VISION 2023

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Editor Tori Hall

Writers Vicki Frye, Tori Hall, Lori Malone, Mary-Russell Roberson and Michael Penn

Art Direction Pam Chastain Design

Photography Erin Hull, Duke Health; Ken Huth Photo; Chris Hildreth

Copyright 2023 © Duke Eye Center dukeeyecenter.duke.edu

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1 Message from the Chair 26 Development News 28 New Faculty 30 Research Roundup 36 Honors and Awards 44 Administration, Faculty and Staff 2023 VOLUME 39 2 A New Era in Dry AMD Treatment 4 An Engineer at Heart Cynthia Toth, MD 8 Bench to Bedside and Back 12 Gene Therapy Aims to Help Eyes Produce their Own Medicine 14 From One Room to Worldwide Recognition Duke Reading Center 16 A Study of Retinal Ganglion Cells Leads to a Passion for Education Jullia Rosdahl, MD, PhD 18 Eyes on a Miracle Duke Eye Surgeons in West Africa 22 Duke Eye Center by the Numbers 24 A Life of Service for People with Disabilities 42 Duke Ophthalmology Continuing Education 43 Duke Ophthalmic Technician Program
@dukeeye @dukeeyecenter @dukeeyecenter @dukeeyecenter

From our Chair, Edward G. Buckley, MD

Dear Alumni, Colleagues and Friends, Renewal—is a feeling I have as we are in the first part of 2023. We are living our lives the most normal since before the pandemic, and it’s a very exciting time in the field of ophthalmology. Duke is pioneering innovative research, education, and clinical care—a sense of renewal that is propelling the future of ophthalmology.

Some of our accomplishments that you will read about in this issue of VISION:

• Leon Herndon, MD has been named the 2023 American Glaucoma Society President. Glenn Jaffe, MD served as President of the Macula Society.

• The first ever treatment for geographic atrophy, pegcetcoplan, was approved by the FDA. Eleonora Lad, MD, PhD led the OAKS trial that contributed to the approval, and included many other Duke retina faculty who were collaborators.

• Gene therapy is continuing to show potential as a one-time treatment for AMD for which Duke Eye Center is a lead site and Lejla Vajzovic, MD, FASRS is a lead PI for the ATMOSPHERE AND ASCENT trials.

• Our faculty have received a record amount of NEI grants in the history of the department and received major grant awards, which will fund the groundbreaking research to continue our reputation of excellence in research.

• Lloyd Williams, MD, PhD is leading the Duke Global Ophthalmology program and demonstrates his passion for curing blindness worldwide by making multiple trips to Africa, Honduras, and other areas of the world that have a high rate of curable blindness—teaching and performing surgery.

• The first stand-alone clinical space for Duke Eye Center, the Wadsworth building, turns 50 this year. Named after our first chair, Joseph A.C. Wadsworth, and we are still going strong. In 2005, we added the Albert Eye Institute, a five-floor space dedicated to research, and in 2015, a new stateof-the art clinical building and have grown to eight satellite clinics with more on the way. Duke Eye Center has lived up to the vision Dr. Wadsworth set for the department and is still growing.

I am excited to share some great news with you in this issue of VISION magazine.

Best wishes for a healthy, happy, and successful 2023! The cover of this issue of VISION exudes a time for renewal. Best wishes for a peaceful year ahead.

Sincerely,

A New Era in Dry AMD Treatment

FDA Approves First Treatment for Geographic Atrophy

On February 17, 2023, the U.S. Food and Drug Administration (FDA) approved a groundbreaking treatment to treat geographic atrophy (GA), an advanced form of dry macular degeneration (AMD). Eleonora Lad, MD, PhD, director of clinical research and associate professor, was a lead investigator in the OAKS trial, a pivotal clinical trial that supported the FDA approval.

The drug, pegcetacoplan, is the first ever FDAapproved treatment for GA, which affects about one million people in the United States and five million worldwide.

This approval is “the most important event in retinal ophthalmology in more than a decade,” said Lad.

Almost 20 million Americans older than 40 were living with some form of AMD in 2019, with most still in the early dry stage, according to the Centers for Disease Control and Prevention (CDC). Roughly 15 percent of people with AMD eventually transition to the vision-threatening stages known as geographic atrophy and wet, or neovascular AMD.

Until now, there have been no approved therapies to offer people living with GA as their vision relentlessly declined,” said Lad. “With pegcetacoplan, we finally have a safe and effective GA treatment for this devastating disease, with increasing effects over time.”

Lad served on the Apellis Steering Committee and as the lead principal investigator (PI) of the international OAKS phase 3 registration trial. She began work with Apellis in 2014 when they approached her to learn about research on alternative visual function endpoints for dry AMD that were developed at Duke Eye Center.

Duke served in the phase 2 FILLY trial with Lad as PI, which performed at a high level. Lad assisted with the design of the phase 3 study protocol and was asked to serve as lead PI of the OAKS phase 3 registration trial that focused on functional assessments.

The Duke Eye Center clinical research unit was instrumental in the OAKS trial, setting a new standard of excellence in clinical research activities at Duke. OAKS met the primary endpoint, and both DERBY and OAKS phase 3 trials which had increased treatment effects over time, leading to the historic FDA approval for pegcetacoplan.

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Example of what progression looks like to a patient. Apellis Pharmaceuticals

This is a wonderful moment for patients afflicted to GA, and a start of a new therapeutic era in dry AMD. Lad and Duke researchers are contributing to interventions for earlier stages of disease through development of endpoints and AI algorithms, for which Duke has a validated algorithm for GA prediction that promises to be transformative.

“Clinical research is paramount in advancing the standard of care for patients, and I am very grateful to be part of this important mission in our outstanding Department and institution. I look forward to next steps in this exciting journey,” said Lad.

Pegcetacoplan, an injectable treatment, is the first medication to use targeted C3 therapy to diffuse the harmful three-pronged “complement cascade” triggered by geographic atrophy, a physiological response that attacks and destroys healthy tissue. In 2022, promising results and limited side effects achieved in clinical trials put pegcetacoplan on a fast-track designation for FDA approval.

The approval of pegcetacoplan is based on positive results from the Phase 3 OAKS and DERBY studies at 24 months across a broad and representative population of patients. Pegcetacoplan is approved for GA patients with or without subfoveal (central) involvement and provides dosing flexibility for patients and physicians with a dosing regimen of every 25 to 60 days.

In the OAKS and DERBY studies, pegcetacoplan reduced the rate of GA lesion growth compared to sham and demonstrated increasing treatment

effects over time, with the greatest benefit (up to 36% reduction in lesion growth with monthly treatment in DERBY) occurring between months 18-24.

“Just as exciting is the focus shifting towards earlier stages of disease and more durable interventions, along with novel imaging, AI, and endpoints for efficacy assessment,” said Lad.

“Fortunately, the therapeutic pipeline for dry AMD is already becoming explosive, so I expect that we will have better and better treatments for GA and earlier stages of dry AMD in the next few years. This is certainly a major milestone, but a lot of very meaningful work remains to be done for our families and our patients.”

Ophthalmology and Lead Investigator Duke co-investigators include (top row, left to right) Oleg Alekseev, MD, PhD; Michael Allingham, MD, PhD; Sharon Fekrat, MD; Dilraj Grewal, MD; Majda Hadziahmetovic, MD; (bottom row, left to right) Glenn Jaffe, MD; Prithu Mettu, MD; Stefanie Schuman, MD; Cynthia Toth, MD; and Lejla Vajzovic, MD, FASRS.
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These images demonstrate that GA progression was slow in the treated right eye and fast in the untreated left eye.

An Engineer at Heart

Cynthia Toth’s 25 years of revolutionizing eye care and surgery

As Cynthia Toth, MD, prepares to “dive” inside the eye, she practices a relaxed mind. “Slow breath, focus, concentrate,” she tells herself. In 30 years as a retinal surgeon, she has trained to make her left hand as proficient as her right, so she can smoothly reach the part of the retina she needs to.

Toth is rewarded with immersion in an ocean of color. “When you use the operating microscope, it’s like you’re a deep-sea diver,” she said. “The whole world in there is glowing orange. It’s just fun and beautiful.”

Toth’s love of exploring the retina has led to her revolutionizing retinal imaging for both adult and pediatric ophthalmology. The Joseph A.C. Wadsworth Distinguished Professor of Ophthalmology, she is a world expert in a highresolution, three-dimensional imaging technology called optical coherence tomography, and she has pioneered its use during surgery and in very young children. Her research in this and other areas has led to better ways to diagnose and predict the course of blinding eye diseases such as macular degeneration and retinopathy of prematurity, one of the most common causes of childhood vision loss. Toth was instrumental in developing Duke Eye Center’s Pediatric Retina Clinic, and she is the first female vice chair of clinical research in the Department of Ophthalmology.

Toth made her last “dive” inside the eye in June 2022, and she stepped down from clinical practice in August. She will continue her duties as vice chair of clinical research and will focus on running her lab—(the Duke Advanced Research in SD/ SSOCT Imaging (DARSI) Laboratory). Toth said she will now have more time to spend on her medical device company in downtown Durham and cooking with her husband.

FALLING IN LOVE WITH OCT

The first doctor in her family, Toth attended college and medical school on a U.S. Air Force

Scholarship. After she finished residency, she spent two years as a general ophthalmologist on active duty in the Air Force. Toth liked the precision of cataract surgery, but she decided to pursue subspeciality training in vitreoretinal diseases and surgery.

“I loved moving tissue around, and I realized that retina would be such a fun challenge,” Toth said. The retina changes light into signals that it transmits to the brain, she explained. “When you operate on the retina, you’re actually interacting with brain tissue in the back of the eye.”

“I loved moving tissue around, and I realized that retina would be such a fun challenge. When you operate on the retina, you’re actually interacting with brain tissue in the back of the eye.”

After a retina fellowship at University of California at Davis, Toth returned to the Air Force in 1991 as chief of the retina service at Wilford Hall Medical Center in San Antonio, Texas. It was here that she became fascinated with optical coherence tomography (OCT). She met and collaborated with Air Force physicist Pat Roach, PhD, and an inventor of the technology, Jim Fujimoto, PhD, of MIT, who brought an OCT system to the base to conduct studies of how laser injury or treatment with lasers affected the retina. This work would help form the basis for the current laser safety standards in the U.S.

Traditionally, research like this had been conducted in animal models by creating laser burns in the eye, then viewing the eye with an ophthalmoscope to determine whether a white spot (lesion) would appear. But OCT showed the microscopic injury evolve in real time. “With OCT, instead of seeing just a white spot, you would see the different layers of cells in the

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DUKE EYE CENTER 2023
Cynthia Toth

retina,” Toth said. “The lesions would start out deep in those layers, and we watched as bubbles of fluid and different injury patterns formed.”

When Toth joined the Duke faculty in 1993, she found the perfect setting to develop OCT to improve patient care. She was appointed director of a biophysics laboratory that developed new surgical tools, a lab founded by longtime chair of ophthalmology Robert Machemer, MD, who was known as “the father of vitreoretinal surgery.” Seeing promise in OCT imaging and image-guided surgery, Toth changed the lab’s focus to imaging tools. Toth was eager to use OCT during surgery, but the systems were large, tabletop affairs. That would change after Toth met biomedical engineer Joseph Izatt, PhD. While he was at Case Western Reserve University, Izatt’s team had built what he calls a “rudimentary” handheld OCT probe. “That was a very preliminary version, and it had very little input from physicians,” said Izatt, now professor and chair of biomedical engineering in the Pratt School of Engineering. “Dr. Toth really inspired us with her applications and ideas and gave us a lot more direction.”

In 2001, Toth helped recruit Izatt to the Duke faculty. They brought Izatt’s handheld spectral-domain (SD-OCT) device into the operating room in the early 2000s. At a couple of different points during surgery, Toth would move the surgical microscope aside and switch to the handheld OCT probe. Switching back and forth was disruptive, Izatt said, “But she did it because she was so anxious to see what was going on in real time as surgery developed.” OCT gives the surgeon real-time feedback to avoid pulling or tearing the “microns thin” tissues of the retina, Toth said. “It helps you to be a better surgeon.”

When Toth joined the Duke faculty in 1993, she found the perfect setting to develop OCT to improve patient care. She was appointed director of a biophysics laboratory that developed new surgical tools, a lab founded by longtime chair of ophthalmology Robert Machemer, MD.

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Toth’s first feedback to Izatt was, “‘Please build this into the surgical microscope so that I can see it all of the time during surgery,’” Izatt said. “So that became our biggest project together for the past 15 years. And we’re still finding new ways to do it better.”

For the last two decades, Izatt, Toth, and their trainees have met for two hours at least once a week to present design ideas and receive feedback from the physicians. The engineers build prototypes that the surgeons try out with eye models in Toth’s wet lab. Several of the resulting devices have moved into clinical research. “Cindy is our main conscience in terms of making sure that we have thought through every possible way that things could go wrong,” Izatt said. Are lights too bright for patient eyes? Are the bolts used to attach an imager to a microscope strong enough? “Anything that we propose for her to use in the operating room, she’s going to go over with a fine tooth comb herself before it goes to the safety board for review,” Izatt said.

Today, the third version of the intra-operative OCT is used in clinical research in patient operating rooms. It displays the OCT view alongside the operating microscope view on a large screen near the patient’s feet. A fourth version involves an augmented-reality headset that displays the normal surgical view as well as the OCT view. Toth has tried it in trials with animal tissue to give initial feedback. “I doubt I could find any other surgeon in the world who would even be willing to think about wearing a headset during surgery where we controlled what they see,” Izatt said.

Izatt calls Toth, who has a secondary appointment in the Department of Biomedical Engineering, “an engineer at heart.” He said, “She’s contributed very substantial technical aspects to our work. When we’re talking about new designs, she’ll often come up with an idea that just wouldn’t have occurred to us. “

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Toth and Izatt have been collaborating since the early 1990s and are pioneers in eye imaging development.
DUKE EYE CENTER 2023
“Cindy is our main conscience in terms of making sure that we have thought through every possible way that things could go wrong. Anything that we propose for her to use in the operating room, she’s going to go over with a fine tooth comb herself before it goes to the safety board for review.”
Joseph Izatt

IMAGING THE TINIEST EYES

In 2008, Toth put her mind to developing a handheld version of OCT for use in babies. Children under five couldn’t benefit from OCT at the time because they weren’t able to sit still for imaging. “Adults could just sit down at the camera, put their chin in the chin rest, and we could capture all these amazing images,” Toth said. But in the nursery, Toth and her colleagues examined babies with “antiquated technology” developed in the 1850s and refined in the 1940s—the indirect ophthalmoscope, which is worn on the ophthalmologist’s head.

That disparity bothered her, and she and Izatt, working with Duke ophthalmology faculty Sharon Freedman, MD, and Lejla Vajzovic, MD, FASRS, collaborated to correct it, developing the first handheld version of OCT for this purpose. Toth is now recognized as the founder of pediatric OCT. For infants and children, her multidisciplinary team has published dozens of papers demonstrating novel eye findings that are visible only with OCT imaging and that are often

associated with retinopathy of prematurity and other diseases or challenges of eye and brain development.

A version of handheld SD-OCT created by Izatt’s lab was developed by his Duke spin-off company, Bioptigen, and in 2012 the device became the only handheld OCT system to be approved by the Food and Drug Administration (FDA) for preterm infant and neonate use. This device is used in pediatric care worldwide. Toth’s research group continues to partner with Izatt and other biomedical engineers to make their research handheld OCT system lighter, better, and faster for use in National Institutes of Health studies and other research studies of infant eyes. Toth and two Duke-trained engineering colleagues, Christian Viehland, PhD and Dhalla Hafeez, PhD, MBA, have also created a company, Theia Imaging, to develop a streamlined commercial OCT system for infant use and will seek FDA approval for clinical use.

BREAKING GLASS CEILINGS

In 2019, an imaging center inside Duke Eye Center designed just for pediatric patients and their families opened, spearheaded by Toth and colleagues, including Freedman, Vajzovic, and Mays Dairi, MD. The center offers children the same leading-edge imaging technologies that are offered to adult patients, plus childspecific imaging equipment, in a child-friendly environment. It is also the clinical home of the Duke Pediatric Retina and Optic Nerve Center, one of few centers across the U.S. to treat pediatric patients with complex retinal and optic nerve diseases.

Vajzovic came to Duke for the last step in her training, a vitreoretinal surgery fellowship, in 2011, when Toth was fellowship director. She credits Toth with generous mentorship and providing her such good guidance during her surgical retina fellowship that she didn’t feel the need to pursue an additional pediatric retina fellowship. “She really inspired me to not only pursue retina, but to become a pediatric retina surgeon,” Vajzovic said. “I was following in her footsteps, in every way.”

There are few women retina surgeons, even today, and there were even fewer a couple of decades ago when Toth was pursuing the specialty, Vajzovic said. “The retina world is a maledominated field. Having her as such a strong role model has been so important for me.”

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Toth using the handheld OCT to image a baby in the NICU accompanied by a member of her laboratory staff. Toth using the interoperative OCT during a procedure.

Bench to Bedside and Back

The Clinical Research Unit at Duke Eye Center is Delivering Hope to Patients Now, and in the Future

For more than three consecutive decades, innovations in research and a fundamental commitment to patient care have resulted in Duke Ophthalmology being ranked among the nation’s best by U.S. News and World Report.

The Clinical Research Unit (CRU) at Duke Eye Center plays a meaningful role in the department earning this perennial accolade and is a vital contributor to the overall mission of curing eye disease worldwide. Insights gained from the CRU’s patient-oriented studies position our acclaimed specialists at the forefront of ophthalmology and equip them in their discovery of new methods of detection, diagnosis, treatment and prevention; delivering hope to patients of all ages who are battling challenging eye conditions.

“Duke Eye Center is really special. There is an amazing group of clinician scientists here—our research is always ethical, something I can be proud of, and I know is changing the world of science and patient care,” says Cynthia Toth, MD, Joseph

A Team Effort

Every member of the Duke Eye Center CRU shares a passion for partnering with patients to drive research that leads to continuous improvements in the standards of ophthalmic care and disease prevention. With over 40 clinical research faculty, the CRU currently has over 100 approved studies (and counting) of which more than a third have active participants, and another dozen are being guided through the Institutional Review Board (IRB) approval process.

It’s patients—in search of better eye health—who generously volunteer to take part in trials that make it possible for the physician scientists leading the Duke Ophthalmology CRU to conduct groundbreaking investigations. From retrospective departmental studies to federal, foundation and industrysponsored programs across specialties including pediatric ophthalmology, corneal disease, glaucoma and retina diseases, each patient and their family is a catalyst in the discovery of promising new treatments and cures for eye disease.

Each proposed study within the expanding CRU portfolio undergoes a comprehensive

review by a respected group comprised of CRU leadership, members of the Duke Eye Center finance team and a faculty advisory board. Together, they authorize studies and cultivate stakeholder confidence in the scientific integrity, quality, academic productivity, regulatory compliance and financial viability of all research conducted by the department. Collectively, this cross-functional panel empowers the lifechanging work of our dedicated clinical research investigators and willing patient participants.

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“Duke Eye Center is really special. There is an amazing group of clinician scientists here—our research is always ethical, something I can be proud of, and I know is changing the world of science and patient care.”
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Cynthia Toth

CRU Research Clusters and Medical Directors

Cornea

Anthony Kuo, MD

Victor Perez, MD

Glaucoma

Joanne Wen, MD

Neuro-ophthalmology

Sidney M. Gospe, III, MD, PhD

Pediatric ophthalmology

Grace Prakalapakorn, MD

Plastics

Julie Woodward, MD

Retina

Lejla Vajzovic, MD, FASRS

Ramiro Maldonado MD

Oleg Alekseev MD, PhD

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The Duke Difference

Proximity Matters

The old saying, “location is everything” certainly rings true for the Duke Eye Center CRU. Situated strategically amidst Duke University Hospital (ranked #1 in the region) and the Duke University School of Medicine (ranked in the Top 3 for research), the CRU has a distinct advantage over other research programs. Our association with Duke Medical Center simplifies pre-site selection visits with potential study sponsors; assuring them we have premium access to the resources required to complete the studies they value. This connection also enables us to grow, conduct more complex studies and collaborate across a range of other disciplines and study groups that have an ophthalmic component. For example, it is common for oncology drugs to produce adverse effects on patient vision, therefore members of the Duke Eye Center CRU work in partnership with the Oncology CRU to support these patients and help advance their studies.

Furthermore, the academic expertise of our medical directors and our association with other disciplines within the School of Medicine uniquely establishes the CRU as a leader, increasing the probability and complexity of future studies.

“Our connection to the hospital, and more than a dozen specialized clinical research units within the Duke University School of Medicine, creates unparalleled opportunities for collaboration and allows us

to work in close partnership with other Duke researchers,” says Eleonora Lad, MD, PhD, Director of the Duke Eye Center CRU. “Ultimately, we all benefit from access to adjacent research studies; and, it’s these connections that offer us the chance to take a holistic, one-on-one approach to patient care; recognizing that ophthalmic conditions can often have a relationship to other health concerns.”

A Culture of Caring

“I’ve rarely seen the level of hands-on, team involvement that we have. Everyone who works at the Duke Eye Center CRU truly cares for the patients and their families,” shares Lad. “Each of us has a genuine compassion for every patient and an enthusiasm to deliver impactful research today, and for the future.”

Supporting the CRU’s regulatory and clinical studies, is a dedicated team of Clinical Research Specialists and Coordinators made up of practitioners from diverse backgrounds in both research and hands-on ophthalmic patient care. It’s this unique dynamic that fosters a peoplefocused culture committed to compassionately conducting studies, while providing treatments that both raise the standard of care and lead to disease prevention.

“We care for the whole person, and look after them as if they’re family,” notes Sarah Jones, Research Practice Manager, Duke Eye Center CRU. “Our coordinators understand that details matter. For instance, we make every effort to limit the amount of time and travel required of each participant by

aligning their clinical research visits with their clinical care visits. Likewise, we work deliberately to expedite the series of next steps needed to help improve their vision.”

Each research coordinator assumes ownership of their studies from the start; carrying them step-by-step through a systematic process and on to completion. Most importantly, the CRU at Duke Eye Center delivers a differentiated level of individualized attention to each patient, carefully monitoring their treatment and supporting them throughout the duration of the study.

A Vision for the Future

What does the future look like for the Duke Eye Center CRU? It looks like more.

Increased capacity for more studies, more participants, a growing complexity in the research we conduct and above all, enhanced levels of care, new treatments and improved patient outcomes; all leading to cures for some of today’s most debilitating eye diseases.

Learn more about the Duke Eye Center CRU.

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“Each of us has a genuine compassion for every patient and an enthusiasm to deliver impactful research today, and for the future.”
Eleonora Lad

CRU Leadership and Staff

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Olivia Everett Clinical Research Coordinator Carol White Assistant Research Practice Manager Ethel Cuenca Clinical Research Nurse Coordinator Sarah Jones Research Practice Manager Corren White Clinical Research Coordinator Katia Soleil Clinical Research Coordinator Alice Ventura Clinical Research Coordinator Malina Sexton Clinical Research Coordinator Iris Navarro Clinical Research Coordinator Terry Hawks Clinical Research Coordinator Rebecca Schmidt Clinical Research Coordinator Victoria Griffiths Clinical Research Coordinator Nathan Hamilton Clinical Research Specialist, Senior Jacob Craft Clinical Research Specialist, Senior Elizabeth Pawlica Clinical Research Specialist, Senior Rylee Bledsoe Clinical Research Specialist, Senior Eleonora Lad, MD, PhD CRU Director

Gene Therapy Aims to Help Eyes Produce

their Own Medicine

New Macular Degeneration Treatments on the Horizon

Duke Eye Center is participating in two pivotal gene therapy clinical trials that may become promising treatments for age-related macular degeneration, the most common cause of vision loss and blindness in older Americans.

The studies, ATMOSPHERE and ASCENT are large multisite trials, and Duke is the lead site for the latter.

Both treatments involve a novel gene therapy that essentially turns the eye into a “biofactory” that produces its own medicine.

“This research is exciting because it could offer a one-time treatment approach,” says Lejla Vajzovic, MD, FASRS, associate professor of Ophthalmology and principal investigator for the

trials. “It may be a permanent fix for patients.” In the treatment, a modified virus is injected into the eye. The virus contains engineered genes and cannot make people sick. Once in the eye, the virus spreads genes to other cells, where they produce a protein that slows or halts the disease process.

“We are introducing a novel gene that expresses medicine continuously in the eye,” Vajzovic says. “The results have been quite promising thus far.”

One-Time Treatment

The clinical trials are evaluating treatments for both kinds of age-related macular degeneration (AMD): dry and wet. In wet AMD, extra blood vessels form in the eye and leak, making the

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OR Team with Lejla Vajzovic, MD, FASRS trainees, and OR and research staff

central field of vision cloudy or opaque and rapidly leading to severe vision loss. The dry form doesn’t always cause troublesome vision symptoms, but it can progress to the wet form. The new treatment being tested would replace multiple injection treatment with a one-time eye surgery in which a retina specialist would inject the modified virus underneath the retina.

Duke is participating in another clinical trial, called HORIZON, that is evaluating a similar treatment

for the advanced form of dry AMD, in which clumps of cells in the retina die in a process called geographic atrophy. Patients with this kind of dry AMD can experience significant vision loss, although it progresses more slowly than wet AMD. In this case, the engineered virus injected during surgery contains genes that express a protein to tamp down the inflammation that drives geographic atrophy.

Ophthalmology at the Forefront

The eye provides an ideal site for gene therapy because it is a self-contained organ, which means drugs or genes injected into the eye rarely cause systemic side effects. It’s also a small organ, so doses can be small. Furthermore, imaging technologies give investigators an easy way of looking inside the eye to track the effects of the treatment.

For all these reasons, the field of ophthalmology is leading the charge when it comes to exploring treatments using gene therapy, with dozens of clinical trials underway.

In fact, the first FDA-approved gene therapy treatment in any medical subspecialty was for an eye disease. That treatment is for a rare inherited disease, but the treatments being tested as part of the ATMOSPHERE, ASCENT, and HORIZON trials have the potential to help many more patients, because about 11 million people in the United States have some form of AMD.

“Gene therapy is so novel and there are a lot of questions to be answered,” Vajzovic says, “but it’s exciting that ophthalmology is at the forefront of this approach, and it’s super exciting to be talking about having these options for patients.”

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Lejla Vajzovic, MD, FASRS Associate Professor of Ophthalmology
“We are introducing a novel gene that expresses medicine continuously in the eye. The results have been quite promising thus far.”
Lejla Vajzovic

From One Room to Worldwide Recognition

Around the world, investigators depend on Duke Reading Center to interpret optical coherence tomography (OCT), visual field and other ophthalmic images to determine treatment efficacy for all stages of clinical trials —from early phase testing to phase four.

Data generated by Duke Reading Center has helped to support FDA, European, and Asian regulatory approvals of several of the most important current drug treatments for retinal diseases such as uveitis, macular degeneration, and diabetes. It has also generated many research publications in respected peerreviewed journals.

Established in 2001 by Glenn Jaffe, MD and colleague Cynthia Toth, MD in a small patient room in the original Duke Eye Center clinic when optical coherence tomography (OCT) was a newly available technology and there were few treatments for retinal diseases.

Jaffe and Toth had a vision for Duke Reading Center—to become the premier institute for ophthalmic image reading in the world—to advance treatment for blinding eye diseases.

“We saw the potential to be at the cutting edge of clinical trials and as practicing retina specialists, wanted to help get these drugs into the market to help our own patients.” says Jaffe, Robert Machemer M.D. Distinguished Professor of Ophthalmology, and vitreoretinal diseases division chief.

Creating the Center seemed like a natural fit for Duke which has a long history of expertise in vitreoretinal diseases and eye imaging. Toth, Joseph A.C. Wadsworth Distinguished Professor of Ophthalmology is a pioneer in OCT who has revolutionized the technology in adult and pediatric patients—from the exam lane to the operating room, to the NICU. (see An Engineer at Heart: Cynthia Toth’s 25 years of revolutionizing eye care and surgery, page 4).

Jaffe and his team created a proprietary standardization method for image collection and image reading to ensure exceptional reproducibility. Photographers, technicians, and readers are certified to ensure images are acquired and results are standardized. To date, more than 20,000 photographers and technicians have been certified around the world.

Each project has a team of individuals— project managers serve as the point of contact for the sponsor and study site, data managers program the grading forms, obtain data and report results, readers or graders who evaluate the images and look for changes over time, and directors of grading who are physicians who oversee the reading. Indeed, the original vision of Jaffe and Toth has been realized: the Duke Reading Center plays an essential role in studies that result in new treatments or new indications being approved for eye diseases and has become the premier reading center in the world.

“We’re very proud of our accomplishments and that Duke Reading Center plays a pivotal role in development of new treatments for blinding eye diseases,” says Jaffe.

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“We saw the potential to be at the cutting edge of clinical trials and as practicing retina specialists, wanted to help get these drugs into the market to help our own patients.”
Glenn Jaffe

Duke Reading Center Project Teams

DATA MANAGERS

PROJECT MANAGERS

• point of contact for the sponsor and study site

DIRECTORS OF GRADING

• program the grading forms

READERS/ GRADERS

1 2 3 4

• obtain data

• report results

• evaluate the images

• look for changes over time

The Duke Reading Center proprietary standardization method includes teams in four categories for each project.

• physicians who oversee the reading

Duke Reading Center Directors of Grading

Duke Ophthalmology faculty serve as directors of grading in their respective specialty. Duke Biomedical Engineering faculty also serve as graders and there is strong collaboration among other departments at Duke such as Neurology.

Glenn Jaffe, MD Founder and Director

Cynthia Toth, MD Founder

Dilraj Grewal, MD Director of Grading

Eleonora Lad, MD, PhD Director of Functional Testing

Stefanie Schuman, MD Retina

Sanjay Asrani, MD Glaucoma

Mays Dairi, MD Neuro-ophthalmology

Jullia Rosdahl, MD, PhD Glaucoma

Anthony Kuo, MD Cornea

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“We’re very proud of our accomplishments and that Duke Reading Center plays a pivotal role in development of new treatments for blinding eye diseases.”
Glenn Jaffe

Study of Retinal Ganglion Cells Leads to a Passion for Education

Medical Education

Rosdahl became the medical student education director at Duke Eye Center in 2018. She knew that she had an opportunity to make a difference in the lives of med students and encourage them to consider ophthalmology as a specialty. The Duke Ophthalmology medical student rotation is unique; it includes dedicated teaching sessions such as the clinically oriented anatomy session and case sessions with eye center faculty and residents, as well as a community service project, and the ability to tailor the clinical activities to each students’ goals. Students also have the access to low vision curriculum and a microsurgery curriculum developed in collaboration with prior Duke medical students, one of the few programs in the country to offer this.

“I am really proud of our microsurgery course. During the course, students learn microscope basics, use foot petal at scope, drape a patient, what instruments are used for, pupillary distance suturing basics, have scopes to take home to practice suture, and learn how to measure pupillary distance,” said Rosdahl. “This robust 4-week course really digs into the key functions of what it takes to be an ophthalmologist.”

Focus on Medical Education During COVID Shutdown

When the world shut down for the COVID-19 pandemic, med students were not able to come for clinical rotations; Rosdahl knew she had to continue teaching, so she created the Duke Ophthalmology Virtual Medical Student Elective. The goal was to continue educating med students even if virtually, especially to reach those that are

most impacted by COVID.

“It was special to be able to help educate those impacted by the pandemic. And what is one of the best parts is that students were getting to experience the greatness of Duke Eye Center who may not have been able to,” said Rosdahl. “A lot of the students who participated in the virtual elective matched to ophthalmology residency programs including at Duke.”

Even when visiting med students were allowed back at Duke in-person, she decided that the virtual elective was such a success, it should be continued each year, but focusing more on students who are minorities and those who are at med schools where there is no home ophthalmology program.

The virtual elective has continued, and Rosdahl is content to have her students back onsite to see first-hand what ophthalmology is about.

Growing Underrepresented Minorities in Ophthalmology

The field of ophthalmology is one of the least diverse in medicine. Rosdahl has been instrumental in growing the number of

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Education is a passion for Jullia Rosdahl, MD, PhD, associate professor of ophthalmology and director of the medical student program at Duke Eye Center. She is passionate about medical education, patient education and the importance of wellness and taking care of yourself.
Rosdahl with medical students and residents at an educational event for underrepresented minorities.

Underrepresented Minorities in Ophthalmology. She routinely participates in the various programs to grow minorities in ophthalmology such as the Student National Medical Association, the American Academy of Ophthalmology MOM program, serves on the Duke Eye Center equity, diversity, and inclusion council, and encourages minority medical students who rotate through Duke Eye Center to consider a career in ophthalmology.

Patient Education is Key to Treatment Success

Rosdahl started out as molecular/cellular MD/PhD, studying retinal ganglion cells—those are cells that are damaged or killed from Glaucoma. This area of study led to her choosing ophthalmology and ultimately glaucoma as clinical subspecialty.

As a glaucoma specialist—trying to save ganglion cells—she understands the importance of saving these neurons and helping her patients understand their disease to avoid the risk of going blind from glaucoma.

In addition to working with her own patients, she serves as the National Eye Institute’s National Eye Health Program (NEHEP) planning group chair. In this role, she serves as a ‘subject matter expert’ in glaucoma, helping to develop equitable, easy to understand patient education materials for glaucoma and other eye diseases. Through NEHEP, she also has the opportunity to collaborate with organizations like Hadley, Bright Focus, and Prevent Blindness. Her passion for patient education led the American Glaucoma Society to ask her to develop and lead a new subcommittee on Patient Engagement in 2020. “Patient education is so important. Ophthalmologists need to make a connection with their patients to help patients understand what is going on with their eyes, why they need to come to their appointments, why it is important to engage with their therapy, this is where you can have successful outcomes and help your patients maintain their vision,” says Rosdahl.

Wellness is Key to Success

Focusing on wellness is important to maintain health and burnout so that physicians can continue to take care of patients. Rosdahl is the wellness director for Duke Eye Center and provides frequent tips and educational information on mental and physical wellness.

She lectures on wellness whenever she can, to remind physicians, students and staff about the importance of taking care of themselves to stay mentally and physically healthy.

“If we are not healthy then it makes a difference in our day-to-day activities, performing our jobs and being present for our loved ones,” says Rosdahl.

Rosdahl continues to be a strong advocate and educator on a multitude of situations. She takes pride in this role and makes a difference in the lives of her patients, students, and colleagues on a daily basis.

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Rosdahl, Rosdahl with Joanne Thomas at the Women in Ophthalmology Mentorship Program.

Eyes on a Miracle

Bhen Balu Sesay had been blind for 29 years when Lloyd Williams, MD, PhD first met her. It was a sweltering day in July 2021, in a small hospital exam room in Freetown, the bustling port capital of Sierra Leone. Williams saw immediately that both of Sesay’s eyes were badly damaged, the right one completely ruined and a milky haze covering the left, both the result of injuries she sustained as a teenager. Now 46 and the mother of five, Sesay had never seen her husband or her children. What brought her to Freetown, nearly three hours from her home, was a promise she still couldn’t quite believe: that her left eye could be fixed and that her years in the dark might end. The next day, Williams worked with a team of Sierra Leonean ophthalmologists to replace the opaque cornea in her left eye with one from a donor. It was one of eight corneal transplants that week, the first ever performed in the West African country. Twenty-four hours later, when doctors removed the patch protecting her repaired eye, she walked into the waiting room and toward a teenage child whose eyes were flooding with tears. “Girl, why are you crying?” she asked in Krio, the local language.

“Mom, it’s me,” the girl cried, reaching out to embrace her mother. “I am your daughter.” Even for Williams, who has performed hundreds of vision-restoring surgeries in the United States and other countries, those moments are soulstirring. It’s why he’s back in Freetown nine months later, having traveled 7,000 miles, taking three planes and a boat, clutching a Styrofoam cooler packed with human eyeballs.

“It’s the closest we can come to performing miracles on Earth,” he says.

“Miracle” is a word that Williams, a devout Christian and the son of Lutheran missionaries, invokes with a good deal of reverence. He notes that healing the blind is among the most frequently described miracles attributed to Jesus. But as a scientist, he knows what he and others are doing to restore sight in places like Sierra Leone is not divine intervention. It’s actually pretty straightforward ophthalmology. Consider cataracts—the most common cause of blindness globally, leaving more than 17 million people with no functional vision—can usually be fixed with a simple, one-time surgery that costs as little as $12 to perform. Millions more, like Balu Sesay, could have their vision restored with a corneal transplant. In fact, according to the International Agency for the Prevention of Blindness, more than three-quarters of the estimated 43 million people around the world who are blind could regain sight through medical intervention.

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In West Africa, a Duke eye surgeon is helping local doctors restore sight to the blind, a mission that is both easier and harder than you’d think.
>
DUKE EYE CENTER 2023
“No one person is going to end preventable blindness alone. We need an army of people.”
Lloyd Williams

That so many remain in darkness is primarily a function of the massive inequities in global health care. Ninety percent of people with preventable blindness live in low-income countries, which often lack the resources to offer anything like comprehensive eye care. In sub-Saharan Africa, there are just 2.5 trained eye specialists for every million people, akin to a city the size of Durham having only one eye doctor. Problems like cataracts or glaucoma, which are typically painless and progress slowly, often go untreated for years, eroding vision until a person is left completely blind.

“There are no campaigns in West Africa to tell people to go get their eyes checked,” says Leon Herndon, MD, Professor of Ophthalmology and glaucoma division chief who has done clinical research and training in Ghana and Nigeria.

“There’s very little education about eye diseases, and many people believe that once you lose vision, it’s just hopeless.”

After finishing medical school and joining a private practice in Utah, Williams threw himself into that mission with characteristic, high-motor zeal. A competitive cyclist who builds guitars to unwind, he crammed his calendar with trips abroad, usually funded by himself or with small donations. He estimates he has done some 700 cataract surgeries in countries including Nepal, Guatemala and South Sudan.

But such drop-in visits are a Band-Aid solution at best. Williams came to Duke in 2019 to work on something more sustainable. He now leads Duke’s Global Ophthalmology Program, adroitly rebranded as Duke GO, which is aiming to provide more structure to the international efforts of several Duke eye doctors across Africa, Asia, and Central America. The point is not just to help eye doctors in those places, but to empower them, he notes.

“No one person is going to end preventable blindness alone,” he says. “We need an army of people.”

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“There are no campaigns in West Africa to tell people to go get their eyes checked. There’s very little education about eye diseases, and many people believe that once you lose vision, it’s just hopeless.”
Leon Herndon
An excerpt from “Eyes on a Miracle” that appeared in the Fall 2022 Duke Magazine. To read the full story, scan the QR code.
Ranking US News & World Report Best Hospitals in Ophthalmology DUKE EYE CENTER 2023 Award Funding $15,009,671 Non-Federal $10,449,132 Federal $25,458,803 Total NIH Grants 101 NIH Funding Ranking 10 6 Retina 49,815 Glaucoma 51,550 Pediatrics 20,561 Plastics 8,081 Neuro 8,021 Low Vision/ Vision Rehab 2,043 clinical physicians research scientists residents 320 14 19 23 75 ophthalmology fellows Faculty, Trainees and Staff 451 health staff 2022 Stats

Duke Eye Center

16,243

Locations 8 Cornea 41,382 Comprehensive 31,291 Cary Duke Eye Center Main Campus WinstonSalem South Durham Raleigh Holly Springs Arringdon Duke Oculofacial and Plastic Surgery
Surgeries Total Patients 212,744 Duke Eye Center ranked #4 Best Overall Program by Ophthalmology Times #3 Best Research Program #7 Best Clinical Care Program #4 Best Residency Program

A Life of Service for People with Disabilities

When Melissa Daluvoy, MD, was a high school track and field athlete in a small town in Pennsylvania, a friend’s father asked her to help out with a Special Olympics event he was organizing. She said yes, little knowing it was the first step of a lifelong journey.

Daluvoy never stopped volunteering with the Special Olympics. “It’s really rewarding,” she says. “The athletes are truly appreciative of any help you give. It’s always a great day and when you leave, you feel happy.”

Today, as an associate professor of ophthalmology at Duke Eye Center, Daluvoy’s volunteer role has changed. She now provides eye care to the athletes as part of a program called Opening Eyes, which is a partnership between the Special Olympics and the Lions Club International Foundation. During Special Olympics events, athletes are invited to stop by the vision area for a variety of vision tests and, if needed, are given a free pair of prescription glasses, which can often be made on the spot.

A Circuitous Route to Ophthalmology

Back in high school, Daluvoy planned to become a physical therapist—she pictured herself working on the sidelines during Philadelphia Eagles games—and she did in fact earn a MPT degree after college. However, during PT school, she realized she wanted to delve deeper and learn more about the biological processes behind her patients’ injuries and ailments. So she took a few extra prerequisites and applied to medical school.

At first, she didn’t have a particular subspeciality in mind, but after her ophthalmology rotation, she was hooked. “I really liked the intricacy and fine detail that came with eye surgery,” she says. She also appreciated the opportunity to work with both adults and children.

Throughout all of it—college, PT school, medical school, and ophthalmology residency and cornea fellowship—she stayed involved with the

Special Olympics. “Every city and lots of little towns host their own version,” Daluvoy says, “so every time I moved, I would seek it out.” She began working with Opening Eyes when she was an ophthalmology resident at George Washington University.

Reviving Opening Eyes NC

When she joined the Duke Eye Center faculty in 2013, the North Carolina chapter of Opening Eyes was dormant. She and an optometrist in private practice, restarted the program and codirected it for several years. Now, she is the sole official director of Opening Eyes NC.

Duke Eye Center supports Daluvoy’s efforts with donated supplies and lots of volunteers to help staff the two main events—in Raleigh every June and in Blowing Rock every January—and smaller regional and local tournaments.

Caring for Patients with Disabilities

Daluvoy has drawn on her years-long experience with athletes in the Special Olympics. “My work with the Special Olympics makes me comfortable working with families or patients with a disability,” she says.

As a cornea specialist, she often treats patients with Down syndrome who have keratoconus, in which the surface of the cornea bulges out. It is about 15 times more common in people with Down syndrome than the general population.

Daluvoy also seeks out opportunities to teach others the skills she’s learned while working with athletes at the Special Olympics and patients with disabilities. “Not all providers feel comfortable treating and examining patients with intellectual disabilities,” she says. For that reason, whenever she is giving a lecture to current or future ophthalmologists, she always takes the opportunity to offer tips on caring for people with disabilities.

“Barriers to care are a big deal for people with intellectual disabilities,” she says. “I’m just trying to break down as many barriers as I can.”

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“Barriers to care are a big deal for people with intellectual disabilities. I’m just trying to break down as many barriers as I can.”
Melissa Daluvoy
Melissa Daluvoy, MD Associate Professor of Ophthalmology

Gift Supports Duke Ophthalmology Training Program

In the decades since Peter Holland, MD, completed his residency training at Duke Eye Center in 1975, he and his wife Merle have lived and worked in Boston, Washington, Houston, and Chicago. But no matter their address, they have always savored fond memories of Duke and Durham. “My experience at Duke was wonderful,” Peter says. It was a special time for Merle too. “We made lifelong friends with the other residents,” she says. “It was an idyllic time for both of us.” Now the couple are supporting the Duke Ophthalmology Training Program so that other residents can continue to have the same kinds of wonderful experiences. “We feel like we want to pay back to Duke some of what it gave to us,” Peter says.

The Hollands chose to make a planned gift through their will. “It was a way to give to Duke that allowed us to still have the funds until both of us have passed away and also reduce the taxation on our estate,” Peter says.

The funds from their gift will be used to support residents in activities that aren’t already supported financially by the department. For example, if a resident wants to travel to a conference to present a paper, the funds could be used to help pay for travel and hotel expenses.

“It’s something to help future residents,” Merle says. “We hope the excellence of the program continues for other people, because it was so instrumental in our lives.”

Peter, who grew up on Long Island and went to medical school in New York City, had heard about the excellent medical center at Duke. When he came down to interview in 1970, he was struck by the beauty of the area and by the friendliness of the faculty and residents. “All of the residents raved about the program,” he says. “I was accepted at several programs in New York, but when I got the acceptance letter from Duke, I knew that was where I was going.”

After completing his training at Duke, Peter did a fellowship in diseases and surgery of the retina at Massachusetts Eye and Ear Infirmary in Boston. He spent his career specializing in diseases and surgery of the retina. For 32 years, he was in private practice in Houston, while also serving on the faculty at Baylor Medical School, operating with residents and teaching. Peter also worked in a teaching capacity at Northwestern University Feinberg School of Medicine, his most recent position, where he supervised residents providing emergency eye care.

Looking back, he feels that training at Duke set a standard of excellence for his entire career.

As Merle says, “When you train at an outstanding institution like Duke, those are the expectations you have for yourself and for other people. You know what you are looking for. No matter where you go in the country or what you do, there is a level of excellence that you expect.”

Peter says his Duke training instilled in him a strong ethos to be prepared, put the patient first, and be willing to discuss hard cases with colleagues rather than going it alone. “It’s important to know what you don’t know,” he says. “The greatest risk to patients is a physician who feels that they are all-knowing, and of course none of us are.”

Even though the training program was rigorous and time-consuming, Peter found the atmosphere to be supportive, with attendings and older residents generously sharing their knowledge and experience with the younger residents. In their free time, the couple enjoyed sharing meals with other residents in their homes. They also spent time at the Duke Faculty Club and ate an occasional meal at the former Oak Room on West Campus. While Peter was working, Merle cared for their baby boy and took classes at the University of North Carolina at Chapel Hill, on her way to eventually becoming a psychologist specializing in family therapy and children with learning issues.

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Duke Eye Center Development News 2023

“It’s something to help future residents. We hope the excellence of the program continues for other people, because it was so instrumental in our lives.”

The couple are now retired and living in Chicago. One son and his family live nearby, and another son and his family live in Charlottesville, Virginia. In retirement, Peter and Merle have more time to spend with their five grandchildren and pursue their hobbies, including bicycle trips in the United States and abroad. Retirement also spurred them to think about giving back.

“We were getting to a point in life where we had to give some thought to making charitable contributions, and first on our list was Duke,” Peter says. “We wanted to contribute, and they just made it so easy for us to do it. Like everything else I’ve done at Duke, it was a pleasure.”

Gift Planning Q&A

With thoughtful planning, you can leave a lasting legacy to Duke Eye Center. There are many ways to make a legacy gift. Your gift can support any area of the Eye Center, augment your current giving, and even establish an endowed fund.

Can I support Duke Eye Center’s future needs while maintaining estate flexibility and peace of mind?

A gift through a will or trust allows you to remain in control of your assets during your lifetime. Moreover, you can modify your plans if your needs change.

What can I give through a will or trust?

Many types of assets may be given through your will or trust. These include cash, stock or mutual fund shares, and real estate. Retirement accounts are also a terrific source of legacy gifts and can offer tax advantages.

Can I receive fixed income for life—for myself or a loved one—with a gift to the Eye Center?

A charitable gift annuity provides a future source of support for the Eye Center and guaranteed income for you and/or a loved one for life, along with several other tax benefits. These include an immediate tax deduction for the value of your gift, partially tax-free income, and favorable treatment of capital gains if you donate appreciated securities.

How can I fund a charitable gift annuity? You may establish a charitable gift annuity with a gift of $10,000 or more. You may fund the charitable gift annuity with either cash or appreciated securities.

To learn more, contact the Office of Gift Planning: Call us at 919.385.3115 or email us at giftplanning-dukehealth@duke.edu.

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The Hollands outside of Kitzbuhel, Austria en route from Munich, Germany to Salzburg, Austria.

New Faculty

Oleg Alekseev, MD, PhD, Medical Instructor, is a member of the Duke Center for Retinal Degenerations

and Ophthalmic Genetic Diseases and specializes in inherited retinal degenerations. He joined Duke Eye Center faculty after completing doublefellowship training in Medical Retina and Inherited Retinal Degenerations at Duke. He is a K08-scholar and dedicates the majority of his time to basic and translational research in the laboratory. He is interested in developing gene-agnostic approaches to extend the longevity of ailing photoreceptors in conditions like retinitis pigmentosa, thereby preserving the vision of affected patients. The approaches he investigates include both gene-therapy and smallmolecule-based therapeutic modalities.

Alekseev completed combined MD-PhD training at Drexel University College of Medicine and pursued post-doctoral fellowship training at the University of Pennsylvania School of Medicine. He completed Ophthalmology residency training at the University of North Carolina School of Medicine, where he also served as a chief resident.

Ramiro Maldonado, MD, Assistant Professor of Ophthalmology, is a member of the vitreoretinal diseases division. He specializes in pediatric retinal diseases, and pediatric and adult ophthalmic genetics and inherited retinal diseases. Prior to joining Duke, he was Assistant Professor of Ophthalmology and Founder and Director of Ophthalmic Genetics and Electrophysiology Service at the University of Kentucky Medical Center.

Maldonado provides pediatric medical retina services in addition to pediatric and adult inherited retinal disease care. He studies how new DNA variants cause inherited eye diseases. To do this, he devotes his efforts to create big-data genetic analysis, develop novel imaging tools to improve diagnosis, and team with biologists to understand the functional consequences of abnormal DNA variants. He completed a fellowship in pediatric retinal imaging at Duke Ophthalmology. He also completed an ophthalmic genetics and electrophysiology and medical retina fellowships at the National Institutes of Health (NIH-NEI).

Ryan McNabb, PhD, Medical Instructor, McNabb is an engineer by training with a research focus on combining optical coherence tomography (OCT) and robots for use in the ophthalmology clinic. He recently joined the Department of Ophthalmology faculty after post-doctoral training and serving as a lead Research Scientist under Anthony Kuo, MD at Duke Eye Center.

He enjoys working closely with clinicians to combine technology and medicine. He is the principal investigator on an NIH R21 grant for “Assistive Robotically Aligning OCT and Laser Photocoagulation Therapy of the Retinal Periphery” in collaboration with Cynthia Toth, MD. This grant will develop robotically aligned OCT to locate suspected retinal breaks in a patient’s peripheral retina before they can become vision threating detachments. McNabb earned his undergraduate from North Carolina State University in Electrical Engineering and completed his doctoral training at Duke University in the Department of Biomedical Engineering under the mentorship of Joseph Izatt, MD.

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Alekseev Maldonado McNabb

Optometrists Join Duke Eye Center to Streamline Care

Wisely

joined Duke Eye Center after completing fellowship training in Cornea, External Disease, and Refractive Surgery at Duke in 2022.

During fellowship, Wisely gained expertise in anterior segment, corneal diseases, refractive surgery, and surgical procedures. He was also involved in cutting edge care for patients with ocular surface diseases including dry eye disease.

Wisely received dual medical and business degrees from The Ohio State University. He completed his residency and served as chief resident at Duke Ophthalmology, where he was a clinical instructor and the director of the ophthalmology consultation and ophthalmic trauma services at Duke University Hospital. In addition, he supervised resident cataract surgical education at the Durham Veterans Affairs Medical Center (VAMC).

He serves as principal and co-investigator on numerous research endeavors, including projects with charitable foundation and health industry sponsorship. Wisely is an affiliate of the Duke Sports Vision Center, serving as a consultant ophthalmologist for Duke University Athletics.

Duke optometrists have extensive experience in ocular disease treatment and management, emergent ophthalmic care and anterior segment post-surgical care. They see a wide range of patients from children to adults. Duke optometrists perform comprehensive eye exams ranging from routine glasses exams to diagnosing and managing acute and chronic eye conditions. They see patients for emergency care such as red eyes or sudden changes in their vision. Duke optometrists direct patients to any specialty care that they may need, as well as co-manage before and after eye surgeries. They screen for and manage the beginning stages of diseases of the eyes such as dry eyes, cataract, glaucoma, diabetic retinopathy, macular degeneration and other retinal conditions.

Comprehensive

Comprehensive

OD

Comprehensive, Vision Rehabilition

Comprehensive

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Research Roundup

Research to Prevent Blindness (RPB) Research Awards

Duke Eye Center has remained a top academic medical institution for laboratory and clinical research in ophthalmology. Faculty, trainees and research staff are passionate about new discoveries to improve patient care and are recipients of many prestigious research grants. Research to Prevent Blindness has been an important partner in Duke Eye Center research funding.

Anthony Kuo, MD, associate professor of ophthalmology, was granted the prestigious RPB Physician-Scientist Award to support his project “Robotically Assisted Anterior Eye Examinations for Acute Eye Care.” The Physician-Scientist Award is designed to allow physicians to devote more time to clinical research activities. Kuo will use this grant to extend the capabilities of a previously developed imaging system that can provide robotically aligned optical coherence tomography (RAOCT) for semi-automated retinal imaging of patients and test diagnostic performance of this system. Kuo is one of 17 RPB Physician-Scientists who have received the award since it was re-established in 2015. The Department of Ophthalmology has been awarded an RPB Unrestricted Grant to support eye research conducted by the department. 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.

Soha Noorani, MS4 and Duke Visiting Observer received a $30,000 Research to Prevent Blindness/ American Osteopathic College of Ophthalmology and Otolaryngology – Head and Neck Surgery (RPB/AOCOOHNS) Foundation Medical Student Eye Research Fellowship. This grant supports Noorani taking a year off from medical school to pursue a research project within the Duke Department of Ophthalmology. Since it was founded in 1960, RPB has channeled more than $403 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.

Soha Noorani, MS4 Duke Visiting Observer
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Anthony Kuo, MD Associate Professor of Opthalmology

Research Shows Promise for Treatment

Targets and Functional Endpoints

Goldis Malek, PhD is a primary investigator at Duke Eye Center. Her lab is focused on understanding the cellular and molecular pathogenic mechanisms underlying the dry and wet forms of AMD. The ultimate goals for Malek and her research colleagues are to identify signaling pathways, which become dysfunctional in AMD; develop animal models, which present with features of the human disease; and identify potential therapeutic targets.

Potential New Target for AMD Therapy

Morphological and functional changes in the retinal pigment epithelium (RPE), nurse cells to the retina contribute to the development of ocular diseases including age-related macular degeneration (AMD). Duke researchers report in the July 2022 issue of Proceedings of the National Academy of Sciences (PNAS), identifying a transcription factor called

NURR1 or Nuclear Receptor— Related 1, as a regulator of epithelial morphology using cell culture and animal models. The study shows that activation of the receptor improves RPE function and morphology and decreases pathologies associated with AMD including inflammation and lipid accumulation, thus supporting targeting this receptor as potential therapy for AMD.

Identification and Characterization of Measurable Endpoints for Clinical Trials

The use of pre-clinical models to test for and identify potential therapies in patients is a necessary step to drug discovery. Success in using these models depends on the development and characterization of disease relevant-testable endpoints. In this study, published in the April 2022 issue of Laboratory Investigation, the authors report disease appropriate

morphological and retinal functional endpoints that could be assessed when testing candidate therapeutic drugs for ocular diseases such as agerelated macular degeneration, in which inflammation and lipid dysregulation play a role. Success in models such as these is an important step in the path to clinical trials.

Risk Factors Associated with Diabetic Retinopathy in Pregnancy

Diabetic retinopathy (DR) in pregnancy is a very important risk factor for pregnant people with diabetes and is an issue that does not receive the attention it deserves. Duke researchers, led by Majda Hadziahmetovic, MD, assistant professor of ophthalmology, performed meta-analysis and systematic review of literature aimed to provide physicians with more information on the risk factors associated with the progression of DR in pregnancy and how to counsel this vulnerable patient population appropriately.

Results published in Clinical & Experimental Ophthalmology shows pre-eclampsia and hypertension treatment during pregnancy were significantly associated with the development/progression of DR. HbA1c at baseline, duration of diabetes, and diastolic blood pressure at baseline were all significantly higher in the progression group while only mean birth weight was significantly higher in the non-progression group. This research may better inform physicians and help patients from potentially blinding eye disease.

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Ophthalmology

Forefront of the Future: Artificial Intelligence, Augmented Reality and Imaging

Intraoperative Imaging for Infant Optic Nerve Health

Sharon Freedman, MD, along with co-authors Tanya Glaser, MD, assistant professor of ophthalmology and Mays Dairi, MD, associate professor of ophthalmology, recently published novel work on the use of Intraoperative mounted optical coherence tomography (OCT) to document optic nerve changes that occur in infants with glaucoma by imaging their optic nerves and maculae both before and several months following successful surgical reduction of the intraocular pressure.

Clinical optic nerve cupping reversal has long been seen in such eyes, but this research published in the American Journal of Ophthalmology, shows OCT imaging was able to quantify these changes.

Virtual Reality-Based Visual Field Testing in Children

Sharon Freedman, MD, received a generous gift from Saving Kids’ Sight to continue work on Virtual Reality-Based Visual Field Testing in children. Using a novel virtual reality headset videogame-based algorithm, children fly a ‘spaceship’ as their peripheral vision is being tested on both eyes simultaneously.

Pilot work by Freedman, professor of ophthalmology and pediatrics and strabismus division chief, and colleagues suggest that this technology may facilitate testing for visual field damage in children with glaucoma and dangerous neurologic conditions who have trouble with tabletop standard visual field tests.

This novel testing can also be performed by families at home, with the results immediately uploaded to a cloud-based secure platform shared with their physician.

The authors also verified that the peripapillary retinal nerve fiber layer (pRNL) remains stable even when the optic nerve appearance improves, and represents a truer measure of optic nerve health in infants with glaucoma.

Artificial Intelligence for Pediatric Retinal Disease Screening

Pediatric retinal diseases can have devastating visual outcomes, and often are diagnosed late. Tele-ophthalmology, imaging with fundus photography, and artificial intelligence (AI) have been studied for pediatric retinal diseases such as retinopathy of prematurity and can help screen a greater number of patients. Duke researchers evaluated the use of artificial intelligence for screening for pediatric retinal diseases through analysis of pediatric wide-field fundus photos. Results published in Ophthalmology Science indicates the deep learning algorithm shows promising results with sensitivity and specificity.

The AI algorithm demonstrated good performance in screening for retinal diseases in this proof-of-concept preliminary study. Further training of the algorithm with more graded images is needed to help improve performance prior to clinical use.

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Sharon F. Freedman, MD Professor of Ophthalmology Patient wearing the Virtual Reality-Based Visual Field testing device

A 3D model of retinal landmarks (i.e., optical disc, macula, and blood vessels) will be extracted from the patient’s color fundus photos and visualized as holograms by Microsoft HoloLens 2, an AR headset worn by the doctor (shown above left). This hologram will be overlaid on the magnifying lenses providing visualization-based guidance to the surgeon. The AR system will provide an alert with textual guidance (shown above right), indicating which retinal landmark the laser is pointing at. Additionally, the system will alert the doctor with auditory guidance when the laser is predicted to hit the wrong target.

AR-assisted guidance system for retinal laser therapy

Augmented Reality (AR) is a rising technology widely implemented across various applications. In medical applications, AR can be used to visualize medical information such as patient’s information or anatomical diagram for patient consultation, pre-operative surgical planning, and intra-operative surgical guidance.

A multi-disciplinary team at Duke Ophthalmology and Duke University Pratt School of Engineering is developing an AR-assisted guidance system for retinal laser therapy that can visualize the retinal landmarks in holograms and guide doctors and trainees on the regions that need to be treated with the laser and the areas that need to be avoided.

The AR-assisted guidance system in retinal laser therapy can be beneficial in both clinical settings and training. In training, medical students, residents, and fellows can practice retinal laser therapy using the AR system and learn the required skills through the guidance provided by the system. In clinical settings, the AR system can improve the efficiency and accuracy of the procedure and potentially reduce doctors’ cognitive loads.

A demo of this work was presented at the 20th ACM Conference on Embedded Networked Sensor Systems (SenSys) in Boston. The team will continue implementing the system in combination with the retina phantom model to evaluate the use case in retinal laser therapy. This work is supported by National Science Foundation (NSF) and Thomas Lord Educational Innovation grants.

The team led by Sarah Eom, PhD, an electrical and computer engineering student at Duke University Pratt School of Engineering, in collaboration with Majda Hadziahmetovic, MD, assistant professor of ophthalmology, Miroslav Pajic, PhD, Dickinson Family Associate Professor, electrical and computer engineering and Maria Gorlatova, PhD, Nortel Networks Assistant Professor of electrical and computer engineering envisions that AR can be integrated into the retinal laser therapy commonly used for the treatment of various retinal pathologies (e.g., proliferative diabetic retinopathy, diabetic macular edema, and retinal tears).

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The AR-assisted guidance system in retinal laser therapy can be beneficial in both clinical settings and training.

Duke Researchers Seek to Bridge Knowledge Gap in the Biology of Corneal Nerves

Corneal nerves are extremely complex as they need to respond to such a vast number of different stimuli and then must convey this information to the brain with utmost precision. Due to this complexity, scientists and physicians still do not fully understand the biology of corneal nerves. To address this gap in knowledge, the National Eye Institute at the NIH established a 5-year consortium with eight extramural research groups across the country to specifically fund and develop this area of research.

Duke School of Medicine, and Duke Pratt School of Bioengineering, will serve as a major research site in collaboration with Jules Stein Eye Institute and Brain Research Institute at University of California, Los Angeles.

The interdisciplinary team includes Daniel Saban, PhD, associate professor of ophthalmology and colleagues at UCLA, who will unravel the genetic, molecular, and functional

properties of corneal nerves in animal models. In parallel, Sina Farsiu, PhD, professor of biomedical engineering and Victor Perez, MD, Stephen and Frances Foster Distinguished Professor of Ophthalmology will conduct combined behavioral analysis, imaging modalities, and machine learning studies to elucidate corneal nerves in human subjects. The bold research plan will establish the first multi-level classification of the corneal circuitry—integrating animal models and human data into one atlas.

This compendium will enable researchers in the future to identify novel pain processes, markers, and targets from whole genome catalogs; establish conserved morphological and molecular motifs with functional precision; reveal structure-function relationships from “real-world” clinical data; and openly access our standardized AI platform to examine confocal imaging for future observational studies and clinical trials.

Capture of a cornea from a live mouse showing the complex and intricate network of corneal nerves, of which scientists and doctors know very little about with respect to how these nerves contribute to normal corneal functions (i.e. tearing, blinking, sensation) and how their dysfunction contributes to ocular pain and corneal disease.

34 DUKE EYE CENTER 2023 Duke Eye Center Research Roundup 2023
Set of captures from a patient cornea. The left column represents image capture; right column is AI rendering. Daniel Saban, PhD Associate Professor of Ophthalmology Sina Farsiu, PhD Professor of Biomedical Engineering Victor Perez, MD Stephen and Frances Foster Distinguished Professor of Ophthalmology Sejiro Littleton Zane Zemborain; Mattias Soifer, MD; Nadim Azar, MD; Sina Farsiu, PhD

Longitudinal Analysis of Choroidal Vascularity Index in Branch Retinal Vein Occlusion

Branch retinal vein occlusion (BRVO) is the second most common retinal vascular disease, estimated to affect 14 million people worldwide. Cystoid macular edema (CME) is the most common vision-threatening complication of BRVO. Understanding the pathophysiology of CME in eyes with BRVO can lead to better treatment decision-making and may improve visual prognosis for patients with BRVO-related CME.

In a study led by Duke School of Medicine student, Praruj Pant, MS4 with Sharon Fekrat, MD, FACS, and Dilraj Grewal, MD, as mentors, sought to better understand BRVO by studying choroidal vascularity index (CVI), a novel OCT imaging metric that may be a more robust metric of choroidal

vascular integrity than is choroidal thickness. Through a retrospective longitudinal study, CVI was compared between eyes with treatmentnaïve BRVO-related CME and unaffected fellow eyes at time of diagnosis and at 12-month followup visit.

Baseline CVI was lower in BRVO vs fellow eyes, but that there was no difference in CVI between BRVO and fellow eyes at 12-month follow-up. Over this same time frame, CME and visual acuity significantly improved in the BRVO eyes. Findings indicate initial differences in choroidal vascularity between treatment-naïve

BRVO eyes with CME compared to fellow eyes, but suggests that these differences resolve over time. In the context of existing literature, these findings support the theory that changes in

choroidal vascularity in BRVO eyes are mediated by vascular endothelial growth factor (VEGF), which is known to play a role in pathologic angiogenesis in many retinal vascular diseases. Much remains unknown about the pathophysiology of CME in BRVO. This research adds to the growing body of literature investigating the relationship between choroidal vascular changes and retinal vascular disease. With further exploration, this line of research will help better understand what causes CME after acute retinal ischemia, which may help guide management for this vision-threatening condition.

This project received the 2021 Vitreoretinal Surgery Foundation Research Award.

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Illustration of Comprehensive Ocular Imaging Network (COIN) Console for Computing choroidal vascularity index (CVI) in eyes with macular edema (CMO). Praruj Pant, MS4 Sharon Fekrat, MD, FACS, FASRS Professor of Ophthalmology Dilraj Grewal, MD Associate Professor of Ophthalmology

Honors and Awards

(For a list of research awards, please see Research Roundup page 30)

AAO 2022

The American Academy of Ophthalmology and Academy President Robert E. Wiggins, MD, MHA recognized Edward G. Buckley, MD as a guest of honor at AAO 2022.

Chantal Bosivert, MD, OD served as Neruoophthalmology symposia co-chair.

Kelly Muir, MD served as a Program Director for Glaucoma Subspecialty Day.

Sharon Freedman, MD served on the Program Planning Committee and served as a moderator for Pediatric Ophthalmology Subspecialty Day.

Durga Borkar, MD received the 2022 Achievement Award.

Frank Brodie, MD, MBA, Duke Vitreoretinal Surgery Fellowship alumnus received the 2022 American Academy of Ophthalmology Artemis Award.

Faculty

Sanjay Asrani, MD was the keynote speaker at the South African Glaucoma Society Meeting in Durban, SA in May 2022.

Chantal Bosivert, MD, OD was a NANOS 2022 Hot Topics Symposia Co-Chair. She was named America’s Most Honored Doctors – Top 1% by The American Registry, a Top Doctor and Exceptional Women in Medicine by Castle Connolly.

Durga Borkar, MD received the 2022 ASRS Honor Award.

Xi Chen, MD, PhD received the Golden Globe Award for her commitment to resident teaching, in clinic, surgery, and in didactic lectures at Duke Eye Center.

Laura Enyedi, MD was selected as an Exceptional Women in Medicine by Castle Connolly. Elected AAO Councilor for Women in Ophthalmology (WIO) and to the WIO Board of Directors.

Romain Cartoni, PhD received an NIH RO1 NOA for his project “Regulation of the retinal ganglion cell repair program by the mitochondrial protein Armcx1.”

Sharon Fekrat, MD, FACS, FASRS was chosen as the 2022 recipient of the Crystal Apple Award by the American Society of Retina Specialists Early Career Section for her mentorship and sponsorship of others. She was invited to be a member of The Retina Society’s Website Committee for a 3-year term.

DUKE EYE CENTER 2023
Edward G. Buckley, MD was recognized as a guest of honor at AAO 2022.
36

Leon Herndon, MD is the 2023–2024 President of American Glaucoma Society.

Glenn Jaffe, MD was elected the 2022 Macula Society President, the most prestigious of the major Retina Societies.

Anthony Kuo, MD received a Research to Prevent Blindness Physician-Scientist Award.

Eleonora Lad MD, PhD was an ARVO 2022 meeting “Hot Topic” presenter. She became Associate Editor, Ophthalmic Surgery, Lasers and Imaging (OSLI) Retina Journal and was selected to serve on Retina Society Bylaws Committee and Grant Review Committee.

Terry Kim, MD, Past President of the American Society of Cataract and Refractive Surgery (ASCRS), was invited to give the Keynote Lecture at the 61st Annual Walter Wright Symposium in Toronto Canada. He was appointed to the Executive Committee of the Alcon Research Institute and was also ranked in the top 5 out of 150 ophthalmologists in America’s Best Eye Doctors 2022 List by Newsweek.

Goldis Malek, PhD was named co-Editor in Chief of Current Eye Research.

Miguel Materin, MD is SecretaryTreasurer and Senior Director for AAO Subspecialty Day Planning 2023 for the American Association of Ocular Oncology and Pathology. He is a member of National Comprehensive Cancer Network (NCCN) Uveal Melanoma Committee.

Kelly Muir, MD received the Excellence in Education Award for her outstanding contribution to medical student education.

Victor Perez, MD was accepted to be an active member of the American Ophthalmology Society and selected to serve on the NIH/NEI National Advisory Eye Council (NAEC).

S. Grace Prakalapakorn, MD, MPH was invited as a faculty to speak at the 5th World ROP Congress in Dubai and a featured speaker at the New Mexico Academy of Ophthalmology (NMAO) Annual Scientific Meeting.

Stefanie Schuman, MD completed the 2022 cohort of the Duke AHEAD Certificate in Health Professions Education & Teaching program as one of 12 faculty chosen Duke-wide to further interprofessional work and education. She was awarded the 2022 DASHE (Duke AHEAD support for our health professions educators) Award for her role as a health professions educator.

W. Daniel Stamer, PhD was elected to the Glaucoma Research Society, a public-interest, nonprofit organization of the world’s leading glaucoma researchers.

Cynthia Toth, MD delivered the closing keynote for the 2022 ARVO Annual Meeting.

Lejla Vajzovic, MD was recognized as a 2022 Castle Connolly Top Doctor. She was nominated to be The Retina Society AAO Council Representative, a 3-year term. She was elected to serve as a Treasurer of Women in Ophthalmology and will continue to serve on WIO Board of Directors and direct the WIO Clinical Trials Training Program.

Julie Woodward, MD was awarded the Henry Baylis Award for contributions to cosmetic surgery, the highest honor for ASOPRS members.

Fellows

Jordan Deaner, MD received the Hornaday Award for demonstrating exceptional ability in clinical, research, and teaching efforts at Duke Eye Center.

Kevin Jackson, MD received the Edward K. Isbey, Jr. Award for demonstration of excellence in clinical care, ethics, and research at Duke Eye Center.

> 37

Honors and Awards

Grant Justin, MD was selected among the top 20 entries for the Vit-Buckle Society (VBS) Fellows Foray 2022 Surgical Video competition. He received the Vitreoretinal Surgery Foundation Award. He received a VitreoRetinal Surgery Foundation Award for “Evaluating the Retinal Structure and Microvasculature in Mild and Moderate Traumatic Brain Injury using Multimodal Retinal Imaging.”

Lauren May, MD was named Duke Ophthalmic Technician Fellow Teacher of the Year.

Faculty Promotions

Pratap Challa, MD Professor of Ophthalmology, with Tenure

Dilraj S. Grewal, MD Associate Professor of Ophthalmology, with Tenure

Eleonora G. Lad, MD, PhD Associate Professor of Ophthalmology, with Tenure

Katy Liu, MD, PhD Assistant Professor of Ophthalmology

S. Grace Prakalapakorn, MD, MPH Associate Professor of Ophthalmology, with Tenure

Lejla Vajzovic, MD, FASRS Associate Professor of Ophthalmology, with Tenure

Residents

Darren Schuman, PhD received the Best Research Presentation by a full-time Research Fellow Award for his poster presentation at the 2022 Duke Ophthalmology Scientific Session.

C. Ellis Wisely, MD, MBA received the Best Research Presentation by a Clinical Fellow Award for his podium presentation at the 2022 Duke Ophthalmology Scientific Session.

2022-2023 Heed Fellows

Sahil Aggarwal, MD was invited to the Heed Ophthalmic Foundation Resident Retreat and received the ASCRS Resident Excellence Award. He was awarded Duke Eye Center’s RPB Small Grant Award for his project titled “Postoperative Emergency Department Visits after Anterior Segment Surgery” under the mentorship of Leon Herndon, MD, for which he also won first place in the poster competition at NCSEPS and was featured in EyeNet Magazine. His research on resident-involved cataract surgeries at the Veterans Health Administration, funded by a $96,000 Independent Research Grant from Bausch & Lomb, was published in the Journal of Cataract and Refractive Surgery. He completed the Duke Graduate Medical Education Leadership Track (MELT) program.

Michael De leso, PhD received the Best Research Presentation by a Full-Time Research Fellow Award for his podium presentation at the 2022 Duke Ophthalmology Scientific Session.

Nelli Galoyan, MD, PhD received the Best Research Presentation by a Clinical Fellow Award for her poster presentation at the 2022 Duke Ophthalmology Scientific Session.

S. Tammy Hsu, MD received the Jack McGovern Coats’ Disease Foundation Education Grant for her project on Preliminary Evaluation of Pediatric Widefield Fundus Photos using Artificial Intelligence. She received an award for a top 10 presentation at the 2022 Cosmetic Surgery Forum.

Sri Meghana Konda, MD received an award for a top 10 presentation at the 2022 Cosmetic Surgery Forum.

38
DUKE EYE CENTER 2023
Grant Justin, Rolake Alabi, MD MD, PhD

Katherine Peters, MD received the ASCRS Best Paper of Session Award. She was accepted into Mentoring URiM Rising Stars in Cornea (MUST) Program, and received a $46,000 grant from the Duke School of Medicine Research at Pickett Community Outreach and Engagement Voucher Program for the project “Addressing the Racial Health Disparity in Keratoconus: Improving Keratoconus Screening and Identifying the Barriers to Follow-Up in Black Patients”.

Cason Robbins, MD received the 2022 VitreoRetinal Surgery Foundation Award for “Characterizing and comparing surgical management options for submacular hemorrhage” and Vit-Buckle Society Academic Grant Award for “Evaluating the retinal architecture and microvasculature in traumatic brain injury using optical coherence tomography angiography.”

Alexander Snyder, MD was named OpTech Resident Teacher of the Year as Chief Resident.

James Tian, MD was selected as the 2021-2022 Machemer Resident Research Award recipient.

Nita Valikodath, MD was selected among the top 8 entries for the Vit-Buckle Society (VBS) Fellows Foray 2022 Surgical Video competition. She was also awarded the 2021-2022 Vitreoretinal Surgery Foundation Grant for her work on pediatric retinal disease screening using artificial intelligence and widefield fundus photos. Nita also recevied

2022–2023 Residents

Third Year Residents (PGY4)

Sahil Aggarwal, MD

Alice Choi, MD

Andrew Gross, MD

Tammy Hsu, MD

Katherine Peters, MD

James Tian, MD

Second Year Residents (PGY3)

Nizar Abdelfattah, MD

Rami Gabriel, MD

Lucy Hui, MD

Meg Konda, MD

Richmond Woodward, MD

Yuxi Zheng, MD

First Year Residents (PGY2)

Modupe Adetunji, MD

Kelly Donovan, MD, PhD

Angela Li, MD

Aaron Lindeke-Myers, MD

Richard Morgan, MD, PhD

Cason Robbins, MD

Interns (PGY1)

Juno Cho, MD

Jinwon (Terry) Lee, MD

Keke Liu, MD

Gregory McElroy, MD, PhD

Esteban Peralta, MD

James Robbins, MD

the Women In Retina travel grant in 2022.

XinXin (Steph) Zhang, MD received the K. Alexander Dastgheib Surgery Video Competition Award.

Yuxi Zheng, MD received the Vit-Buckle Society Academic Grant and Vit-Buckle BullDogger (Best Poster) Award for

2022–2023 Clinical Fellows

Rolake Alabi, MD, PhD V-Retina

Andrew Bowman, MD Cornea

Rick Cui, MD Glaucoma

Eliot Dow, MD, PhD M-Retina

S. Madison Diff, MD Pediatrics

Daliya Dzhaber, MD M-Retina

Abhinav Golla, MD, MPH Glaucoma

Kevin Jackson, MD Cornea

Grant Justin, MD V-Retina

Yue Li, MD, PhD Neuro

Arpita Maniar, MD Ocular

Oncology

Basil Mathews, MD Glaucoma

Kubra Sarici, MD M-Retina

Nia Sathiamoorthi, MD Pediatrics

Gabriel Scott, MD Plastics

June Si, MD Glaucoma

Alex Snyder, MD Cornea

Sudip Thakar, MD Plastics

Ramyar Torabi, MD Plastics

Nita Valikodath, MD V-Retina

Anal Vyas, MD Retinal Genetics

Bo Wang, MD, PhD Pediatrics

Qiaohui Wei (Vivi) White, OD, MS Pediatrics OD Resident

Kristi Wu, MD Glaucoma

Ellie Zhou, MD V-Retina

“optical coherence tomography findings associated with anatomic and visual outcomes in vitreomacular adhesion and vitreomacular traction.”

Golden Apple Awards for Excellence in Teaching

PGY-1: Cason Robbins, MD

PGY-2: Rami Gabriel, MD & Yuxi Zheng, MD

PGY-3: Sahil Aggarwal, MD & James Tian, MD

PGY-4: Kevin Jackson, MD

Fellows/Chief: Alex Snyder, MD & Ellis Wisely, MD, MBA

39
>

Honors and Awards

Medical Students

Suzanna Joseph, MS3 received support from Genentech for “Community involvement and engagement to increase representation and diversity in iMIND clinical research cohorts: a model for other ophthalmic clinical studies.”

Anita Kundu, MS3 received Duke Eye Center’s Research to Prevent Blindness (RPB) Small Grant Award for her proposal titled “Longitudinal Analysis of Multimodal Retinal and Choroidal Imaging in Parkinson’s Disease.” She won 2nd place at the 2022 NCSEPS poster competition for her work “Longitudinal Analysis of Retinal

Structural and Microvascular Parameters in Parkinson’s Disease Compared to Controls.”

Praruj Pant, MS4 received a Vitreoretinal Surgery Foundation Award.

Mason Seely, MS3 received the Jack McGovern Coats’ Disease Foundation Travel Award for the ARVO 2022 annual meeting and received VitreoRetinal Surgery Foundation Award.

Soha Noorani, MS4 and Duke Visiting Observer received a $30,000 Research to Prevent Blindness/ American Osteopathic

College of Ophthalmology and Otolaryngology– Head and Neck Surgery (RPB/AOCOO-HNS)

Foundation Medical Student Eye Research Fellowship. This grant supports Noorani taking a year off from medical school to pursue research project within the Duke Department of Ophthalmology.

Jay Rathinavelu, MS3 received a Vitreoretinal Surgery Foundation Award for his proposal titled “Repeatability, Reproducibility, and Characterization of Choroidal Vascularity Index (CVI) in Handheld versus Tabletop OCT images in adults and premature infants.”

40 DUKE EYE CENTER 2023
Vajzovic, Borkar, Zeng and Konda at the 2022 Women in Ophthalmology meeting.

Ophthalmic Imagers Receive Top Honors

Duke Ophthalmic Imagers, Kathleen Warren and Christiaan Lopez-Miro receive top 10 honors in the Haag-Streit 2022 Slit Lamp Imaging Competition, and were selected among 168 images submitted by participants from 20 countries.

Warren received third place for her image displaying a case of epithelial ingrowth, taken with a Haag-Streit BX 900 slit lamp. The image features large magnification, not only rich in detail and fully in focus, but was selected for its artistic qualities.

Lopez-Miro had two beautiful, detailed images that placed in the top 10.

Haag-Streit is the leading global manufacturer of slit lamp imaging solutions. The annual competition gives eyecare professionals across the globe an opportunity to showcase their slit lamp imaging skills. Judging criteria includes image quality, technical execution, and disease interest.

Warren serves on the Board of Directors for the Ophthalmic Photogrpaher’s Society (OPS) and was named Editor-in Chief of the Society’s Journal of Ophthalmology. She transformed the publication to make it available on a digital platform.

41
Warren’s image showing a case of epithelial ingrowth placed third place. Kathleen Warren One of two images by Lopez-Miro which placed in the top 10. Christiaan Lopez-Miro

Continuing Education 2023 Events

All events are in person unless otherwise noted.

Annual Trainee Scientific Sessions

June 24

Resident Grand Rounds

September 7 (virtual)

Mittra Family Foundation Lecture

September 14

Dean Eliott, MD

Director, Emeritus, Retina Service

Fellowship Director, Vitreoretinal Surgery

Fellowship

Massachusetts Eye and Ear

Stelios Evangelos Gragoudas Professor of Ophthalmology

Harvard Medical School

Dastgheib Pioneer Award Lecture

October 12

Dimitri Azar, MD, MBA

Distinguished Professor of Ophthalmology, Bioengineering and Pharmacology;

B.A. Field Chair in Ophthalmologic Research; Dean Emeritus of the College of Medicine

University of Illinois College of Medicine

Annual Glaucoma Fellows Course

October 13

Annual Glaucoma Symposium

October 14

Resident Grand Rounds

October 19 (virtual)

Resident Grand Rounds

November 17 (virtual)

Stephen and Frances Foster

Distinguished Lecture

November 30

Russell Van Gelder, MD, PhD

Professor and Chair

Boyd K. Bucey Professor

Director of UW Medicine Eye Institute

UW Medicine Department of Ophthalmology

Resident Grand Rounds

December 1 (virtual)

Annual Cornea Fellows Course

March 1, 2024

Annual Cornea Symposium

March 2, 2024

Fellows Advanced Vitreoretinal Symposium

March 21–23, 2024 Visit

42 DUKE EYE CENTER 2023
our website for events listings and more information.

A Bright Future in Sight! THE DUKE

OPHTHALMIC TECHNICIAN PROGRAM

The Duke Ophthalmic Technician Program is a 1-year allied health certificate program that prepares students for the certified ophthalmic technician exam and an excellent career in eye care.

Offered by the Duke School of Medicine for almost 40 years, Duke Ophthalmic Technician Program includes interactive classroom work and wet labs for the first three months and nine months of hands-on clinical rotations that take place at Duke Eye Center clinics.

Learn more about the program and access the application.

Benefits of the Duke Ophthalmic Technician Program

 Students may begin the program after earning a high school diploma

 No college degree or prerequisites required

 Earn a certificate in one year with eligibility to take the certification exam

 Nine months spent getting hands on experience in clinical rotations at Duke Eye Center

 Starting pay $22–$24/hr

 90% employment rate after program completion

 Affordable tuition and financial aid is available

43

Follow us:

The Duke Journal of Case Reports in Ophthalmology (DJCRO) coming soon!

No fees. Fast turnaround. 100% Digital.

Editors-In-Chief: Sharon Fekrat, MD FACS FASRS and Cason Robbins, MD

Instagram, Twitter, and LinkedIn for the latest updates. dukeeyecenter.duke.edu/djcro Contact: djcro@duke.edu

Duke Eye Center Administration, Faculty and Staff

FACULTY LEADERSHIP

Edward G. Buckley, MD Chair, Department of Ophthalmology

Vice Dean of Medical Education

Duke University School of Medicine

Vice Chancellor Duke-NUS Affairs

Scott W. Cousins, MD Vice Chair of Strategy Director, Center for Macular Diseases

Vadim Arshavsky, PhD Co-Vice Chair, Basic Science Research

Scientific Director of Research

Goldis Malek, PhD Vice Chair, Diversity Equity and Inclusion

Eric A. Postel, MD Vice Chair, Clinical Affairs Vice Chair, Faculty Vice Chair, Patient Safety Chief, Ambulatory Surgery, Ophthalmology

P. Vasantha Rao, PhD Chair, Department APT Committee

Daniel W. Stamer, PhD Co-Vice Chair, Basic Science Research

Cynthia A. Toth, MD Chair, Research Advisory Council Vice Chair, Clinical Research Director for Clinical and Translational Research for Ophthalmology

Sanjay Asrani, MD Medical Director Duke Eye Center, Cary

Christopher S. Boehlke, MD Medical Director Duke Eye Center, Raleigh

Laura Enyedi, MD Medical Director Duke Eye Center, South Durham

Amy M. Fowler, MD Medical Director Duke Eye Center, Holly Springs

Frank J. Moya, MD Medical Director Duke Eye Center, Winston Salem

Robin R. Vann, MD Medical Director Duke Eye Center, Arringdon Perioperative Services

Prithu Mettu, MD Medical Director, Retina Injections

Miguel Materin, MD Medical Director, Duke Eye Center OR Director, Ophthalmic Imaging Director, Ophthalmic Oncology

Glenn J. Jaffe, MD Director, Duke Reading Center

Eleonora Lad, MD, PhD Director, Clinical Research Unit Research Quality Officer

Victor Perez, MD Director, Foster Center for Ocular Immunology

Lloyd Williams, MD Director of Global Health Affiliate, Duke Global Health Institute

Kelly Muir, MD, MHSc Chief, Division of Ophthalmology, Durham Veterans Affairs Medical Center

Sharon Fekrat, MD, FACS, FARS Associate Chief of Staff Durham Veterans Affairs Health Care System

Divakar Gupta, MD Access Champion

Stefanie G. Schuman, MD Patient Experience Representative

Nicola (Nicky) Kim, MD Committee Chair for Credentialing and QI/ QA for the department

Division Chiefs Chantal Boisvert, OD, MD – Neuro Ophthalmology

Sharon F. Freedman, MD – Pediatric Ophthalmology and Strabismus Division

Leon W. Herndon, MD – Glaucoma Division

Anupama Horne, MD – Comprehensive Division

Glenn J. Jaffe, MD – Vitreoretinal Division

Terry Kim, MD – Cornea, External Disease and Refractive Surgery Division Diane Whitaker, OD – Vision Rehabilitation and Performance Division

Julie A. Woodward, MD – Oculofacial Division

EDUCATION LEADERSHIP

Kourtney Houser, MD Medical Director, Ophthalmic Technician Program

Catherine Bowes Rickman, PhD Director, Third-Year Medical Student Program

Pratap Challa, MD Director, Residency Program

Nathan Cheung, OD Director, Optometry Education

Melissa Daluvoy, MD Director, Cornea, External Disease and Refractive Surgery Fellowship

Sharon F. Freedman, MD Director, Pediatric Ophthalmology Fellowship

Miguel Materin, MD Director, phthalmic Oncology and Pathology Fellowship

Prithu Mettu, MD Director, Medical Retina Fellowship

Kelly Muir, MD, MHSc Director, Ophthalmology Fellowship Program Director, Glaucoma Fellowship

Jullia A. Rosdahl, MD, PhD Director, Medical Student Education Director, Patient Education Chief Wellness Officer

Lejla Vajzovic, MD Director, Ophthalmology Continuing Medical Education Program Director, Vitreoretinal Surgery Fellowship

Julie A. Woodward, MD Director, Faculty Mentoring and Career Development Director, Oculofacial and Orbital Surgery Fellowship

ADMINISTRATION

Elizabeth Hunter, MHA, CFM Chief Administrator

Jessica Habecker, MBA Director of Finance

Martha Dellinger, MHA Division Administrator

Tammy Clay, MHA Division Administrator

Heidi Campbell, COT Director of Clinical Operations

George Toutloff Grants and Contracts Manager

Sarah Jones, MS, CRC, RPM Research Practice Manager

COMPREHENSIVE OPHTHALMOLOGY

Rabia Ali, OD Assistant Professor of Ophthalmology

Melissa Barbor, OD Assistant Professor of Ophthalmology

Anna Bordelon, MD Assistant Professor of Ophthalmology

Thomas S. Devetski, OD Assistant Professor of Ophthalmology

Anupama Horne, MD Assistant Professor of Ophthalmology

Thomas Hunter, MD Assistant Professor of Ophthalmology

Charlene James, OD Assistant Professor of Ophthalmology

Nicola (Nicky) Kim, MD Associate Professor of Ophthalmology

Jeffrey Kozlowski, OD Medical Instructor

Tina K. Singh, MD Assistant Professor of Ophthalmology

Robin R. Vann, MD Associate Professor of Ophthalmology

CORNEA AND REFRACTIVE SURGERY

Christopher S. Boehlke, MD Assistant Professor of Ophthalmology

Corina Busuioc, OD Medical Instructor in the Department of Ophthalmology

Alan N. Carlson, MD Professor of Ophthalmology

44 DUKE EYE CENTER 2023

Melissa Daluvoy, MD Associate Professor of Ophthalmology

Amber Hoang, MD Medical Instructor in the Department of Ophthalmology

Kourtney Houser, MD Assistant Professor of Ophthalmology

Terry Kim, MD Professor of Ophthalmology

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

Victor Perez, MD Stephen and Frances Foster Distinguished Professor of Ocular Immunology and Inflammation

Terry Semchyshyn, MD Assistant Professor of Ophthalmology

Amol Sura, MD Medical Instructor in the Department of Ophthalmology

Lloyd Williams, MD, PhD Assistant Professor of Ophthalmology

C. Ellis Wisely, MD, MBA Assistant Professor of Ophthalmology

GLAUCOMA

Sanjay Asrani, MD Professor of Ophthalmology

Pratap Challa, MD Professor of Ophthalmology

Divakar Gupta, MD Associate Professor of Ophthalmology

Leon W. Herndon, MD Professor of Ophthalmology

Jill B. Koury, MD Assistant Professor of Ophthalmology

Katy Liu, MD, PhD Medical Instructor in the Department of Ophthalmology

Stuart J. McKinnon, MD, PhD Associate Professor of Ophthalmology Associate Professor in Neurobiology ++

Frank J. Moya, MD Assistant Professor of Ophthalmology

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

Jullia Rosdahl, MD, PhD Associate Professor of Ophthalmology

Henry Tseng, MD, PhD Associate Professor of Ophthalmology

Joanne Wen, MD Associate Professor of Ophthalmology

VISION REHABILITATION AND PERFORMANCE

Diane Whitaker, OD Assistant Professor of Ophthalmology

Madison Dunning, OD Medical Instructor in the Department of Ophthalmology

NEURO-OPHTHALMOLOGY

Chantal Boisvert, OD, MD Associate Professor of Ophthalmology

Mays Dairi, MD Associate Professor of Ophthalmology

Sidney Gospe III, MD, PhD Assistant Professor of Ophthalmology

N. Troy Tagg, MD Associate Professor of Ophthalmology

OCULOPLASTICS

Amy M. Fowler, MD Associate Professor of Ophthalmology

Jason Liss, MD Assistant Professor of Ophthalmology

Julie A. Woodward, MD Professor of Ophthalmology Professor in Dermatology ++

PEDIATRIC OPHTHALMOLOGY AND STRABISMUS

Edward G. Buckley, MD Gills Professor of Ophthalmology Professor in Pediatrics ++

Nathan Cheung, OD Assistant Professor of Ophthalmology

Laura B. Enyedi, MD Professor of Ophthalmology Associate Professor in Pediatrics ++

Sharon F. Freedman, MD Professor of Ophthalmology Professor in Pediatrics ++

Tanya Glaser, MD Assistant Professor of Ophthalmology

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

Affiliate, Duke Global Health Institute

Yos Priestley, OD, FAAO Assistant Professor of Ophthalmology

Chelsea Scriven, OD Medical Instructor in the Department of Ophthalmology

VITREORETINAL DISEASES AND SURGERY

Oleg Alekseev, MD, PhD Medical Instructor in the Department of Ophthalmology

Michael Allingham, MD, PhD Assistant Professor of Ophthalmology

Durga Borkar, MD Assistant Professor of Ophthalmology

Xi Chen, MD, PhD Assistant Professor of Ophthalmology

Sharon Fekrat, MD, FACS, FASRS Professor of Ophthalmology

Associate Professor of Surgery ++

Dilraj Grewal, MD Associate Professor of Ophthalmology

Majda Hadziahmetovic, MD Assistant Professor of Ophthalmology

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

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

Eric A. Postel, MD Professor of Ophthalmology

Stefanie G. Schuman, MD Assistant Professor of Ophthalmology

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

Professor in Biomedical Engineering++

Lejla Vajzovic, MD Associate Professor of Ophthalmology

RESEARCH OPHTHALMOLOGY

Vadim Arshavsky, PhD Helena Rubinstein Foundation Professor of Ophthalmology

Professor in Pharmacology & Cancer Biology ++

Catherine Bowes Rickman, PhD George and Geneva Boguslavsky Professor of Eye Research

Professor in Cell Biology ++

Romain Cartoni, PhD Assistant Professor of Pharmacology and Cancer Biology

Assistant Professor in Ophthalmology, Assistant Professor in Neurobiology ++

Scott W. Cousins, MD Robert Machemer, MD Professor of Ophthalmology

Professor in Immunology ++

Sina Farsiu, PhD Professor of Biomedical Engineering and Ophthalmology

Associate Professor in Electrical and Computer Engineering++, Professor in Computer Science++

Paulo Ferreira, PhD Associate Professor of Ophthalmology

Associate Professor in Pathology ++

Jeremy Kay, PhD Associate Professor of Neurobiology

Associate Professor of Ophthalmology, Associate Professor in Cell Biology ++

Paloma Liton, PhD Associate Professor of Ophthalmology

Associate Professor in Pathology ++

Goldis Malek, PhD Associate Professor of Ophthalmology

Associate Professor in Pathology ++

P. Vasantha Rao, PhD Richard and Kit Barkhouser Professor of Ophthalmology

Professor in Pharmacology & Cancer Biology ++

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

Associate Professor in Immunology ++

Nikolai Skiba, PhD Associate Professor of Ophthalmology

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

Professor in Biomedical Engineering++

Sandra Stinnett, DrPH Associate Professor of Biostatistics & Bioinformatics

Associate Professor in Ophthalmology ++

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

Professor in Biomedical Engineering++

Fulton Wong, PhD Professor Emeritus of Ophthalmology

Professor in Neurobiology and Pathology ++, Assistant Professor in Pathology ++

Secondary appointment ++

Duke University Health System

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Duke Eye Center Ophthalmic Photographers receive top honors in the 2022 Haag Streit International Slit Lamp Competition. Read more on page 41. Kathleen Warren Christiaan Lopez-Miro
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