News for Supporters and Friends
2023 FALL EDITION
A New Horizon for Hearing Care
T
he Department of Otolaryngology at the University of Pittsburgh is creating a premier Pittsburgh Hearing Institute, to be housed on the sixth floor of the new UPMC Mercy Pavilion.
The Institute will advance the boundaries of science and treatments to include new discoveries, breakthrough therapies, clinical trials, and new devices. This new endeavor will accelerate discoveries through synergy and co-location of ophthalmology, rehabilitation sciences, and hearing sciences. Along with Anantha Shekhar, MD, PhD, Senior Vice Chancellor for the Health Sciences John and Gertrude Petersen Dean School of Medicine, José P. Zevallos, MD, Eugene N. Myer, MD Chair of Otolaryngology, outlined the Institute’s vision: Establish the world’s leading institute for treating and finding cures for hearing loss. The co-location of neurotology, audiology, vestibular, and translational and basic science research programs will facilitate a true bench-tobedside approach toward our goal of curing hearing loss, tinnitus, and related diseases. The vision includes world-class clinical and research training programs focused on otology, audiology, and the basic science of hearing and a hub for collaborations across the globe to cure hearing loss.
The Institute will provide a new standard for clinical care and research in hearing disorders. Patients will have easy access to participate in research and clinical trials, and there will be greater opportunities for precision/ personalized medicine. Partnerships with the University of Pittsburgh and Carnegie Mellon University bioengineering programs on new prototypes and proof of concept studies will expand reach. As a central hub for otology and audiology, the Institute will support
peripheral outreach in communities in Pennsylvania and beyond (including globally), which means utilizing telemedicine, remote care, and monitoring. In terms of research, the new standard will result in deeper clinical engagement in research and clinical touch points for basic researchers, educational and training opportunities for local and international scientists and clinicians aimed at bridging continued on page 5
In This Issue UPMC Vision Institute, Leading the World in Imaging the Eye
2
Building Head and Neck Cancer Care Around the Best Functional Outcomes for Patients 3
Simulating Life to Understand the Impact of Vision Loss or Gain 4 Navigating the Challenges of HNC with Generous Support
Developing a Model with Stakeholders to Improve Hearing and Vision Care in the Community Muse Dinner 2023
Breakthrough Research Getting Much Needed Support
7
5
6
Back Cover
All stories written by Lisa A. Goldstein
UPMC Vision Institute, Leading the World in Imaging the Eye
O
nly six devices in the world house a rare kind of imaging technology called laser doppler holography. Three are in Paris and two are in other parts of France. Ethan Rossi, PhD’s lab, Rossi Lab, or the Advanced Ophthalmic Imaging Lab, has the only one in the U.S. and the only one outside of France. The Eye & Ear Foundation helped fund this through a generous gift from Dr. E. Ronald Salvitti, an alumnus of the University of Pittsburgh School of Medicine and an Eye & Ear Foundation Board member. “This is a type of imaging technology that allows us to see functional activity in the retina with high precision,” Dr. Rossi said. It relies on the principle of interference for generating the images. The technology is similar to optical coherence tomography (OCT), which is commonly used in the clinic. The difference is the way the images are acquired. With this new technology, images are received at a very fast rate, which means the ability to view rapid changes over time. “We think the technology has a lot of potential applications beyond what we’ve been starting to look at,” Dr. Rossi said.
The focus has been looking at vascular activity in the retina. The technology generates images that show where the blood vessels are as well as about the blood flow. A novel feature of the technology is that arteries can be identified from veins just from the direction of the doppler signal. Different types of vascular changes are accessible, so the imaging can be used to understand how intraocular pressure/glaucoma affect the blood flow. Not all of these things could previously be done, even with the use of contrast agents injected intravenously. Dr. Rossi explained how the device works: light from a laser is split into two paths. One path sends light into the eye, while the rest of the light goes directly into the camera, serving as a “reference beam.” The light that comes out of the eye interferes with the reference beam. It is that interference that provides a signal about the activity of what is happening inside the eye. These interference patterns, called interferograms, are captured at a very fast rate. The camera runs at 67,000 frames per second and is one of the fastest
Color low-high flows of the retina taken with the laser doppler holography. cameras in the world. A “slower” camera, which runs at 10,000 frames per second provides a real-time image and streams that data to the computer for the experimenter to evaluate the data during acquisition. The light-sensing part of the eye, the retina, is one of the most metabolically active tissues in the body, which requires a lot of blood flow. “Evaluating blood flow in the eye can tell us a lot about what’s happening in different diseases, many of which have a vascular component,” Dr. Rossi said. Dr. Rossi wants to look at changes in patients that have age-related changes to the retina, like age-related macular degeneration. “I’m interested in the potential to use this technology to be able to detect earlier changes than we typically can,” he said. Dr. Rossi is trying to secure funds to have dedicated personnel on this equipment and support to bring this technology forward.
A laser doppler holography located in the Rossi Lab. 2
Building Head and Neck Cancer Care Around the Best Functional Outcomes for Patients
U
nder the leadership of Dr. Zevallos, one of the big changes that is moving forward for the Department of Otolaryngology is to hire otolaryngology head and neck surgeons to perform complex head and neck reconstruction. Microvascular reconstructive surgery involves using tissues from other parts of the body and transplanting them to fix defects in the head and neck. This can include using bone from the fibula bone to reconstruct the mandible after cancer surgery, and skin and muscle from the thigh or forearm to reconstruct the tongue, among many other applications. The Department of Otolaryngology has recruited Matthew Spector, MD, one of the most experienced and accomplished head and neck microvascular surgeons in the United States, to lead this effort. As the Director of Head and Neck Surgical Oncology & Microvascular Reconstruction, the goal is to build a cutting-edge head and neck reconstructive surgery program at UPMC based in the Department of Otolaryngology. Kevin Contrera, MD, MPH, a head and
“Our goal is to maximize function and minimize the morbidity of surgery using cutting-edge reconstructive techniques. We want to provide an individualized approach for each patient, understanding their goals and needs to provide the best outcome.” - Dr. Spector neck surgical oncologist and microvascular reconstructive surgeon trained at MD Anderson Cancer Center, was also hired for the same reason. These changes are in line with national trends at most major academic cancer centers across the United States, where highly trained head and neck microvascular reconstructive surgeons based in Otolaryngology perform the majority of these complex cases.
we have a wealth of skill and knowledge to perform these surgeries. We have trained across the country to bring in this expertise. When performing these complicated reconstructions, there are a number of goals. The overarching goal is to improve the speaking and swallowing outcomes of patients, to bring an individual back to their employment, and to maximize the cosmetic outcome, to name a few.”
“The major goal of the head and neck reconstructive program is to improve on the functional outcomes of patients who undergo reconstruction at UPMC,” Dr. Spector said. “Between Shaum [Sridharan], Kevin, and I,
The group will be able to not only provide these complex services, but also do further research on how to maximize these outcomes. They partner closely with Dr. Steve Kim, Dr. Zevallos, Dr. Jessica Maxwell, and Dr. Ferris, as well as the multidisciplinary team that includes speech-language pathology, medical oncology, and radiation oncology. They have interests in tongue reconstruction, soft tissue reconstruction after cutaneous cancer surgery, parotid reconstruction after salivary gland surgery, voice box reconstruction and throat reconstruction after larynx cancer surgery, reconstruction after trauma, and management of difficult head and neck wounds – among others. “Our goal is to maximize function and minimize the morbidity of surgery using cutting-edge reconstructive techniques,” Dr. Spector explained. “We want to provide an individualized approach for each patient, understanding their goals and needs to provide the best outcome.”
3
Simulating Life to Understand the Impact of Vision Loss or Gain
T
he Vision Institute at UPMC Mercy Pavilion has two unique programs for people with low vision: a StreetLab and a driving simulator. The Pittsburgh StreetLab for Low Vision Research is the first clinical research facility in Western PA dedicated to the enhancement and maintenance of independence in people with low vision, run by Rakie Cham, PhD, professor in the Departments of Bioengineering, Ophthalmology, and Physical Therapy at the University of Pittsburgh. She is part of the Human Movement and Balance Laboratory (HMBL), housed in the Department of Bioengineering. According to Dr. Cham, the Pittsburgh StreetLab will be a state-of-the-art collaborative environment in which patientcentric interdisciplinary research will be conducted in four focus areas: evaluation of the needs of patients with low vision, qualitative and quantitative assessments of capacity in multiple domains, e.g., mobility, navigation, dexterity, etc., evaluation of current interventions and technologies, and developing new and innovative solutions. The StreetLab looks like a small movie studio. The lighting and sound can be set to create the type of environment according to the desired study protocols. Some props can be used to make SteetLab look like a street, café, or just an obstacle course. Cameras are mounted high on the walls around the room and the subjects wear captors and eye trackers to create an avatar image to analyze gate and eye movements.
“We believe that the research conducted in the Pittsburgh StreetLab for Low Vision Research will ultimately improve the quality of life of patients with low vision conditions,” Dr. Cham said. It is anticipated that the StreetLab will be fully operational by the end of October 2023. The driving simulator – up and running since September -- is a new acquisition to the low vision research and rehabilitation capabilities at the Vision Institute. Very few, if any, ophthalmology Departments in the U.S. have one, according to Clive D’Souza, PhD, MS, Assistant Professor in the Department of Rehabilitation Science & Technology, the Department of Industrial Engineering, and the Department of Ophthalmology. The simulator features original vehicle components such as the steering wheel, gas/brake pedals, driver seat, and dashboard mounted on a wheelchair-accessible motion platform, a 180-degree field-of view using three large visual displays, blind spot displays, and surround sound audio feedback. The motion platform is calibrated to reproduce movement cues exactly corresponding to the
driver’s responses. The software program running the simulator contains a wide range of customizable driving scenarios from basic to more complex situations, safe to more hazardous road conditions, and impaired and distracted driving. Ongoing plans include adding sophisticated instrumentation to obtain objective measurements of driver behavior and performance, like eye tracking to understand the driver’s visual behavior, and physiological sensors like heart rate to quantify the driver’s cognitive workload. Driving is one of the most important functions to help people maintain their independence. The driving simulator provides the capability to assess the driving performance of low vision patients in a safe and controlled environment. Researchers will also be able to test the effectiveness of vision rehabilitation and therapies on driving ability and performance of low vision patients in a wide range of driving scenarios. “This creates new opportunities in both low vision driver rehabilitation, training, and research into interventions and innovative technology solutions to support safe driving in drivers with low vision,” Dr. D’Souza said.
The Pittsburgh StreetLab is based on the experience gained in Paris and benefits from the partnership with the Paris team under an agreement between the institutions. The facility will be used by a team of investigators from the University of Pittsburgh, other national and international academic centers and industry. University of Pittsburgh investigators will include researchers with primary appointments in the School of Medicine, the Swanson School of Engineering, the School of Health and Rehabilitation Sciences, and Arts and Sciences. 4
Driving simulator located at the Vision Institute at the UPMC Mercy Pavilion
Navigating the Challenges of HNC with Generous Support
T
he Department of Otolaryngology is excited to welcome two new patient navigators to the head and neck surgical oncology team, thanks to a significant grant the Eye & Ear Foundation received from the Jack Buncher Foundation. Patients who receive a diagnosis of cancer face a tremendous amount of uncertainty and distress. They must make decisions that can affect their chances of survival, often within hours or days of receiving such lifealtering news. Navigating a complex and fragmented healthcare system is one of the largest challenges new cancer patients face, along with the lack of helpful information about their disease and care plan and lack of attention to their social and emotional needs. It has been widely documented that patients who begin treatment within 45 days of diagnosis have a higher rate of survival than those who wait longer to begin treatment.
successful course of treatment and a happy and healthy life after cancer. One way to reduce the amount of time that patients wait to begin their chemotherapy and/or radiation treatment is to increase care coordination, specifically through the involvement of a patient navigator who follows each case of head and neck cancer from diagnosis through treatment and into survivorship. Adonis Zaghab began on August 28, and Susanna Gjurich started September 10. “Both Adonis and Sue bring years of healthcare coordination and patient advocacy experience to this role,” said Dr. José P. Zevallos, MD, MPH, FACS, Professor, Department of Otolaryngology, and the Eugene N. Myers, MD, Professor and Chairman of Otolaryngology.
In addition to these challenges, many patients are faced with major barriers to receiving care, such as low health literacy and a lack of necessary assets like transportation, health insurance, food security, childcare, permanent and affordable housing, and more.
Prior to this position, Zaghab served as the international referral liaison at UPMC Children’s Hospital followed by a supervisory role at UPMC Corporate Services. Gjurich was a patient navigator and specialty care coordinator for the Neuro-oncology service at Hillman Cancer Center.
The team of head and neck cancer surgeons and physicians at the University of Pittsburgh and UPMC, led by the Chairman of the Department of Otolaryngology, Dr. José P. Zevallos, are unified in their goal to do more for these vulnerable patients so they have a
“They will work together to ensure that our complex head and neck cancer patients receive the most effective and timely treatment possible,” Dr. Zevallos said. “I am excited to welcome them to the Department of Otolaryngology family!”
“Both Adonis and Sue bring years of healthcare coordination and patient advocacy experience to this role. They will work together to ensure that our complex head and neck cancer patients receive the most effective and timely treatment possible. I am excited to welcome them to the Department of Otolaryngology family!” - Dr. José P. Zevallos
Continued from front page the bench-to-bedside gap, biobanking of patient samples for research, and fostering direct multidisciplinary collaboration for solving problems in hearing disorders. The Pittsburgh Hearing Institute will build on a legacy of clinical and research excellence at UPMC and the University of Pittsburgh. In the coming months, the Department of Otolaryngology will announce a new Division Chief of Otology and Neurotology who has been recruited to help lead this effort and brings significant translational research
and an entrepreneurship experience. He will work with Thanos Tzounopoulos, PhD, director of The Pittsburgh Hearing Research Center (PHRC) in the Department of Otolaryngology, to make this new center a reality. The PHRC is already one of the nation’s leading hearing research programs and receives approximately $4 million per year in federal grant support. Additionally, a joint PhD certificate program in Hearing and Visual Sciences is launching in 2024 that is designed to attract the best and brightest graduate students to Pittsburgh.
Creating the Pittsburgh Hearing Institute will require funds for the recruitment of additional top scientists, construction, equipment, staff, and other investments. “Together, we can create the premier hearing institute in Pittsburgh that is unparalleled in the world, advancing our research, academic, and clinical missions by targeting a $50 million commitment through the fundraising efforts of the Eye & Ear Foundation and the in-kind and matching support of the University of Pittsburgh School of Medicine,” Dr. Zevallos said. 5
Breakthrough Research Getting Much Needed Support
G
ary Yam, PhD, received a U01 grant from the National Institutes of Health (NIH) based on work from the Hillman-funded Funderburgh Corneal Regeneration Project. Dr. Yam is a Research Associate Professor of Ophthalmology, Corneal Regeneration Laboratory at the University of Pittsburgh School of Medicine. The Corneal Regeneration Lab focuses on the cornea, an organ that provides a visual portal to the world. The connective tissue of cornea (stroma) is extremely tough and transparent to light. It also presents a strong focusing power to achieve a high level of visual acuity. Corneal blindness due to corneal scarring affects millions of people worldwide, according to Dr.Yam. Corneal transplantation is effective but has limitations, including the global shortage of donor corneas. His project aims “to establish a new stem cell-based approach to reduce the need of corneal allograft transplantation,” he said. “The scope of work is to validate and confirm procedures to generate Good Manufacturing Practice (GMP) stem cells, verify cell safety, and analyze clinical data towards a cell-based therapy for corneal scarring disorders.” The Yam Lab and the Corneal Task Force at the Department of Ophthalmology following the innovative work by the late James L. Funderburgh have confirmed the regenerative effects of human corneal stromal stem cells (CSSC) in animal models of corneal scarring. The Hsu Lab and the Immunologic Monitoring and Cellular Products Laboratory (IMCPL) at UPMC Hillman Cancer Center have immense
6
experience in establishing Investigational New Drug Application (IND) manufacturing procedures, quality assurance systems, and documentation to support GMP cell product manufacturing and processing for FDA-registered clinical trials. The grant will allow these groups to join forces to pave a route to stem cell-based therapy in future clinical trials and clinical applications treating corneal scarring. It supports work targeting three specific aims: •
SA-1 will establish Chemistry and Manufacturing Control (CMC) for GMP grade CSSC for allocation towards IND in FDA. The team will characterize and compare the quality of GMP-raised CSSC and lab-generated cells and establish a complete GMP production protocol.
•
SA-2 will elucidate the pharmacological and toxicological effects of GMP-CSSC. The team will study cell safety and efficacy using their established mouse corneal injury model and will determine CSSC distribution, metabolism, absorption, excretion, metabolism, and tumorigenicity.
•
SA-3 will run clinical data mining and analysis that will direct future clinical trial design. The team will do retrospective data analysis using corneal keratitis and scarring patient database at the UMPC Eye Centre and obtain statistical data to direct future clinical trial design on patient eligibility and treatment outcome analysis.
Gary (Hin-Fai) Yam, PhD
Developing a Model with Stakeholders to Improve Hearing and Vision Care in the Community
T
he Eye & Ear Foundation recently received a grant from the Eden Hall Foundation to fund a training program for hearing and vision care for community health workers. A Community Health Care Worker (CHW) is a frontline public health worker who is a trusted member or has a particularly good understanding of the community served. A CHW serves as a liaison between health and social services and the community to facilitate access to services and to improve the quality and cultural competence of service delivery. A joint effort between the Departments of Otolaryngology and Ophthalmology, this training program will be led by Catherine V. Palmer, PhD, and Evan “Jake” Waxman, MD, PhD. Dr. Palmer is Professor and Interim Chair, Department of Communication Science and Disorders, Professor, Department of Otolaryngology, and Director of UPMC Audiology. Dr. Waxman is Professor of Ophthalmology, Vice Chair, Medical & Resident Education, Director, UPMC Eye Center Mercy, and Director, Comprehensive Eye Service.
“In our goal to improve access to hearing and vision care, we are partnering with Community Health Care workers to discover how we can support them in helping community members get the care they need,” Dr. Palmer said. “Guidance from a trusted Community Health Care worker can ensure that an individual gets the care they need that supports their ability to thrive in their community. This work will result in Community Health Worker training in hearing and vision that is co-created by CHWs and hearing and vision experts that can be used across the country.” The three-year program will consist of an initial stakeholder study to identify best practices and resources, the development and implementation of a training program in the Pittsburgh community, and finally, the wide-spread dissemination of the training program to community health workers, medical centers, and organizations nationwide.
“In our goal to improve access to hearing and vision care, we are partnering with Community Health Care workers to discover how we can support them in helping community members get the care they need”
Evan “Jake” Waxman, MD, PhD
Catherine V. Palmer, PhD
- Dr. Palmer
7
NONPROFIT ORG U.S. POSTAGE
PAID
PITTSBURGH, PA PERMIT NO. 612
eyeandear.org 203 Lothrop Street Suite 251 EEI Pittsburgh, PA 15213 412.864.1300 O 412.864.1305 F
UPMC Eye Center
(412) 647-2200
University Ear, Nose & Throat Specialists of UPMC
(412) 647-2100
If you no longer wish to receive our newsletter, please submit requests to our mailing address, or email optout@eyeandear.org. The official registration and financial information of the Eye & Ear Foundation may be obtained from the Pennsylvania Department of State by calling toll free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement. The Eye & Ear Foundation of Pittsburgh is a nonprofit 501 (C)(3) organization. Our mission is to support the research and academic efforts of the Departments of Ophthalmology and Otolaryngology at the University of Pittsburgh. Donations to support our research initiatives can be made online at eyeandear.org or by returning the enclosed envelope. For more information on the Foundation, our research, or the articles in this newsletter, please contact Katherine Troy, Director of Operations, at katherine@eyeandear.org or 412-864-1300. Medical Disclaimer: The Eye & Ear foundation does not assume any responsibility or risk for the use of any information contained within the newsletters. Reliance on any information available through the newsletters is solely at your own risk. All information and content found in this newsletter were created for educational purposes only. The newsletter is not intended as, or as a substitute for, professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in the newsletters. We encourage you to view our full disclaimer by visiting the eyeandear.org website.
Celebrating the 20th year of the Muse Prize The 2023 Albert C. Muse Prize
The 2023 Albert C. Muse Award
Excellence for Research and Advancement of Care in Otolaryngology
Excellence for Innovation and Service in Otolaryngology
muse Dinner 2023
Randal S. Weber, MD, FACS
Jonas T. Johnson, MD, FACS
Retired Professor, Department of Head and Neck Surgery, Division of Surgery
Emeritus Distinguished Service Professor and Chairman
The University of Texas MD Anderson Cancer Center, Houston, TX
Department of Otolaryngology University of Pittsburgh School of Medicine
November 14, 2023 This event benefits Head and Neck Cancer Research in the Department of Otolaryngology at the University of Pittsburgh. For more details, visit eyeandear.org or email admin@eyeandear.org.