller practice with a large one

• The perspective of a nurse who works in a high-volume practice, to teach about how the whole medical team works together to realize all the benefits that EMR has to offer, including how EMR helps optimize insurance reimburse-ments

• Details about the unique integration of imaging results into the EMR system

• A thought piece on how the vast amount of data now harvested as a result of EMR can be used to inform the future prac-tice of ophthalmology

• How all this interconnectivity facilitates our work with other specialists treating our com-mon patients for a variety of other conditions that may manifest themselves first in the ophthalmologist’s office

You will also find an update on the two-year results from the Comparison of AMD Treatments Trials (CATT). And you will find the other information that you have come to rely on from this publication, such as CME opportunities, our staff listing (including some new faces) and an overview of our staff’s recent publications. If you have additional thoughts on Ophthalmology Update, please do not hesitate to contact me at [email protected].

Sincerely,

Daniel F. Martin, MDCha IrMan , Cole eye Inst I tute

Defining what makes us different

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O p h t h a l m O l O g y U p d a t e | S p e c i a l e d i t i O n 2 0 1 2 | c l e v e l a n d c l i n i c . O r g / O U S p e c i a l

Electronic Medical Records: The Future Is Now

Like it or not, electronic medical record (EMR) systems are slated to become com-

monplace in ophthalmology over the next few years, regardless of practice setting,

geographic location and subspecialty focus. Our field in particular faces significant

obstacles to widespread adoption, based on the unique features of its practice. For

example, in just the management of age-related macular degeneration, monthly

patient visits are commonplace and result in the accumulation of large amounts

of diagnostic and procedural documentation over the lifetime of the patient. In ad-

dition, ophthalmologists are used to manual entry methods such as hand drawings

of pathology, which is poorly emulated in current EMR systems.

These obstacles and others are

the reasons why adoption of

EMR systems has been poor.

In 2006, the American Academy of

Ophthalmology’s (AAOs) survey of its

members found a 12 percent adoption

rate of an EMR system, compared with a

17 percent adoption rate for physicians

across all other medical specialties.

A reason often given for not adopting

EMR is the cost of implementing the

system. Health Information Technology

for Economic and Clinical Health’s $27

billion grant might help offset some of

these costs, but there is no textbook or

preferred practice pattern to go by on

how to begin this process.

At Cleveland Clinic, we have successful-

ly implemented an EMR system within

our practice. This discussion will focus

on the pearls of the process, such as

identifying essential functions to look

for in vendor products and tips on the

implementation process.

Both Sides of the Coin – The Pros

and Cons of Adoption

The addition of EMR has some signifi-

cant advantages. The level of compli-

ance with time stamps, procedure

documentation and security measures

increases greatly with EMR. Most

EMR systems have predefined docu-

mentation for common ophthalmic

procedures, and it’s important when

evaluating the system to compare

these to your local carrier or CMS

guidelines to see if they match up.

When under the scrutiny of an audit,

the EMR system can be a lifesaver.

Many EMR systems allow for the

documentation of normal values for

the specific eye fields, and compo-

nents can be globally modified with

a keystroke. For example, when an

audit showed another practice lacked

a particular exam component, we

could implement a change in the EMR

template within a day.

Having the records available anywhere

and anytime really helps with patient

care. According to the AAO, 45 percent

of ophthalmologists work in multiple

offices; when EMR is in place, patient

care is informed and updated regard-

less of location. Consequently, medical

record storage costs decline consider-

ably with EMR. When integrating values

such as intraocular pressure, corneal

thickness and other quantitative mea-

surements, the EMR permits trending

of patients over time, allowing for a

much more comprehensive evaluation

of disease progression. (see article on

page 12)

Finally, EMR allows for the determina-

tion of practice efficiencies and pitfalls.

For example, we can allocate clinic re-

sources such as space and tech coverage

based on reports on previous technician

and clinic performances. Our system

has been able to drill down to determine

how long technicians take to work up

By Rishi P. Singh, MD

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C l e v e l a n d C l i n i C | C o l e e y e i n s t i t u t e | i n n o v a t i o n s

patients and how long a procedure or

diagnostic procedure takes to perform.

But with as many advantages EMR offers,

there is a balance of significant draw-

backs. Whatever you think you will save

by converting from paper charts (storage

fees, personnel for records management)

will be offset by information technology

maintenance, high-speed Internet lines,

and electronic backup and storage. Ex-

pect monthly or yearly software upgrades

with the expected bugs, annoyances and

potential downtime. Keystroke entry is

virtually universal so you must be a pro-

ficient typist. The temporary decrease in

efficiency and lost revenue on the initial

implementation are sometimes too

much for practices to bear.

Choosing the Right System for You

The first item to consider when choosing

the proper system is to make sure that

you are receiving a government-certified

product (see cchit.org/find). Consider

whether to partner up or go it alone. Lo-

cal hospital systems may offer usage of

their EMR for a nominal charge, but few

have ophthalmic-ready systems. A better

option might be to share the cost of the

IT system or bargain collectively with

another nearby practice when dealing

with the EMR vendors.

When evaluating a system, determine

the level of customization needed.

Does the EMR mimic your workflow

or practice pattern? Do the items with-

in the EMR represent all the specialties

within your practice? Some EMRs are

specialty-specific even within ophthal-

mology. Finally, visit your colleagues

who have successfully implemented a

system to understand what their real

experience has been. We visited many

sites prior to finalizing our choice to

seek out the features and functions

that we wanted to implement within

our own system.

Putting Your System to Work

Choosing the right system is only half

of the job, and the implementation

can make or break your conversion.

Assembling a multidisciplinary team

composed of a physician, technician,

biller/coder and administrator is a

good first step. Walking through the

EMR workflow with this team can help

in troubleshooting early problems.

Consider choosing a lower-volume

time of year to make the switch, to

reduce the economic impact of the

implementation process.

We chose to down-book by 25 percent

for the two-week duration of the go-live

in order to give our physicians adequate

time to acquaint themselves with the sys-

tem. By bringing the clinical volume back

to normal levels quickly, we found that

many physicians began to employ work-

flow efficiencies in order to keep pace.

When considering big-bang rollouts

versus gradual implementations, we

chose a more gradual approach that al-

lowed us to troubleshoot the workflow,

off-load patients to another provider

and train technicians by rotating them

through the clinic prior to their go-live.

Scribes are an important consideration

for any practice. Every study performed

has shown that the utility of scribes

decreases significantly as the practice

becomes more familiar with the EMR

system. Thus, we chose to hire addi-

tional technicians to serve as physician

extenders within the clinic.

Conclusions

With all the pitfalls and efforts needed

to navigate the process, why would

practices choose to go forward? Having

three years of experience using Cleveland

Clinic’s EMR system has taught me how

invaluable it can be. Patient calls can

be answered quickly and efficiently. I’m

communicating more than ever with

referring and primary care physicians.

I can perform chart reviews and clinical

research studies within days and not

weeks. Lastly, patients have now come to

expect information on demand, which

EMR systems allow. This ready access

to their records has enabled patients to

become better partners in their care. ■

Contact Dr. Rishi P. Singh at [email protected].

Choosing the right system is only half of the job, and the implementation can make or break your conversion.

6


Imaging Solutions in the Age of EMR

Ophthalmology is becoming more and more of an image-driven subspecialty.

Recent developments in diagnostic testing, such as optical coherence tomogra-

phy (OCT), guide management decisions and enhance our diagnostic capabilities.

This significant influx of testing can lead to information overload if the data is not

presented to the clinician and handled in an appropriate way. In many practices,

this may simply involve printing a report. However, the utility of printed reports is

limited because paper limits the accessibility and functionality of the reports. In

the age of EMR, an electronic image archiving and display system is the logical

solution for most practices.

Three common ophthalmology

imaging solution suites are

Zeiss FORUM,® Merge Eye Care

(OIS) and ANKA EyeRoute. These three

packages provide digital alternatives

for publishing reports from diagnostic

devices. Each of these systems has ad-

vantages and disadvantages. Function-

ality also continues to evolve with the

deployment of EMR. Many practices

converted to electronic image display

solutions long before converting to an

EMR system. The integration between

imaging solutions and EMR systems

is an active area of development

and progress.

The imaging system utilized at Cole

Eye Institute is Zeiss FORUM. Nearly

all our diagnostic reports are stored

and displayed within this system. This

includes OCT, photography, angiog-

raphy and visual field testing. The

comprehensive nature of this package

provides the clinician with a practi-

cal interface that enhances workflow,

facilitates optimal interpretation and

allows integration of test results, such

as visual field and OCT correlation.

In addition, we have elected to utilize

this system throughout our satellite

network. The servers that provide the

data for the software system communi-

cate with all the community locations.

This system gives the clinician access

to a test performed at one location even

when the patient is seen at another.

Data integrity is also a critical compo-

nent for any EMR and imaging solution.

One important enhancement to the

consistency of patient identification and

labeling is the multidirectional com-

munication among the EMR system,

the diagnostic device and the imaging

solution. In our current system, an

order is placed within the EMR system

and then is transferred to an electronic

work-list. The diagnostic device is able

to pull the order from the work-list with

the patient’s identifying information al-

ready populated from the EMR system.

Following the diagnostic procedure,

the reports are then published to the

image viewing software. This ensures a

seamless transition from the EMR to the

imaging solution, helping to eliminate

transcription errors and variability in

data entry.

When making the transition to a digital

interface, access to previously collected

data and test reports is an important

consideration. A practice must consider

the practical aspects of importing previ-

ous diagnostic studies and how far back

to go when including such studies. If

data is not included, an archiving solu-

tion needs to be in place to provide a

backup if older data is needed.

The communication and interface for

opening reports between the EMR sys-

tem and imaging solution software also

varies from system to system.

By Justis Ehlers, MD

7


In some packages, there is no direct

way to open diagnostic testing within

the EMR system. Others use a link that

opens the imaging solution program

and the patient’s information with a

single mouse click. Finally, some pack-

ages have the reports embedded within

the EMR system itself. All these features

can potentially impact workflow and

should be considered when selecting an

imaging solution.

A final consideration is how to display di-

agnostic reports. As our clinical practices

have become more imaging-centric, the

interface for the clinician as well as for

the patient becomes important. Often,

clinicians will review the testing with the

patient directly. The ease and flexibility

of the display system is vital, particularly

when many patients may be dealing with

visual impairment. Possible solutions in-

clude tablets, iPads, laptops, large-screen

monitors and dual-monitor systems. The

choice certainly comes down to practice

style and personal preference. The type

of imaging used and the patient popula-

tion may impact which solution fits best

for a given practice.

The options for the imaging solutions

will continue to expand. These software

The comprehensive nature of this package provides the clinician with a practical interface that enhances workflow, facilitates optimal interpretation and allows integration of test results, such as visual field and OCT correlation.

packages enhance patient care and im-

prove communication between offices

and physicians. There is often a signifi-

cant initial learning curve during which

efficiency may initially suffer. However,

the advantages of an electronic display

system over paper records are signifi-

cant. Careful preparation and research

regarding the system that best fits your

practice’s requirements can help dra-

matically ease the transition. ■

Contact Dr. Justis Ehlers at [email protected].

8


It has also helped involve patients in

their own care and has made billing

more accurate and timely. Judging

from the feedback from other institu-

tions, it would be fair to say that Cleve-

land Clinic’s new system is raising the

national standard of ophthalmic care.

It wasn’t always this way.

“In ophthalmology we’ve been reluc-

tant to embrace EMR,” says Dr. Kaiser.

“Our charts are visually based, and the

traditional EMR system only allowed

data. Ophthalmologists need to make

drawings of the eye to create the visual

history that is critical to the therapeu-

tic plan. Until now, inserting drawings

into an electronic record was all but

impossible.”

Cole Eye Institute’s new EMR platform

easily allows the incorporation of graph-

ics (see related articles in this issue) and

facilitates the move from paper charts

to the computer. Designed within the

institute by a group of staff, the platform

sits on top of the common and widely

used Epic EMR system.

“The standard Epic EMR is text-based

and not graphical, so it wouldn’t have

worked for us,” says Dr. Kaiser.

A Bright New Window on

the Whole Patient

The new system allows an expanded

level of interaction between ophthal-

mologists and other providers, which

is core to the collaborative practice of

medicine at Cleveland Clinic.

“It isn’t just the eyes that concern us, it’s

the whole patient,” says Dr. Kaiser. “An

ocular issue in a diabetic patient can

now be shared in real time with that

patient’s endocrinologist, internist, car-

diologist and nephrology team. Having

a single, all-inclusive medical record is

much more than just a nicety; it opens

important new channels to provide

patients world-class care.”

The federally mandated medicine

reconciliation is a perfect example.

Reconciliation was very difficult to ac-

complish on paper but with the advent

of EMR is now very easy. The electronic

record maintains a real-time history

of the patient’s medication orders and

helps avoid omissions, duplications,

dosing errors and drug interactions.

Refills are sent electronically to the

patient’s pharmacy, eliminating tran-

scription errors.

Improving Information Flow

at Satellite Locations

In the past, a Cleveland Clinic oph-

thalmologist seeing a patient at a

community location did not have

complete access to the thorough and

descriptive imaging that was available

at the main campus. EMR has changed

that, and not just for remote locations.

Now, any doctor who participates in

Cleveland Clinic’s MyPractice online

referral and patient monitoring system

Newly Developed System Is Bringing Far-Reaching and Unexpected Benefits

Better overall medical care, a new perspective on the whole patient and

improved access for referring physicians are just three of the ways the new

electronic medical record system has improved Cole Eye Institute, says Peter

K. Kaiser, MD, a staff member of the vitreoretinal faculty of the Cole Eye

Institute at Cleveland Clinic’s main campus.

Peter K. Kaiser, MD

9


can review all charts and images from

any connected location. “The more

information that’s available, the better

the medical decisions,” says Dr. Kaiser.

This is especially beneficial in emer-

gency situations, which can happen at

any time of the day or night.

Opening New Channels with

Referring Doctors

Communication with referring doctors

can now be maintained more easily, and

can be updated far more quickly.

“We can now send referring doctors

electronic images. If, for example, we

have a patient with a macular hole, we

can image the macula before and after

surgery and update the referring doctor

almost in real time electronically,” says

Dr. Kaiser. “This improves our com-

munication and creates opportunities

to further improve patient care,” he

adds. “The referring doctors can see

exactly what we did and why since they

can see patient records. This also can

help ensure that patients return to their

referring doctor for follow-up care.”

Better Care from the Patient’s View

Patients who use Cleveland Clinic’s

web-based MyChart to track their medi-

cal care can now be kept more current,

more easily. In the past, no patient

had access to ophthalmology-related

tests. The new EMR system allows

ophthalmologists to make a variety of

information available to MyChart. Test

results and other relevant data can now

be released electronically, allowing con-

nected patients to access it at will.

“This gives patients a sense of involve-

ment in the dynamics of their own care,

which is very empowering. They can

track their progress in therapy, and this

tends to improve their outlook, which is

therapeutic in itself,” he says.

Eliminating Billing and Insurance Errors

Financial efficiencies are built into the

new system. “It’s a huge plus to be able

to make sure that everything we order

and interpret is billed appropriately,”

says Dr. Kaiser. “With paper this was

often complicated, and, quite frankly,

sometimes we missed things for which

we should have billed.”

The new system has automatic drop-

down menus to remind the doctor to

interpret tests. Once the interpretation

is completed, the billing automatically

goes out to the patient’s insurance pro-

vider. It’s an efficient system in which

little falls through the cracks.

The new system allows an expanded level of interaction between ophthalmologists and other providers, which is core to the collaborative practice of medicine at Cleveland Clinic.

“For those of us who are very busy, it’s

nice to have someone looking over our

shoulder to make sure we’ve done every-

thing that’s required,” he says.

Setting a New National Standard

The new EMR system is setting a new

national standard. “Other eye institutes

around the country have tried to use the

stock Epic system with limited success;

they’ve lost productivity and suffered

decreased patient volumes without

improving patient care,” says Dr. Kaiser.

“We didn’t want to follow in their foot-

steps. Our system is light years ahead

of where we started.”

As word of the new system gets out,

many eye institutes using Epic have

approached Cleveland Clinic’s Cole Eye

Institute to learn more. Cleveland Clinic

is sharing its knowledge, the better to

improve patient care nationwide. ■

Dr. Peter K. Kaiser can be reached at [email protected].

10


Building the Toolbox – Essential Features and Functions in EMR Systems

Good features can significantly smooth the bumpy road to EMR adoption.

Adding customized, intuitive functions within an EMR system can improve

your workflow and practice efficiency. When Cleveland Clinic’s Cole Eye

Institute first made the transition to EMR, our group spent several months

evaluating several systems to find just the right tools.

Even if specific capabilities

weren’t initially within the sys-

tem, we worked with the vendor

and our own IT people to create and

implement those special features. These

can be broken down into three distinct

groups: improving the user experience of

both providers and support staff; improv-

ing the billing capture and process; and

integrating outcomes, administrative

tasks and research activities.

Improving the User Experience

Ergonomics is a key element in facili-

tating user adoption and acceptance

of any EMR system. By incorporating

the largest monitors possible, we were

able to distribute a significant amount

of information across a larger space.

We added personal computers to the

hallways to mimic the normal workflow

where a physician reviews the chart

before entering the examination or

procedure room. Placing printers in

the hallway minimized the distance

that physicians had to travel for printed

prescriptions and patient instructions.

All of these enhancements made it

easier for physicians to adapt to the

new EMR workflow.

Drawing is a mainstay of ophthalmol-

ogy practices. We first created newer

pictures to represent the portions of the

eye that needed or required documenta-

tion. We were able to create numerous

stencils for each of the drawing photos

that allowed for both annotation of the

image and insertion of text into the

same exam field of the patient, eliminat-

ing duplication of work. The draw-

ings could be placed within the chart,

pulled forward to a new encounter for

modification or even added to a letter to

another provider.

We improved the letter-writing and

documentation capabilities of our sys-

tem by implementing letter templates

with drop-down menus for quick anno-

tation. By adding an autocorrect feature

to our system (converting common

abbreviations such as OD to right eye),

we were able to better communicate to

other physicians without ophthalmic

backgrounds what transpired with the

patients. Finally, by adding the capabil-

ity to fax letters directly from the EMR,

our physicians could maintain faster

contact with referring providers and

their staff.

Improving Billing Capture and Process

The number of procedures and diagnos-

tics in ophthalmology has drastically in-

creased over the past few years. Take for

example the use of intravitreal injections

for eye disease. In the past five years, the

number of times that procedure is done

has quadrupled. Increased volume has

made it difficult to track procedures and

submit charges in an efficient fashion.

We implemented a charge-on-comple-

tion system which has improved our

billing compliance, led to significantly

improved documentation of patient

By Rishi P. Singh, MD

11


testing and procedures, and increased

our efficiency in billing and reimburse-

ment for professional fees.

Here’s how it works: The physician

places an order for the procedure or

diagnostic test. The order then gener-

ates a form for the physician to fill out.

After the physician electronically signs

the form, the charge is submitted with

the specific procedural or diagnostic

code to our billing team for review. Once

reviewed electronically, the biller can

submit the charge to the local carrier for

processing. This has streamlined our

billing cycle from weeks to two days. It’s

also decreased the potential for miscod-

ing since it has completely eliminated

manual entry. Finally, it allows for a

transparent review of the indication and

necessity of the procedure.

Integrating Outcomes, Administrative,

and Research Activities with the EMR

Since 2005, all Cleveland Clinic institutes

have participated in a patient outcomes

reporting initiative. Until recently, the

outcomes data has been compiled using

manual entry and physician reporting,

both ways by which reporting biases could

be introduced. When we developed the

entry system for our EMR, a conscious ef-

fort was made to use discrete documenta-

tion whenever possible. For example, few

areas in the system have plain-text boxes

for entry. Rather, buttons and checkboxes

are used to document imaging, proce-

dures and exam elements. This allows us

to collect outcome metrics in an almost

completely automated fashion.

In addition, by using the discrete ele-

ments within our system, we created

additional data streams that determine

a multitude of administrative and

research functions. For example, we

can now monitor our usage of supplies

in real time to determine whether our

pharmacy needs to be restocked. We

can evaluate the wait times by ophthal-

mology specialist line in an effort to

Overall, these features have allowed for the ongoing evaluation and management of the physician and patient experience and will lead to future enhancements of both functions.

maintain the proper technician-to-phy-

sician ratios. Finally, our practice has

been able to monitor the frequency of

use of our lasers and diagnostic modali-

ties so we can adjust schedule templates

to maximize patient flow. Research has

become easier, with only a few clicks

necessary to analyze multiple patient

charts rather than the arduous process

of chart retrieval and review. (See article

on page 15 for a nurse’s perspective.)

Overall, these features have allowed

for the ongoing evaluation and man-

agement of the physician and patient

experience and will lead to future

enhancements of both functions. ■

Contact Dr. Rishi P. Singh at [email protected].

12


Patient History an Open Book - a Bonus of Record Systems

Community ophthalmologist Michael Millstein, MD, says Cleveland Clinic’s EMR

system provides a complete picture of a patient’s medical history. “When we

open an electronic chart, we finally can see the patient’s entire medical history.

We don’t have to ask over and over what happened in the past. Everything is

there in detail, and it’s all legible,” he says.

Because all Cleveland Clinic phy-

sicians share the same system,

each patient has a single chart.

When one of Dr. Millstein’s patients is

seen by a colleague, he now has access

to details about the patient encounter.

“It’s a great educational opportunity.

I can read in depth what my colleague

was thinking, what tests were done and

why, and what the results were. It helps

me to better learn about the disease

process and enables me to take better

care of the patient,” he says.

Improving Speed and Safety

When the EMR is opened to a patient’s

chart, the first screen offers a menu of

tabs for the typical workflow aspects of

an ophthalmology patient visit, includ-

ing medications, allergies and reasons

for being seen. The information is

filled in by typing or by choosing from

drop-down menus of the most-utilized

medications and most common aller-

gies and complaints.

“I can review the medication list with

a patient and not worry about whether

they forgot to tell me about a medica-

tion or don’t know a dosage. This is

because the list not only includes pre-

scribed medications but an active list

of recently filled medications from their

pharmacies,” he says.

When he covers for a colleague, he

no longer worries about misreading a

medication order. Moreover, the system

sends warnings about potential drug-

drug interactions and allergies. “It defi-

nitely helps prevent mistakes,” he says.

Better Documentation

Sophisticated graphics software al-

lows the ophthalmologists to docu-

ment ocular diseases by selecting a

preset stencil and drawing the pathol-

ogy with a mouse or copying and

pasting from a menu of images. For a

patient with macular degeneration, for

example, Dr. Millstein simply clicks

on drusen and drops them on the

image. All prior images are stored for

comparison, allowing progress or lack

of progress to be tracked over time.

For a physician who describes himself

as “extremely detail-oriented,” the EMR

facilitates thorough documentation that

is guaranteed to be legible.

“I have horrible penmanship. So do my

partners. At times it is difficult to deci-

pher each other’s handwriting,” he says.

“The EMR lets me enter notes in a way

that can be neatly reviewed and printed

out. It takes a little longer initially, but it

is legible. The next time I see the patient,

I simply call up the last assessment and

plan and make quick changes based on

that day’s visit,” he says.

Dr. Millstein can send these notes

electronically to the inbox of any other

physician using the system, improving

physician-to-physician communication.

For those doctors outside of Cleveland

Clinic’s system, letters and notes can

be directly faxed from the EMR system

Michael Millstein, MD

13


to their office, and the system retains

their mailing addresses, fax numbers

and office locations. “We don’t have

to engage our secretaries nearly as

much for dictation or correspondence

because of our system.”

Coding goes more quickly, because the

most commonly used diagnoses can

be selected from tabs on the screen.

Patients can be rapidly provided with

instructions: Dr. Millstein may type a

very brief “smart phrase” consisting of

only a few letters, and the system popu-

lates the discharge section with detailed

instructions. One more click, and the

information is printed. “It’s very useful.

It helps me make sure a patient has

critical instructions,” Dr. Millstein says.

Nearly Perfect

Cleveland Clinic continues to refine

the EMR system developed at Cole Eye

Institute. Software was recently added

that allows the storage of images from

diagnostic testing modalities such as

Coding goes more quickly, because the most commonly used diagnoses can be selected from tabs on the screen. Patients can be rapidly provided with instructions.

optical coherence tomog-

raphy , visual fields and

ocular photographs and

complex ocular mea-

surements for cataract

surgery. And while Dr.

Millstein laughingly calls

himself “a data-entry

individual,” he says it’s

all worth it.

“I find I access the system

at home every day to com-

municate with staff or

residents or check when

a patient needs a new

prescription. It’s an im-

portant part of a modern

practice,” he says. ■

Dr. Michael Millstein can be reached at [email protected].

14


EMR Facilitates Communication and Improves Treatment of Uveitis

Caring for patients with uveitis often requires a multidisciplinary team

- an ophthalmologist, a rheumatologist and often other providers - to

ensure a coordinated effort. At Cole Eye Institute, implementation of an

EMR system has improved the care of these complex cases and opens

the door for coordinated care and research activities.

T hree ophthalmologists care

for patients with uveitis, and

the rheumatology section

includes 12 adult providers and three

pediatric providers. Additionally, the

pulmonary, neurology and infectious

disease services are often consulted to

assist in the care of uveitis patients.

Prior to EMR, communication among the

services was adequate – emails, printed

letters and phone calls were primarily

used to discuss cases. However, the

inability to read the other findings and

plans limited each particular service’s

ability to assess the patient. It was also

apparent that providers may not have

understood what was needed or what to

look for in a specific patient. The review

of laboratory tests and images was tedious

and sometimes incomplete. Most impor-

tant, tracking the success or failure of vari-

ous immunosuppressants was difficult

since endpoints were embedded within

visits and not summarized.

With the implementation of a shared

EMR chart between ophthalmology and

non-ophthalmology providers, both

communication and care for patients

have improved considerably. Sharing

of notes and letters between providers

can be accomplished while evaluating

a patient, often with one or two clicks.

If the providers aren’t part of Cleveland

Clinic’s system, the letters can be faxed

directly to the providers’ offices, keep-

ing them in the loop of ongoing findings

and treatments. Often clinical care

decisions can be made very quickly as

providers receive messages, with instant

transfer of information. Additionally,

the ability to view each other’s clinical

exams and notes without having to

decipher handwriting has improved

clinicians’ understanding of what the

other team is looking for when making

decisions for these patients. Finally,

our clinicians can now track ophthal-

mic endpoints graphically over time as

a method of determining response to

treatments and procedures.

Improving our ability to track outcomes

of patients is the next step of imple-

mentation. Shared patients with uveitis

By Sunil Srivastava, MD

are now easily identified and screened

for visual outcomes and for potential

enrollment in clinical trials. A common

outcome form is under development

between services to serve as a shared

measure of disease severity and to track

succeses or failures with particular drug

regimens. Patient registries are also

under development to allow tracking of

particular subtypes (e.g., pediatric uve-

itis patients) to assess quality and suc-

cessful visual and systemic outcomes.

With imaging being linked to EMR, a

large database of complex diseases with

outcomes data is under construction,

which will allow an improved under-

standing of this complex disease.

Overall, EMR in its current form has

improved care for our patients with

complex inflammatory disease. In the

future, EMR will continue to facilitate

improvements in our understanding

of these diseases through research and

clinical outcome measurements. ■

Dr. Sunil Srivastava can be reached at [email protected].

15


Cole Eye Institute’s EMR system has not just improved the

workflow of the ophthalmologists and optometrists on staff

but also the daily work of nurses and technicians.

T iffany Rodstrom, RN, a five-year

veteran of Cole Eye Institute

who works primarily with a reti-

na specialist, says the system reduces

problems with unclear plans from pre-

vious visits. “Prior to EMR, it was diffi-

cult to tell what tests the doctor wanted

performed on the next visit; and EMR

has helped tremendously in this regard

because the future visit plans are con-

cise and easy to understand.” It also

improves communication between the

providers and their secretaries, surgi-

cal schedulers, referring physicians

and other departments.

Although some staff members were

wary of the changes initially, she

says most like it now. Rodstrom had

previously been through another EMR

implementation, and during this

implementation process, she worked

closely with the information technol-

ogy team as the system was developed.

“With my previous role as a certified

ophthalmic technician and now as a

nurse, I used my knowledge to help

customize our EMR system and stream-

line our patient exams,” she says.

One of her favorite features is the abil-

ity to add ophthalmic drawings, previ-

ously done by hand, into the EMR.

“We added stencils that annotate the

drawing and put information into the

exam (saving the physician steps). The

drawings are improved, allowing for

clearer communication about our find-

ings,” she says.

She finds that the EMR particularly

boosts efficiency in Cole Eye Institute’s

busiest services. With some of the

specialists seeing 70 or more patients

a day, about half of whom need some

form of diagnostic testing, moving

them all through and documenting

their exams, procedures and diag-

nostic interpretations is crucial. The

“Study Review” module, a feature that

tracks all procedures and diagnostic

tests a patient has undergone, was

made available in the EMR and is very

helpful, she adds.

“We’ve added buttons for documentation

of exams and procedures, vs. tradi-

tional manual entry, which increases our

ability to document in a clear, compliant

Ophthalmic Nurse Uses EMR in Every Aspect of Her Work

and concise fashion,” she says. “As part

of this, we created 104 custom smart

forms and 180 order sets to help us make

our workflow efficient.”

Rodstrom says she uses the EMR in ev-

ery aspect of her work: rooming of pa-

tients, phone encounters, patient care

issues and documentation of instruc-

tions to patients. Although scribes are

not part of Cole Eye Institute’s overall

approach to EMR, Rodstrom occa-

sionally fills that role as well in the

course of her daily work. She adds that

utilizing the system has made patient

handoffs to other technicians or doc-

tors much easier, thereby improving

the overall patient experience. ■

Contact Tiffany Rodstrom, RN, at [email protected].

16


And with customized snapshots

that provide detailed history

of a patient’s last surgical pro-

cedure or diagnostic test, her team can

process all visits without any paper.

“It’s all right in front of them,” she says.

“They don’t have to search or wait for it.”

The EMR system has made capturing

charges a much more streamlined

process, Ms. Surender says. When all

Cole Eye Institute billing was done via

paper tickets, some diagnostic tests did

not get billed if the ticket was misplaced.

Her team spent many hours a day manu-

ally keying information into a separate

billing system. Now, the system bill is

created when the ordering physician

signs off on the results (adding an

extra level of assurance that all tests

are accounted for prior to the bill being

submitted). Similarly, for treatments,

providers enter what they have done and

link the treatment to a diagnosis. This

process, a first anywhere in Cleveland

Clinic, automatically drops all charges

into a tank for her team to review before

sending them out to insurance compa-

nies for reimbursement.

“We are no longer losing revenue when

paper gets lost or waiting days to sub-

mit claims,” says Ms. Surender, who

has worked on billing at Cole Eye Insti-

tute for about 10 years. “And we are eas-

ily capturing 15 percent more charges

as a result of the new system,” she says.

“I am very particular about compliance

and this really helps improve our work,”

she adds.

Ophthalmology is unique in the fre-

quency of tests and treatments being

performed during the same patient

visit; almost 50 percent of patients will

have a diagnostic test or procedure done

during a visit. A major problem in eye

care is that the employees who perform

the billing function do not sit with the

providers and do not always know what

services were provided to the patient

and whether those procedures were

completed.

The EMR lets the billers visualize charts

on a real-time basis and see everything

that was done. They no longer have to

chase the doctors around to fill in any

blanks. All the components they need to

submit proper billing are right there. And

in the case of an audit or denied claim by

an insurance company, the charts can be

queried with the push of a button.

Another advantage EMR has provided Ms.

Surender’s team relates to the increased

presence of Cole Eye Institute in com-

munity facilities. It’s not uncommon for

staff physicians to travel between two

offices each week. Prior to EMR, patients

who alternated the location they went

to didn’t have a complete chart. In ad-

dition, her billing counterparts in the

community couldn’t see what was being

performed in other offices. Now, with

EMR, seamless care can be provided ev-

erywhere, greatly enhancing the patient

expereince . ■

Nandini Surender can be reached at [email protected].

For Nandini Surrender, a reimbursement manager at Cleveland Clinic’s

Cole Eye Institute, the transition to an EMR system has improved many

aspects of her work. “It has greatly increased our surveillance of billing,

compliance and documentation. With no bad handwriting to interpret

or missing signatures, the billing staff feels that the process has

become a lot more efficient and standardized,” she says.

EMR Boosts Compliance and Captures Charges

17


In 1993, at the age of 29, life

brought Ms. Hardesty face to face

with an almost universal fear:

going blind. Previously enjoying good

vision, Ms. Hardesty was shocked to

learn that she had presumed ocular

histoplasmosis and was bleeding inter-

nally in her right eye. She has endured

multiple surgeries in order to stabilize

her condition.

Her retina specialist now treats her

with monthly ocular injections of

Lucentis® and multiple topical drops.

Keeping track of the details of all these

conditions and all other medications

and treatments Ms. Hardesty has for

other conditions is simple with Cole

Eye Institute’s EMR.

When considering the savings in both

money and time that EMR systems pro-

vide to patients and health systems alike,

Ms. Hardesty speaks without hesitation:

“Golly, I can’t imagine what the savings

will be. It’s great for patients who don’t

have to keep repeating tests when they

go from place to place, not to mention

how much the hospitals probably save

from maintaining all those records.”

“We really don’t enjoy being tested,”

she says from her perspective as a patient.

“And the cost is a stress, too - especially for

people who don’t have insurance, like I

didn’t for some time during all this.”

She relates that one of her first doctors

used his collection of colored pencils

to draw her macula on her paper charts.

No longer is this the case with EMR.

Ms. Hardesty says that special func-

tions of the EMR preclude the use of

colored pencils - the only implements

needed are a keyboard and a mouse.

And, she adds, wherever she goes, her

records - in full - are present.

Requesting records and and giving

patients access to their own records are

also a snap. When Ms. Hardesty needed

letters to her employer, they were given

Patients See the Value in EMR

to her the same day since they could be

generated within the EMR quicker than

sending the request to a transcription

service. Since Ms. Hardesty is so com-

fortable with computers, she is happy

about the efficiencies the EMR brings.

Cleveland Clinic’s MyChart online portal

for patients allows access to test results

and important reminders for complete

patient care. She adds that long wait

times are a thing of the past - in some

cases, the doctor has been waiting to see

her, rather than Ms. Hardesty having

to endure sometimes hours-long waits

to see a doctor due to nonemergency

scheduling issues.

“Not only are all my records available

when I see any specialist I may need to

see, but I like to look at what they are

looking at.” ■

Karen Hardesty is a self-professed computer geek. That’s one

part of the reason why she sees tremendous value in the migra-

tion to electronic medical record systems. The other reason is

that she’s had to endure a long history of ophthalmic procedures

over the past 20 years.

She adds that long wait times are a thing of the past - in some cases, the doctor has been waiting to see her, rather than Ms. Hardesty having to endure sometimes hours-long waits to see a doctor due to nonemergency scheduling issues.

Striving for Answers

19

C l e v e l a n d C l i n i C | C o l e e y e i n s t i t u t e | i n v e s t i g a t i o n s

CATT Second-Year Results Show Lucentis and Avastin Produce Similar Results

T he study also showed that

monthly dosing produced

slightly more vision gain than

as-needed dosing. But the final visual

results were similar in all treatment

groups, regardless of dosing frequency,

with 60 percent or more of the patients

achieving driving vision.

“Both drugs were highly effective regard-

less of the approach to dosing,” says Dan-

iel F. Martin, MD, study chair for CATT

and Chairman of Cole Eye Institute.

“There was slightly less vision gain with

as-needed treatment. However, patients

seeking the small extra advantage of

monthly treatment need to be mindful

of the additional burden, risks and costs

of monthly injections. Since as-needed

dosing required 10 fewer eye injections

over the course of two years and yielded

similar visual results, many patients

may choose this option.”

Ten years ago, 60 to 70 percent of

patients with wet AMD were legally

blind in two years. Due to the powerful

therapeutic effects of the drugs studied

in CATT, only 5 to 10 percent of patients

are legally blinded from AMD today.

However, prior to the results of this trial,

doctors did not know the optimal way

to use these drugs or whether one drug

was better than the other.

Over two years, the rates of death,

myocardial infarction and stroke did

not differ between drugs. In the first

year of the study, there was a higher rate

of nonspecific serious adverse events for

bevacizumab-treated patients than for

ranibizumab-treated patients, and this

difference persisted in year two. How-

ever, the importance of this difference

was unclear.

Serious adverse events occurred at a

40 percent rate for patients receiving

bevacizumab and a 32 percent rate

for patients receiving ranibizumab.

Although bevacizumab had a higher

rate of serious adverse events, they

were distributed across many different

conditions, most of which were not

associated with bevacizumab when

evaluated in cancer clinical trials.

In conjunction with the clinical find-

ings from this study, the cost differ-

ences between treatments may have

implications for both patients and

physicians. One dose of ranibizumab

costs approximately $2,000, while beva-

cizumab costs about $50 per dose. Both

drugs are manufactured by Genentech.

“In 2010, ranibizumab accounted for

nearly 10 percent of the entire Medicare

Part B drug budget, its single largest

expenditure,” write the study authors.

“As the treatment of patients continues

indefinitely, the cumulative financial

burden to third-party payers and pa-

tients will only increase.”

Funded by the National Eye Institute,

as part of the National Institutes of

Health, CATT seeks to compare the rela-

tive safety and effectiveness of the two

drugs in treating wet AMD. Ophthalmol-

ogists began using bevacizumab while

awaiting FDA approval of ranibizumab

because of the drugs’ structural similari-

ties. Bevacizumab, approved by the FDA

for treating colorectal cancer, has been

widely prescribed off-label by ophthal-

mologists to treat AMD since 2005. ■

More information is available at clevelandclinic.org/CATT.

In the ongoing Comparison of AMD Treatment Trials (CATT) drug-comparison study, Cleveland Clinic

researchers found that bevacizumab (Avastin®) is equivalent to ranibizumab (Lucentis) in the treatment

of wet age-related macular degeneration (AMD) through two years.

20


Retinal Diseases

Investigator-Initiated Observational Study of Intravitreal Aflibercept Injection for Exudative Age- Related Macular Degeneration Previously Treated with Ranibizumab or BevacizumabObjective: Observational study to assess the efficacy of intra-

vitreal aflibercept injection in subjects previously treated with

Ranibizumab or Bevacizumab on central retinal thickness as

measured by spectral domain optical coherence tomography

(SDOCT)

Contact: Rishi P. Singh, MD, 216.445.9497,

or Stephanie Bennett, 216.445.6497

Fluocinolone Acetonide Intravitreal Inserts for Vein Occlusion in Retina (FAVOR)Objective: This study will assess the safety and efficacy of

fluocinolone acetonid eintravitreal inserts in subjects with

macular edema secondary to RVO .

Contact: Peter K. Kaiser, MD, 216.444.6702,

or Gail Kolin, RN, 216.445.4086

Home Vision Monitoring Using the Foresee Home Device Following Treatment of Neovascular Age-Related Macular Degeneration (CNV)Objective: The purpose of the current study is to evaluate if,

in post-treatment patients, parameters as measured with the

Foresee Home Device are in agreement with clinical decisions

and retinal characteristics as measured with optical coherence

tomography (OCT).


or Sonal Uppal, PhD, 216.444.7137

Uveitis

A Proof-of-Concept Study of Intravitreal LFG316 in Patients with Multifocal Choroiditis (MFC)Objective: The study is designed to provide information on

the safety, tolerability, pharmacokinetics, pharmacodynamics,

and efficacy of successive intravenous (IV) doses of LFG316

in eligible patients with neovascular age-related macular

degeneration (AMD).

Contact: Sunil Srivastava, MD, 216.636.2286,

or Laura Holody, 216.445.3762

Pediatric Eye Disease

Bilateral Lateral Rectus Recession Versus Unilateral Recess-Resect for Intermittent Exotropia (IXT1)Objective: The purpose of this study is to evaluate the effec-

tiveness of bilateral lateral rectus muscle recession vs. uni-

lateral lateral rectus recession with medial rectus resection

procedures for the treatment of strabismus.

Contact: Elias Traboulsi, MD, 216.444.4363,

or Sue Crowe, RN, 216.445.3840

Increasing Patching for Amblyopia in Children 3 to < 8 Years Old (ATS15)Objective: This study is designed to evaluate the effectiveness

of increasing prescribed patching treatment after visual acuity

has stabilized with initial treatment and amblyopia is still

present.


or Sue Crowe, RN, 216.445.3840

The following studies are either currently enrolling new patients or are pending

approval by the Institutional Review Board and should be enrolling shortly.

Clinical Trials

21


Genetics

Molecular Genetics of Eye DiseasesObjective: The objective of this project is to study the molecu-

lar genetics of ophthalmic disorders through the compilation

of a collection of DNA, plasma and eye tissue samples from

patients and from families with a broad range of eye diseases

and malformations.


or Sonal Uppal, PhD, 216.444.7137

Cornea/Refractive Surgery

LASIK Flap Thickness and Visual Outcomes Using the WaveLight FS200 Femtosecond LaserObjective: To evaluate the visual outcome, accuracy and predict-

ability of LASIK flap thickness using the new WaveLight® FS200

femtosecond laser and compare these results to those obtained

using the IntraLaseTM FS60 femtosecond laser.

Contact: Ronald Krueger, MD, 216.444.8158,


Long-Term Safety Follow-up for Subjects Previously Implanted With The AcrySof Cachet Phakic Lens in Clinical Studies C-02-23, C-02-40, C-03-21 and C-05-57Objective: To estimate the annualized endothelial cell loss

rate (for up to 10 years following date of implantation) of

subjects previously implanted with the L-series AcrySof®

Cachet™ Phakic Lens from clinical studies.

Contact: Ronald Krueger, MD, 216.444.8158,


Other Open Studies

Safety Study of a Single IVT Injection of QPI-1007 in Chronic Optic Nerve Atrophy and Recent-Onset NAION Patients (NAION)Objective: This is an open-label, dose escalation, safety,

tolerability and pharmacokinetic study, where the active study

drug (QPI -1007) will be given to all patients who participate.

This study will determine whether QPI-1007 is safe when it is

injected into the eye. The study will also reveal if there are any

side effects of the drug and how long it takes for the body to

clear the drug.



The following studies have completed patient enrollment

in the last year at Cole Eye Institute and are in follow-up:

Comparing the Effectiveness of Treatment Strategies for Primary Open-Angle Glaucoma

A Phase II Dose-Ranging Study of Pazopanib to Treat Neovascular Age-Related Macular Degeneration (GSK AMD)

Infant Aphakia Treatment Study (IATS)

22


Adv.Exp.Med.Biol.

Bagheri N, Bell BA, Bonilha VL, Hollyfield JG. Imaging human postmortem eyes with SLO and OCT. Adv Exp Med Biol. 2012;723:479-488.

Bell BA, Kaul C, Rayborn ME, Hollyfield JG. Baseline imaging reveals preexisting retinal abnormalities in mice. Adv Exp Med Biol. 2012;723:459-469.

Grossman GH, Pauer GJ, Hoppe G, Hagstrom SA. Isolating photoreceptor compartment-specific protein complexes for subsequent proteomic analysis. Adv Exp Med Biol. 2012;723:701-707.

Hagstrom SA, Watson RF, Pauer GJT, Grossman GH. Tulp1 is involved in specific photoreceptor protein transport pathways. Adv Exp Med Biol. 2012;723:783-789.

Stohr H, Anand-Apte B. A review and update on the molecular basis of pathogenesis of Sorsby fundus dystrophy. Adv Exp Med Biol. 2012;723:261-267.

Sugimoto M, Cutler A, Grossman G, Anand-Apte B. Regulation of retinal vascular per-meability by betacellulin. Adv Exp Med Biol. 2012;723:293-298.

Am.J.Hum.Genet.

Peachey NS, Ray TA, Florijn R, Rowe LB, Sjoerdsma T, Contreras-Alcantara S, Baba K, Tosini G, Pozdeyev N, Iuvone PM, Bojang P Jr., Pearring JN, Simonsz HJ, Van Genderen M, Birch DG, Traboulsi EI, Dorfman A, Lopez I, Ren H, Goldberg AFX, Nishina PM, Lachapelle P, McCall MA, Koenekoop RK, Bergen AAB, Kamermans M, Gregg RG. GPR179 is required for depolarizing bipolar cell function and is mutated in autosomal-recessive complete congenital stationary night blindness. Am J Hum Genet. 2012 Feb 10;90(2):331-339.

Webb TR, Matarin M, Gardner JC, Kelber-man D, Hassan H, Ang W, Michaelides M, Ruddle JB, Pennell CE, Yazar S, Khor CC, Aung T, Yogarajah M, Robson AG, Holder GE, Cheetham ME, Traboulsi EI, Moore AT, Sowden JC, Sisodiya SM, Mackey DA, Tuft SJ, Hardcastle AJ. X-linked megalocornea caused by mutations in CHRDL1 identifies an essential role for ventroptin in anterior segment development. Am J Hum Genet. 2012 Feb 10;90(2):247-259.

Am.J.Ophthalmol.

Chappelow AV, Tan K, Waheed NK, Kaiser PK. Panretinal photocoagulation for prolif-erative diabetic retinopathy: pattern scan laser versus argon laser. Am J Ophthalmol. 2012 Jan;153(1):137-142.

Sezgin E, Van Natta ML, Ahuja A, Lyon A, Srivastava S, Troyer JL, O’Brien SJ, Jabs DA. Association of host genetic risk factors with the course of cytomegalovirus retinitis in patients infected with human immu-nodeficiency virus. Am J Ophthalmol. 2011 Jun;151(6):999-1006.

Am.J.Pathol.

Morais C, Ebrahem Q, Anand-Apte B, Parat MO. Altered angiogenesis in caveolin-1 gene-deficient mice is restored by ablation of endothelial nitric oxide synthase. Am J Pathol. 2012 Apr;180(4):1702-1714.

Anesthesiology

Farag E, Sessler DI, Kovaci B, Wang L, Mascha EJ, Bell G, Kalfas I, Rockwood E, Kurz A. Effects of crystalloid versus col-loid and the alpha-2 agonist brimonidine versus placebo on intraocular pressure during prone spine surgery: a factorial randomized trial. Anesthesiology. 2012 Apr;116(4):807-815.

Annu.Rev.Biomed.Eng.

Ruberti JW, Sinha Roy A, Roberts CJ. Cor-neal biomechanics and biomaterials. Annu Rev Biomed Eng. 2011 Aug 15;13:269-295.

Arch.Ophthalmol.

Charkoudian LD, Kaiser GM, Steinmetz RL, Srivastava SK. Acute retinal necrosis after herpes zoster vaccination. Arch Ophthalmol. 2011 Nov;129(11):1495-1497.

Ehlers JP, Kernstine K, Farsiu S, Sarin N, Maldonado R, Toth CA. Analysis of pars plana vitrectomy for optic pit-related maculopathy with intraoperative optical co-herence tomography: a possible connection with the vitreous cavity. Arch Ophthalmol. 2011 Nov;129(11):1483-1486.

Gabriel LAR, Sachdeva R, Marcotty A, Rock-wood EJ, Traboulsi EI. Oculodentodigital dysplasia: new ocular findings and a novel connexin 43 mutation. Arch Ophthalmol. 2011 Jun;129(6):781-784.

Lowder C, Belfort R, Jr., Lightman S, Foster CS, Robinson MR, Schiffman RM, Li XY, Cui H, Hollander DA, Hashad Y, Whitcup SM. A report of high intraocular pressure with the dexa-methasone intravitreal implant - reply. Arch Ophthalmol. 2011 Dec;129(12):1639-1640.

Lowder C, Belfort R, Jr., Lightman S, Foster CS, Robinson MR, Schiffman RM, Li XY, Cui H, Whitcup SM. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol. 2011 May;129(5):545-553.

Arthritis Care Res.(Hoboken)

Angeles-Han ST, Griffin KW, Harrison MJ, Lehman TJA, Leong T, Robb RR, Shainberg M, Ponder L, Lenhart P, Hutchinson A, Sriv-astava SK, Prahalad S, Lambert SR, Drews-Botsch C. Development of a vision-related

Cole Eye Institute Publications

23


quality of life instrument for children ages 8-18 years for use in juvenile idiopathic arthritis-associated uveitis. Arthritis Care Res (Hoboken). 2011 Sep;63(9):1254-1261.

Tarabishy AB, Ahn E, Mandell BF, Lowder CY. Central serous retinopathy. Arthritis Care Res (Hoboken). 2011 Aug;63(8):1075-1082.

Br.J.Ophthalmol.

Hallahan KM, Sood A, Singh AD. Acute episode of eyelid oedema. Br J Ophthalmol. 2012 Jun;96(6):909, 913.

Seregard S, Singh AD. Retinoblastoma: direct chemotherapeutic drug delivery into the vitreous cavity. Br J Ophthalmol. 2012 Apr;96(4):473-474.

Steinle NC, Gupta N, Yuan A, Singh RP. Oral rifampin utilisation for the treatment of chronic multifocal central serous retinopa-thy. Br J Ophthalmol. 2012 Jan;96(1):10-13.

Tarabishy AB, Khatib OF, Nocero JR, Budev M, Kaiser PK. Ocular complications in patients with lung transplants. Br J Ophthal-mol. 2011 Sep;95(9):1295-1298.

Can.J.Ophthalmol.

Cherfan CG, Traboulsi EI. Slipped, severed, torn and lost extraocular muscles. Can J Ophthalmol. 2011 Dec;46(6):501-509.

Ehlers JP, Chavala SH, Woodward JA, Postel EA. Delayed recalcitrant fungal endo-phthalmitis secondary to Curvularia. Can J Ophthalmol. 2011 Apr;46(2):199-200.

Chem.Res.Toxicol.

Salomon RG, Hong L, Hollyfield JG. Discov-ery of carboxyethylpyrroles (CEPs): Critical insights into AMD, autism, cancer, and wound healing from basic research on the chemistry of oxidized phospholipids. Chem Res Toxicol. 2011 Nov 21;24(11):1803-1816.

Clin.Experiment.Ophthalmol.

Martin DF, Maguire MG, Fine SL. Bevaci-zumab: Not as good with more adverse reac-tions? Response. Clin Experiment Ophthal-mol. 2011 Sep-Oct;39(7):718-720.

Clinics (Sao Paulo)

Medeiros FW, Sinha-Roy A, Alves MR, Dupps WJ, Jr. Biomechanical corneal changes induced by different flap thickness created by femtosecond laser. Clinics (Sao Paulo). 2011;66(6):1067-1071.

Mello GR, Pizzolatti ML, Wasilewski D, San-thiago MR, Budel V, Moreira H. The effect of subconjunctival bevacizumab on corneal neovascularization, inflammation and re-epithelization in a rabbit model. Clinics (Sao Paulo). 2011;66(8):1443-1450.

Cornea

Ghanem RC, Netto MV, Ghanem VC, San-thiago MR, Wilson SE. Peripheral sterile corneal ring infiltrate after riboflavin-UVA collagen cross-linking in keratoconus. Cornea. 2012 Jun;31(6):702-705.

Santhiago MR, Netto MV, Wilson SE. Mito-mycin C: biological effects and use in refrac-tive surgery. Cornea. 2012 Mar;31(3):311-321.

Santhiago MR, Wilson SE. Cellular effects after laser in situ keratomileusis flap for-mation with femtosecond lasers: a review. Cornea. 2012 Feb;31(2):198-205.

Curr.Eye Res.

DeCroos FC, Ehlers JP, Stinnett S, Fekrat S. Intravitreal bevacizumab for macu-lar edema due to central retinal vein occlusion: Perfused vs. ischemic and early vs. late treatment. Curr Eye Res. 2011 Dec;36(12):1164-1170.

Endocr.Pract.

Payne JF, Ray R, Watson DG, Delille C, Rimler E, Cleveland J, Lynn MJ, Tangpricha V, Srivastava SK. Vitamin D insufficiency in diabetic retinopathy. Endocr Pract. 2012 Mar-Apr;18(2):185-193.

Eur.J.Ophthalmol.

Hood CT, Budd GT, Zakov ZN, Singh AD. Male breast carcinoma metastatic to the choroid: report of 3 cases and review of the literature. Eur J Ophthalmol. 2011 Jul-Aug;21(4):459-467.

Exp.Eye Res.

Barbosa FL, Lin M, Santhiago MR, Singh V, Agrawal V, Wilson SE. Interleukin-1 recep-tor role in the viability of corneal myofibro-blasts. Exp Eye Res. 2012 Mar;96(1):65-69.

Grossman GH, Watson RF, Pauer GJT, Bollinger K, Hagstrom SA. Immunocyto-chemical evidence of Tulp1-dependent outer segment protein transport pathways in photoreceptor cells. Exp Eye Res. 2011 Nov;93(5):658-668.

Hollyfield JG. Manuscript fabrication, im-age manipulation and plagiarism. Exp Eye Res. 2012 Jan;94(1):1-2.

Santhiago MR, Singh V, Barbosa FL, Agrawal V, Wilson SE. Monocyte develop-ment inhibitor PRM-151 decreases corneal myofibroblast generation in rabbits. Exp Eye Res. 2011 Nov;93(5):786-789.

Singh V, Santhiago MR, Barbosa FL, Agrawal V, Singh N, Ambati BK, Wilson SE. Effect of TGFbeta and PDGF-B blockade on corneal myofibroblast development in mice. Exp Eye Res. 2011 Dec;93(6):810-817.

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Singh V, Agrawal V, Santhiago MR, Wilson SE. Stromal fibroblast-bone marrow-derived cell interactions: Implications for myofibro-blast development in the cornea. Exp Eye Res. 2012 May;98(1):1-8.

Wilson SE. Corneal myofibroblast biology and pathobiology: Generation, persis-tence, and transparency. Exp Eye Res. 2012 Jun;99(1):78-88.

Yu M, Sturgill-Short G, Ganapathy P, Taw-fik A, Peachey NS, Smith SB. Age-related changes in visual function in cystathio-nine-beta-synthase mutant mice, a model of hyperhomocysteinemia. Exp Eye Res. 2012 Mar;96(1):124-131.

Expert Opin.Biol.Ther.

Dhoot DS, Kaiser PK. Ranibizumab for age-related macular degeneration. Expert Opin Biol Ther. 2012 Mar;12(3):371-381.

Expert Opin.Pharmacother.

Ohr M, Kaiser PK. Intravitreal aflibercept injection for neovascular (wet) age-related macular degeneration. Expert Opin Pharma-cother. 2012 Mar;13(4):585-591.

Expert Rev.Ophthalmol.

Steinle N, Barakat M, Moshfeghi D, Kaiser PK. Radiation therapy in the treatment of exuda-tive age-related macular degeneration. Expert Rev Ophthalmol. 2011 Jun;6(3):323-337.

Future Oncol.

Triozzi PL, Singh AD. Blood biomarkers for uveal melanoma. Future Oncol. 2012 Feb;8(2):205-215.

Int.Ophthalmol.Clin.

Dhoot DS, Martin DF, Srivastava SK. Pediat-ric infectious posterior uveitis. Int Ophthal-mol Clin. 2011 Winter;51(1):113-128.

Sears NC, Sears JE. Oxygen and retinopathy of prematurity. Int Ophthalmol Clin. 2011 Winter;51(1):17-31.

Invest.Ophthalmol.Vis.Sci.

Bollinger KE, Crabb JS, Yuan X, Putliwala T, Clark AF, Crabb JW. Quantitative pro-teomics: TGF{beta}2 signaling in trabecular meshwork cells. Invest Ophthalmol Vis Sci. 2011;52(11):8287-8294.

Bonilha VL, Rayborn ME, Li Y, Grossman GH, Berson EL, Hollyfield JG. Histopathol-ogy and functional correlations in a patient with a mutation in RPE65, the gene for retinol isomerase. Invest Ophthalmol Vis Sci. 2011;52(11):8381-8392.

Ebrahem Q, Qi JH, Sugimoto M, Ali M, Sears JE, Cutler A, Khokha R, Vasanji A, Anand-Apte B. Increased neovascularization in mice lacking tissue inhibitor of metal-loproteinases-3. Invest Ophthalmol Vis Sci. 2011;52(9):6117-6123.

Ehlers JP, Tao YK, Farsiu S, Maldonado R, Izatt JA, Toth CA. Integration of a spectral domain optical coherence tomography system into a surgical microscope for intra-operative imaging. Invest Ophthalmol Vis Sci. 2011;52(6):3153-3159.

Gabriel LAR, Wang LW, Bader H, Ho JC, Majors AK, Hollyfield JG, Traboulsi EI, Apte SS. ADAMTSL4, a secreted glycoprotein widely distributed in the eye, binds fibril-lin-1 microfibrils and accelerates microfi-bril biogenesis. Invest Ophthalmol Vis Sci. 2012;53(1):461-469.

Hong CW, Sinha Roy A, Schoenfield L, Mc-Mahon JT, Dupps WJ, Jr. Collagenase-medi-ated tissue modeling of corneal ectasia and collagen cross-linking treatments. Invest Ophthalmol Vis Sci. 2012;53(4):2321-2327.

Singh AD, Aronow ME, Sun Y, Bebek G, Saunthararajah Y, Schoenfield LR, Biscotti CV, Tubbs RR, Triozzi PL, Eng C. Chro-mosome 3 status in uveal melanoma: a comparison of fluorescence in situ hybridization and single-nucleotide poly-morphism array. Invest Ophthalmol Vis Sci. 2012;53(7):3331-3339.

Sinha Roy A, Dupps WJ, Jr. Patient-specific computational modeling of keratoconus progression and differential responses to collagen cross-linking. Invest Ophthalmol Vis Sci. 2011;52(12):9174-9187.

Triozzi PL, Aldrich W, Singh A. Effects of interleukin-1 receptor antagonist on tumor stroma in experimental uveal melanoma. Invest Ophthalmol Vis Sci. 2011;52(8):5529-5535.

J.AAPOS

Natan K, Traboulsi EI. Unilateral rectus muscle recession in the treatment of Duane syndrome. J AAPOS. 2012 Apr;16(2):145-149.

Nicholson BP, De Alba M, Perry JD, Traboul-si EI. Efficacy of the intraoperative relaxed muscle positioning technique in thyroid eye disease and analysis of cases requiring reop-eration. J AAPOS. 2011 Aug;15(4):321-325.

Sachdeva R, Turell ME, Meadows SR, Emch TM, Singh AD. Congenital intradiploic arachnoid cyst presenting as painless pro-ptosis. J AAPOS. 2011 Dec;15(6):601-603.

Sachdeva R, Schoenfield L, Marcotty A, Singh AD. Retinoblastoma with autoinfarc-tion presenting as orbital cellulitis. J AAPOS. 2011 Jun;15(3):302-304.

J.Biol.Chem.

Wu C, Agrawal S, Vasanji A, Drazba J, Sarkaria S, Xie J, Welch CM, Liu M, Anand-Apte B, Horowitz A. Rab13-dependent traf-ficking of RhoA is required for directional migration and angiogenesis. J Biol Chem. 2011 Jul 1;286(26):23511-23520.

J.Cataract Refract.Surg.

Kara-Junior N, Espindola RF, Gomes BAF, Ventura B, Smadja D, Santhiago MR. Effects of blue light-filtering intraocular lenses on the macula, contrast sensitivity, and color vision after a long-term follow-up. J Cataract Refract Surg. 2011 Dec;37(12):2115-2119.

Santhiago MR, Wilson SE, Netto MV, Ghanen RC, Monteiro MLR, Bechara SJ, Espana EM, Mello GR, Kara-Junior N. Modulation transfer function and optical quality after bilateral implantation of a +3.00 D versus a +4.00 D multifocal intra-ocular lens. J Cataract Refract Surg. 2012 Feb;38(2):215-220.

Smadja D, Santhiago MR, Mello GR, Espana EM, Krueger RR. Suction loss during thin-flap femto-LASIK: Manage-ment and beneficial refractive effect of the epithelium. J Cataract Refract Surg. 2012 May;38(5):902-905.

Wilson SE, Santhiago MR. Flaporhexis: Rapid and effective technique to limit epi-thelial ingrowth after LASIK enhancement. J Cataract Refract Surg. 2012 Jan;38(1):2-4.

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J.Fr.Ophtalmol.

Smadja D, Reggiani-Mello G, Touboul D, Colin J. Les profils de photoablation cornéenne en chirurgie réfractive. Partie 1: la quête de l’excellence [Ablation profiles in refractive surgery. Part 1: In search of excellence] [French]. J Fr Ophtalmol. 2012 Feb;35(2):126-135.

J.Refract.Surg.

Ambrosio R, Jr., Caiado ALC, Guerra FP, Louzada R, Sinha-Roy A, Luz A, Dupps WJ, Belin MW. Novel pachymetric parameters based on corneal tomography for diag-nosing keratoconus. J Refract Surg. 2011 Oct;27(10):753-758.

Morales EL, Rocha KM, Chalita MR, Nose W, Avila MP. Comparison of optical aberrations and contrast sensitivity between aspheric and spherical intraocular lenses. J Refract Surg. 2011 Oct;27(10):723-728.

Salomao MQ, Chaurasia SS, Sinha Roy A, Ambrosio R, Jr., Esposito A, Sepulveda R, Agrawal V, Wilson SE. Corneal wound heal-ing after ultraviolet-A/riboflavin collagen cross-linking: a rabbit study. J Refract Surg. 2011 Jun;27(6):401-407.

Santhiago MR, Barbosa FL, Agrawal V, Binder PS, Christie B, Wilson SE. Short-term cell death and inflammation after intracor-neal inlay implantation in rabbits. J Refract Surg. 2012 Feb;28(2):144-149.

Santhiago MR, Wilson SE, Netto MV, Es-pindola RF, Shah RA, Ghanem RC, Bechara SJ, Kara-Junior N. Visual performance of an apodized diffractive multifocal intraocular lens with +3.00-d addition: 1-year follow-up. J Refract Surg. 2011 Dec;27(12):899-906.

Smadja D, Reggiani-Mello G, Santhiago MR, Krueger RR. Wavefront ablation profiles in refractive surgery: description, results, and limitations. J Refract Surg. 2012 Mar;28(3):224-232.

Johns Hopkins Advanced Studies in Ophthalmology

Do DV, Gordon D, Kaiser PK. Impact of AMD and treatment regimens on patient-report-ed visual function. Johns Hopkins Advanced Studies in Ophthalmology. 2011;8(1):9-15.

Mol.Vis.

Payne JF, Tangpricha V, Cleveland J, Lynn MJ, Ray R, Srivastava SK. Serum insulin-like growth factor-I in diabetic retinopathy. Mol Vis. 2011;17:2318-2324.

Monogr.Clin.Cytol.

Biscotti CV, Singh AD. Uveal melanoma: diagnostic features. Monogr Clin Cytol. 2012;21:44-54.

Biscotti CV, Singh AD. Uveal metastases. Monogr Clin Cytol. 2012;21:17-30.

Chute DJ, Biscotti CV, Singh AD. Uveal lym-phoma. Monogr Clin Cytol. 2012;21:31-43.

Singh AD, Dolan B, Biscotti CV. Future of ophthalmic fine needle aspiration biopsy. Monogr Clin Cytol. 2012;21:90-96.

Singh AD, Pelayes DE, Brainard JA, Biscotti CV. History, indications, techniques and limitations. Monogr Clin Cytol. 2012;21:1-9.

Turell ME, Tubbs RR, Biscotti CV, Singh AD. Uveal melanoma: prognostication. Monogr Clin Cytol. 2012;21:55-60.

N.Engl.J.Med.

Martin DF, Maguire MG, Fine SL. The authors reply [Ranibizumab and bevaci-zumab for AMD]. N Engl J Med. 2011 Dec 8;365(23):2237.

Nat.Med.

Doyle SL, Campbell M, Ozaki E, Salomon RG, Mori A, Kenna PF, Farrar GJ, Kiang AS, Humphries MM, Lavelle EC, O’Neill LAJ, Hollyfield JG, Humphries P. NLRP3 has a protective role in age-related macular de-generation through the induction of IL-18 by drusen components. Nat Med. 2012 May;18(5):791-798.

Neuron

Matsuoka RL, Chivatakarn O, Badea TC, Samuels IS, Cahill H, Katayama K, Kumar SR, Suto F, Chedotal A, Peachey NS, Nathans J, Yoshida Y, Giger RJ, Kolodkin AL. Class 5 transmembrane semaphorins control selec-tive Mammalian retinal lamination and func-tion. Neuron. 2011 Aug 11;71(3):460-473.

Ocul.Immunol.Inflamm.

Gangaputra SS, Altaweel MM, Peng Q, Fried-man DS, Rao PK, Foster CS, Kim RY, Reed SB, Srivastava SK, Wong IG, Kempen JH.

Morphologic assessment for glaucoma in the Multicenter Uveitis Steroid Treatment (MUST) trial. Ocul Immunol Inflamm. 2011 Aug;19(4):267-274.

Stewart JM, Srivastava SK, Fung AE, Mah-moud TH, Telander DG, Hariprasad SM, Ober MD, Mruthyunjaya P. Bacterial con-tamination of needles used for intravitreal injections: a prospective, multicenter study. Ocul Immunol Inflamm. 2011 Feb;19(1):32-38.

Ocular Surgery News

Bakri SJ, Cousins SW, Gower EW, Kaiser PK, Martin DF, Rich WL, III. CATT, Hopkins analysis add fervor to ranibizumab vs. beva-cizumab debate. Ocular Surgery News. 2011 Aug 10;29(15):1-12.

Ophthal.Plast.Reconstr.Surg.

Goshe JM, Lewis CD, Meine JG, Schoen-field L, Perry JD. Primary dermatofibro-sarcoma protuberans invading the orbit. Ophthal Plast Reconstr Surg. 2012 May-Jun;28(3):e65-e67.

Lee BJ, Nelson CC, Lewis CD, Perry JD. Ex-ternal dacryocystorhinostomy outcomes in sarcoidosis patients. Ophthal Plast Reconstr Surg. 2012 Jan-Feb;28(1):47-49.

Pasquali TA, Mehta MP, Perry JD. Conjunc-tival bleeding after ectropion repair due to paraneoplastic primary fibrinolysis. Ophthal Plast Reconstr Surg. 2012 Mar-Apr;28(2):e44-e45.

Perry JD, Lewis CD. Lacrimal canalicular transposition with composite eyelid graft. Ophthal Plast Reconstr Surg. 2011 Jul-Aug;27(4):306-307.

Ophthalmic Genet.

Turell ME, Leonardy NJ, Singh AD. A unique presentation of grouped congenital hyper-trophy of the retinal pigment epithelium. Ophthalmic Genet. 2011 Sep;32(3):162-164.

Ophthalmic Surg.Lasers Imaging

Canton VM, Quiroz-Mercado H, Velez-Montoya R, Lopez-Miranda MJ, Moshfeghi AA, Shusterman EM, Kaiser PK, Sanislo SR, Gertner M, Moshfeghi DM. 16-Gy low-voltage x-ray irradiation with ranibizumab therapy for AMD: 6-month safety and func-tional outcomes. Ophthalmic Surg Lasers Imaging. 2011 Nov-Dec;42(6):468-473.

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Canton VM, Quiroz-Mercado H, Velez-Montoya R, Lopez-Miranda MJ, Moshfeghi AA, Shusterman EM, Kaiser PK, Sanislo SR, Gertner M, Moshfeghi DM. 24-Gy low-volt-age x-ray irradiation with ranibizumab ther-apy for neovascular AMD: 6-month safety and functional outcomes. Ophthalmic Surg Lasers Imaging. 2012 Jan-Feb;43(1):20-24.

Lee LB, Srivastava SK. Intraoperative spec-tral-domain optical coherence tomography during complex retinal detachment repair. Ophthalmic Surg Lasers Imaging. 2011;42 Online:e71-e74.

Moshfeghi AA, Canton VM, Quiroz-Mercado H, Velez-Montoya R, Lopez-Miranda MJ, Shusterman EM, Kaiser PK, Sanislo SR, Gertner M, Moshfeghi DM. 16-Gy low-volt-age x-ray irradiation followed by as-needed ranibizumab therapy for AMD: 6-month outcomes of a “radiation-first” strategy. Ophthalmic Surg Lasers Imaging. 2011 Nov-Dec;42(6):460-467.

Ophthalmology

Bollinger K, Kim J, Lowder CY, Kaiser PK, Smith SD. Intraocular pressure outcome of patients with fluocinolone acetonide in-travitreal implant for noninfectious uveitis. Ophthalmology. 2011 Oct;118(10):1927-1931.

Kaiser PK, Boyer DS, Cruess AF, Slakter JS, Pilz S, Weisberger A. Verteporfin plus ranibizumab for choroidal neovasculariza-tion in age-related macular degeneration: Twelve-month results of the DENALI study. Ophthalmology. 2012 May;119(5):1001-1010.

Ray R, Baranano DE, Fortun JA, Schwent BJ, Cribbs BE, Bergstrom CS, Hubbard GB, III, Srivastava SK. Intraoperative microscope-mounted spectral domain optical coher-ence tomography for evaluation of retinal anatomy during macular surgery. Ophthal-mology. 2011 Nov;118(11):2212-2217.

Schachat AP. Better outcomes for patients with diabetic macular edema. Ophthalmol-ogy. 2011 Apr;118(4):607-608.

Singh AD, Turell ME, Topham AK. Uveal melanoma: trends in incidence, treat-ment, and survival. Ophthalmology. 2011 Sep;118(9):1881-1885.

Thorne JE, Van Natta ML, Jabs DA, Duncan JL, Srivastava SK. Visual field loss in patients

with cytomegalovirus retinitis. Ophthalmology. 2011 May;118(5):895-901.

Orbit

Pasquali T, Schoenfield L, Spalding SJ, Singh AD. Orbital inflammation in IgG4-related sclerosing disease. Orbit. 2011 Oct;30(5):258-260.

Plast.Reconstr.Surg.

Czyz CN, Rich NE, Foster JA, Kavanagh MC, Perry JD, Holck DEE. Comparison of postop-erative eyelid position using fibrin sealant versus suture for wound closure in Müller’s muscle-conjunctiva resection ptosis repair. Plast Reconstr Surg. 2011 Aug;128(2):423-430.

PLoS ONE

Gu X, Neric NJ, Crabb JS, Crabb JW, Bhat-tacharya SK, Rayborn ME, Hollyfield JG, Bonilha VL. Age-related changes in the retinal pigment epithelium (RPE). PLoS ONE. 2012;7(6):e38673.

Sivakumaran TA, Igo RP, Jr., Kidd JM, Itsara A, Kopplin LJ, Chen W, Hagstrom SA, Peachey NS, Francis PJ, Klein ML, Chew EY, Ramprasad VL, Tay WT, Mitchell P, Seiels-tad M, Stambolian DE, Edwards AO, Lee KE, Leontiev DV, Jun G, Wang Y, Tian L, Qiu F, Henning AK, Laframboise T, Sen P, Aarthi M, George R, Raman R, Das MK, Vijaya L, Kumaramanickavel G, Wong TY, Swaroop A, Abecasis GR, Klein R, Klein BEK, Nickerson DA, Eichler EE, Iyengar SK. A 32 kb critical region excluding Y402H in CFH mediates risk for age-related macular degeneration. PLoS ONE. 2011;6(10):e25598.

Retin.Cases Brief Rep.

Barakat MR, Sachdeva R, Sepulveda RN, Schoenfield L, Dupps WJ Jr., Sears JE. Man-agement of posteriorly dislocated endotheli-al keratoplasty donor lenticule. Retin Cases Brief Rep. 2011 Spring;5(2):163-164.

Retina

Ehlers JP, DeCroos FC, Fekrat S. Intravitreal bevacizumab for macular edema second-ary to branch retinal vein occlusion. Retina. 2011 Oct;31(9):1856-1862.

Ehlers JP, Maldonado R, Sarin N, Toth CA. Treatment of non-age-related macular degeneration submacular diseases with macular translocation surgery. Retina. 2011 Jul;31(7):1337-1346.

Payne JF, Bergstrom C, Yan J, Aaberg TM, Sr., Srivastava SK. Residual triamcino-lone acetonide sequestered in the fovea after macular hole repair. Retina. 2011 Jan;31(1):148-153.

Retina Today

Brown DM, Dugel PU, Humayun MS, Kaiser PK, Trese MT. Symptomatic vitreomacular adhesion (VMA): Diagnosis, pathologic im-plications, and management. Retina Today. 2011 Aug;(Suppl):4-12.

Ehlers JP. Intraoperative OCT and vitreo-retinal surgery: This technology has the potential to improve clinical outcomes and enhance understanding of the pathophysi-ology of a wide variety of surgical vitreoreti-nal diseases. Retina Today. 2011 Sep;50-53.

Taban M, Sonnie C, Hayden BC, Sears JE. Ultrasound biomicroscopy-guided surgical intervention for cyclodialysis clefts. Retina Today. 2011 May-Jun;38-41.

Rev.Bras.Oftalmol.

da Silva RS, da Silva JAS, de Lima FBF, Val-bon BF, Salomao MQ, Junior RA. Estudo das correlações entre a área do disco óptico e as características geométricas e biomecânicas da córnea [Study of correlation between optic disc size and corneal geometry and biomechanics] [Portuguese]. Rev Bras Oftal-mol. 2011 Nov;70(6):349-357.

Pereira IC, Saraiva PGC, Saraiva FP, de Medeiros FW, Miki G, Matayoshi S. Análise da ceratometria corneana em pacientes portadores de espasmo hemifacial [Analysis of corneal keratometry in patients with hemifacial spasm] [Portuguese]. Rev Bras Oftalmol. 2011 Nov;70(6):363-366.

Saudi Journal of Ophthalmology

Singh AD, Biscotti CV. Fine needle aspiration biopsy of ophthalmic tumors. Saudi Journal of Ophthalmology. 2012;26(2):117-123.

Semin.Oncol.

Saunthararajah Y, Triozzi P, Rini B, Singh A, Radivoyevitch T, Sekeres M, Advani A, Tiu R, Reu F, Kalaycio M, Copelan E, Hsi E, Lichtin A, Bolwell B. p53-Independent, normal stem cell sparing epigenetic differentiation therapy for myeloid and other malignancies. Semin Oncol. 2012 Feb;39(1):97-108.

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Semin.Ophthalmol.

Silva RA, Moshfeghi AA, Kaiser PK, Singh RP, Moshfeghi DM. Radiation treatment for age-related macular degeneration. Semin Ophthalmol. 2011 May;26(3):121-130.

Surv.Ophthalmol.

Ehlers JP, Fekrat S. Retinal vein occlusion: beyond the acute event. Surv Ophthalmol. 2011 Jul-Aug;56(4):281-299.

Espana EM, Levine M, Schoenfield L, Singh AD. Ocular surface squamous neoplasia in an anophthalmic socket 60 years after enucleation. Surv Ophthalmol. 2011 Nov-Dec;56(6):539-543.

WhOLE BOOk

LaVail MM, Ash JD, Anderson RE, Hollyfield JG, Grimm C. Retinal Degenerative Diseases. New York, NY: Springer; 2012. 407 pgs.

BOOk ChAPTERS

Age-related macular degeneration diagnosis and treatment

Steinle N, Kaiser PK. Combination therapy with ocular photodynamic therapy for age-related macular degeneration. In: Ho AC, Regillo CD, eds. Age-Related Macular Degeneration Diagnosis and Treatment. New York, NY: Springer; 2011:99-118.

Clinical atlas of procedures in ophthalmic and oculofacial surgery

McGannon P, Koch DD, Weikert MP. Pho-torefractive keratectomy (PRK). In: Albert DM, Lucarelli MJ, eds. Clinical Atlas of Procedures in Ophthalmic and Oculofacial Surgery. 2nd ed. New York, NY: Oxford Uni-versity Press; 2012:85-100.

Gass’ atlas of macular diseases

Singh AD, Agarwal A. Tumors of the retinal pigment epithelium (RPE). In: Agarwal A, ed. Gass’ Atlas of Macular Diseases. 5th ed. Ed-inburgh: Elsevier Saunders; 2012:1065-1097.

Singh AD, Agarwal A. Neoplastic diseases of the retina. In: Agarwal A, ed. Gass’ Atlas of Macular Diseases. 5th ed. Edinburgh: Elsevier Saunders; 2012:1099-1178.

Singh AD, Agarwal A. Neoplastic diseases of the choroid. In: Agarwal A, ed. Gass’ Atlas of Macular Diseases. 5th ed. Edinburgh: Elsevier Saunders; 2012:1179-1253.

Macular Surgery

Singh RP, Kaiser PK. New and future antian-giogenic therapy. In: Quiroz-Mercado H, ed. Macular Surgery. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011:108-114.

Singh RP, Lewis H. Submacular hemor-rhage. In: Quiroz-Mercado H, ed. Macular Surgery. 2nd ed. Philadelphia, PA: Lippin-cott Williams & Wilkins; 2011:459-465.

Ophthalmic Surgery: Principles and Practice

Dupps WJ Jr., Hallahan K. Biomechanics in refractive surgery. In: Spaeth GL, ed. Ophthalmic Surgery: Principles and Practice. 4th ed. Edinburgh: Elsevier; 2012:172-178.

Singh AD, Schachat AP. Treatment of retinal capillary angioma. In: Spaeth GL, ed. Ophthalmic Surgery: Principles and Practice. 4th ed. Edinburgh: Elsevier; 2012:622-623.

Ophthalmology Review Manual

Hariprasad SM, Ahmed I, Bakri SJ, Con-way MD, Mahmoud TH, Moshfeghi AA, Mruthyunjaya P, Ober MD, Srivastava SK, Telander DG, Vu CD. Retina and vitreous. In: Chern KC, Saidel MA, eds. Ophthalmology Review Manual. 2nd ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012:99-227.

Pediatric Retina

Fu EX, Singh AD. Phacomatoses. In: Reynolds JD, Olitsky SE, eds. Pediatric Retina. Heidelberg; New York, NY: Springer; 2011:159-189.

Hood C, Lowder CY. Pediatric uveitis. In: Reynolds JD, Olitsky SE, eds. Pediatric Retina. Heidelberg; New York, NY: Springer; 2011:433-457.

Sears JE. Macular choroidal neovasculariza-tion and defects in Bruch’s membrane in children. In: Reynolds JD, Olitsky SE, eds. Pediatric Retina.Heidelberg; New York, NY: Springer; 2011:345-349.

Phacoemulsification

Mello GR, Talamo JH, Krueger RR. Fem-tosecond laser-assisted refractive cataract surgery. In: Agarwal A, Agarwal A, Jacob S, eds. Phacoemulsification. 4th ed. New Delhi: Jaypee Medical Publishers; 2012:559-565.

Studies on Retinal and Choroidal Disorders

Anand-Apte B. Dysfunction of circulating endothelial progenitor cells in diabetic retinopathy. In: Stratton RD, Hauswirth WW, Gardner TW, eds. Studies on Retinal and Choroidal Disorders. New York, NY: Humana Press; 2012:517-528.

Crabb JW. Oxidative modifications as triggers of AMD pathology. In: Stratton RD, Hauswirth WW, Gardner TW, eds. Studies on Retinal and Choroidal Disorders. New York, NY: Humana Press; 2012:65-84.

Surgery of the Eyelids, Lacrimal System, and Orbit

Perry JD, Lewis C. Surgical decompression of the orbit. In: Yen MT, ed. Surgery of the Eyelids, Lacrimal System, and Orbit. 2nd ed. New York, NY: Oxford University Press; 2012:265-278.

Uveitis

Charkodian L, Srivastava SK. Kawasaki’s dis-ease. In: Garg SJ, ed. Uveitis. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins; 2012:108-109.

Payne JF, Srivastava SK. Cancer-associated retinopathy syndrome. In: Garg SJ, ed. Uve-itis. Philadelphia, PA: Wolters Kluwer/Lip-pincott Williams & Wilkins; 2012:297-299.

Wills Eye Institute 5-Minute Ophthalmology Consult

Ehlers JP. Toxocariasis. In: Maguire JI, Mur-chison AP, Jaeger EA, eds. Wills Eye Institute 5-Minute Ophthalmology Consult. Philadel-phia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012:680.

Helping Professionals Develop

29

C l e v e l a n d C l i n i C | C o l e e y e i n s t i t u t e | e d u C a t i o n

Cole Eye Institute CMEMark your calendars for continuing medical education symposia hosted by Cole Eye Institute. You’ll

gain insights into state-of-the-art diagnostic, medical and surgical techniques, as well as the prom-

ise that research holds for patients with ophthalmic conditions.

Ophthalmic Ultrasonography: Practical AspectsFor ophthalmologists, optometrists,

nurses, technicians, photographers

and others

Friday-Saturday, March 15-16, 2013

Location: InterContinental Hotel and

Conference Center, Cleveland, Ohio

Activity Directors:

Arun D. Singh, MD

Brandy Hayden

Uveitis Update Saturday, April 20, 2013

Location: Cole Eye Institute

Cleveland, Ohio

Activity Directors:

Careen Lowder, MD, PhD

Sunil K. Srivastava, MD

Retina Summit (date pending for May 2013)

Location: Cole Eye Institute

Cleveland, Ohio

Activity Directors:

Daniel F. Martin, MD

Sunil K. Srivastava, MD

International Society of Ocular Oncology (ISOO 2013) - NON-CME Sunday - Thursday,

September 29 - October 3, 2013

Location: InterContinental Hotel and

Conference Center, Cleveland, Ohio

Activity Director:

Arun D. Singh, MD

Most CME courses will be held at the Cole Eye Institute’s James P. Storer Conference Center. For details, exact location or to confirm dates for any of our 2013 CME courses, please contact Jane Sardelle at [email protected].

30


Training the Leaders of Tomorrow

Residency ProgramsOur residency training program’s mission is to prepare

future leaders in patient care, teaching and vision research.

The program meets all the requirements of the American

Board of Ophthalmology and the Accreditation Council for

Graduate Medical Education.

Four residents are matched annually in the three-year

program. Residents rotate among the Institute’s nine de-

partments and at MetroHealth Medical Center, Cleveland

Clinic Lakeland and Cleveland Clinic Stephanie Tubbs

Jones Health Center. Residents work under the direct

supervision of the staff during each rotation through:

• Cornea, external disease, anterior segment

• Glaucoma

• Neuro-ophthalmology/oncology

• Ophthalmic pathology

• Ophthalmic plastic, reconstructive and orbital surgery

• Pediatric ophthalmology and adult strabismus

• Refractive surgery

• Retina, vitreous, low vision

• Uveitis, ocular inflammatory disease and immunology

This curriculum provides a balanced exposure to all subspe-

cialty areas of ophthalmology, ensuring graduates the ability

to perform general ophthalmology with skill, knowledge and

confidence. Each resident works in a one-on-one relationship

with a staff physician to provide the best opportunity to study

disease processes and their medical and surgical manage-

ment. This arrangement also provides excellent supervision

and optimal continuity of patient care in the outpatient and

hospital settings.

Residents are expected to participate in clinical and basic

research activities utilizing the staff’s expertise. They com-

plete independent clinical research projects that involve re-

viewing the literature, developing a hypothesis, and designing

and executing the study. Activities are carefully supervised by

an experienced clinical investigator. Residents are expected

to submit and present their research at national meetings

and to write several papers for publication based on their

research activities. Each June, ophthalmology residents, fel-

lows and staff participate in the Annual Research, Residents

and Alumni Meeting, a scientific forum for the presentation

of research projects.

Residency and fellowship training is considered a high priority at Cleveland Clinic Cole Eye Institute

and is led by outstanding faculty in a state-of-the-art facility. Our programs are highly competitive

and produce superbly trained clinical and academic ophthalmologists.

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C l e v e l a n d C l i n i C | C o l e e y e i n s t i t u t e | e d u C a t i o n

Residency Graduates

June 2012

Baseer Ahmad, MD

Eric Ahn, MD

Theodore Pasquali, MD

Xiang Werdich, MD, PhD

Breno Lima, MD

(February 2012)

Aimee Chappelow, MD

(December 2011)

Residents, First Year

July 2012 – June 2013

Katie Hallahan, MD

Priyanka Kumar, MD

Tal Rubinstein, MD

Jack Shao, MD

Residents, Second Year

July 2012 – June 2013

Jedediah McClintic, MD

Stephen McNutt, MD

Karolinne Rocha, MD, PhD

Georgios Trichonas, MD

Residents, Third Year

July 2012 – June 2013

Elisabeth Aponte, MD

John Au, MD

Igor Estrovich, MD

Sumit Sharma, MD

Fellowship ProgramWe offer high-quality fellowship training

opportunities in a variety of subspecial-

ties to create the next generation of

academic leaders in their fields. Training

combines an excellent academic envi-

ronment with close mentorship support.

Fellowships include:

• Two-year vitreoretinal fellowship

(two positions)

• One-year cornea, external disease

and refractive surgery fellowship

(two positions)

• One-year glaucoma fellowship

(one position)

• One-year pediatric ophthalmology

fellowship (one position)

• Two-year oculoplastics fellowship

(sponsored by ASOPRS) (one position)

• One-year ophthalmic oncology

fellowship (one position)

Fellowship Graduates

June 2012

Cornea, External Disease

and Refractive Surgery

Michael Savetsky, MD

Brent Timperley, MD

Glaucoma

Phyllis Eze, MD

Ophthalmic Oncology

no fellow

Pediatric Ophthalmology

Virginia Utz, MD

(August 2012)

Vitreoretinal Surgery

Dilsher Dhoot, MD

Alex Yuan, MD, PhD

Current Fellows

July 2012 to June 2013

Cornea, External Disease

and Refractive Surgery

Patrick Chan, MD

Neema Nayeb-Hashemi, MD

Glaucoma

Elisa Bala, MD

Oculoplastics

Bryan Costin, MD

Pediatric Ophthalmology

Virginia Utz, MD

(August 2012)

Palak Wall, MD

Vitreoretinal Surgery

Robert “Jack” Courtney, MD

Miriam Englander, MD

Matthew Ohr, MD

Omar Punjabi, MD

For more information about Cole Eye Institute fellowship programs, visit clevelandclinic.org/eyefellowships or ontact Jane Sardelle at [email protected].

32


Distinguished Lecture SeriesThe Cleveland Clinic Cole Eye Institute is proud to present the 2012-2013 Distinguished Lecture

Series, which provides a forum for renowned researchers in the visual sciences to present their latest

research findings. This series of lectures will feature advances in many areas of ophthalmic research

presented by noted basic and clinical scientists from throughout the world. Ample opportunity for

questions and answers will be provided.

January 17, 2013

Discovery of New Glaucoma Pathogenic PathwaysAbbot Clark, PhD Professor, Cell Biology & Anatomy Director, North Texas Eye Research Institute University of North Texas Health Science Center Fort Worth, Texas

February 21, 2013

Mitochondrial Dysfunction: A Potential Mechanism for Age-Related Macular DegenerationDeborah Ferrington, PhD Associate Professor Departments of Ophthalmology and Visual Neurosciences University of Minnesota Minneapolis, Minn.

March 14, 2013

The Role of the Choriocapillaris in Early AMDRobert Mullins, PhD Hansjoerg E.J.W. Kolder, MD, PhD Associate Professor of Best Disease Research, Department of Ophthalmology & Visual Sciences University of Iowa Iowa City, Iowa

April 18, 2013

Genetic Control of Angiogenesis: Implications for ARMDRobert D’Amato, MD, PhD Judah Folkman Chair in Surgery Professor of Ophthalmology Harvard Medical School Vascular Biology Program Boston Children’s Hospital Boston, Mass.

May 16, 2013

Global Blindness: Can We Control It?Gullapalli Rao, MD Chairman, LV Prasad Eye Institute L V Prasad Marg Banjara Hills Hyderabad, Andhra Pradesh India

September 19, 2013

Responding to Clinical Need: Taking OCT Imaging Beyond Standard Clinical ApplicationsCynthia A. Toth, MD Professor of Ophthalmology and Biomedical Engineering Duke University Eye Center Durham, N.C.

October 17, 2013

The Hypoxic Response: Sought and Dreaded by the RetinaChristian Grimm, PhD Professor for Experimental Ophthalmology Department of Ophthalmology University of Zurich Schlieren, Zurich Switzerland

Cleveland Clinic Executive Education Learn from Top Healthcare ExecutivesThe competencies needed to lead and manage differ from those needed to be an effective administrator, clinician or scientist. Take advantage of this opportunity to acquire skills and insights into the business of healthcare excellence from top executives at Cleveland Clinic.

Two-day and two-week programs are open to healthcare executives, including physicians, nurses and administrators. Visit clevelandclinic.org/ExecutiveEducation for details, including the opportunity to earn 72.5 CME credits.

November 21, 2013

Leukocytes Take Directives from the Extracellular Matrix in Ocular Infections and InflammationShukti Chakravarti, PhD Associate Professor Departments of Medicine, Cell Biology and Ophthalmology Johns Hopkins University School of Medicine Baltimore, Md.

Please join us for these insights into ophthalmic research and the promises they hold for patient care. No registration is required; call 216.444.5832 with any questions.

The Distinguished Lecture Series is held from 7 to 8 a.m. in the James P. Storer Conference Center on the first floor of Cole Eye Institute. Attendees should park in the East 102nd Street parking lot (facing the front of Cole Eye Institute) or the visitor’s parking garage at East 100th Street and Carnegie Avenue. We will validate your parking ticket.

Our People, Our Results

34


Cole Eye Institute OverviewAt Cleveland Clinic Cole Eye Institute, we have assembled a team of the world’s foremost clinicians

and researchers who are committed not only to delivering the finest healthcare available, but also

to improving tomorrow’s care through innovative basic, clinical and translational research.

W e believe that research

and patient care are inter-

dependent. Therefore, we

forge synergistic relationships through

analytical and integrative processes,

such as surgical outcomes analysis. We

are pioneering treatment protocols for

complex vision-threatening disorders

through our clinical trials and aggres-

sive research programs to shorten the

gap between the laboratory discoveries

of today and the patient care of tomor-

row. Our goal: Answering tomorrow’s

medical problems through today’s

laboratory and research endeavors.

Clinical Expertise

As one of the country’s leading compre-

hensive eye institutes, Cole Eye Institute

is able to enhance the lives of our patients

and to serve our referring physicians by

providing early, accurate diagnosis and

excellent, efficient, state-of-the-art care.

Our ophthalmology program was

ranked among the top 10 programs in

the nation in the most recent annual

U.S. News & World Report survey. We

have one of the largest patient volumes

in the United States, with more than

180,000 patient visits and more than

7,500 surgeries per year.

We offer primary, secondary and tertiary

ophthalmologic services for all ages.

Our internationally recognized staff of

45 ophthalmologists and researchers is

composed almost entirely of subspecial-

ists, and eight optometrists round out

our comprehensive services.

Patient-Centered Facilities

Cleveland Clinic Cole Eye Institute

offers state-of-the-art care at our main

campus and in the community. The

goal is to deliver maximum patient

comfort and optimum service and

quality. Our main campus building

allows us to provide the full spectrum

of clinical services at one location.

Exam lanes, a diagnostic services suite

and operating rooms are all housed in

one building, with features such as:

• Windows with special filters to

minimize light on dilated or newly

treated eyes.

• A comfortable waiting room with

a special play area for children.

• Valet parking and an easy post-

operative pickup area.

• Conveniently located food services.

For patients’ convenience, our regional

eye care program provides both general

ophthalmology and selected specialty

services at a number of locations.

Fostering Innovation

Our institute is specially designed

to enable clinicians to develop tomor-

row’s advances. Our facility includes an

Experimental Surgery Suite, one of the

few in the country with full operating

capacity.

Training future eye specialists is

greatly enhanced in the Education

Pavilion with the James P. Storer

Conference Center (designed with

televideo technology), as well as video

rooms, resident carrels and ample

conference space. ■

2 0 1 1 K e y s tat I s t I C s

Total clinic visits 187,640

Total surgeries 7,615

Total surgical procedures 9,669

(OR and outpatient)

Total laser procedures 1,564

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C l e v e l a n d C l i n i C | C o l e e y e i n s t i t u t e | o u r i n s t i t u t e

Cole Eye Institute OutcomesClinical outcomes allow us to understand and objectively measure the success of our surgical results.

Cole Eye Institute recently released its 2011 Outcomes book. This is the sixth year we have shared our

clinical outcomes with referring physicians, alumni and potential patients around the country.

A lmost all the surgical proce-

dures performed at Cole Eye

Institute have been tracked

and reported. Because Cole Eye

Institute is a regional, national and

international referral center, many of

our patients are followed by their local

ophthalmologists, and the data do not

include patients who are not followed

at Cole Eye Institute.

The scope of the Cole Eye Institute

outcomes project is significant, our ap-

proach is innovative and, in spite of the

complexity of cases and sometimes the

absence of a defined benchmark, our

outcomes are exceptional. Our physi-

cians strive to push the boundaries of

science and technology to provide excel-

lence for our patients. We hope that by

reviewing and analyzing information,

we will continue to improve and offer

patients superior clinical outcomes.

How We Measure Up

Our key evaluative measures continue to

be visual acuity and the rate of surgical

complications, and we continue to use

ETDRS protocol refraction as the means

of measuring visual acuity. The key mea-

surement variables are mentioned under

each section of the Outcomes book.

In addition to measuring clinical out-

comes, world-class customer service is

very important to us. Consequently, we

have spent significant time understand-

ing patient flow process and experience.

We continue to seek best-practice mea-

surement processes for both clinical

and administrative areas. We strive to

set the standard for excellence through

innovation and consistent follow-up

and measurement to evaluate our over-

all clinical proficiency.

The Outcomes book has data from

across the full spectrum of ophthalmic

surgery, including:

• Cataract surgery

• Cornea surgery

• Glaucoma surgery

• Oculoplastic surgery

• Oncologic eye procedures

• Refractive surgery

• Vitreoretinal surgery

• Strabismus surgery

Cleveland Clinic has created a series

of Outcomes books for all its institutes.

These contain a summary of our surgi-

cal and medical trends and approaches;

data on patient volume and outcomes;

and a review of new technologies and

innovations. ■

To view all our Outcomes books or to download a copy of Cole Eye Institute’s 2011 Outcomes book, visit Cleveland Clinic’s Quality & Patient Safety Insti-tute’s website at clevelandclinic.org/outcomes.

36


Unique Programs at Cole Eye Institute

The Center for Genetic Eye Diseases

The Center for Genetic Eye Diseases

provides multidisciplinary clinical

diagnostic and therapeutic services for

patients with inherited eye conditions

such as corneal and retinal dystrophies

and microphthalmia. Patients with

inherited disorders that involve the eye,

such as neurofibromatosis, albinism,

neurodegenerative disorders and Mar-

fan syndrome, are referred to the center

by physicians from around the country.

A regular specialty clinic is dedicated

to patients with retinal dystrophies

and their families.

National Eye Donor Program

The Foundation Fighting Blindness

Center, a central collection agency for

eyes donated by individuals across the

United States for blindness research,

shares tissue samples with researchers

worldwide.

Formally known as the Retinal Degen-

eration Pathophysiology Facility, the

collection center accepts eye donations

after death from any person of any age

who had normal vision or any degree

of vision loss resulting from a retinal

degenerative disease.

Cole Eye Institute staff members pre-

pare a detailed medical report about

each donated eye to help researchers

track the effects of eye disease in differ-

ent types of people and environments.

For more information or to refer a patient, please call 216.444.2020 or 800.223.2273, ext. 42020, or visit clevelandclinic.org/OUspecial.

37


Cole Eye Institute New Staff SpotlightFatema Ghasia, MDPediatric ophthalmology specialist Fatema Ghasia, MD, joined Cleveland Clinic

Cole Eye Institute this summer after completing a fellowship in Pediatric Ophthal-

mology and Strabismus at Duke University. She also completed an ophthalmology

residency and two fellowships at Washington University School of Medicine.

Her specialty interests are within pediatric ophthalmology. Her awards and

honors include the Rosenbaum Resident Research Award and several academic

achievement awards. Dr. Ghasia has published a significant body of work on

vision in children with cerebral palsy and other neurobehavioral disorders. She

also has been awarded a Knights Templar research grant and a Fight For Sight

grant to conduct oculomotor studies that involve eye movement recordings in

patients with strabismus and nystagmus and eye motility deficits in patients

with neurologic disorders.

Dr. Ghasia graduated from the Medical College at Maharaja Sayajirao University

of Baroda, India.

Dr. Ghasia practices at Cole Eye Institute’s main campus location. She can be reached at 216.444.0999 or [email protected].

Alex Yuan, MD, PhDRetina specialist and surgeon Alex Yuan, MD, PhD, joined Cleveland Clinic

Cole Eye Institute this summer after completing a fellowship in Vitreoretinal

Surgery at Cleveland Clinic. He also completed both a residency and a research

fellowship at the Jules Stein Eye Institute at UCLA.

His specialty interests are regenerative and stem cell therapy, cell-based

therapy, and gene and drug delivery. His awards and honors include the Cole

Eye Fellow Teaching Award, the Cole Eye Fellow Research Award, the Heed

Fellowship Award and the UCLA Excellence in Research Award, among others.

Dr. Yuan is widely published on topics related to retinal diseases and their

treatments, as well as research related to stem cell microvesicles.

Dr. Yuan graduated from Washington University School of Medicine with an MD

and PhD in neuroscience.

Dr. Yuan practices at Cole Eye Institute’s main campus location. He can be reached at 216.444.0079 or [email protected].

38


Cole Eye Institute Leadership

Chairman, Cole Eye Institute

Daniel F. Martin, MD 216.444.0430

Institute Vice Chairman

Institute Quality Review Officer

Andrew P. Schachat, MD 216.444.7963

Institute Vice Chairman for Education

Elias I. Traboulsi, MD 216.444.2030

Comprehensive Ophthalmology

John Costin, MD 440.988.4040

Richard E. Gans, MD, FACS 216.444.0848

Philip N. Goldberg, MD 216.831.0120

Michael Gressel, MD 440.988.4040

Mohinder Gupta, MD 419.289.6466

Martin A. Markowitz, MD 440.461.4733

Shari Martyn, MD 216.831.0120

Peter McGannon, MD 216.529.5320

Michael E. Millstein, MD 216.831.0120

Wynne Morley, MD 440.366.9444

Sheldon M. Oberfeld, MD 440.461.4733

Allen S. Roth, MD 216.831.0120

David B. Sholiton, MD 216.831.0120

Scott A. Wagenberg, MD 440.461.4733

Cornea and External Disease

William J. Dupps Jr., MD, PhD 216.444.2020

Jeffrey M. Goshe, MD 216.444.0845

Roger H.S. Langston, MD 216.444.5898

Martin A. Markowitz, MD 440.461.4733

Peter McGannon, MD 440.529.5320

David M. Meisler, MD 216.444.8102

Wynne Morley, MD 440.366.9444

Sheldon M. Oberfeld, MD 440.461.4733


Scott A. Wagenberg, MD 440.461.4733

Steven E. Wilson, MD 216.444.5887

Glaucoma

Jonathan A. Eisengart, MD 216.445.9429

Edward J. Rockwood, MD 216.444.1995

Shalini Sood-Mendiratta, MD 216.445.5277

Keratorefractive Surgery


Ronald R. Krueger, MD, MSE 216.444.8158

Michael E. Millstein, MD 216.831.0120


Steven E. Wilson, MD 216.444.5887

Cole Eye Institute Staff List

39


Neuro-Ophthalmology

Gregory S. Kosmorsky, DO 216.444.2855

Lisa D. Lystad, MD 216.445.2530

Oculoplastics and Orbital Surgery

Mark Levine, MD 440.988.4040

Julian D. Perry, MD 216.444.3635

Ophthalmic Anesthesia

Marc A. Feldman, MD 216.444.9088

M. Inton-Santos, MD 216.445.1016

J. Victor Ryckman, MD 216.444.6330

Sara Spagnuolo, MD 216.444.6324

Ophthalmic Oncology

Arun D. Singh, MD 216.445.9479

Ophthalmic Research

Bela Anand-Apte, MBBS, PhD 216.445.9739

Vera Bonilha, PhD 216.445.7960

John W. Crabb, PhD 216.445.0425


Stephanie Hagstrom, PhD 216.445.4133

Joe G. Hollyfield, PhD 216.445.3252

Neal S. Peachey, PhD 216.445.1942

Pediatric Ophthalmology and Adult Strabismus

Fatema Ghasia, MD 216.444.0999

Andreas Marcotty, MD 216.831.0120

Paul Rychwalski, MD 216.444.4821

Elias I. Traboulsi, MD 216.444.2030

Retina

Amy Babiuch, MD 440.366.9444

Ryan Deasy, MD 440.695.4010

Justis P. Ehlers, MD 216.636.0183

Peter K. Kaiser, MD 216.444.6702

Daniel F. Martin, MD 216.444.0430

Andrew P. Schachat, MD 216.444.7963

Jonathan E. Sears, MD 216.444.8157

Rishi P. Singh, MD 216.445.9497

Sunil K. Srivastava, MD 216.636.2286

Richard Wyszynski, MD 440.988.4040

Alex Yuan, MD 216.444.0079

Uveitis

Careen Y. Lowder, MD, PhD 216.444.3642

Sunil K. Srivastava, MD 216.636.2286

40


Cole Eye Institute Resources24/7 ReferralsReferring Physician Hotline

855.REFER.123 (855.733.3712)

Hospital Transfers

800.553.5056

On the Web at clevelandclinic.org/refer123

Stay connected with us on …

Twitter/YouTube/Facebook

About Cleveland ClinicCleveland Clinic is an integrated healthcare delivery system

with local, national and international reach. At Cleveland

Clinic, 2,800 physicians represent 120 medical specialties

and subspecialties. We are a main campus, 18 family health

centers, eight community hospitals, Cleveland Clinic Florida,

the Cleveland Clinic Lou Ruvo Center for Brain Health in Las

Vegas, Cleveland Clinic Canada, Sheikh Khalifa Medical City

and Cleveland Clinic Abu Dhabi.

In 2012, Cleveland Clinic was ranked one of America’s top 4

hospitals in U.S.News & World Report’s annual “America’s Best

Hospitals” survey. The survey ranks Cleveland Clinic among the

nation’s top 10 hospitals in 14 specialty areas, and as the top

hospital in three of those areas.

Resources for PhysiciansReferring Physician Center and Hotline

Cleveland Clinic’s Referring Physician Center has established a

24/7 hotline — 855.REFER.123 (855.733.3712) — to streamline

access to our array of medical services. Contact the Referring

Physician Hotline for information on our clinical specialties

and services, to schedule and confirm patient appointments,

for assistance in resolving service-related issues, and to connect

with Cleveland Clinic specialists.

Physician Directory

View all Cleveland Clinic staff online at clevelandclinic.org/staff.

Track Your Patient’s Care Online

DrConnect is a secure online service providing real-time

information about the treatment your patient receives

at Cleveland Clinic. Establish a DrConnect account at

clevelandclinic.org/drconnect.

Critical Care Transport Worldwide

Cleveland Clinic’s critical care transport teams and fleet

of vehicles are available to serve patients across the globe.

• To arrange for a critical care transfer, call 216.448.7000 or

866.547.1467 (see clevelandclinic.org/criticalcaretransport).

• For STEMI (ST elevated myocardial infarction), acute stroke,

ICH (intracerebral hemorrhage), SAH (subarachnoid hemor-

rhage) or aortic syndrome transfers, call 877.379.CODE (2633).

Outcomes Data

View clinical Outcomes books from all Cleveland Clinic

institutes at clevelandclinic.org/outcomes.

Clinical Trials

We offer thousands of clinical trials for qualifying patients.

Visit clevelandclinic.org/clinicaltrials.

CME Opportunities: Live and Online

The Cleveland Clinic Center for Continuing Education’s website

offers convenient, complimentary learning opportunities. Visit

ccfcme.org to learn more and use Cleveland Clinic’s myCME

portal (available from the site) to manage your CME credits.

Executive Education

Cleveland Clinic has two education programs for healthcare ex-

ecutive leaders — the Executive Visitors’ Program and the two-

week Samson Global Leadership Academy immersion program.

Visit clevelandclinic.org/executiveeducation.

Same-Day Appointments

Cleveland Clinic offers same-day appointments to help your

patients get the care they need, right away. Have your patients

call our same-day appointment line, 216.444.CARE (2273), or

800.223.CARE (2273).

41

C l e v e l a n d C l i n i C | C o l e e y e i n s t i t u t e | r e s e a r C h

Main Campus 9500 Euclid Ave./i20 Cleveland, Ohio 44195 216.444.2020

Ashland Lakeland Eye Surgeons 21 Sugarbush Court Ashland, Ohio 44805 419.289.6466

Avon Lakeland Eye Surgeons 33100 Cleveland Clinic Blvd. Avon, Ohio 44011 440.695.4010

Beachwood Cole Eye Institute, Beachwood 25101 Chagrin Blvd. Beachwood, Ohio 44122 216.831.0120

Elyria Lakeland Eye Surgeons 303 Chestnut Commons Drive Elyria, Ohio 44035 440.366.9444

Independence Cleveland Clinic Independence 5001 Rockside Road Crown Center II Independence, Ohio 44131 216.986.4000

Lakewood Lakeland Eye Surgeons Lakewood Hospital Professional Bldg. 14601 Detroit Ave. – Suite 550 Lakewood, Ohio 44107 216.529.5320

Lorain Lakeland Eye Surgeons 5700 Cooper Foster Park Road Lorain, Ohio 44053 440.988.4040

Mansfield Lakeland Eye Surgeons 1456 Park Avenue West – Suite P Ontario, Ohio 44906 419.529.5156

Mayfield heights Hillcrest Hospital Atrium Medical Building 6770 Mayfield Road - Suite 326 Mayfield Heights, Ohio 44124 440.461.4733

Strongsville Cleveland Clinic Strongsville 16761 SouthPark Center Strongsville, Ohio 44136 440.878.2500

Twinsburg Cleveland Clinic Twinsburg 8701 Darrow Road Twinsburg, Ohio 44087 330.888.4000

Please direct any correspondence to:

Medical Editor Rishi P. Singh, MD

Cole Eye Institute/i32 Cleveland Clinic 9500 Euclid Ave. Cleveland, OH 44195

Chairman, Cole Eye Institute Daniel F. Martin, MD

Vice Chairman and Quality Review Officer Andrew P. Schachat, MD

Director, Residency Training Program Vice Chairman for Education Elias I. Traboulsi, MD

Managing Editor Kimberley Sirk

Art Director/Designer Michael Viars

Marketing Manager Bill Sattin, PhD

Marketing Associate Mary Anne Connor

Principal Photography Russell Lee

Contributing Photography Cleveland Clinic Center for Medical Art and Photography

OphthalmologyUpdate EMR - Cleveland Clinic

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