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2013 YEAR IN REVIEW

LEADING OCULAR MEDICINE JACK S. BLANTON SR. EYE INSTITUTE


A PROUD TRADITION OF EXCELLENCE, WITH A NEW NAME. The Methodist Hospital is now Houston Methodist Hospital. This new name reflects the pride in who we are and where we are from. Our commitment to advancing medicine with global impact begins in Houston, Texas, where we pioneer a better tomorrow through research, cutting-edge innovation and breakthroughs to rewrite the future of health.

THAT’S THE DIFFERENCE BETWEEN PRACTICING MEDICINE AND LEADING IT.


CONTENTS

5

8

11

14

LEADING MEDICINE: AN OVERVIEW

2

DELIVERING BETTER OUTCOMES

4

ADVANCING TECHNOLOGY

8

BREAKING NEW GROUND

10

PURSUING MEDICAL DISCOVERIES

12

EDUCATING FOR TOMORROW

14


Leading Medicine: An Overview

Delivering Better Outcomes

Advancing Technology

Breaking New Ground

Pursuing Medical Discoveries

Educating For Tomorrow

LEADERS IN VISION AND EYE CARE Houston Methodist Hospital has consistently been ranked as one of the nation’s best hospitals in ophthalmology by U.S. News & World Report. We are proud that the Houston Methodist Department of Ophthalmology is comprised of physicians from across the Texas Medical Center — including faculty from Weill Cornell Medical College and The University of Texas Medical Branch (UTMB) — all working towards the common goal of providing the highest quality of care for patients, particularly with complex and challenging eye disorders. As of January 1, 2015 we will be named the Jack S. Blanton Sr. Eye Institute. Our physicians have expertise in all subspecialties of adult ophthalmology, including retinal disease and detachment, diabetic macular edema, corneal diseases, neuro-ophthalmological conditions, oculoplastics and orbital disease, refractive surgery, systemic eye disorders, optic nerve conditions and tumors, ocular cancers, uveitis, cataracts and glaucoma. We also offer comprehensive eye care, including nationally recognized expertise in contact lenses. We have invested in dedicated operating suites tailored for the unique conditions of complex eye surgeries. In addition, we are one of only a handful of medical centers in the country that offers dedicated ocular pathology, an advanced science that determines accurate prognoses and helps direct appropriate treatments for eye diseases. At Houston Methodist, our multidisciplinary expertise brings superior therapy to our patients. We provide excellent comprehensive care through a collaboration with the Houston Methodist Institute for Technology, Innovation & Education (MITIESM), the Houston Methodist Research Institute and some of the world’s top specialists in neurology, neurosurgery, neuroradiology, neuro-oncology and metabolic diseases such as diabetes.

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Houston Methodist Department of Ophthalmology

In ophthalmology, as in the other disciplines, we stand by our “I CARE” values of integrity, compassion, accountability, respect and excellence. Our patients are our main priority.

ONE OF THE FEW MEDICAL CENTERS NATIONWIDE TO OFFER DEDICATED OCULAR PATHOLOGY

THE ONLY ACGME APPROVED

OCULAR PATHOLOGY FELLOWSHIP


MESSAGE FROM THE CHAIR: MOVING FORWARD, WITH VISION By virtue of our outstanding eye physicians, researchers, technicians, staff and collaborators, the Houston Methodist Department of Ophthalmology has made continued advancements in improving the lives of our patients with eye disease. We are proud that Houston Methodist continues to be ranked as one of the nation’s best hospitals for ophthalmology by U.S. News & World Report and pleased to announce that as of January 1, 2015 we will be the Jack S. Blanton Sr. Eye Institute, named for a renowned state and local philanthropic champion in research, education and medical care programs. I am encouraged by the advances our team has made. We have brought new drugs to market that make existing treatments better and safer. We continue to provide new and unique hospital-based pathologic diagnostics in the operating room to determine the presence of ocular melanoma, which can potentially save lives. Cutting-edge technology allows for a window from the eye into the brain with the use of increasingly sophisticated techniques. Oculoplastics continues to witness innovative treatment procedures that address the tremendous overlap between functional and cosmetic problems of the eye. We are proud to be one of 67 participants in a large, multicenter trial involved in the research of non-arteritic anterior ischemic optic neuropathy (NAION). We offer new technologies that have the potential for preventing blindness and vision loss for patients with advanced glaucoma, and we have introduced new and better ways to train future physicians in the art of ophthalmic diagnostics. I am particularly gratified, personally, to continue to participate in the training of ophthalmology residents and neuro-ophthalmology fellows at Houston Methodist Hospital from UTH, UTMB and BCM. We are proud of their individual learning achievements, and I feel privileged to be in the company of my exceptional teaching colleagues and peers. Houston Methodist Ophthalmology is specifically dedicated to caring for challenging, complex and tertiary/quaternary care hospital-based ophthalmology. We are pleased to be able to continue to offer 365 days per year, 24/7 emergency ophthalmology services, including comprehensive eye care, sub-specialty emergency care, emergency ocular surgery and hospital-based ophthalmology consulting services though our emergency department. With such a broad base of expertise from which to draw, we aspire to continually grow and improve the treatments and cures available to patients with eye disease. I hope that you enjoy this update, and I welcome comments and questions.

Andrew G. Lee, MD Chairman of the Houston Methodist Department of Ophthalmology


Leading Medicine: An Overview

Delivering Better Outcomes

Advancing Technology

Breaking New Ground

Pursuing Medical Discoveries

Educating For Tomorrow

OCULAR PATHOLOGY : FROM IMMEDIATE ASSESSMENT FOR EYE TUMORS TO BETTER HEADGEAR FOR ASTRONAUTS A check of the biopsy tissue for adequacy of tumor sampling assures that tumoral tissue has been obtained and that enough material is available for diagnosis and molecular prognostic profile. This aids the surgeon in diagnosis and determines the course of treatment and follow-up for the patient.

Dr. Patricia Chévez-Barrios is the director of the Ocular Pathology Research Laboratory at Houston Methodist Hospital. She is one of three pathologists worldwide participating in the first prospective, multicenter, multinational trial of retinoblastoma, the most common ocular malignancy in children. This trial established treatment criteria and protocols for retinoblastoma after eye removal. “If the tumor is inside of the eye, then it’s curable about 96 percent of the time. But if the tumor is outside of the eye, especially when it is spreading to the brain, the mortality rate is very high, and the cure rate drops to 20 percent or lower,” says Dr. Chévez-Barrios.

Most recently, the Houston Methodist Department of Pathology and Genomic Medicine teamed with NASA to study the impact of space travel on vision. By examining the eyes of mice sent to the International Space Station for 13 days, the ocular pathologist is able to observe certain oxidative and mechanical changes. Early cataract formation, macular degeneration and possible mechanical changes in the back of the eye and optic nerve have been observed in astronauts. Work in this area may lead to better understanding the role of insulation in exposure to radiation (the cause of oxidative damage) and against potential trauma caused by forceful acceleration at takeoff and reentry as well as the mechanical stresses caused by different fields of gravity.

A more surprising ocular malignancy is melanoma. Research in the past decade has shown that certain types of molecular changes act as a signal to identify patients who may develop metastatic disease. A tissue sample from the intraocular tumor is required for molecular testing which, historically, has not been part of the diagnosis and treatment of these patients. Pathologists at Houston Methodist employ a method for testing the adequacy of tumor sampling during the surgical procedure. “We have a mobile microscope and stains. We go to the OR with our microscope and are there with the surgeon who is doing the intraocular biopsy. The surgeon aspirates a small amount of tissue and we can do an ‘adequacy check’ right there,” says Dr. Chévez-Barrios.

“If the tumor is inside of the eye, then it’s curable about 96 percent of the time. But if the tumor is outside the eye, especially in the brain, the mortality rate is very high, and the cure rate drops to 20 percent.” Patricia Chévez-Barrios, MD

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Houston Methodist Department of Ophthalmology


Leading Medicine: An Overview

Delivering Better Outcomes

Advancing Technology

Breaking New Ground

Pursuing Medical Discoveries

Educating For Tomorrow

TRABECTOME AND ENDOCYCLOPHOTOCOAGULATION: COMBINATION MINIMALLY INVASIVE TREATMENT FOR GLAUCOMA The Houston Methodist Department of Ophthalmology is advancing the treatment of glaucoma by combining two minimally invasive yet entirely different procedures, trabectome and endocyclophotocoagulation (ECP). Trabectome reduces intraocular pressure through the ablative removal of clogged meshwork and the creation of a portal to Schlemm’s canal.

“What we are capable of doing here is unique because we have minimally invasive technology to treat both aspects of intraocular pressure homeostasis — aqueous production as well as drainage.” Rahul Pandit, MD

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Houston Methodist Department of Ophthalmology

“The trabectome opens up an entire pathway in the trabecular meshwork, allowing fluid to drain directly from the inside of the eye to the collector channels,” says Rahul Pandit, MD, director of the Houston Methodist Ophthalmology Operating Room and assistant professor of Ophthalmology. This procedure is performed through a small incision that can be performed on an outpatient basis.

ECP is another minimally invasive procedure in which physicians use a fiber optic camera to visualize and treat the ciliary processes with laser energy thereby decreasing fluid production. It is theorized that when ECP is combined with trabectome surgery, the compound procedure will result in a better effect on intraocular pressure reduction and a decreased eye drop burden for the patient.


NOTABLE HIRES SUSHMA YALAMANCHILI, MD Sushma Yalamanchili, MD, received her medical degree from Albany Medical College and completed her medical internship at Albany Medical Center and her ophthalmology residency at the State University of New York — Downstate Medical Center in New York City. Dr. Yalamanchili returned to her hometown of Houston after several years of private practice in Rochester, New York. As a member of Houston Methodist Eye Associates, Dr. Yalamanchili is able to pursue her interest in neuro-ophthalmology, which extends to optic neuropathies, myasthenia gravis, giant cell arteritis, diplopia, visual field defects and headache disorders. Dr. Yalamanchili is deeply committed to patient care and endeavors to offer the most advanced treatment options for her patients. She is a member of multiple professional associations, including the Alpha Omega Alpha Honor Medical Society, and is a fellow with the American Academy of Ophthalmology. ALLISON ANNE DUBLIN, MD Allison Anne Dublin, MD, pursued her medical degree at The University of Texas Health Science Center at San Antonio and completed her internship in medicine at The Reading Hospital and Medical Center in Pennsylvania. Dr. Dublin comes to Houston Methodist Hospital following her residency in ophthalmology at George Washington University and her fellowship training in glaucoma at Baylor College of Medicine. Dr. Dublin’s ophthalmic interests include primary and secondary glaucoma, cataract surgery, specialized lens implantation for cataracts, and student and resident education.


Leading Medicine: An Overview

Delivering Better Outcomes

Advancing Technology

Breaking New Ground

Pursuing Medical Discoveries

Educating For Tomorrow

THE EYE AS A WINDOW TO THE BRAIN : USING ADVANCED IMAGING TO DIAGNOSE NEUROLOGICAL DISEASE At Houston Methodist Hospital, advanced applications using magnetic resonance imaging (MRI) help ophthalmologists, neurologists and neurosurgeons understand pathologies of the visual system in unique ways. MRI is a versatile tool in the diagnosis of diseases of the eyes and central nervous system. For example, dynamic MRI of the orbits can be used to record movies of the eyes in motion. As the patients are instructed to move their eyes in certain directions, ophthalmologists are able to visualize pathologies in extraocular muscle structure and function to aid the diagnosis and treatment of strabismus.

fMRI is frequently performed to identify areas of the brain that are important for motor, language, memory and vision, and their proximity to the tumor or lesion that requires resection. Diffusion tensor imaging (DTI) provides information on the directional motion of water, which is useful for evaluating the integrity of structured tissues such as white matter tracts along the visual pathway. “Pathologies such as ischemia, demyelination and traumatic injury can be determined along the course of the optic nerve, optic tract and optic radiation by DTI. Tractography can also be performed to determine if a tumor, for example, is directly involving or displacing a white matter tract,” says Steve Fung, MD, assistant professor and medical director of the MRI Core at the Houston Methodist Research Institute.

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Houston Methodist Department of Ophthalmology

Functional MRI (fMRI) can be used to localize eloquent cortex in neurosurgical cases. fMRI is frequently performed to identify areas of the brain that are important for motor, language, memory and vision and their proximity to the tumor or lesion that requires resection. “We had a case in which a patient with vision change was found to have an arteriovenous malformation, or AVM, close to the anterior occipital lobe. fMRI was performed to test the visual system which demonstrated the AVM nidus was close to the anterior tip but not involving the primary visual cortex. Endovascular embolization of the AVM resulted in correction of the visual symptoms,” says Dr. Fung. Frequently, neurological disease first presents as a visual disorder. Ophthalmologists, neurologists, neurosurgeons and radiologists at Houston Methodist are dedicated to the sophisticated application of technology to ensure accurate diagnosis for planning the most efficacious treatment. “Most people see an ophthalmologist for problems of their eyes which are really part of the central nervous system,” says Dr. Fung. “The eye is a window to the brain.”


High-resolution dynamic M R I of the orbits acquires multiple volumetric images of the eyes in rapid succession.


Leading Medicine: An Overview

Delivering Better Outcomes

Advancing Technology

Breaking New Ground

Pursuing Medical Discoveries

Educating For Tomorrow

ORBIT AND OCULOPLASTICS : THE INTEGRATED ART Cross-pollination of ideas between disciplines has led to many advances in oculoplastics at Houston Methodist Hospital. “Borrowing concepts from neurosurgery allowed us to develop and perfect an orbital decompression procedure that used to take more than six hours but is now accomplished in 20 to 40 minutes with minimal complications,” says Charles Soparkar, MD, PhD, clinical associate professor in Ophthalmology and Plastic Surgery. Working with ENT colleagues, Houston Methodist oculoplastic surgeons developed a dual approach to optic canal decompressions, a technique that has become the gold standard in safety for such surgeries. Co-management of patients with neurologic spastic disorders gave insight into the inconsistency of botulinum toxins and prompted the investigation and clarification of the role of topical anesthetics, cryo-anesthetics and dietary zinc supplementation in modifying toxin effects.

The multidisciplinary aspect of oculoplastics is exemplified by the simultaneous concern for functional and aesthetic issues related to patients with thyroid eye disease.

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Houston Methodist Department of Ophthalmology

8%

CORNEA SURGERY

Houston Methodist provides services for one of the busiest thyroid eye disease practices in the world. “In oculoplastics there is a tremendous overlap between cosmetic and functional concerns. Most people with functional medical problems such as facial trauma or an invasive tumor have cosmetic concerns and many people with cosmetic concerns have underlying functional problems. Sometimes the practice of oculoplastics helps save lives. Sometimes it saves vision. Sometimes it makes the eyes more comfortable and sometimes it simply helps people feel better about themselves,” says Dr. Soparkar. Dr. Soparkar believes oculoplastics truly exemplifies collaboration. “It takes a well-integrated, collaborative team to care for a complicated oculoplastic patient,” says Dr. Soparkar.

“Borrowing concepts from neurosurgery allowed us to develop and perfect an orbital decompression procedure that used to take more than six hours but now is accomplished in 20 to 40 minutes.” Charles Soparkar, MD, PhD

SURGICAL PROCEDURES

4%

GLAUCOMA SURGERY

48%

25%

RETINA SURGERY

CATARACT SURGERY

12%

OCULOPLASTICS

3% OTHER


Leading Medicine: An Overview

Delivering Better Outcomes

Advancing Technology

Breaking New Ground

Pursuing Medical Discoveries

Educating For Tomorrow

REGAINING LOST VISION : CHANGING THE STANDARDS OF CARE FOR DIABETIC MACULAR EDEMA Retinal Consultants of Houston at Houston Methodist Hospital is the largest recruiting clinical trial center for retina diseases in the United States and focuses on diabetic retinopathy, age-related macular degeneration and other blinding retinal diseases.

David Brown, MD, an associate member of the Houston Methodist Research Institute and clinical assistant professor, Department of Ophthalmology, helped design and run an international protocol for phase III clinical trials of an anti-vascular endothelial growth factor agent, or VEGF-inhibitor, for the treatment of diabetic macular edema (DME). The VISTA-DME and VIVID-DME studies test the efficacy of aflibercept, a VEGF-inhibitor, currently approved only for the treatment of wet macular edema. Based on results from these trials, aflibercept has now been filed for FDA approval for the treatment of diabetic macular edema. Previously, Retina Consultants of Houston was the lead site for phase II and III clinical trials that led to the approval of the first anti-VEGF agent ranibizumab for the treatment of DME. “Ranibizumab was approved by the FDA for diabetic macular edema, an approval that led to changing the standard of care from laser therapy to ocular injections for a type of blinding disease that is extremely common,” says Dr. Brown. These anti-VEGF agents are injected intravitreally and block the upregulation of VEGF. Together with other growth factors and metabolites in diabetic individuals, VEGF can cause a breakdown of the blood-retinal barrier that allows exudation into the interstitial space. This process results in diabetic macular edema in approximately 30 percent of diabetic patients. While previous laser therapy limited vision loss in patients with DME, very few patients regained lost vision. Now, intravitreal injections of anti-VEGF agents are leading to sustained vision gains in most patients with continued therapy.

“Our clinical trials have led to changing the standard of care from laser therapy to ocular injections with resulting vision gains in patients with vision loss from diabetic eye disease.” David Brown, MD

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Houston Methodist Department of Ophthalmology


This initiative brings hope to patients across Eastern Europe by providing experience, expertise and advanced treatment skills to places they didn’t exist. It also educates physicians, enabling them to grow the pool of experience and training in their own communities and countries.

ONGOING RESEARCH : THE PERCEPTION STUDY ON NAION NON-ARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY The Houston Methodist Department of Ophthalmology is one of 67 participants in a large, multicenter trial researching non-arteritic anterior ischemic optic neuropathy (NAION). Andrew Lee, MD, chair of the Department of Ophthalmology and professor of Ophthalmology, Neurology, and Neurosurgery, and Sushma Yalamanchili, MD, assistant professor of Clinical Ophthalmology, are the primary investigators. Known as the PERCEPTION study, the purpose of the trial is to assess risk factors for the development of NAION in males aged 18 and older. “In addition, our hope is to determine whether or not there is any association between PDE5 inhibitors and NAION,” says Dr. Lee.

PDE5 inhibitors block the degradation of smooth muscle cells that line the blood vessels that supply blood to the penis and are used in the treatment of erectile dysfunction. NAION results from impaired blood flow to the front of the optic nerve without significant inflammation of the blood vessels. The condition causes rapid vision loss or impairment in one eye without associated pain. The trial is currently in its third year. The goal is to enroll 125 men with a confirmed diagnosis. The rarity of the condition, however, limits the number of participants. “We are investigating this condition to uncover any potential treatable etiologies. One important unanswered question is whether or not PDE5 inhibitors are associated with this disease,” says Dr. Lee.


Leading Medicine: An Overview

Delivering Better Outcomes

Advancing Technology

Breaking New Ground

SHAPING A LEGACY OF INGENUITY Houston Methodist provides hospital-based training for subspecialty ophthalmology fellows in neuro-ophthalmology. We also offer clinical rotations to residents in neurology, neurosurgery, internal medicine, family practice and transitional year. We also have one approved neuro-ophthalmology fellowship from the Association of University Professors of Ophthalmology Fellowship Compliance Committee (AUPO FCC) as part of a collaborative effort with Baylor College of Medicine and Texas Children’s Hospital. The Houston Methodist Department of Ophthalmology and The University of Texas Medical Branch at Galveston (UTMB) Department of Ophthalmology and Visual Sciences will launch the first integrated ophthalmology residency training program in Texas during the summer of 2014. Combined faculty will number 24, with 3 fellows and 12 residents. The combined program, to be known as UTMB/HMH Ophthalmology Residency, will sponsor the first annual National Eye Research Conference for residents and fellows in January 2015 in Galveston, Texas.

Pursuing Medical Discoveries

RESEARCH PROJECTS

2

Educating For Tomorrow

12

NEURO-OPHTHALMOLOGY FELLOWS

3

MEDICAL STUDENTS

2

CLINICAL TRIALS

33 ROTATING RESIDENTS

ACCOLADES HILARY A. BEAVER, MD Who’s Who in America 2013 (67th Edition), 2013

ANDREW G. LEE, MD Houston Methodist Hospital Faculty Teaching Award, 2013 Resident Faculty Teaching Award, UT Houston Department of Ophthalmology, July 2012 - June 2013 Southeastern Texas Top Doctors, Castle Connolly, 2013 Texas Super Doctors, 2013

ALICE R. MCPHERSON, MD Gonin Medalist, 2014

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Houston Methodist Department of Ophthalmology


HOUSTON METHODIST INSTITUTE FOR TECHNOLOGY, INNOVATION & EDUCATION (MITIE ) SM

LEADING MEDICINE

HOUSTON MITIE AT A GLANCE MORE THAN

6,300

LEARNERS IN 2013

One of the largest and most comprehensive education and research facilities in the world, MITIE is leading the practice of medicine for physicians and health care providers. MITIE offers multi-disciplinary, hands-on learning opportunities using advanced imaging systems and robotics. Surgeons and other health professionals are able to continually refine and acquire new skills that allow them to perform at optimal levels throughout their careers. Using procedural laboratories and sophisticated simulation tools, our research programs are focused on the development and assessment of emerging technologies and technical skills to improve the care of patients through less-invasive therapies. At MITIE, the finest researchers and clinicians are building on our legacy of ingenuity and accelerating the discovery and delivery of better care and better cures.

40,000 SQUARE FEET OF EDUCATION AND RESEARCH SPACE

26 MORE THAN

SURGICAL SPECIALTIES FROM ACROSS THE WORLD

20,000

LEARNERS SINCE INCEPTION

For more information, visit mitietexas.com


HOUSTON METHODIST HOSPITAL LEADING MEDICINE YESTERDAY, TODAY AND TOMORROW At Houston Methodist, we’ve built a legacy of ingenuity that spans multiple decades and disciplines. In the last 95 years, we’ve transformed from a humble 19-bed community hospital to a global leader in health care, treating patients from 90 countries in more than 8,150 visits last year. In 2004, Houston Methodist established a long-term affiliation with Weill Cornell Medical College and New York-Presbyterian Hospital in New York City. Through this affiliation, three internationally renowned institutions collaborate to bring tomorrow’s advances to our patients today. Together, we provide cutting-edge clinical and biomedical research, and education and training for future physicians and scientists. One of the nation’s top research medical schools, Weill Cornell Medical College ranked No. 15 in the 2015 U.S. News & World Report Best Medical Schools list. For Houston Methodist clinicians and researchers, “leading medicine” is a holistic call for excellence in every aspect of patient care. We consistently rank among the best hospitals in the country. In 2013, U.S. News & World Report named Houston Methodist the “Best Hospital in Texas” for the second consecutive year, with 12 specialties recognized in the Best Hospitals list. Houston Methodist is consistently recertified to Magnet status for exceptional nursing. Because of our reputation, the finest researchers and clinicians from around the world are joining us to build on our legacy of ingenuity and accelerate the discovery and delivery of better care and better cures. That’s the difference between practicing medicine and leading it.

FAST FACTS 73 Operating Rooms

1,119

Licensed Beds (824 operating beds)

1,862

Affiliated Physicians

6,101 Employees

8,150

International Patient Encounters (from 90 foreign countries)

36,310 Inpatients in 2013

61,043

Emergency Room Visits in 2013

301,478

Outpatient Visits in 2013

FORTUNE is a registered trademark of Time Inc. and is used under license. From FORTUNE Magazine, February 3, 2014 ©2014 Time Inc. FORTUNE and Time Inc. are not affiliated with, and do not endorse products or services of, Licensee.


LEADERS IN RESEARCH Accelerating discovery and delivery to patients

At Houston Methodist, we are dedicated to defining the future of medicine. We engineer discoveries in the lab to become clinically useful products, channel the best innovations through early stage clinical trials and actively transition those innovations to our industry partners. Our commitment to the full cycle of discovery and delivery sets us apart as leaders who provide patients from around the world access to the latest health care advances.

More than 840 active clinical protocols $55m TOTAL RESEARCH FUNDING IN 2013 See all the ways we’re leading medicine at hmleadingmedicine.com

Photo courtesy of WHR Architects, Inc. Š Aker/Zvonkovic Photography, Houston, Texas


Houston Methodist Hospital 6565 Fannin Street Houston Texas 77030

LEADING MEDICINE YESTERDAY, TODAY AND TOMORROW. At Houston Methodist we have a proud tradition of revolutionizing medicine. Our past achievements have built a legacy that spans multiple decades and disciplines, and that same culture of excellence inspires us to be the pioneers of tomorrow.

houstonmethodist.org/ophthalmology

Houston Methodist Ophthalmology Annual Report 2013  
Houston Methodist Ophthalmology Annual Report 2013