UNC Eye Magazine 2020

K I T T N E R E Y E C E N T E R | U N C D E PA R T M E N T O F O P H T H A L M O L O G Y

Clinical Eye Care in the Congo A Novel Approach to Treating AMD Dr. Zongchao Han, M.D., Ph.D.

2020

Donors to Ophthalmology January 1, 2019 to December 31, 2019 $100,000 and Above

$1,000–$2,499 cont.

$100–$499 cont.

BrightFocus Foundation Prior Family Foundation Edward N. & Della L. Thome Memorial Foundation

Wendy S. & Kenneth B. Simons, M.D. Claudie B. Williams

Jessica A. Olayanju, M.D. Jane & Henry Patterson Isaac Porter, M.D. Linda Prager & Michael G. Parker Arthur J. Prange, M.D. Marjorie S. & J. Milton Read Sara E. Stoneburner, M.D. Cindy & Robert Stoothoff Penelope C. Tate Robert A. Van der Vaart, M.D. Wilmington Eye Robert W. Winston Jonathan T. Zoghby, M.D.

$50,000–$99,999 Susan Kittner Huntting & Rabbi Geoff Huntting Harriett Kittner Miracles in Sight

$10,000–$49,999 Berry & Ralph Stout

$5,000–$9,999 Debra L. Bynum, M.D. & Robert T. Stone, M.D. Arthur W. Clark Charles W. G. Eifrig, M.D. Peggy Leatt, Ph.D.+ & George H. Pink, Ph.D. Gail G. & Charles D. Nottingham, III Clyde Williams

$2,500–$4,999 Laura A. & Steven D. Bergman Sharon Devaney Glaukos Corporation Stephen E. Mehlberg North Carolina Lions Foundation

$1,000–$2,499 Margaret A. & Edward S. Barclay Amy A. & Jon P. Brisley, M.D. Jennifer & Howard E. Cochran Constance S. Kittner Foundation Mary S. & Steven A. Dingeldein, M.D. Karen L. & Travis A. Meredith, M.D. Jennifer F. Jordan, M.D. Oculoplastic Consultants of the Carolinas Dee K. LeRoy Shashi K. Sethi, M.D. 2 UNC Eye Magazine

$500–$999 Ricky D. Bass Rebecca T. & G. Munroe Cobey Dean Ellis, M.D. Susan & Thomas Hohenshil Gina R. Kidd, M.D. & Steven R. Virata, M.D. A. Charles Lunsford Eydie Miller-Ellis, M.D. Nancy Odom Sara H. & Thomas H. Sears, Jr. Jennifer & William Tatum Jeff White, M.D.

$100–$499 Jane E. Arndt Lucy M. Bane Judith Barrett, M.D. & Stephen Barrett, M.D. Susan & Donald L. Budenz, M.D. Cape Fear Eye Associates Cary Eye Center Christian Eye Ministry Margrit & Joel Cotten Julie Cross Susan B. Ervin Neda Esmaili, M.D. & Michael E. Stadler, M.D. Paul Farrell Michelle S. Go, M.D. Kathleen G. Gordon, M.D. & Gary Gordon Lynne K. Kane Kay Khine, M.D. Martha E. King, M.D. & Bradley M. King, M.D. Wolters Kluwer Jeannette D. & Adolph K. Lagarde Myrtis J. & H. Maxwell Morrison, Jr., M.D. Berta Kittner Levin & Robert E. Levin Edward P. Lewy K. Casey Mathys, M.D.

$50–$99 Nancy S. Alguire Sally S. & William S. Atkins, M.D. Barbara P. & Edwin R. Fuller Jr, Ph.D. Betty Kittner & Kent Dewey R. Evan Levy, M.D. Beverly W. & William E. Melville Lucinda A. Mitchin James K. Wilson

Gifts in Kind Susan & Donald L. Budenz, M.D. Amy M. Fowler, M.D. We regret if we omitted your name. [+ Deceased]

Support UNC Ophthamology Today!

Make your gift on-line at med.unc.edu/ ophth/how-can-you-help or use the reply envelope in this magazine.

A Letter From the Chair

Dear Friends, Alumni, and Patients of UNC Ophthalmology, UNC Ophthalmology had an extraordinary year in 2019. Our practice grew by 12% in nine locations. We added new clinical faculty from top practices and institutions. Our mission to serve patients with the highest-quality clinical care, pioneer new ways to treat and prevent eye disease, and educate the next generation of ophthalmologists is one we deliver every day.

We have also made some remarkable strides in research. Our faculty published 50 articles in peer-reviewed journals and continue to work on therapies and treatments for blinding eye disease including glaucoma, corneal disease, and age-related macular degeneration. All of this is made possible through grants and philanthropy, which accelerate our progress.

Donald L. Budenz, MD, MPH Kittner Family Distinguished Professor and Chair, Department of Opthalmology

UNC OPHTHALMOLOGY RESIDENCY PROGRAM Extremely Competitive & Highly Selective

APPLICATIONS

The UNC Ophthalmology training program is a dynamic, energized component of our mission. We are committed to producing leaders in the field of ophthalmology who are medically, surgically, and culturally competent. In December we interviewed forty residency candidates for the class of 2024 after receiving 545 applications for four positions.

We now offer all of our residents the opportunity to participate in international service. In 2019 ophthalmology residents visited China, Peru, India and the Dominican Republic and had the opportunity to examine patients and teach nurses, doctors, and staff who have limited access to high-quality eye care and education. Our residents also have the opportunity to care for local patients in need at the Student Health Action Coalition clinic in Carrboro, the oldest student-run free health clinic in the country. Service at home and abroad instills the value of caring for those who do not have access to ophthalmology care.

Driving our service, clinical care, education, and research missions is the knowledge that approximately 256,000 individuals in North Carolina are blind or vision impaired. We are aware that our efforts have the ability to make a difference for every patient we treat.

We are privileged to be a part of a great institution with a long history of advances in science, medicine and service. We are honored to continue the tradition.

Donald L. Budenz, MD, MPH Kittner Family Distinguished Professor Chair, Department of Ophthalmology

for Four Residency Spots for the Class of 2024 UNC Eye Magazine 3

ALEXIS WOLSON

Clinical Eye Care in the Congo The Ebola outbreak in Central Africa may be miles away from the dynamic UNC campus, but for Dr. Jean-Claude Mwanza, Research Associate Professor at UNC Ophthalmology, it hits close to home.

Dr. J.C. Mwanza examines an Ebola survivor in the Democratic Republic of the Congo.

Dr. Mwanza’s research is focused on the early detection, diagnosis, and progression of glaucoma but he recently took on a more global issue, helping Ebola survivors in his home country of the Democratic Republic of the Congo (DRC).

Ebola is not new to the DRC. The first virus outbreak ever identified occurred there in 1976 and there have been nine additional outbreaks in the Congo since. The current epidemic is taking place against a backdrop of political instability, military conflict, and a deep distrust of outsiders, making it particularly complicated and dangerous.

This outbreak comes on the heels of the largest and most complex epidemic in history—the 2014–2016 outbreak in West Africa, with 28,600 confirmed cases and more than 11,300 deaths.

4 UNC Eye Magazine

The unprecedented number of infected individuals in the West Africa epidemic led to an extraordinary number of survivors. At the height of the outbreak, healthworkers were so overwhelmed with caring for the sick they were not able to focus on survivors. When the epidemic waned, doctors and researchers quickly realized recovering patients were facing significant health complications.

Some of the more serious symptoms that worried doctors were eye complications including inflammation, reduced or blurred vision, and loss of sight. A primary concern was the prevalence of Uveitis—an inflammation of the middle layer of the eye that can damage vital eye tissue, leading to permanent vision loss.

“We learned a lot from the outbreak in West Africa,” said Mwanza. “Over

20% of survivors developed eye complications at some point, especially Uveitis. About 40% of those survivors ultimately suffered from severe vision impairment and even blindness. So we took what we learned and applied it to the current epidemic in Congo.”

Given the impact vision loss has on quality of life, independence, mobility, and economic stability, Mwanza knew there was a need to quickly evaluate and support survivors.

Knowing the DRC’s history with Ebola, he also realized how important it was to train doctors to manage future outbreaks. So he and two colleagues from Emory University, Dr. Jessica G. Shantha and Dr. Steven Yeh, set out to implement a program that would screen survivors, deliver care to patients, and strengthen the vision health of the country.

Due to the risks of working in the region, Mwanza and his colleagues operated through the DRC’s Ministry of Health and the WHO Global Outbreak Alert and Response Network, an international collaboration that ensures that during outbreaks, the right technical expertise and skills are on the ground where and when they are needed most. “We had many objectives we needed to accomplish,” said Mwanza. “We wanted to provide hands-on training for local ophthalmologists, evaluate the risk of eye disease in the current outbreak, develop a system to screen survivors and provide care if needed, and collect critical information for research.

All in a short period of time.”

The first step was to procure equipment. “There are no resources in Congo so we took an entire clinic with us,” he explained. Once on the ground, the team set up a clinic, trained 10 Congolese ophthalmologists from across the country on how to identify and treat Ebola-related eye issues, and began seeing patients. In 5 days, the clinic treated 250 Ebola survivors and examined an additional 200 patients from the general public.

“The need for eye care is overwhelming,” stressed Mwanza. “Congo has close to 100M people but there are only 107 ophthalmologists in the entire country. Each morning when we arrived, there were dozens of people already lined up outside the clinic, waiting to be seen.”

Because the Ebola virus cannot survive on the surface of the eye, Mwanza and his team of ophthalmologists were able to provide eye exams using the standard medical

Quality medical care and education is our goal locally, nationally, and around the world. Annual visits to the same global cities allow us to work more effectively to improve medical training and clinical outcomes over time.

Nowhere is this need for consistency more apparent than in the DRC. During his most recent trip, JC formed a special bond with two children suffering from Ebola-related eye complications. Although his care provided significant relief, the work is not over and Dr. Mwanza is already planning the next trip. He, along with UNC EYE, is committed to assisting those in need.

You support of our clinical health efforts is critical if we are to make an impact locally and globally. Please call 919-537-3762 or email Susan Ervin at Susan_Ervin@med.unc.edu to learn more and make a gift.

protections such as protective clothing and latex gloves.

The virus can survive in the inner eye, however. This is the primary reason why no surgeries were performed at the clinic during Mwanza’s trip, even though they were equipped to do so.

Another finding from the West Africa epidemic was that Ebola is a cunning virus, exploiting the eye’s immune privilege status and lingering in the back of the eye, where the immune system is not very active. Although researchers think the virus remains contained in the inner eye, invasive procedures like cataract surgery run the risk of exposing doctors and

health care workers to the virus and introducing it back into the population. The first step before such surgical procedures is to ensure the virus is not present in liquid inside the eye. Even then, doctors have to take protective measures including immunization and wearing personal protective equipment.

With more Ebola survivors suffering from ocular complications every day, Mwanza has plans to go back to the DRC. “Now that we have a full clinic on site, we can continue our efforts to make sure that the local ophthalmologists are prepared to care for patients.”

UNC Eye Magazine 5

More about

Jean-Claude Mwanza, M.D., M.P.H., Ph.D., UNC Ophthalmology

Mwanza was born and raised in the DRC. His large family emphasized school and studies. In middle school, his grandfather urged him to become an engineer in the hopes that he would one day join him at the mining company where he worked.

But a close uncle who was in medical school in Kinshasa encouraged him to study medicine. When his uncle came to visit, he would tell Mwanza about “what he was studying and learning. He would catch rats and dissect them to show me their internal organs like the heart and stomach. That captured my interest,” he recalled. “After that, I knew I was going to medical school.”

As a medical student, he enjoyed working with patients and faculty. After completing medical school and an ophthalmology residency, he joined the faculty at the University of Kinshasa, intending to make that his career.

A call from a colleague looking for assistance changed all that. Rural

6 UNC Eye Magazine

areas in the DRC were experiencing an outbreak of Konzo, a disease ultimately linked to cyanide levels in cassava. A group of international re– searchers working on the outbreak observed that many patients were complaining of vision loss and realized they needed an ophthalmologist on the team. Mwanza aided the effort by providing care for patients and collecting data for the researchers.

But the researchers were not able to analyze the data he was providing because they weren’t familiar with ophthalmology, so they invited him to join the team.

perform basic research and see how things were run in a lab. But being at the EPA helped me realize that I wanted to get back to clinical research. I missed interacting with patients, speaking to different people, and learning different cultures. I wanted to work with people again.”

Professionally, Mwanza’s work reflects UNC Eye’s commitment to taking the research, solutions, and treatments developed on campus and sharing them with communities in North Carolina and around the world. Personally, going back That work led to an M.P.H. and a Ph.D. at to the DRC to aid in patient care the University of Bergen, Norway. For his gave him a sense of being helpful.

Ph.D., Mwanza studied the neuro-oph“Even though we didn’t have much thalmological and electrophysiological growing up, we shared what we abnormalities of Konzo, HIV, and African had. It is the same for me now— sleeping sickness. A presentation of his using my education and knowledge research triggered a conversation amto be useful. If I am in a position to ong interested collaborators that led to help, if there is somewhere my skills a 3-year research position at the EPA can be of use, I will go.” in Research Triangle Park, North Carolina. “It was a good experience, to

ALEXIS WOLSON

A Novel Approach to Treating AMD Zongchao Han, M.D., Ph.D., has made a research breakthrough that could change the lives of patients suffering from age-related macular degeneration (AMD).

Dr. Zongchao Han’s lab is buzzing with a combination of researchers, post docs, graduate students, and undergrads. This is deliberate. Han, as his friends and colleagues call him, believes that having people in the lab at different stages of research and education helps keep the ideas and thinking fresh.

Han’s unique perspective comes from years of experience as a clinician, professor, academic advisor, and scientist. Originally a neurologist, he was discouraged by the lack of treatment options for his patients with common neurodegenerative disorders. This frustration influenced his decision to leave medicine and become a researcher, determining that, if there were no treatments available, he’d create them himself.

Dr. Zongchao Han, M.D., Ph.D., pictured in his lab in 2019. Han receives funding from the National

Eye Institute, the Edward N. & Della L. Thome Me-

morial Foundation, and the BrightFocus Foundation. His lab has also been recognized as a Carolina Center of Cancer Nanotechnology Excellence.

Today, as an Associate Professor at UNC Ophthalmology, much of Han’s research is focused on designing and refining non-viral vehicles (such as nanoparticles or biomaterials) that deliver therapeutic genes and drugs. Some of these delivery vehicles and materials also double as the therapy itself, as in the case of nanoceria.

Oxidative stress, the imbalance between free radicals and antioxidants in the body, plays a key role in the development of both forms of AMD. To counteract the stress, scientists believe that introducing a powerful antioxidant like nanoceria to fight and neutralize free radicals in the eye could be an effective treatment.

Han and his team have been working on nanoceria, a microscopic antioxidant, in an effort to help treat Age Related Macular Degeneration, a progressive blinding disease that affects approximately 11 million individuals in the US and more than 170 million people globally.

Currently, there are no proven treatments for dry (geographic atrophy) AMD and the primary treatment for wet (neovascular) AMD consists of monthly eye injections, which can be a source of discomfort and anxiety for patients.

Nanoceria has considerable biomedical potential.

Its auto-regenerative property means it can continually scavenge free radicals. Therefore, a single-treatment can potentially provide a lifetime benefit. But its full potential is hindered by another property—water insolubility. For therapeutic use and drug delivery, insolubility is a significant limitation that results in treatment inefficiencies and lower efficacy. Higher required dosages often lead to toxicity and other adverse health effects.

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UNC Eye Magazine 7

CONTINUED...

The Han Lab has overcome that limitation by synthesizing a water-soluble formulation of nanoceria—an advanced design that retains its auto-regenerative ability while adding better distribution, greater efficacy, and lower toxicity.

This is a significant breakthrough in the effort to harness and utilize the beneficial properties of nanoceria. In addition to AMD, Han sees this innovation being applied to other diseases caused by oxidative stress, including neuro-degenerative disorders, tumors, and diabetes, all of which currently have inadequate treatments.

Dr. Kathy Whitfield, Assistant Professor of Pediatric Ophthalmology, recently served as a visiting professor at the Tianjin Eye Hospital in Tianjin,

Ongoing research on this advanced design has shown encouraging antioxidant activity, signaling its viability and potential use as an alternative therapy to improve the care of AMD patients. Although still in the preclinical stage, UNC EYE just received a patent for this new formulation, making it ready to move forward towards clinical trial (PCT/US2018/018298).

Thanks to this breakthrough, future patients may be offered a novel new therapy—a single application of nanoceria, placed in the eye that continually reduces oxidative stress and deters the onset of AMD.

Dr. Nik Ulrich of UNC Ophthalmology accepts

a check from Lion Dale Dupree of the North Car-

olina Lions. The donation funded the travel of Dr.

China. Dr. Whitfield was also a speaker at the 2019 Tianjin

John Deans, a UNC Ophthalmology Resident, who accom-

is pictured with colleague Grace Prakalapakorn, M.D., from

and Deans treated infants born with retinopathy of prema-

International Ophthalmology Forum. Dr. Whitfield (middle) Duke, and a local ophthalmologist.

panied Dr. Ulrich to Liaocheng, China. While there Drs. Ulrich turity, taught ophthalmology trainees how to use an indirect laser, lectured local physicians, and worked with ICU staff to strengthen their treatment protocols.

8 UNC Eye Magazine

UNC Eye Welcomes New First Year Residents

R. Elliot Browning, M.D.

Jessica Duddleston, M.D.

UNDERGRADUATE

UNDERGRADUATE

First Year Resident

Auburn University, 2014, Biomedical Sciences MEDICAL SCHOOL

University of Mississippi School of Medicine (2018) INTERNSHIP

Internal Medicine, UNC OUTSIDE INTERESTS

Reading, golf, Bible study, woodworking and mechanical/electrical projects.

First Year Resident

Mississippi State University, 2013, Biomedical Engineering ME DIC AL SCHOOL

University of Mississippi School of Medicine (2018)

Basil Mathews, M.D.

Roma Pegany, M.D.

UNDE RGR ADUATE

UNDERGRADUATE

First Year Resident

Virginia Commonwealth University, 2014, Biology and Spanish ME DIC AL SCHOOL

ME DIC AL SCHOOL

INTE RNSHIP

INTE RNSHIP

Internal Medicine, UNC OUTSIDE INTE RE S TS

OUTSIDE INTE RE S TS

Marathon running, soccer, tennis, cooking, reading and travel.

University of California, Berkeley, 2008, Public Health and Southeast Asian Studies

University of Oklahoma College of Medicine (2018)

Internal Medicine, University of Oklahoma

INTE RNSHIP

First Year Resident

Weightlifting, running, basketball, snorkeling/ SCUBA, car maintenance, camping, hiking, basic website management and computer hardware, exploring restaurants, cooking, barbecuing at home.

Georgetown University (2018)

Internal Medicine, UNC

OUTSIDE INTE RE S TS

Mentoring and advocacy for disadvantaged youth, church, hiking, travel, architecture and ancient civilizations, reading nonfiction biographies and historical novels.

UNC Eye Magazine 9

UNC OPHTHALMOLOGY WELCOMES DR. BEATRICE BREWINGTON Dr. Brewington has joined the Retina Service at Kittner Eye Center and Holly

Springs. Dr. Brewington earned her undergraduate degree in biology and his-

tory at Duke University. She completed a one year Research Fellowship at Duke

University Eye Center after earning her medical degree at the James H. Quillen College of Medicine at East Tennessee State University in Johnson City, Tennessee. Dr. Brewington

completed a residency in ophthalmology at the University of Louisville in Louisville, Kentucky, a fellowship in Pediatric Ophthalmology at Emory University Eye Center in Atlanta, and completed a fellowship in Medical Retina/Ocular Oncology at Ohio State in Columbus, Ohio.

To make an appointment with Dr. Brewington, call 984-974-2020.

Dr. Donald Budenz examines a patient in Accra, Ghana.

UNC OPHTHALMOLOGY CLASS OF 2019 Congratulations to the UNC Ophthalmology Class of 2019 pictured with Dr. Amy Fowler, Director of Resident Education in Ophthalmology: Lee Moore, M.D. (cornea fellow-

ship at University of Oklahoma); Lauren Rushing, M.D., (fellowship

in Medical Retina at University of Michigan); Michael Taggart, M.D.,

(private practice in Morganton, NC); Chris Hwang, M.D., (fellowship

in Oculoplastic Surgery at Mayo Clinic, Rochester, Minnesota).

Kittner Family Distinguished Professor & Chair of UNC Ophthalmology Donald L. Budenz, M.D., M.P.H., has been named President of the American Glaucoma Society for 2020. The Society was established in 1985 by 13 founders and has grown to include more than 1,450 members from 17 countries. Members include fellowship trained glaucoma specialists, scientists active in glaucoma research and current glaucoma fellows.

The mission of the organization is to maintain and improve the quality of patient care primarily through improvement, exchange and dissemination of information and scientific knowledge pertinent to glaucoma and related diseases.

Prior to his appointment as President, Budenz served on and chaired numerous committees, received the AGS Humanitarian of the Year Award, and delivered the Clinician Scientist Lecture at the annual meeting. Concurrently, he will serve as President of the American Glaucoma Society Foundation, the fundraising arm of the organization.

10 UNC Eye Magazine

PHILANTHROPY AT WORK AT UNC OPHTHALMOLOGY Philanthropy is a key component to

our success. Gifts from alumni, patients,

Intensive Cataract Surgical Training: UNC Residents Oleg Alekseev, Sailaja

Bondalapati, John Deans, and Ryan O’Meilia join Dr. Ken Cohen at the 15th Annual Harvard Medical School Intensive Cataract Surgical Training Course

at Mass Eye and Ear. Resident travel was made possible through alumni contributions to the UNC Eye Resident Research, Training and Global Education Fund.

and friends like you helps support patient care, advances residency educa-

tion, and expands our global outreach.

It also accelerates our research, bringing us closer to cures and treatments for blinding eye disease.

Your gift drives change at UNC Ophthalmology— make your gift today.

Make your gift on-line at med.unc.edu/ ophth/how-can-you-help

Dr. Nik Ulrich teaches a local

Dr. Sailaja Bondalapati, M.D.,

an indirect laser.

patient at LVPEI, India.

ophthalmologist how to use

UNC Eye Resident, examines a

2020 UNC EYE MAGAZINE

UNC OPHTHALMOLOGY ADVISORY BOARD

Donald L. Budenz, M.D., M.P.H. Kittner Family Distinguished Professor & Chair, Department of Ophthalmology

Laura A. Bergman

Charles D. Nottingham, III

Steven D. Bergman

Dr. George H. Pink

Sandra H. Gaddy

Cornelius B. Prior, II

Susan Kittner Huntting

Dr. Alan M. Rich

Harriett Kittner

Linda H. Rich

Bert Kittner Levin

Sara H. Sears

Dr. Travis A. Meredith

Thomas H. Sears, Jr.

Susan Ervin Director of Development Publisher Alexis Wolson Editor UNC Creative Design

UNC Eye Magazine 11

Department of Ophthalmology 5144 Bioinformatics Building Campus Box 7040 Chapel Hill, NC 27599-7040

UNC Ophthalmology Locations: Kittner Eye Center

UNC Eye Roxboro

UNC Eye Holly Springs

Alamance Eye Center

UNC Specialty Care at Pittsboro

For Appointments call 984-974-2020

Visit our Optical Shop at UNC Kittner Eye Center!

For Appointments and Information, call 984-974-2039