VISION 2019

30 2019 VOLUME 35

2 A Champion Lost

Remembering R. Rand Allingham, MD

1 Message from the Chair 25 New Faculty

COVER STORY

26 News and Notes

The New Frances and Stephen Foster Center for Ocular Immunology

30 Honors and Awards

4 Behold the Eye: “The Perfect Organ”

36 Administration, Faculty and Staff

10 New Resident Wet Lab

Alum Gives Back to Enhance Resident Training

12 Immune Response Likely Culprit in Eyelid Gland Condition New Dry Eye Research

14 Developing Gene-Specific Molecular Approaches to Treat Inherited Retinal Diseases

Duke Pediatric Eye Imaging Suite

Transforming Eye Care for Children

18 Duke Eye Center by the Numbers 20 Duke Team Adapts Newest

Retinal Imaging Technology Addressing Unique Needs of Infants and Children

22 Ophthalmologists Coordinate Care to Preserve Infant’s Vision

24 New Glaucoma Treatments

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Editor Tori Hall Writers Laura Ertel, Samiha Khanna, Catherine Lewis, Tori Hall Art Direction Pam Chastain Design Photography Kevin Caldwell Photography, Chris Hildreth, Ken A. Huth Photography Copyright 2019 © Duke Eye Center Durham, NC 27710 919.668.1345 dukeeye.org

For questions, comments or to add or remove your name from our mailing list, please contact us by e-mail, phone or mail using the contact information below: Office of Marketing and Communications Duke Eye Center 2351 Erwin Road Durham, NC 27710 e-mail: tori.hall@duke.edu phone: 919.668.1345

From our Chair, Edward G. Buckley, MD

s I reflect on the past year, I am filled with immense pride and gratitude. We have achieved significant milestones and accomplishments to advance our missions of research, education and patient care. I am delighted to share a glimpse of some of our accomplishments with you in this issue of VISION. Our talented and dedicated faculty, fellows, residents, staff, and collaborators are instrumental to our success by accelerating us to new heights of excellence. While the year has been filled with celebration, we have also experienced sorrow. The loss of our friend and colleague Rand Allingham was devastating. He leaves a legacy as a global leader in the field of glaucoma. Rand will certainly be missed by his colleagues at Duke and beyond. The Foster Center for Ocular Immunology—the first of its kind in the world is one of our proudest moments of the year. The center was made possible by the generous support of Dr. C. Stephen and Mrs. Frances Foster and will make an impact on eye care for years to come. We are so grateful for our donors. Because of your generous support, we have a dedicated building to fuel discovery and innovation, possess the latest equipment, offer an esteemed training program, have a new Microsurgical Education Laboratory, and are on the forefront of patient care. It is quite an honor that our alumni and colleagues consistently recognize us as a respected hospital for ophthalmology in the US News and World Report annual Best Hospitals survey. Yet again, we ranked 6th and have remained in the top 10 since the survey was established—almost 30 years ago! I am extremely proud that Dan Stamer, PhD will become the next president of the Association of Research in Vision and Ophthalmology (ARVO), what an honor and great achievement for him and our department. I am certain Dan will be a phenomenal leader and will do great things for the future of ophthalmic and vision research. There are so many outstanding accolades our faculty and trainees have received this year that you can read more about in this publication. We hope you will join us for one of our CME events throughout the year. We strive to offer invigorating

educational programs to enhance your scholarship. We offer programs for all specialties. I promise you won’t be disappointed. It has been an unprecedented year and we have so much to look forward to in 2019 as we continue to build on our impressive legacy and stellar achievements. We hope you will enjoy reading more in the following pages. Sincerely, Edward G. Buckley, MD Vice Dean for Education, School of Medicine Chair, Department of Ophthalmology Vice Chancellor for Duke-National University Singapore Affairs James P. and Joy Gills Professor of Ophthalmology Professor of Pediatrics Duke University Medical School

A Champion Lost BY LAURA ERTEL

DUKE EYE CENTER AND THE GLOBAL OPHTHALMOLOGY COMMUNITY MOURN THE LOSS OF R. RAND ALLINGHAM, MD, GLAUCOMA EXPERT AND TIRELESS ANSWER-SEEKER

‘He cared deeply about the research’ Over his remarkable career, Allingham made pivotal contributions to glaucoma clinical care and to understanding the most basic causes of glaucoma. He helped develop new treatments and research paths and engineer new drug delivery methods to improve care for glaucoma patients at Duke and around the world. Allingham was determined to unravel the genetic basis for glaucoma, and he understood very early on the importance of Africa in this quest. In the mid-1990s, before others realized how critically important it was, he began spearheading collection of what would become the world’s largest and most powerful glaucoma dataset of individuals of African ancestry. He built partnerships with clinicians in Ghana, Nigeria, South Africa, and the Gambia, and later with genetics researchers in Singapore. His efforts have led to the first identification of a glaucoma susceptibility gene in individuals of African ancestry, a seminal discovery that will be published soon and will hopefully be the first of many valuable findings.

n August, the Duke Eye Center community lost a colleague, friend, mentor, and care provider, and the global community lost one of its greatest champions for improving the lives and health of people with glaucoma.

R. Rand Allingham, MD, Barkhouser Professor of Ophthalmology Emeritus and former chief of the Eye Center’s glaucoma division was an outstanding clinician-scientist. His passion for research, education, and patient care was clear to anyone he met. He touched many lives and made a tremendous impact on the field of glaucoma.

Allingham came to Duke Eye Center in 1993 as a star recruit, and quickly became an internationally recognized physician and researcher. Beloved by his colleagues, trainees, and patients, his gift for bringing out the best in others helped define his career and his legacy. DUKE EYE CENTER

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“Back when everyone thought it was impossible to get genetic samples from Africa because of the logistical difficulties of working on that continent, Rand didn’t just get on the phone, he got on the airplane! Rand cared deeply about the research. It wasn’t easy, but he spearheaded the collection of this extremely valuable dataset that led to this important discovery.” — Michael Hauser, PhD, Duke professor in medicine, associate research professor in molecular genetics and microbiology, and longtime co-investigator and friend TO SEE DR. ALLINGHAM AT HIS BEST, WATCH HIS 2017 LECTURE TO THE AMERICAN GLAUCOMA SOCIETY, “OUT OF AFRICA: HUMAN MIGRATION GLAUCOMA GENES AND SOME UNUSUAL PATHS TO A CURE.” https://anyscreeninc.com/catalog/media-by session.php/?sid=40474

‘He was loved by his patients’ Patients loved, admired, and trusted Dr. Allingham — to the point that many sought his advice on concerns beyond the scope of his practice. “I can’t tell you how many times I would pick up the phone and hear a patient say, ‘I LOVE Dr. Allingham!’ Even though he was their eye doctor, we would get calls all the time asking him who they should see for a knee problem or an earache! If he didn’t know off the bat, he would take the time to figure out who to refer them to. He would worry about his patients. He would literally lose sleep over a difficult surgery, until he could see that patient back again at post-op to know they were doing okay.” — Robin Goodwin, Dr. Allingham’s administrative assistant and friend for 25 years

‘He had a deep passion for mentoring’ Dr. Allingham directed Duke Ophthalmology’s education programs for medical students and fellows for many years. He mentored med students, residents, fellows, and junior faculty who passed through Duke Eye Center and worked with him on glaucoma projects throughout the world. Dr. Allingham took great pride in training what he called “the next generation.” “It is rare gift to find a mentor as generous, insightful, and creative as Dr. Allingham. [He] constantly challenged my assumptions in ways that improved my research design and execution. I still return to the lessons I learned from him in my research today. I also had the pleasure of learning from Dr. Allingham during my clinical training. [He was] the most inspiring and effective teacher I have ever met. He clearly had a deep passion for mentoring future clinicians who truly care for their patients. He was the model of the idealized clinician-scientist, drawing inspiration from his patients and, in return, giving his patients hope that his work will someday cure their disease.” — Kathryn Pepple MD, PhD, former Duke ophthalmology resident

“Rand was my ‘mentor’—and what an inspiring mentor! At the time I met him, I knew nothing about genetics and my work was purely clinical. My interactions with Rand…excited me about research. After our surprising [study] results, I was hooked. Rand was supportive and encouraging and a

wonderful collaborator and mentor. I will miss him.” — Susan Williams, MD, co-PI, Eyes of Africa project

“Rand was a great teacher. He would have nuggets of wisdom that he dispensed among trainees at our educational meetings. Little did Rand know that I was paying attention to everything he said, as I continued to learn from him as well. He was a Master Teacher. Not only did he teach me about various patient management concerns, he taught me about life.” — Leon Herndon, Jr., MD, chief, Duke ophthalmology glaucoma division

‘He gave more than he got’ Those who collaborated with Allingham in the laboratory, the clinic, or the field, use words like “inspiring,” “passionate,” and “charismatic” to describe him. “Rand was a joy to work with, because he brought all of his clinical expertise to the table and used it to inform our genetic analyses. He was so engaging and personable and friendly, but he was also able to communicate the importance of the work and empower people.”

— Michael Hauser, PhD, longtime co-investigator and friend

“Rand was a special individual who gave more than he got and did so graciously with respect and devotion. As chief of the glaucoma division, he was influential in shaping the Duke Eye Center and its renowned glaucoma division at a time of unprecedented growth. Rand was an avid fly fisherman, so for him eventually, all things merge into one, and a river runs through it. We will miss Rand. May he always have ‘tight lines.’” — Edward G. Buckley, MD, chair, Duke department of ophthalmology

In recognition of Dr. Allingham’s contributions to the field of ophthalmology and his outstanding mentorship of young faculty, the Department of Ophthalmology has established The R. Rand Allingham, MD Research Fund, a permanent endowment to provide research support for early career faculty in the department. If enough funding is received, we may eventually be able to create an assistant/associate termed professorship. To donate to this fund, visit gifts.duke.edu/dukeeye and select the Allingham Fund in the drop-down menu. Contact Jillian Ream, Duke Eye Center Development (919.385.3197, jillian.ream@duke.edu) with questions.

BEHOLD T HE E Y E

The Perfect Organ G

NEW CENTER FOR OCULAR IMMUNOLOGY — THE WORLD’S FIRST UNIVERSITY-BASED CENTER OF ITS KIND — AIMS TO RESTORE VISION THROUGH PERSONALIZED MEDICINE, TRANSLATIONAL RESEARCH, AND INNOVATION.

BY LAURA ERTEL

et Victor L. Perez, MD talking about the eye, and he quickly becomes animated. “The eye is the perfect organ!” he says with a smile. “It is very accessible: We can actually see it; we can image it; and we can treat it directly, because it’s right in front of us.”

These are distinct advantages to Perez, an ocular immunologist who specializes in diagnosing and treating eye conditions caused by inflammation – conditions that can lead to partial or total vision loss and reduced quality of life due to blurry vision, foreign body sensation, redness, itching, and pain. “Inflammation causes many diseases in the body—and the eye is no different,” he says. “By understanding how the immune system behaves, or misbehaves, we can determine ways to control the inflammation and prevent vision loss. We can also apply what we learn about the eye to inflammation in other, less accessible, parts of the body. And, because many diseases of the body also attack the eye, we can also use this knowledge to improve treatment for patients with a wide variety of complex diseases.”

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Perez is so optimistic about ocular immunology’s potential to improve the treatment of inflammatory eye diseases and eye-related complications from diseases like cancer and diabetes that he came to the Duke Eye Center in 2017 to launch, and lead, The Frances and Stephen Foster Center for Ocular Immunology. The new center was made possible through generous gifts

05 “In a few years, we’ll be able to use your immunological signature to tell you: ‘Your cells express these factors or receptors, so you’ll respond better to this particular medication.’ That’s personalized medicine, and that’s where we’re headed.” Victor L. Perez, MD Director, Frances and Stephen Foster Center for Ocular Immunology

“Patients who are referred to us with these issues now have a central, ‘one stop shop.’ We bring in adult and pediatric rheumatologists, nephrologists, dermatologists, oncologists, and specialists in uveitis and other diseases, all consulting together with our ocular immunologists to provide standard-of-care treatment for our patients.” DUKE EYE CENTER

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Carolina Betancurt, OD Administrative Manager, Frances and Stephen Foster Center for Ocular Immunology

Dr. Perez examines a patient in his clinic.

by Dr. C. Stephen and Mrs. Frances Foster (see sidebar). It is the only university-based center in the world dedicated to the evaluation, diagnosis, and treatment of patients with uveitis and other inflammatory eye diseases, and to conducting research that uncovers new understanding of the basic mechanisms of inflammation in and around the eye and translates this knowledge into effective treatments. The center focuses on:

• • •

U veitis, an autoimmune attack that causes inflammation inside the eye. I nflammatory diseases that affect the surface of the eye, including mucous membrane pemphigoid, graft-vs-host disease, Sjogren’s and Stevens-Johnson syndromes, allergies, dry eye syndrome, meibomian gland dysfunction rosacea and other inflammatory diseases. T ransplantations, including corneal and limbal stem cell transplants, which have the potential to be rejected by the immune system. Including reconstruction of patients suffering corneal blindness utilizing keratoprosthesis and other novel devices.

The Foster Center for Ocular Immunology’s new clinic, located on the main floor of the Eye Center’s Hudson Building, includes seven exam rooms, a diagnostic imaging room, and a treatment/infusion suite. “This new space allows us to standardize care for these patients,” Perez notes. “The translational research we’ll do here will enable us to take observations from the clinic into the lab, so we can create a personalized immunological signature to guide treatment for each patient. The ophthalmologists we will train in this important specialty will make an impact on global eye care for years to come.”

One-stop, multidisciplinary care for patients Because most ocular immunological diseases are complex, Perez works closely with colleagues throughout Duke Eye Center and Duke University Medical Center to evaluate, diagnose, and treat patients using the most advanced technologies and treatments. “Patients who are referred to us with these issues now have a central, ‘one stop shop,’” says Administrative Manager of the Foster Center for Ocular Immunology Carolina Betancurt, OD. “We bring in adult and pediatric rheumatologists,

nephrologists, dermatologists, oncologists, and specialists in uveitis and other diseases, all consulting together with our ocular immunologists to provide standard-of-care treatment for our patients.” Patients can receive injections, medications, or intravenous treatments right in the clinic, and have access to clinical trials not otherwise available in this area.

Translational research: From clinic to laboratory, and back The Foster Center for Ocular Immunology also features a state-of-the-science research laboratory where Duke scientists perform biochemical, genetic, molecular, and immunological analyses of tear fluid and cellular tissue collected from each patient. These analyses will help researchers identify new biomarkers to monitor disease progression and determine optimal therapies. The goal, Perez says, “is to create an immunological signature for every patient so we can predict their response to different therapies and choose the best treatment path for each individual. That’s personalized medicine, and that’s where we’re headed. By understanding the phenotype of patients, we might find new pathways that we can control, and develop new therapies or find drugs already out there that could be used for this purpose.” Perez eventually intends to extend collaborative efforts with other translational programs at Duke Eye Center, including the Center for Macular Degeneration directed by Scott Cousins, MD and the Visual Performance Lab directed by Felipe Medeiros, MD, PhD. These partnerships will allow the center to expand the investigation of the role that inflammation plays in degenerative diseases like macular degeneration, diabetic retinopathy, glaucoma and in systemic diseases such as cancer, lupus and rheumatoid arthritis that can also affect the eyes.

Training others in ocular immunology Because ocular immunology is a relatively young field, Perez knows that one of the center’s most important roles is to train new generations of specialists to provide, and advance, care for patients with inflammatory diseases of the eyes—not just at Duke but globally.

“Education is how you leave a legacy,” Perez maintains, echoing the outlook of his mentor, Dr. Foster. “We have a unique opportunity to train ophthalmology residents and cornea and retina fellows to diagnose and manage common and rare diseases of the immune system. We’ll also train doctoral and post-doctoral scientists, so they understand how their efforts in the lab tie directly to clinical issues. And, we’ll bring international ophthalmology fellows to Duke to learn how to make a difference in this field when they return to their own countries. This is especially important, because uveitis and immune disease is the third leading cause of blindness in the world.” “Duke has given me the opportunity to take pure immunology and develop a center for diagnosis and treatment, and the Fosters’ generosity has made this opportunity possible,” Perez says appreciatively. “We’re creating a unique program of distinction that is not only aimed to deliver the best possible existing care, but are also committed to transforming care through innovation and invention to change how inflammatory diseases of the eye are treated and to save vision for people everywhere.”

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“We have a unique opportunity to train ophthalmology residents and cornea and retina fellows to diagnose and manage common and rare diseases of the immune system.” Victor L. Perez, MD Medical Director, Frances and Stephen Foster Center for Ocular Immunology

State-of-the-art imaging used to assist in diagnosis and management of ocular inflammatory diseases.

Couple’s Gifts Help Duke Build Unique Ophthalmology Program

n early October, 2018, the Duke Ophthalmology community celebrated Dr. C. Stephen and Mrs. Frances Foster, a couple whose generosity and foresight have enabled Duke to take the lead globally in the field of ocular immunology. The Fosters have made a suite of gifts to launch and endow a lecture series, professorship, and the new Frances and Stephen Foster Center for Ocular Immunology.

The celebration began with the annual Stephen and Frances Foster Distinguished Lecture and Reception, which featured guest lecturer Dr. Reza Dana of Harvard. The evening following the lecture, Duke Ophthalmology and Duke School of Medicine faculty, staff, residents, fellows, family, and friends (including several from Boston) gathered to celebrate the opening of a physical space that will advance Duke’s commitment to excellence in patient care and translational research to improve the lives of individuals with uveitis and inflammatory eye disease. School of Medicine Dean Mary Klotman, MD, acknowledged the couple, whose Duke connections go back to his days as an undergraduate and medical student. “He is a world leader in ocular immunology and founder of the Massachusetts Eye Research and Surgery Institution (MERSI) and its Ocular Immunology & Uveitis Foundation; she is a nurse practitioner and manager at MERSI. Together, they are a real force. They have a strong vision, and it is completely

Dr. C. Stephen and Mrs. Frances Foster with Dr. Perez during the dedication events.

aligned with the Department of Ophthalmology’s vision for the future.”

to recruit top-notch faculty like Victor is possible only with the partnership of donors.”

Ophthalmology Chair Edward Buckley, MD, called the Fosters “gracious contributors to Duke, and to the Eye Center in particular. The fact that they have chosen to invest in our capacity to impact this field means a tremendous amount to us.”

Perez, who trained under Dr. Foster, thanked the couple for their efforts to make this center a reality. “With this investment, we become the world’s first academic center to have a center dedicated to ocular immunology! I am excited to continue the Fosters’ legacy of dedication and passion for patients with inflammatory diseases of the eye. We look forward to continuing this important work in their names.”

“The Fosters have not only given us the place; they have also given us the person,” Buckley noted, referring to the endowed professorship that enabled Duke to recruit Victor Perez, MD, a highly regarded clinician-scientist and ocular immunologist from Bascom Palmer, to establish and direct the new center. “The ability

Alum Gives Back to Enhance Training for Today’s Ophthalmology Residents BY LAURA ERTEL

ack when Michael Vu, MD was an ophthalmology resident at Duke in the 1980s, trainees didn’t have a dedicated space to practice their surgical skills. When an opportunity to try out a new instrument or technique arose, Vu and his fellow residents would search for a quiet place, scrounge up a few pig eyes, and practice wherever they could.

As Vu’s son, Daniel, now a third-year Duke ophthalmology resident, can attest, things have come a long way since the elder Vu’s days as a Duke medical student and resident. For many years the ophthalmology residents have had a Microsurgical Education Laboratory (also known as a “wet lab”). But Michael Vu, a successful ophthalmologist in private practice in southern California, knew the facility wasn’t up to par for a program of Duke’s national stature. So last year, he made a gift to the Department of Ophthalmology to create an enhanced laboratory where burgeoning ophthalmology residents, as well as fellows and faculty, can hone their surgical skills, practice new techniques, and build their confidence before operating on patients. “Every ophthalmologist remembers his or her first few cases, and I think it’s important to start off right,” says Vu. “I owe my medical success to my training at Duke, and I felt that it was time to give back.” Rather than simply renovate the longtime space in the Eye Center’s original Wadsworth Building, Vu’s generous gift allowed Duke to create an entirely new Microsurgical Education Laboratory in the Hudson Building (to which Vu also donated), right down the hall from the residents’ headquarters. The brand-new space, which opened this summer, is equipped with state-of-the-art instruments, several bench spaces and microscopes, and ample opportunities for residents, fellows, and faculty to refine their surgical skills.

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“We are incredibly excited to have a new wet lab for our trainees that fosters learning, collaboration, and research on new techniques and instruments,” says Chief Ophthalmology Resident Tanya Glaser,

MD. “Dr. Vu’s generosity has given us the means to optimize the way that we train residents for surgery.” For Vu, the gift was an opportunity to give back to the place where his career began. “Duke gave me the surgical skills and the mindset to be successful in ophthalmology, so this was my way of returning the favor,” he says. The fact that Vu ended up at Duke for his medical training is a story in itself. After immigrating to the U.S. from Vietnam as a teenager, Vu grew up in New York City and attended Columbia University, where he studied biomedical engineering with the intent of going to medical school somewhere in the Northeast. Duke wasn’t even on his radar, but a friend encouraged him to apply. Once accepted, he looked into the southern school and decided to say yes—without even visiting the campus. Fortunately, once he arrived in Durham, he knew he had made the right choice. Vu is impressed with the growth of Duke Ophthalmology over the past few decades, beginning with the addition of the Albert Eye Research Institute and later the Hudson Building. The new Microsurgical Education Laboratory continues that growth and bolsters Duke’s reputation as one of the nation’s top ophthalmology training programs. “The education of our residents and fellows is one of our highest priorities,” says Pratap Challa, MD, director of the ophthalmology residency program. “Duke’s tradition of excellence in training individuals like Michael and Daniel Vu has been instrumental in distinguishing our Eye Center as a top institution defining the future of ophthalmology. This new lab will help us maintain and strengthen our leading-edge residency program and attract and train the best and the brightest medical school graduates.” Opposite Page Top L-R: Dr. Michael Vu and his son, Dr. Daniel Vu, Residents enjoying the new Microsurgical Education Laboratory. Bottom: Dr. Challa working with resident Dr. Jane Kim on her surgical skills.

â&#x20AC;&#x153;This new lab will help us maintain and strengthen our leading-edge residency program and attract and train the best and the brightest medical school graduates.â&#x20AC;? Pratap Challa, MD Director, Ophthalmology Residency Program

Immune Response Likely Culprit in Eyelid Gland Condition That Causes Dry Eye Mouse, human data suggest inflammation tips immune response, which disrupts oil glands BY SAMIHA KHANNA, DUKE HEALTH NEWS OFFICE

IMMUNE CELLS THAT NORMALLY RUSH IN TO PROTECT THE EYES FROM INFECTION MIGHT ACTUALLY BE DISRUPTING MOISTURIZING GLANDS AND CAUSING DRY EYE, A DISEASE THAT AFFLICTS MORE THAN 30 MILLION PEOPLE IN THE UNITED STATES.

his finding from a research team led by Duke Eye Center could lead to more effective therapies for dry eyes instead of treatments that only address symptoms.

“This study shows that some forms of Meibomian gland dysfunction (MGD) are inflammatory diseases, and our studies in mice confirm what we see in the tears of people with blocked glands,” said Duke ophthalmologist Preeya K. Gupta, MD, a co-author of the study published July 25 in the journal Science Translational Medicine. “This pathway may be a new target for therapeutic agents to help treat patients suffering from dry eye disease and MGD.” DUKE EYE CENTER

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Whether brought on by allergies, contact lenses or our tendency to blink less while using computers and other electronic devices, dry eye disease is linked to blockages in the glands of the eyelid, called Meibomian glands.

These glands secrete oils at lid opening each time you blink to retain moisture and maintain a healthy eye. Although doctors can prescribe eyelid scrubs and anti-inflammatory drops to relieve some symptoms, scientists don’t know why the glands malfunction to begin with. The Duke researchers found that immune cells called neutrophils, which rush in to relieve inflamed eyes, might also be disrupting the moisturizing glands. In some people, MGD is a visible condition, marked by small off-white beads along the eyelid that look like plugged pores or whiteheads. For many others, the MGD is undetected and undiagnosed. “In addition to providing new treatment strategies, the presence of neutrophils in the eye could provide a biomarker to detect the disease or measure its severity,” said Daniel R. Saban, PhD, senior author of the study. Neutrophils are found in many tissues of the body. For example, when pathogens such as bacteria make their way into the gut, commanders of the immune system known as T cells identify the invader and help recruit neutrophils to fight the battle.

Preeya K. Gupta, MD

Daniel R. Saban, PhD

“When you sleep, neutrophils come into your tears,” Saban said. “We don’t know why, but they might be like the garbage truck, coming to collect all the waste while you sleep. Once your eyes open up, however, your tears become clear of these cells. But in these patients, their tears contain plenty of neutrophils even during the day.” “The more severe the condition, the more neutrophils were present in the eye,” said former Duke scientist Nancy J. Reyes, PhD, who is the study’s lead author. “The correlation between blocked glands and elevated neutrophils were unmistakable in studies of mice, which had eye inflammation in the form of allergic eye disease.” Additionally, in the 64 people whose tears were collected for the human study, elevated neutrophils were most common in people with severe MGD who also suffered from conditions causing inflammation, including allergies, rosacea and autoimmune diseases. “The neutrophils don’t cause the blockage directly,” Saban said. “They’re being recruited around the gland and changing the actual glandular cells, which is causing them to malfunction. Even under the microscope, you can see that the glandular cells, instead of being plump and round, have changed. They look more like a shriveled raisin than a healthy grape.” The authors stress that there are different causes for MGD, and not all might be related to inflammation from allergies or autoimmune conditions. Conversely, not all inflammation in the eye leads to blockages in the glands, they said. But for the majority of people with MGD and dry eye, the findings could be a clue to more effective treatments. “New treatments might be presented sooner than expected,” Saban said. “The market is robust right now for new drugs that can modulate the immune system. With the new understanding of how immune cells are involved in this condition, the findings could be translatable with a drug that’s already on the market and repurposed for relieving MGD.” In addition to Gupta, Saban and Reyes, study authors include Chen Yu, Rose Mathew, Carolina M. Kunnen, Joan Kalnitsky, Rachel L. Redfern, Andrea Leonardi, Victor L. Perez, and Amanda S. MacLeod. The research was supported by the National Eye Institute, part of the National Institutes of Health (R01EY021798, P30EY005722, F32EY025557) and Miracles In Sight.

Developing Gene-Specific Molecular Approaches to Treat Inherited Retinal Diseases First FDA Approval Marks Beginning of New Era

BY CATHERINE LEWIS DUKE HEALTH CLINICAL PRACTICE TODAY

Alessandro Iannaccone, MD, MS

istorically, the only treatments available for inherited retinal diseases (IRDs) were approaches that slowed rather than reversed disease progression. In late 2017, however, the FDA approved voretigene neparvovec—the first gene therapy approved in the United States for the treatment of a genetic disease—paving the way for a new era of IRD treatments.

One of the primary obstacles to developing IRD treatments has been the lack of understanding of the genetic etiology of these conditions and the kinetics of disease progression specific to each gene, says Alessandro Iannaccone, MD, MS, director of Duke’s Center for Retinal Degenerations and Ophthalmic Genetic Diseases. Now that researchers have identified the causes for most IRDs and are starting to understand the kinetics and molecular mechanisms of some IRDs, more targeted approaches to treatment are being developed and tested. “Years of laboratory work and convincing proof of principle studies have shown that gene therapy is an option for these disorders,” Iannaccone says. “It’s exciting that now we’re at the implementation phase for a number of these therapies,” said Iannaccone. Duke is involved in several new trials:



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afety and efficacy of rAAV-hRS1 in S patients with X-linked retinoschisis. This phase 1/2, multicenter clinical trial is evaluating the safety and efficacy of intravitreal injection of an adenovirusassociated virus (AAV) vector expressing

retinoschisin. Enrollment is complete for adults and is being completed for pediatric patients, and collection of one-year data is planned for between April and May 2019. A phase 2b/3 trial is anticipated.



Safety and efficacy of rAAV2tYF-GRK1RPGR in subjects with X-linked retinitis pigmentosa caused by RPGR-ORF15 mutations. This multicenter, phase 1/2, dose escalation study will assess the safety and efficacy of subretinal injections of an AAV vector expressing RPGR in patients with a mutation in open reading frame 15 (ORF15).

ST-001 phase 1/2 trial for advanced R retinitis pigmentosa. This multicenter dose escalation study is assessing the safety and efficacy of intravitreal injection of RST-001, which uses channelrhodopsin to confer light sensitivity to retinal ganglion cells—an approach that combines gene therapy with optogenetics.

These trials are just the beginning, Iannaccone says. Given the heterogeneity of IRDs—more than 300 genes are involved—many more treatments are needed. He anticipates that approval of the first few therapies will lead more companies to fund research and develop treatments, enabling clinicians to deliver treatments to a wider range of patients. In the meantime, Iannaccone says, researchers will continue to study treatments that aren’t gene specific. “The new therapies are extremely exciting,” he notes. “But not everyone is going to be immediately treatable with these genespecific approaches, so, at the same time, we still need to be looking for ways to provide acrossthe-board benefit and slow down progression while we wait for these other treatments.” To learn more about the trials, please contact Amy Clark, PhD, clinical research coordinator at the Duke Eye Center, at 919.684.8798 or amy.clark@duke.edu.

Duke Pediatric Eye Imaging Suite

Transforming Eye Care for Children

ith bright, cheerful art on the walls, and a location right inside Duke Eye Centerâ&#x20AC;&#x2122;s Pediatric Clinic, the new Duke Pediatric Eye Imaging Suite was clearly created with the Duke Eye Centerâ&#x20AC;&#x2122;s youngest patients in mind. Along with child-friendly ambience, this new facility offers children access to the same cutting-edge imaging technologies available to adult patients and new childspecific imaging equipment. >

The Pediatric Eye Imaging Suite was designed to accommodate all pediatric patients requiring eye imaging while at Duke Eye Center, and is the official clinical home of the Duke Pediatric Retina and Optic Nerve Center (DPROC), one of few centers across in the US to treat pediatric patients with complex retinal and optic nerve diseases. The new suite and DPROC resulted from the commitment and vision of four faculty at Duke Eye Center—Cynthia Toth, MD; Sharon Freedman, MD; Lejla Vajzovic, MD and Mays El-Dairi, MD—along with the collaboration of the entire Pediatric Ophthalmology Division at Duke. Previously, children who required eye imaging had to navigate across Duke Eye Center’s large multidisciplinary pavilion to an area that also served adult patients. The new Pediatric Eye Imaging Suite offers convenience for families and a special place just for kids so they may feel more comfortable in a clinical setting. From the pediatric waiting room and play area, children can be called directly into the suite, have their eyes imaged in a kidfriendly environment, and then go right back to see their eye doctor. “Eye imaging is so critical to patient care, that this is like a dream come true to have it situated right in the pediatric clinic,” says Freedman, professor of ophthalmology and pediatrics, and chief of pediatric ophthalmology.

This eye imaging suite is a significant addition to the pediatric clinic because it provides state-of-the-art patient care through the addition of new eye imaging equipment designed specifically for infants and children. These new tools, such as optical coherence tomography (OCT) will strengthen our already robust program for management of pediatric eye disorders. Toth, Joseph A.C. Wadsworth Professor of Ophthalmology and professor of biomedical engineering, was the first ophthalmologist to take optical coherence tomography (OCT) imaging into the intensive care nursery. She works with engineers to develop imaging devices that will improve eye care for infants and children. “Our multi-disciplinary team here at Duke has unique expertise and technical skills,” she says. “Prior to enhancing our OCT technology to accommodate young children, it was only used for adult eye imaging. We knew that we were missing out on critical in-depth information that would help diagnose and manage our pediatric patients. By identifying problems earlier, we can potentially help infants to have healthier eyes later in life. I am proud of our achievements in this area and look forward to future research that will improve the eye care of young children,” said Toth. “The Duke Pediatric Eye Imaging Suite is one floor up from our pediatric retinal research center,” say Vajzovic and El Dairi. “Through the support of volunteer research participants, we can learn more about healthy eye development and diseases in children. The research volunteers are vital to advancing the science and care of children’s eyes here at Duke Eye Center and around the world.” Having the Duke Pediatric Eye Imaging Suite and DPROC’s new clinical home right in the Duke Eye Center’s Pediatric Clinic, affords us the opportunity to expand research capability with ongoing funding from philanthropic gifts as well as grant funding sources.

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The Duke Pediatric Eye Imaging Suite is the epicenter for pediatric eye care and research that will transform patient care for years to come.

Thank you to Our Donors The passion exuded by Duke Eye Center clinicianscientists to better diagnose and manage young children with eye diseases has extended to individuals and groups with a special interest in helping advance diagnosis and treatment of pediatric ophthalmic diseases. We appreciate the generous support of the Smale family that allowed the establishment of the Pediatric Eye Imaging Registry. The DPROC was made possible in part by generous support from Mr. James Andrew. Duke research that led to the DPROC achievements was supported by The Hartwell Foundation, The National Institutes of Health, The Retinal Research Foundation, Knights Templar, and Research to Prevent Blindness. Opposite page: Dr. Toth helps position a pediatric patient for OCT imaging. Top: Ribbon cutting ceremony held June 21, 2018 for the new Pediatric Eye Imaging Suite. Bottom: Members of the Duke Pediatric Retina and Optic Nerve (DPROC) team and imager Du Tran-Viet working with a patient to get an eye image.

Employees

370

Plastics

8,283

health staff

clinical physicians

23 ophthalmology fellows

19 17 residents research scientists

Neuro

4,558 Low Vision/ Vision Rehab

Pediatric

19,098

1,686

Glaucoma

50,340 10 Locations 1

DUKE EYE CENTER

2019

2 3 4 5 6 7 8 9 10

Main Duke Eye Center Duke Medical Center Campus Page Road South Durham North Durham Cary Raleigh Winston-Salem Aesthetic Center Danville, Virginia (Retina) Fayetteville (Retina)

Duke Eye 2018

Ranking

Patients Total: 196,616 Comprehensive

37,134

US News & World Report Best Hospitals in Ophthalmology

Surgeries

14,664 Retina

39,470 Total NIH Grants

Cornea

36,047

awarded in 2018

e Center Stats

NIH Funding Ranking

Award Funding $8,669,705 Federal

$6,979,820 Non-Federal

Source: Blue Ridge Institute for Medical Research

Total: $15,649,525

When They Simply Can’t Sit Still Duke Team Adapts Newest Retinal Imaging Technology to Address the Unique Needs of Infants and Children

O 20

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ptical coherence tomography angiography (OCT-A) is an exciting new technology that allows ophthalmologists to capture more detailed images of the back of the eye than ever before. OCT-A takes the traditional OCT technology, which has been used for decades, and speeds it up to the point where we can actually map and measure blood flow through the vasculature in the retina and view the images from different angles and layers. One of the major challenges with OCT-A, like most other forms of imaging, is that the patient must sit still for at least a minute. That’s fine for adult patients or older adolescents, notes Duke adult and pediatric vitreoretinal surgeon Lejla Vajzovic, MD, “but you can’t ask a three-year-old or an infant to put her head in a chin rest and stay still!”

Vajzovic and her colleagues, Cynthia Toth,MD; Xi Chen, MD; Sharon Freedman, MD; and Mays El-Dairi, MD at the Duke Pediatric Retina and Optic Nerve Center (DPROC) and Duke Medical School student S. Tammy Hsu, BA are looking for ways to use this valuable technology with children who are too young to sit still. DPROC is partnering with

Heidelberg Engineering to test a portable device with an armature that can be swung over the patient to take OCT-A images while the child is already under anesthesia for an exam or procedure. Through this clinical research, which is being conducted under an IRB-approved protocol, Duke Eye Center will help optimize the technology so it can be submitted for FDA approval. The DPROC team is the first to publish on use of OCT-A in newborns and young children. They have already published a series of journal articles to explain to peers how to use the OCT-A technology with young patients and for various diseases.“ Another advantage of OCT-A, particularly in young children, is that it is noninvasive,” Vajzovic explains. “Fluorescein angiography, which has been used for decades to capture images of the blood vessels

Lejla Vajzovic, MD

in the back of the eye, requires injecting a dye into the patient’s body, so you have a needle stick and a small risk of serious anaphylactic reaction to the dye.

“You can’t ask a three-year-old or an infant to put her head in a chin rest and stay still!“ “With OCT-A, we can eliminate the needle stick and the risk of anaphylactic reaction,” she says. “And eventually, as we develop this technology, we’ll hopefully be able to use it with kids in the clinic, eliminating the need to anesthetize children, which carries its own risks. That would be a huge step forward in the care of our youngest patients.”

S. Tammy Hsu, BA

See page 28 for an update on how OCT-A may be used to detect early Alzheimerâ&#x20AC;&#x2122;s Disease

OCT-A images of the superficial vascular complex (SVC) and deep vascular complex (DVC).

Child being examined under anesthesia to capture OCT-A images of the macula.

Ophthalmologists Coordinate Care to Preserve Infant’s Vision BY CATHERINE LEWIS DUKE HEALTH CLINICAL PRACTICE TODAY

I 22

mmediately after a baby was born, her care team noticed enlargement and clouding of her corneas. An ophthalmologist and glaucoma specialist in her home state of New York recognized the signs of congenital glaucoma. Having little experience working with pediatric glaucoma, they consulted with Duke pediatric glaucoma specialist Sharon Freedman, MD. Freedman confirmed the diagnosis, and the patient was referred to the Duke Eye Center.

The patient had one of the most severe cases of congenital glaucoma Freedman had ever seen. “It’s not common to see this condition in a newborn,” she says. “The cornea was so big you couldn’t see any sclera, and the corneas were so cloudy you couldn’t see the iris.” Freedman knew she needed to perform surgery as soon as possible to reduce the risk that the infant’s cloudy corneas would prevent her from learning to see. However, as Freedman warned the family, her first choice surgery to open the trabecular meshwork and Schlemm Canal— trabeculotomy—might not work because of the severity of the glaucoma. In that case, she would implant an artificial drainage device. DUKE EYE CENTER

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As Freedman had anticipated, her attempt at illuminated microcatheter–facilitated

360-degree trabeculotomy in the left eye was unsuccessful; she could find the Schlemm canal but was unable to cannulate fully, she suspects either because the canal was malformed or because the anatomy of the drainage angle was abnormal. Rather than trying trabeculotomy in the right eye, Freedman implanted a valved glaucoma drainage device (GDD). The challenge with using these devices, she says, is that in congenital glaucoma, the eye stretches nonuniformly, but GDDs are available in only pediatric or adult sizes. This patient’s corneal diameter was extremely large for a newborn at 13 mm, but the axial length of her eyes was ~20 mm, only mildly enlarged comparatively. Whereas a pediatric-sized implant would

Duke pediatric glaucoma specialist Sharon Freedman, MD knew she needed to perform surgery as soon as possible to reduce the risk that the infant’s cloudy corneas would prevent her from learning to see.

likely be too small for long-term pressure reduction, an adultsized GDD would risk contact with the optic nerve. To address this problem, Freedman and her former trainee developed a formula based on theoretical and confirmatory studies in pediatric autopsy eyes to guide placement of an adult GDD for pediatric or short eyes to avoid contact between the optic nerve and the posterior edge of the GDD (Published here: https:// www.jaapos.org/article/S10918531(17)30023-X/pdf). For this patient, in addition to trimming approximately 5 mm off the GDD plate, Freedman placed the implant in the inferior nasal quadrant, leaving the more spacious superior temporal quadrant for later implantation of a larger GDD once the eye had grown if/when the initial GDD was unable to control pressure.

well positioned and functioning adequately. Because the patient has multiple Haab striae in both The next day, the patient was corneas due to her glaucoma, doing well, so the family went home. For the next several weeks, her vision will be permanently affected, Freedman says, she had follow-up visits with stressing the importance of her glaucoma specialist in New consistent follow-up with the York. The right eye, which had received the GDD, recovered well. patient’s local ophthalmologist and glaucoma specialist to ensure There was marked clearing of the adequate pressure control. cornea and noticeably less eye However, her optic nerves appear bulging. quite healthy at this point and Not unexpectedly, the left eye still her corneas are much clearer, had high pressure, so the patient so she anticipates the patient’s returned to Duke for a GDD to corrected vision could reach be placed. During the procedure, 20/80 or better. Freedman also examined the One month after the second right eye, determining that the surgery, the baby’s vision is axial length had decreased by beginning to develop. “She has 2 mm. Ultrasound confirmed a social smile now,” Freedman that the fluid-filled capsule reports. “It’s like she’s a different surrounding the inferior nasal child.” GDD was still approximately 3 mm from the optic nerve. The patient will return to Duke in three months, so Freedman can make sure her eyes are doing well and that the GDDs are

One month after the second surgery, the baby’s vision is beginning to develop. “She has a social smile now,” Freedman reports. “It’s like she’s a different child.”

Sharon Freedman, MD

New Glaucoma Treatments

New FDA-approved Drugs Provide More Options for Glaucoma Patients BY LAURA ERTEL

n 2018, two new glaucoma medications approved by the U.S. Food and Drug Administration (FDA) came to market: Rhopressa® and Vyzulta™. The two are different classes of medicines, so they work in different ways to lower elevated eye pressure in patients with glaucoma.

Vyzulta (latanoprostene bunod) is similar to the most commonly prescribed, first-line glaucoma therapies: a category of medicines called prostaglandin analogs, which includes latanoprost (Xalatan), travoprost (Travatan), bimatoprost (Lumigan), tafluprost (Zioptan). By adding a nitric oxide donor to the prostaglandin analog, Vyzulta can increase the outflow of aqueous fluid from the eye and reduce intraocular pressure a bit more than the prostaglandin analogs by themselves.

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Rhopressa (netarsudil), a drug that was developed based on research conducted at Duke Ophthalmology, is an entirely new class of medicine. As reported in the 2018 issue of VISION Rhopressa was the first new glaucoma drug class to be FDA-approved in 20 years, and the first to target and inhibit Rho kinase as a way to lower intraocular pressure, primarily by increasing aqueous humor outflow through the eye’s trabecular meshwork. It offers a new option for patients who have not yet achieved desired outcomes with traditional glaucoma medications. “One of the big benefits of both Vyzulta and Rhopressa is that they are once-a-day eyedrops

(unlike other glaucoma medications, which may require multiple drops per day), making it much easier for patients to adhere to a daily treatment regimen,” Gupta notes. Aerie Pharmaceuticals, the Duke spin-off that brought Rhopressa to market, has submitted a new drug application to the FDA for Roclatan, a new medicine that combines netarsudil and latanoprost into a single ophthalmic solution to offer two different pathways to lower eye pressure. Once it is FDA-approved, Roclatan will enable patients, and the doctors who treat them, to get the benefits of two effective medications together in a once-a-day eyedrop. Because glaucoma is a disease without a cure, therapies are aimed at trying to slow down progression of the disease using medications, laser procedures, and surgery, Gupta explains. “We also continue to improve laser and surgical treatment for glaucoma, but these new medications give us another option to offer patients to try to control the disease with eyedrops and avoid surgery for as long as possible. We have seen positive effects using Vyzulta and Rhopressa with patients at Duke who were able to get their eye pressure down to a level that they weren’t able to with other medications. It’s very exciting to have these new options to offer our patients at the Eye Center.”

National Eye Institute, National Institutes of Health

THERE’S A LOT OF EXCITEMENT RIGHT NOW IN GLAUCOMA TREATMENT, SAYS DUKE GLAUCOMA SPECIALIST DIVAKAR GUPTA, MD. “THIS IS THE FIRST TIME IN 20 YEARS THAT WE’VE HAD A NEW GLAUCOMA TREATMENT TO OFFER PATIENTS, AND WE ACTUALLY HAVE NOT ONE, BUT TWO.”

Aqueous humor flows out of the anterior chamber via the trabecular and uveoscleral pathways.

New Faculty Jiaxi Ding, MD

Dr. Ding joined Duke Ophthalmology Glaucoma Division as Assistant Professor in October 2018. She came to Duke from private practice in Greensboro, NC. Ding Glaucoma

Dr. Ding completed her Ophthalmology residencey at State University of New York at Buffalo and her Glaucoma fellowship at University of Iowa Hospitals and Clinics. Dr. Ding’s range of Glaucoma services encompasses diagnosis and full spectrum treatment of Glaucoma, including lasers and traditional glaucoma surgeries (filtering and glaucoma drainage implants) as well as many types of newer Minimally Invasive Glaucoma Surgery (MIGS). Dr. Ding also offers cataract surgery with advanced technology, including toric and multifocal intraocular lenses, femtosecond laser, and ORA system. Dr. Ding chose the specialty of Glaucoma within Ophthalmology because she is dedicated to lifelong care of patients with this chronic and potentially blinding disease. She also believes in contributing to her profession by actively participating with the American Glaucoma Society, American Academy of Ophthalmology, and on the Editorial Board for Young Ophthalmology’s newsletter. Faramarz Hidaji, MD

Dr. Hidaji joined Duke Eye Center in November 2017. He is a fellowshiptrained, boardcertified pediatric ophthalmologist treating patients with strabismus, pediatric lacrimal disease, Hidaji ptosis, retinopathy of Oculofacial prematurity (ROP) and Plastics, pediatric cataracts. Pediatrics He also sees patients requiring oculofacial plastic surgery for upper and lower blepharosplasty, brow lift, ptosis repair, tumor removal and eyelid reconstruction. Dr. Hidaji is a diplomate of the American Board of Integrative Holistic Medicine. He is passionate about fighting blindness around the world and has spent time abroad volunteering for

Healing the Children NJ, Project Orbis and World Cataract Foundation. He has lectured and authored several book chapters on nutrition, strabismus and practice management. Dr. Hidaji joins Duke after serving for 17 years as the Medical Director at Visionary Eye Care, P.C. in Memphis, TN. Landon C. Meekins, MD

Dr. Meekins joined Duke Ophthalmology in July 2018 after completing his neuroophthalmology fellowship at Duke. He is a true Duke alumnus having completed Meekins medical school, Neuroophthalmology residency and his neuro-ophthalmology fellowship at Duke. He specializes in the diagnosis and treatment a variety of optic nerve, cranial nerve, orbital and brain disorders. He also provides general eye care, managing common eye conditions such as glaucoma, diabetes, macular degeneration, cataracts, and dry eye. In addition to performing procedures more specific to the subspecialty of neuro-ophthalmology including optic nerve sheath fenestration surgery and botulinum toxin injection for blepharospasm, Dr. Meekins performs cataract surgery and other general ocular procedures. “I believe every physician-patient relationship is unique, and that what we do as physicians is a truly awesome privilege. Working for others at a stateof-the-art place like Duke Eye Center is truly humbling and I am grateful to be a part of it.” Amanda Steele, OD

Dr. Steele joined Duke Ophthalmology in November 2018 as an Assistant Consulting Professor of Ophthalmology. She works collaboratively with our cornea providers by Steele providing compreCornea hensive eye exams, co-management of preand post-operative visits for corneal, cataract and refractive surgeries, as well as treatment of dry eye disease.

Dr. Steele joins us from MyEyeDr (formerly Eye Care Associates) where she focused on comprehensive eye care and anterior segment disease. Dr. Steele is a 1996 graduate of Meredith College in Raleigh, NC and a 2000 graduate of Southern College of Optometry in Memphis, TN. Dr. Steele completed a fellowship in refractive surgery co-management in Orlando, FL. Federico G. Velez, MD

Dr. Velez joined Duke Ophthalmology as Associate Professor in June 2018 from Jules Stein Eye Institute, UCLA.

He is an internationally known pediatric Velez ophthalmologist and eye muscle surgeon. Pediatrics He has developed several successful clinical research and innovative surgical techniques to treat complex forms of strabismus.

His clinical and research interests includes complex strabismus and pediatric lens disorders. He received grant support to develop an innovative technique to treat paralyzed muscles using closed looped integrated stimulation. He has recently published innovative results on ocular coherence tomography angiography in patients at risk for anterior segment ischemia, and pediatric patients with amblyopia and prematurity. He was awarded a grant to investigate strabismus in patients with acquired immune deficiency syndrome. His second research front is pediatric lens disorders, evaluating the safety and effectiveness of medications used during pediatric cataract surgery.

Dr. Velez holds several leadership positions on national and international societies and peer-reviewed journal editorial boards. He has been invited nationally and internationally to deliver more than 400 presentations, including national and international named, visitor scholar and keynote lectures. He is very active teaching medical students, ophthalmology residents, fellows and practicing physicians. In 2010 he was awarded the Best Teaching Award at the Jules Stein Eye Institute at UCLA.

Duke Eye Center News and Notes 2019

Ned Amendola, MD; Terry Kim, MD; Chris Pollard; David Cutcliffe; Latoya Lunsford; John Scheyer; Diane Whitaker, OD; Greg Appelbaum, PhD; Kelsey Rankin; and Omar Mohiuddin, MS, OTR/L, MPH gather during the kick off celebration.

OFFICIAL KICK OFF HELD FOR DUKE SPORTS VISION CENTER

n Thursday September 6, 2018, we officially celebrated the Duke Sports Vision Center (DSVC) with a tailgate themed kickoff event. Joining us as special guests to commemorate the first multidisciplinary sports institution in the nation were Duke head football coach David Cutcliffe, head baseball coach Chris Pollard, assistant basketball coach Jon Scheyer and James R. Urbaniak, MD, Sports Sciences Institute Director Ned Amendola, MD.

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The DSVC incorporates the latest technologies and research to help optimize the visual and athletic performance of our patients and is a combined venture between Duke Eye Center and the Department of Psychiatry and Behavioral Sciences. It is part of the James R. Urbaniak, MD, Sports Sciences Institute (DSSI), the largest and most robust sports sciences institute in academic medicine. With top-notch facilities and technology, the backing of the celebrated DSSI, and a worldclass team at the helm, the DSVC is unlike any other sports vision center in the world.

Below: Guest experiences sports vision training equipment.

DUKE OPHTHALMOLOGY ESTABLISHES A PEDIATRIC OPTOMETRY RESIDENCY PROGRAM

e are pleased to announce that a new pediatric optometry residency program has been established at Duke Ophthalmology and will begin with our inaugural student in August 2019. The program will be led by Nathan Cheung, OD.

DUKE OPHTHALMIC TECHNICIAN PROGRAM EXPANDS

he Duke Ophthalmic Technician Program, an affordable, accelerated certificate program offered through the Duke University School of Medicine, has expanded and is now offering two 51-week sessions each year. More than 90% of our graduates have found an Ophthalmic Technician position within one month of graduation, many committing to positions prior to graduation. For more information about the Duke Ophthalmic Technician Program and the application requirements, visit dukeeyecenter. duke.edu/optech.

Our program offers a multi-specialty, high volume, progressive learning environment involving pediatric care. Residents will become proficient in all aspects of pediatric optometry including primary care, contact lens, binocular vision and diagnosis and medical treatment of ocular pathology. Due to the nature of the setting of this residency, training includes working with pediatric ophthalmologists, pediatric retina specialists, and pediatric neuroophthalmologists. The program is affiliated with Southern College of Optometry in Memphis, TN. “This is one of few optometry residency programs in the country that offers training conducted entirely in an academic medical center setting. We are excited to launch this program to train optometrists on how to create a seamless collaboration with ophthalmologists and provide optimal primary care for our pediatric patients,” said Sharon F. Freedman, MD faculty mentor for the program.

$ Duke Eye Center Total Award Funding Received in 2018:

$15,649,525

Nathan Cheung, OD

Sharon F. Freedman, MD

Duke Eye Center News and Notes 2019

DECEMBER 2018 - ISSUE 18

Cover Story Inspirational Korean Healthcare Leader

Terry Kim, MD, Vice President and President-Elect, American Society of Cataract and Refractive Surgery (ASCRS)

Special Report

New York Health Forum at a Glance

Biopharmaceutical Report Aldeyra’s Reproxalap has Experts Mixed on Seasonal Allergic Conjunctivitis Focus in Phase III Aclaris’ Phase II Results for ATI-502 and ATI- 501 in Alopecia May Lack Cosmetic Significance

Inspirational Korean Healthcare Leader Terry Kim, MD, chief of cornea, external disease and director of refractive surgery was on the cover of the December 2018 issue of World Korean Medical Journal. Kim is also vice president and presidentelect of the American Society of Cataract and Refractive Surgery (ASCRS). The story explores Kim’s motivation to select ophthalmology and love for the specialty, his passion for mentorship, contributions to research, and his increasing responsibilities for ASCRS. This award recognizes his significant and impactful contributions to innovative methods for diagnosing glaucoma and detecting its progression.

Duke Eye Center Ranking in NIH Funding to Medical Schools in 2018:

DUKE EYE CENTER

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Dr. Grewal and Dr. Fekrat by their poster at the Annual Meeting of the AAO 2018

OCT-A MAY DETECT ALZHEIMER’S DISEASE

esults presented at the 122nd Annual Meeting of the American Academy of Ophthalmology (AAO) suggest that optical coherence tomography angiography (OCT-A) can distinguish between people with Alzheimer’s, those with mild cognitive impairment, and those who are cognitively normal. OCT-A has assisted much of the recent research on the eye’s connection with Alzheimer’s. The Duke researchers show that the small blood vessels in the retina at the back of the eye seen on OCT-A are altered in patients with Alzheimer’s. Current techniques to diagnose Alzheimer’s such as a brain scan or lumbar puncture (spinal tap) are costly and invasive, unlike the inexpensive and non-invasive OCT-A, and are also not as easy to obtain. Lead investigators Sharon Fekrat, MD, professor of ophthalmology and Dilraj Grewal, MD, associate professor of ophthalmology, along with their research team expect that their work will ultimately have a positive and far-reaching impact on patients and their families. “We are currently studying patients who have the gene for Alzheimer’s but no symptoms and comparing OCT-A has assisted them to those without the Alzheimer’s gene. We hope that this much of the recent will show that OCT-A can diagnose research on the Alzheimer’s before symptoms eye’s connection develop.”

with Alzheimer’s. “This project meets a huge unmet need,” Fekrat said. “Almost everyone has a family member or extended family affected by Alzheimer’s or another kind of dementia. If we can detect the disease earlier and more easily, then we can study new treatments earlier when they may be more effective.”

Sina Farsiu, PhD

Joseph Izatt, PhD

DUKE MEDX-CHDI PILOT GRANT AWARDED

uke MEDx and the Children’s Health and Discovery Initiative (CHDI) have awarded the 2018 MEDx-CHDI pilot grant to Sina Farsiu, PhD, associate professor of ophthalmology and biomedical engineering and Michael J. Fitzpatrick Professor of Engineering Joseph Izatt, PhD, also a professor of ophthalmology for their proposal “Handheld Adaptive Optics Optical Coherence Tomography for Imaging Individual Photoreceptors in Young Children.” The goal of the proposed project is to develop a hand-held adaptive optics optical coherence tomography imaging system, which will allow for in vivo cone photoreceptor imaging in neonates and young children. Such technology will allow for studies of retinal development and microanatomy, mechanisms of injury and recovery, and help to understand the link between neural and ocular development.

Cynthia Toth, MD delivering the 2018 Club Jules Gonin Wacker Prize lecture.

W. Daniel Stamer, PhD

A NEW OCT TECHNOLOGY ENABLES ASSESSING DISEASE STATUS IN GLAUCOMA

laucoma is the leading cause of irreversible blindness worldwide. The primary and only modifiable risk factor for the development of glaucoma is elevated intraocular pressure (IOP), and lowering IOP effectively slows glaucomatous disease progression. Unfortunately, the majority of available treatments do not target, or intentionally bypass, the diseased and stiffened glaucomatous outflow tissues responsible for IOP elevation. Newly published research in Proceedings of the National Academy of Sciences from Duke researchers “We are excited suggest that detection of about how the use outflow tissue stiffness using noncontact, noninvasive optical of common OCT coherence tomography, in an imaging could help animal model of glaucoma, represents a valuable tool for better manage assessing disease status and tissue function. Thus, this new patients with technology has the potential glaucoma.” to monitor recently approved treatments targeting the W. Daniel Stamer, PhD outflow tissues, and to inform Professor of Ophthalmology glaucoma surgery decisions. President-elect of ARVO “We are excited about our new technological breakthrough that propels the understanding outflow tissue functional status and how the use of common OCT imaging could help better manage patients with glaucoma,” said Joseph A.C. Wadsworth Professor of Ophthalmology W. Daniel Stamer, PhD, also professor of biomedical engineering, president-elect of ARVO and corresponding author on the study.

Honors and Awards Vadim Arshavsky, PhD received an NIH/National Eye Institute award for a project, “Molecular Mechanisms of Photreceptorouter Segment Morphogenesis.” He also received a supplemental award from the NIH/National Eye Institute for a project, entitled “Center Core Grant for Vision Research – Mass Spectrometry Supplement.”

Catherine Bowes Rickman, PhD is the 2019 recipient of an Edward N. & Della L. Thome Memorial Foundation Award in Age-Related Macular Degeneration Research for a project, “HDL: a Therapeutic Target for Age-related Macular Degeneration.” In addition, she received an award from Applied Genetic Technology Corporation. Edward Buckley, MD was invited to deliver the George Ellis Lecture at Louisiana State University and the Arthur Bedell Lecture at Will’s Eye Hospital. He was invited to deliver the Kushner Medal Lecture, which will be part of the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) webinar series. Xi Chen, MD, PhD received an award from Research to Prevent Blindness Career Development Award for a project, “Visualizing Retinal Vascular Development and Pathology in Infants.”

DUKE EYE CENTER

2019

Felipe Medeiros, MD, PhD with 2017-2018 ARVO President Claude F. Burgoyne, MD, FARVO accepting the Cogan Award.

Melissa Daluvoy, MD received an award from Cambium for a project, “A Randomized Multicenter Double-Masked Placebo-Controlled Parallel Phase I/II Study to Determine the Safety and Exploratory Efficacy of Topical Fibrinogen-Depleted Human Platelet Lysate in Subjects with Dry Eye Secondary to Graft vs. Host Disease.” Sina Farsiu, PhD received a 2018 Google Faculty Research Award.

Sharon Fekrat, MD received the Senior Honor Award from the American Society of Retina Surgeons (ASRS) in 2018. She is chief editor of Curbside Consultation

in Retina: 49 Clinical Questions, 2nd edition by SLACK; Duke Eye Center’s ALL ABOUT YOUR EYES, 2nd edition, Duke University Press and The Duke Manual of Vitreoretinal Surgery, WoltersKluwer publishers. She was awarded the Golden Globe Award by the resident class of 2018. She has been on the Editorial Board of the American Journal of Ophthalmology (AJO) for over 15 years and has recently been appointed Executive Editor. Sid Gospe, MD, PhD received an award from the National Eye Institute for a project, entitled “In Vivo Modeling of Mitochondrial Complex I Deficiency in Retinal Ganglion Cells.” He was selected to receive a Duke Strong Start New Physician-Scientist Award, designed to support outstanding lab-based clinician-scientists.

DUKE EYE CENTER 2019 CONTINUING EDUCATION CE EVENTS Controversies in Cornea and Cataract Surgery February 9, 2019 Fellows Advanced Vitreous Surgery Course (fAVS) April 11, 2019 Advanced Vitreous Surgery Course (AVS) April 12–13, 2019 Trainee Day Scientific Sessions and Grand Rounds June 7–8, 2019 Glaucoma Fellows Course October 11, 2019 to coincide with AAO Glaucoma Symposium September 21, 2019 Grand Rounds— now streamed live— dukeeyecenter.duke.edu/ grandrounds February 28, 2019 March 14, 2019 April 23, 2019 May 14, 2019

LECTURES Visiting Science Professor February 21, 2019 Artur Cideciyan, PhD Scheie Eye Institute

Visiting Science Professor October 24, 2019 Kang Zhang, PhD Institute for Engineering in Medicine

Visiting Science Professor November 21, 2019 James Bryan Hurley, PhD University of Washington, Seattle, WA

Joseph M. Bryan Research Lecture November 7, 2019 Robin Ali, PhD Kellogg Eye Center

Gordon K. Klintworth Memorial Lecture March 28, 2019 Jim Handa, MD Wilmer Eye Institute Visiting Science Professor May 10, 2019 Robert Nickell, PhD University of Wisconsin, Madison The Stephen and Frances Foster Distinguished Lecture October 22, 2019 Victor Perez, MD Duke Eye Center

Complimentary CME available

Contact Info:

For more information about Duke CME Events visit dukeeyecenter.duke.edu/cme

DukeEyeEvents@duke.edu 919.684.6593

Honors and Awards Dilraj Grewal, MD received the Senior Honor Award from the American Society of Retina Specialists (ASRS). He is the co-editor of Curbside Consultation in Retina: 49 Clinical Questions, 2nd edition. Divakar Gupta, MD received an award from American Glaucoma Society for a project, entitled “Data Science and Minimally Invasive Glaucoma Surgery.”

Preeya Gupta, MD received the award of excellence at the Indian Intraocular Implant and Refractive Surgery Society in Chennai in July 2018. Leon Herndon, MD has been named the 2019 American Glaucoma Society (AGS) Annual Meeting Surgery Day Lecturer and has been elected secretary of AGS effective 2020. He served as the program co-chair for the NC Society of Eye Physicians and Surgeons. Alessandro Iannaccone, MD, MS, FARVO received an award from Allergan Inc. for a project, entitled ”Phase I/ IIa, Open-Label, Dose-Escalation Study of Safety and Tolerability of Intravitreal RST-001 in Patients with Advanced Retinitis Pigmentosa.”

DUKE EYE CENTER

2018 2019

Glenn Jaffe, MD received an award from Thrombogenics Core Laboratory for a project, “Thrombogenics DRC Phase

2018 Faculty Promotions Catherine Bowes Rickman, PhD Professor of Ophthalmology with Tenure S. Grace Prakalapakorn, MD Associate Professor of Ophthalmology Mays El-Dairi, MD Associate Professor of Ophthalmology Goldis Malek, PhD Associate Professor of Ophthalmology with Tenure Sydney Gospe, MD Assistant Professor of Ophthalmology Anthony Kuo, MD Associate Professor of Ophthalmology with Tenure

1 THR-687 DME study.” He received an award from Novartis Pharmaceuticals Corporation for a project, “Phase 3a nAMD study.” Terry Kim, MD will be serving as vice president of the American Society of Cataract and Refractive Surgery (ASCRS) and will be president elect in 2020. He was invited to give the Gavin Herbert Lecture at the University of California-Irvine as well as the Asian Memorial Lecture in Seoul, Korea. He was featured as the cover story for the World Korean Medical Journal in the December 2018 issue. Goldis Malek, PhD was appointed to serve on the Diseases and Pathophysiology of the Visual System Study Section at the Center for Scientific Review, National Institutes of Health (NIH). She earned tenure as of May 1, 2018. She received an award from the National Institutes of Health for a project, “Regulation of Inflammation and Lipid Homeostasis by the Aryl Hydrocarbon Receptor in Age-related Macular Degeneration.” She received

an award from the National Eye Institute for a project, “Novel Signaling Pathways Regulated by the Liver X Receptor in Age-related Macular Degeneration.” Miguel Materin, MD will serve as President of the Pan-American Ocular Oncology Society. Felipe Medeiros, MD, PhD received the Cogan Award from the Association of Research in Vision and Ophthalmology (ARVO). He received an R01 from the National Institute of Health for a project, “The BCI (Brain Computer Interface) Glaucoma Study: Objective Home-Based Detection of Progressive Visual Function Loss in Glaucoma.” He was the recipient of the Hilton Rocha Medal, Sao Geraldo Hospital, Brazil. He serves as Program Chair of the American Glaucoma Society (AGS) with his term ending 2020. He was guest of Honor at the Japanese Glaucoma Society, Russian Glaucoma Society, Greek

Ophthalmological Society. He was Visiting Professor at the University of California San Francisco. Victor Perez, MD received an award from NIH/National Eye Institute for a project, “Immune Mechanisms in Ocular Graft versus Host Disease.” He received an award from KeraMed Inc. for a project, entitled “The Safety and Performance of the KeraKlear Non-Penetrating Keratoprosthesis.” He received a sub award from Massachusetts Eye and Ear Infirmary & Physicians for a project, “Vision Restoration with a Collagen Crosslinked Boston Keratoprosthesis unit study.” Grace Prakalapakorn, MD was promoted to Associate Professor of Ophthalmology and Pediatrics. Jullia Rosdahl, MD, PhD accepted the position of Director of Medical Student Education for Duke Ophthalmology. W. Daniel Stamer, PhD will become the next president of the Association of Research in Vision and Ophthalmology. He received an award from Allergan Research for a project, “Testing Effect of Sustained Release vs. Cyclic Exposure of Bimatoprost on MMP/TIMP/ECM Expression by Outflow Cells.” Cynthia Toth, MD received the Wacker Prize at the 2018 Jules Gonin Club meeting. She also delivered the 2018 Paul Henkind Memorial Lecture at the Macula Society. She received an award from the National Institutes of Health (NIH)

for a project, entitled “Bedside Optical Retinal Assessment of Hypoxic Ischemic Encephalopathy in Infants.” She received an award from the Emmes Corporation for a project, entitled ”AREDS2 10-Year Follow-On.” Henry Tseng, MD received an award from the Cure Glaucoma Foundation for a project, ”Neurodegenerative biomarkers in primary open angle glaucoma.” Vasantha Rao, PhD received an award from NIH/National Eye Institute for a project, “The Role of GDF-15 in Aqueous Humor Outflow and Glaucoma”. Lejla Vajzovic, MD received the AAO Achievement Award and the Senior Honor Award from ASRS. She was also elected a member of the Jules Gonin Club. Federico Velez, MD received the AAO Achievement Award.

Molly Walsh, MD received the AAO Secretariat Award.

2018–2019 RESIDENTS Tanya Glasser, MD Chief Resident

Third-Year Residents Henry Feng, MD Sanja Galeb, MD Jennifer Lira, MD Samuel Passi, MD Adam Rothman, MD Daniel Vu, MD

Second-Year Residents

Faith Birnbaum, MD Mark Goerlitz-Jessen, MD Jane Kim, MD Nikolas Raufi, MD Obinna Umunakwe, MD Clayton Wisely, MD

First-Year Residents

Cassandra Brooks, MD Abhi Gudru, MD Suzanne Michalak, MD Matthew O’Sullivan, MD, PhD Michael Quist, MD

2018–2019 CLINICAL FELLOWS Cornea

Brenton Finklea, MD Nicole Fuerst, MD Kristen Peterson, MD

Glaucoma

Ayan Chatterjee, MD Katy Liu, MD, PhD Brian Stagg, MD, MS Swarup Swaminathan, MD Atalie Thompson, MD Susan Wakil, MD

Medical Retina

Yousef Aldairy, MD Deepak Sambhara, MD

Ophthalmic Oncology Wajiha Kheir, MD

Pediatrics

Heather Whitson, MD, MHS has been named the next Director of Duke Center for the Study of Aging and Human Development.

Michelle Go, MD Jagger Koerner, MD Hongvan Le, MD Ann Shue, MD

Oculoplastics

Leon Rafailov, MD Roshni Ranjit-Reeves, MD

Vitreoretinal Surgery Cindy Cai, MD Moshin Ali, MD Ananth Sastry, MD Wendy Zhang, MD

Honors and Awards

Group Awards

Gonzalez

Challa

Pedro Gonzalez, PhD and Pratap Challa, MD received an award from NIH/National Eye Institute for a project, entitled “Novel Experimental Model for Pseudoexfolliation Syndrome.”

Eleonora Lad, MD, PhD and Cynthia Toth, MD received an award from Boehringer Ingelheim Pharmaceuticals, Inc. for a project, “Establishing Retinal Imaging Biomarkers for Predicting Disease Progression and Visual Acuity Loss within 1 and 2 in Intermediate AMD.”

Kuo

Izatt

Anthony Kuo, MD, Joseph Izatt, PhD, and Cynthia Toth, MD received an award from the NIH/National Eye Institute for a project, “Portable Motionstabilized Optical Coherence Tomography for Eye Care in Acute Care Settings.”

Trainee Awards Cindy Cai, MD received the 2018-2019 Heed Fellowship Award.

DUKE EYE CENTER

2019

Cindy Cai, MD and Ananth Sastry, MD received a 2018 VitreoRetinal Foundation Research Award.

Stamer to become President and other Faculty Leadership Roles with Association of Research in Vision and Ophthalmology (ARVO) W. Daniel Stamer, PhD was elected to serve as the next president of Association for Vision Research in Vision and Ophthalmology. Several other faculty members serve on the meeting planning committee: • Daniel Saban, PhD serves on the immunology and microbiology section of meeting planning committee • Vasanth Rao, PhD serves as member of the lens section on the Annual Meeting Program Committee • Goldis Malek, PhD serves on the annual meeting planning committee as a member of the retinal cell biology section

Ayan Chatterjee, MD received the 2018-2019 Heed Fellowship Award.

Henry Feng, MD is co-editing Duke Eye Center’s ALL ABOUT YOUR EYES, 2nd edition. Tanya Glaser, MD Chief Resident served as the Women in Ophthalmology representative for the AAO Advocacy Ambassador Program. She is co-editing Duke Eye Center’s ALL ABOUT YOUR EYES, 2nd edition. Wajiha Kheir, MD, our first ocular oncology fellow, won first place for her poster “Choroidal Melanoma During Pregnancy: A Case Report and Review of the Literature” at NC Society of Eye Physicians and Surgeons meeting.

Katy Liu, MD, PhD received the 2018 Duke Eye Center Award for Ocular Innovation and the Robert Machemer Award, both awards are given to a resident for outstanding research during the academic year. Swarup Swaminathan, MD received the 2018-2019 Heed Fellowship Award.

Atalie Thompson, MD, MPH received the 2018-2019 Heed Fellowship Award and the Edward K. Isbey, Jr. Award. Wendy Zhang, MD received the Ronald G. Michels Fellowship Award.

Daniel Saban, PhD, RPB Career Development Award recipient with Brian Hofland, PhD, President of RPB during his visit in December.

Research to Prevent Blindness Awards Support Revolutionary Research

he Department of Ophthalmology has been granted an Unrestricted Grant by Research to Prevent Blindness (RPB) in the amount of $115,000 a year to support eye research. This funding has been awarded based on a thorough review of criteria including the department’s research activities, laboratory environment, and clinical and scientific staff, as evaluated by RPB’s renowned Scientific Advisory Panel (SAP). The funds will be deployed at the discretion of the department chair, to provide maximum flexibility in developing and expanding eye research programs, and to provide opportunities for creative planning that go beyond the scope of restricted

project grants. Duke University School of Medicine holds one of 32 RPB Unrestricted Grants nationwide. The Duke University School of Medicine has also been granted a $30,000 Medical Student Eye Research Fellowship to enable Maria Comez-Caraballo to take a year off from medical school and devote that time to the pursuit of a research project within the Department of Ophthalmology. Vadim Arshavsky, PhD, scientific director of research, has been named to the RPB SAP. In this role he will play an active role in shaping RPB’s grants program by applying his significant expertise to the task of reviewing applications and providing insight into the vision science field at large.

We were eager to welcome Brian F. Hofland, PhD, president of RPB, to our campus in early December. Our faculty were able to share the tremendous research we are able to accomplish from the generous support of RPB. We are so fortunate to be able to embrace and contribute to the mission of RPB. Since it was founded in 1960, RPB has channeled more than $362 million into eye research. As a result, RPB has been identified with nearly every major breakthrough in vision research in that time. For information on RPB’s grants program, listings of RPB institutional and individual grantees, and findings generated by these awards, go to www. rpbusa.org.

Duke Eye Center Administration, Faculty and Staff FACULTY LEADERSHIP

ADMINISTRATION

Edward G. Buckley, MD

Chair, Department of Ophthalmology Vice Dean of Medical Education, Duke University School of Medicine Vice Chancellor Duke-NUS Affairs

Vice Chair, Research Director, Translational Research Program Director, Center for Macular Diseases Director, Ophthalmic Imaging Medical Director, Duke Eye Center Durham

Scott W. Cousins, MD

Felipe Medeiros, MD, PhD Vice Chair, Technology

Director, Clinical Research Unit

Eric A. Postel, MD Vice Chair, Clinical Affairs

Chief, Ambulatory Eye Surgery

Elizabeth Hunter, MHA, CFM

Adrienne Lloyd, MHA, FACHE

Director of Finance

Heidi Campbell, COT Director of Clinical Operations

Tammy Clay, MHA Division Administrator

Martha Wilson, MHA Division Administrator

Amanda Mestler, COT

Health Center Administrator

Lauren Walls, MHA

Health Center Administrator

Tori Hall Director, Marketing and Communications Jillian Ream Executive Director of Development

Michael Flintosh, MBA Human Resources Manager

Renee Wynne Program Director,

Continuing Medical Education Program Director, Special Events

Cynthia A. Toth, MD Chair, Department APT Committee

Chief Administrator

Sanjay Asrani, MD

Medical Director, Duke Eye Center, Cary

Medical Director, Duke Eye Center, Raleigh

Anna Bordelon, MD Assistant Professor of Ophthalmology

Thomas S. Devetski, OD Assistant Professor of Ophthalmology

Laura Enyedi, MD

Medical Director, Duke Eye Center, South Durham

Anupama Horne, MD Assistant Professor of Ophthalmology, Division Chief

Medical Director, Duke Eye Center, Page Road, PDC At-Large Member

Christopher Boehlke, MD

Preeya Gupta, MD

Robin R. Vann, MD Medical Director, Perioperative Services Carol Ziel, MD Medical Director,

Duke Eye Center, Winston Salem

Vadim Arshavsky, PhD Scientific Director of Research

Glenn J. Jaffe, MD Director, Duke Reading Center

Eleonora Lad, MD, PhD Associate Director, Clinical Research Unit

COMPREHENSIVE OPHTHALMOLOGY

Thomas Hunter, MD Assistant Professor of Ophthalmology Charlene James, OD Medical Instructor Nicola (Nicky) Kim, MD Associate Professor of Ophthalmology,

Assoc. Medical Director, Main Eye Center John T. Petrowski III, OD, FAAO

Assistant Professor of Ophthalmology

Laurie K. Pollock, MD Assistant Professor of Ophthalmology

William Rafferty, OD Assistant Professor of Ophthalmology

Dianna Seldomridge, MD PDC Consulting Professional Employee

Tina K. Singh, MD Assistant Professor of Ophthalmology Robin R. Vann, MD Assistant Professor of Ophthalmology

C atherine Bowes-Rickman, PhD Director, Third-Year Medical

Student Program

Pratap Challa, MD Director, Residency Program

Sharon Fekrat, MD, FACS Associate Chief of Staff for Surgery Durham VA Medical Center, Director, Vitreoretinal Surgery Fellowship Director, Faculty Mentoring and Development Kelly Muir, MD, MHSc Director, Fellowship Program Chief, Division of Ophthalmology, Durham VA Medical Center

John T. Petrowski, OD Director, Optometry Education Director, Foster Center for Ocular Immunology

Director, Medical Student Education Director, Patient Education

Julie A. Woodward, MD

Director, Public Education Program Faculty Liaison Director, Ophthalmic Technician Program

DUKE EYE CENTER

2019

Lejla Vajzovic, MD Director, Continuing Education Program

Victor Perez, MD

CORNEA AND REFRACTIVE SURGERY

Jullia A. Rosdahl, MD, PhD

Christopher S. Boehlke, MD Assistant Professor of Ophthalmology Alan N. Carlson, MD Professor of Ophthalmology Melissa Daluvoy, MD

Assistant Professor of Ophthalmology

Preeya Gupta, MD Associate Professor of Ophthalmology Terry Kim, MD Professor of Ophthalmology, Division Chief

Anthony Kuo, MD Associate Professor of Ophthalmology, Assistant Professor Biomedical Engineering ++

Victor Perez, MD Professor of Ophthalmology

Terry Semchyshyn, MD Assistant Professor of Ophthalmology

Amanda Steele, OD Assistant Consulting Professor of

Kenneth Weinlander, MD Assistant Consulting Professor of

Ophthalmology Ophthalmology

GLAUCOMA

Sanjay Asrani, MD Professor of Ophthalmology

Pratap Challa, MD Associate Professor of Ophthalmology

Jiaxi Ding, MD Assistant Professor of Ophthalmology

Divakar Gupta, MD Assistant Professor of Ophthalmology

Leon W. Herndon, MD Professor of Ophthalmology, Division Chief

Jill B. Koury, MD Assistant Professor of Ophthalmology

Stuart J. McKinnon, MD, PhD Associate Professor of Ophthalmology,

Associate Professor of Neurobiology ++

Felipe Medeiros, MD, PhD Professor of Ophthalmology

Sharon Fekrat, MD, FACS Professor of Ophthalmology,

Associate Professor, Surgery ++

Dilraj Grewal, MD Associate Professor of Ophthalmology Majda Hadziahmetovic, MD Medical Instructor

Alessandro Iannaccone, MD, Professor of Ophthalmology MS, FARVO

Glenn J. Jaffe, MD Robert Machemer, MD Professor of Ophthalmology, Division Chief

Eleonora Lad, MD, PhD Associate Professor of Ophthalmology Miguel Materin, MD Professor of Ophthalmology,

Professor of Radiation Oncology ++

Prithu Mettu, MD Assistant Professor of Ophthalmology

Frank J. Moya, MD Assistant Professor of Ophthalmology

Eric A. Postel, MD Professor of Ophthalmology

Kelly W. Muir, MD, MHSc Associate Professor of Ophthalmology

Stefanie G. Schuman, MD Assistant Professor of Ophthalmology

Jullia Rosdahl, MD, PhD Associate Professor of Ophthalmology

Henry Tseng, MD, PhD Assistant Professor of Ophthalmology

Molly M. Walsh, MD, MPH Assistant Professor of Ophthalmology

Carol J. Ziel, MD Assistant Professor of Ophthalmology

LOW-VISION REHABILITATION SERVICE

Diane Whitaker, OD Assistant Professor of Ophthalmology,

Ophthalmology, Professor of Biomedical Engineering++

Lejla Vajzovic, MD

Assistant Professor of Ophthalmology

RESEARCH OPHTHALMOLOGY

Vadim Arshavsky, PhD Helena Rubinstein Foundation Professor of

Ophthalmology Professor of Pharmacology & Cancer Biology ++

Division Chief

NEURO-OPHTHALMOLOGY

Mays El-Dairi, MD Associate Professor of Ophthalmology

Sidney Gospe III, MD, PhD Assistant Professor of Ophthalmology

Cynthia A. Toth, MD Joseph A.C. Wadsworth Professor of

Landon Meekins, MD Medical Instructor

C atherine Bowes-Rickman, PhD Professor of Ophthalmology

Associate Professor of Cell Biology ++

Romain Cartoni, PhD Joint Appointments – Assistant Professor

of Ophthalmology, Assistant Professor of Pharmacology and Cancer Biology

Sina Farsiu, PhD Joint Appointments – Associate Professor of

Biomedical Engineering, Associate Professor of Ophthalmology, Associate Professor of Electrical and Computer Engineering Associate Professor of Computer Science

OCULOPLASTICS

Ilya Leyngold, MD Assistant Professor of Ophthalmology Jason Liss, MD Assistant Professor of Ophthalmology Roshni Ranjit-Reeves, MD Assistant Consulting Professor of Ophthalmology

Julie A. Woodward, MD Professor of Ophthalmology, Division Chief Associate Professor of Dermatology ++

Paulo Ferreira, PhD

Associate Professor of Ophthalmology Associate Professor of Pathology ++

Pedro Gonzalez, PhD

Associate Professor of Ophthalmology Associate Professor of Pathology ++

Jeremy Kay, PhD Joint Appointments – Assistant Professor

of Ophthalmology, Assistant Professor of Neurobiology, Assistant Professor of the Duke Institute for Brain Sciences

PEDIATRIC OPHTHALMOLOGY AND STRABISMUS Edward G. Buckley, MD James P. and Joy Gills Professor of Ophthalmology Professor of Pediatrics ++,

Nathan Cheung, OD Medical Instructor

Laura B. Enyedi, MD Associate Professor of Ophthalmology

Associate Professor of Pediatrics ++

Sharon F. Freedman, MD Professor of Ophthalmology, Division Chief Professor of Pediatrics ++

Faramarz Hidaji, MD Assistant Consulting Professor of Ophthalmology

S. Grace Prakalapakorn, Associate Professor of Ophthalmology MD, MPH Associate Professor of Pediatrics ++

Yos Priestley, OD, FAAO

Assistant Professor of Ophthalmology

Federico Velez, MD

Associate Professor of Ophthalmology

V ITREORETINAL DISEASES AND SURGERY

Paloma Liton, PhD Associate Professor of Ophthalmology

Goldis Malek, PhD Associate Professor of Ophthalmology,

Associate Professor of Pathology ++ Associate Professor of Pathology ++

P. Vasantha Rao, PhD Professor of Ophthalmology,

Professor of Pharmacology & Cancer Biology ++

Daniel R. Saban, PhD, MS Associate Professor of Ophthalmology

Nikolai Skiba, PhD Associate Professor of Ophthalmology

Assistant Professor of Immunology

W. Daniel Stamer, PhD Joseph A.C. Wadsworth Research Professor of

Sandra Stinnett, DrPH Associate Professor of Biostatistics &

Ophthalmology, Professor of Biomedical Engineering++

Bioinformatics Associate Professor of Ophthalmology ++

Fulton Wong, PhD Professor Emeritus of Ophthalmology,

Professor of Neurobiology and Pathology ++, Assistant Professor of Pathology ++

Michael Allingham, MD, PhD Assistant Professor of Ophthalmology Xi Chen, MD, PhD Assistant Professor of Ophthalmology Scott W. Cousins, MD Robert Machemer, MD, Professor of Ophthalmology Professor of Immunology ++

Secondary appointment ++

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Mouse embryonic eye (E12.5) is immunolabeled for Ankyrin-G (green fluorescence) and with in the developing lens, Ankyrin-G shows discrete distribution to the anterior lens vesicle which will eventually become lens epithelium. Image Credit: Rupalatha Maddala, PhD Rao Laboratory

VISION 2019

Articles inside

VISION 2019

Developing Gene-Specific Molecular Approaches to Treat Inherited Retinal Diseases

Foster Center for Ocular Immunology