Welcome to the new edition of Ophthalmic News. It’s been a while coming, but I’m excited to be sending this monthly departmental newsletter, the goal of which is to keep us all informed and engaged with what’s happening in our DOVS world.
Our three major annual symposia occurred in the past few months, and all were resounding successes. Ed Margolin chaired the 54th Annual Walter Wright Symposium in early December. Entitled “Neuro-Ophthalmology 2014—Challenges in Diagnosis and Management”, the 2-day event featured a series of excellent talks from local and visiting faculty. Didactic sessions were mixed with case presentations and discussions. This was one of our largest Walter Wright symposia yet, impressive given the neuro-ophthalmology topic!
The Toronto Cataract Course occurred on February 21, 2015 at the Westin Harbour Castle. The course was directed by Ike Ahmed and featured a great collection of cutting edge talks on cataract surgery. Two provocative sessions covered the politics of eye care delivery models and ethics in cataract surgery; both spurred extensive discussions on topics very important to us all.
The 26th Annual Jack Crawford Day was chaired by Kamiar Mireskandari in early March. The event featured important sessions covering challenging areas in paediatric oculoplastics, as well as strabismus and other areas in paediatric ophthalmology. By design, the meeting was highly interactive, with about one-third of the time allotted to panel discussions and audience participation.
All three events were well attended and offered our faculty, trainees, and guests important state-of-the-art information.
The main purpose of this newsletter is to share information that will increase cohesion within the department. To this end, we are initiating an effort to introduce some of our basic scientists to the wider department. Each month, one of the faculty in our department will be featured, starting this month with Valerie Wallace, Director of the Vision Science Research Program at the Toronto Western Research Institute. We also hope to feature other members in our department, and highlight the notable accomplishments of all. Please note the significant volume of publications from the department in the first 3 months of this year featured in this newsletter: we’re doing well! Feel free to send us notice of recently published papers and awarded grants so we can acknowledge you too.
I sincerely hope you enjoy this newsletter and would encourage you all to submit any thoughts or suggestions for future newsletters to me. My door is always open (figuratively speaking!)
Sherif El-Defrawy
Chair, Department of Ophthalmology & Vision Sciences
University of Toronto
We are pleased to announce the launch of our newly designed website (www.utovs.com). Please click here to visit the new website
PGY-1s
Our resident selection committee, led by Drs. Hall Chew and John Lloyd, worked tirelessly in December and January to review over 75 applicants, interview 24, and select 4 Canadian medical graduates, 1 international medical graduate and 1 foreign trained student. We were fortunate to match stellar individuals again this year.
The list of our PGY-1s beginning in July 2015:
Canadian medical graduates: Brian George Ballios, Alfred Basilious, Jeremy Goldfarb, Angela Zhang
International medical graduate: Rebecca Stein
Foreign trained graduate: Sara Al-Shaker
To these 6 individuals, welcome to the DOVS team! We look forward to having you join us in July.
May 7, 2015
Quality Assurance Rounds
Drs. Nancy Epstein and Wendy Hatch
May 14, 2015
Annual Combined Rounds -
The Toronto Ophthalmological Society & U of T Ophthalmology & Vision Sciences
"The Pharmacology of Diabetic Retinopathy Treatment: Issues to Consider"
Dr. Karl G. Csaky
May 19, 2015
DOVS City Wide Annual General Meeting
May 21, 2015
Faculty Development
Drs. Kylen McReelis & Radha Kohly
May 28, 2015
Research Seminar Series - Retina
Drs. Michael Brent & Chris Hudson
Dr. Brenda Gallie Appointed to the Order of Canada
In late 2014, Dr. Brenda L. Gallie of The Hospital for Sick Children was appointed as a Member to the Order of Canada.
This is a truly fitting tribute to Brenda's lifetime dedication to helping children with retinoblastoma. Her groundbreaking research has had a tremendous impact on our understanding of this rare disease and has improved the lives of patients all over the world. This honour is so well deserved.
Congratulations, Brenda. The Department of Ophthalmology and Vision Sciences is very proud of you!
Dr. Edsel Ing receives PARO Excellence in Clinical Teaching Award
Dr. Edsel Ing has been chosen as one of 2 recipients at the University of Toronto for PARO Excellence in Clinical Teaching Award. The goal of the award is to publicly acknowledge the essential role that good clinical teachers play in the training of physicians. Residents are asked to outline the qualities that make their nominee an excellent teacher including, patient care, quality of bedside teaching, and interest in the trainees' personal development and well-being. This is effectively the most prestigious provincial academic teaching award. Congratulations, Edsel!
Dr. Molly Shoichet wins L’Oréal-UNESCO For Women in Science award
Congratulations to Dr. Molly Shoichet, who holds a cross appointment to DOVS, has been named the L’Oréal-UNESCO For Women in Science North American laureate for 2015. To find out more details about this distinguished award, read the whole story at U of T News.
Research Awards
Congratulations to Drs. Daphne Maurer (SickKids adjunct scientist; PI), Agnes Wong (SickKids Ophthalmologist-in-Chief; PI), Helen Dimaras (SickKids adjunct scientist; co-investigator), Kevin Thorpe (U of T; co-investigator) and Kednapa Thavorn (The Ottawa Hospital: co-investigator) in successfully obtaining a three-year CIHR grant on "Effective vision screening for preschool children".
Congratulations to Dr. Asim Ali and team for their recent award of $74,000 from PSI Foundation for a study on the feasibility of specular microscopy in a paediatric population.
Congratulations to Dr. Crystal Cheung and Dr. Wai Ching Lam for their recent award of $5,000 from the Retina Foundation of Canada for the progression of geographic atrophy with ranibizumab.
1st DOVS Pilot Research Grant Competition
The 1st DOVS Pilot Research Grant Competition received a total of 14 applications. Three criteria were used to evaluate the grants: trainee involvement, multidisciplinary, and translational. The adjudicating committee, including Drs. Martin Steinbach, Valerie Wallace, Sherif El-Defrawy and Agnes Wong, has selected three applications for funding at $10,000 each:
Cytokine levels in patients with persistent diabetic macular edema treated with triamcinolone acetonide: A prospective interventional study.
Trainee: Alaa Al Ali (resident), Robert Gizicki (fellow), Michael Mak (medical student)
PI: Rajeev Muni
Evaluating the cost-effectiveness of corneal cross-linking in the treatment of keratoconus in Ontario.
Trainee: Victoria Leung (resident)
PI: Wendy Hatch
Papilledema: Photography, ultrasonography, and lumbar puncture study (PUPLS)
Trainee: Hannah Chiu (resident)
PI: Agnes Wong
Behind the Science: DOVS researcher
Dr. Valerie Wallace, Director of Vision Science Research Program
Dr. Valerie Wallace obtained her PhD in the Department of Immunology at the University of Toronto and completed postdoctoral studies in developmental neuroscience at University College London. From 1998 until 2013, she was a Senior Scientist and Director of the Vision Research Program at the Ottawa Hospital Research Institute, University of Ottawa.
Dr. Wallace joined the Toronto Western Research Institute in September 2013, where she is the Director of the Vision Science Research Program (VSRP). Dr. Wallace is the holder of the Donald K. Johnson Endowed Chair in Vision Science Research. She has an appointment at U of T DOVS with a cross appointment to the Department of Laboratory Medicine and Pathobiology.
A molecular and developmental biologist by training, Valerie discovered the role of Sonic hedgehog signaling from ganglion cells in neural progenitor proliferation in the retina. Research in the Wallace lab is focused on unraveling how signaling pathways and genes that control these processes are key to cellular regulation and brain function but also important for understanding tumorigenesis and degenerative processes.
Q&A with Dr. Wallace:
What are the themes in your research and how do you see how the body of research that you’re conducting might impact these themes?
There are three themes in my research. The most ophthalmology relevant is our study of cone photoreceptors and transplanting them, with a long-term view of using it as a therapeutic approach in AMD and other diseases where cones have degenerated. We have the only genetically-marked mouse model that allows us to purify live cones, and to track them after we transplant them.
The second theme is asking general questions about how the retina develops, the genes involved, and the way cell behavior impacts development. This is relevant to manipulating stem cells, and perhaps one day actually being able to produce photoreceptors for humans. It was this work that serendipitously helped us identify these cone-marked mice, which we are using for preclinical transplantation.
This research into retinal development also led to my third theme, which is we’ve identified molecules in the retina that control growth and now we’re studying them in the context of tumorigenesis in the cerebellum. Surprisingly, there are quite a number of parallels between how the retina and cerebellum develop. We asked whether we might be able to leverage our knowledge of retinal development to the rest of the brain and it turns out that we can, and that some of the proteins we find in the retina actually play a role in tumor development in the cerebellum.
How is the retina easier to study than the brain?
It’s easier because we can culture it in a dish, which is harder to do with the cerebellum. Most of the genetic manipulations we would do to the retina are not lethal to the mouse, whereas they would be lethal if you targeted other parts of the brain. Also, you can manipulate stages of brain development in the eye much more easily because the eye still has half of its development to go through after birth. We can ask questions in neonates that we would not be able to ask very easily if we were only studying other regions of the brain.
We’ve been studying a protein called Norrie disease protein, which is essential for establishing vasculature in the eye, but mutations in the gene cause congenital blindness in humans as well. I discovered that Sonic hedgehog was regulating Norrie disease protein, which suggests that neuron and blood vessel formation are coordinated.
In your wildest dreams, how will your research change our world?
I hope that some of what we’ve done might lead to ways to intervene in cases of irreversible blindness. So, for example in AMD, maybe we’ll transplant cells, or maybe we’ll discover genes that can be turned on by drugs, that will stop that process. It would be wonderful if our work on cone transplantation would lead to novel ways to tackle what has been a clinically unserved need.
* Photo Credit: UHN
Sick Kids surgeon Asim Ali and colleagues pioneer innovative technique, called corneal neurotization, to restore corneal sensation
As we know, corneal anesthesia related to loss of innervation is recalcitrant to conventional treatment, and can be vision threatening. Rather than repeatedly treat complications of this problem, ophthalmologists Asim Ali and Uriel Elbaz teamed with surgeons from the Division of Plastic and Reconstructive Surgery at Sick Kids to develop a novel technique to address the root cause.
Corneal sensory reconstruction was performed by transplanting nerve tissue from the leg (sural nerve) or the contralateral supratrochlear nerve to reconstruct nerve gaps around the eye. The results from four eyes in three patients were published in November 2014 in JAMA Ophthalmology (132:1289-95), and this exciting research was recently featured on CBC News and CTV News.
"What we've done in this procedure is basically bring sensation from another part of the face through an extension cord bring it across and put it into the cornea where there was no sensation," said plastic and reconstructive surgeon, Dr. Ronald Zuker in a March 5th CBC article.
Their novel multidisciplinary approach restores an ocular defense mechanism and may enable some patients to undergo needed corneal transplantation. None of the operated eyes have developed corneal anesthesia-related complications since reconstruction.
The hospital has done eight cases to date. The group has also published their technique in Plastic and Reconstructive Surgery (2015; 135: 397e-400e).
Congratulations to Dr. Ali and team for this ground-breaking research.
Cataracts are inevitable, but fixable by Dr. John Lloyd
"In the past, someone’s cataracts had to be pretty bad before surgery was worth undertaking. That’s no longer true.
Cataracts are a common, painless condition that can interfere with your vision. They’re almost inevitable as we age. Many people think cataracts are a type of growth or film on the eye, but that’s a misconception. Cataracts develop inside our eyes and cause the lenses — which help us see light and images — to become cloudy, like having fog on your window..."
Congratulations to Dr. Clara Chan and her husband, Ryan Hung, on the birth of their baby boy, Derek on February 3, 2015. "The baby already looks like a corneal surgeon", commented Dr. El-Defrawy.
Dr. Charles Pavlin (1944-2014)
Dr. Charles Joseph Pavlin passed away suddenly but peacefully on November 14, 2014. A dedicated clinician and a pioneer in ophthalmic imaging, Dr. Pavlin studied medicine at the University of Manitoba and served as an officer in the Canadian Air Force before moving to Toronto to complete a residency in ophthalmology at the University of Toronto. Chuck first established a practice at Parliament and Wellesley in Toronto, later moving to Mount Sinai Hospital.
In 1981, Dr. Pavlin completed post-graduate training in ophthalmic ultrasound with Dr. Jackson Coleman in New York. In 1989, he joined with Dr. Stuart Foster of the Department of Medical Physics to develop ultrasound biomicroscopy. Using high-frequency ultrasound to produce in vivo microscopic images of anterior segment structures has allowed for the clarification of mechanisms of ocular disease that had only been speculated on before. Dr. Pavlin published on important topics including the cause of plateau iris syndrome, and the mechanisms of pigmentary glaucoma and malignant glaucoma, and thousands of papers have been published worldwide using this technology. Chuck wrote more than two dozen book chapters, presented his research and taught worldwide, and was the recipient of numerous awards and honors, including the 2015 COS Lifetime Achievement Award. As well, he was posthumously awarded the Department of Ophthalmology and Vision Sciences Lifetime Achievement Award on Walter Wright Day in December 2014.
A lifelong sportsman and musician, Chuck was a dedicated husband, father, and grandfather. We will miss his gentle presence in the Department. At the request of his family, donations can be made to the Ophthalmic Ultrasound Fund by contacting Elizabeth den Hartog at 416-978-4321.
Celebration of Life in Memory of Dr. Charles Pavlin
"Celebration of Life in Memory of Dr. Chuck Pavlin" will take place on Saturday April 25th 2015 at 7:30 PM at the Hard Rock Café, 279 Yonge Street, Toronto.
The "World's Greatest Garage Band" will perform, and for those who wish to share a memory of Chuck there will be an open microphone.
Dr. Martin Kazdan (1930-2014)
Dr. Martin Stephen Kazdan died at home surrounded by his family on November 12, 2014. Dr. Kazdan graduated in Medicine from the University of Toronto, did a residency in ophthalmology at the Mayo clinic and received a Master of Science at the University of Minnesota. After an ophthalmic plastic surgery fellowship with the renowned New York surgeon, Dr. Wendell Hughes, Martin returned to Toronto and joined the ophthalmology practice of his father, Dr. Louis Kazdan. They were later joined by his brother, Dr. Jerome Kazdan.
Martin’s research focused on ocular ultrasound and the treatment of blepharospasm. He retired in 2012 and was recognized for his forty years of dedicated service to the University of Toronto, and his many decades of service to North York General and Mount Sinai Hospital.
Predeceased by his first wife, Dr. Kazdan found love again with his wife Marion. He was a loving father and cherished grandfather, devoted to both family and close friends. He was well known and respected by his peers and admired by his patients. He had a lifelong love of birds and nature and especially enjoyed the Credit River childhood cottage and Gooderham Family cottage.
Recent publications by DOVS Faculty, Staff, Residents and Fellows
January - March 2015
Adatia FA, Munro M, Jivraj I, Ajani A, Braga-Mele R. Documenting the subjective patient experience of first versus second cataract surgery. J Cataract Refract Surg. 2015; 41(1): 116-21.
Ahmed II. Surgical technique for explantation of cosmetic anterior chamber iris implants. J Cataract Refract Surg. 2015; 41(1): 18-22.
Astudillo PP, Durairaj P, Chan HS, Héon E, Gallie BL. Hypersensitivity to sub-Tenon's topotecan in fibrin adhesive in patients with retinoblastoma. J AAPOS. 2015; 19(1): 86-7.
Bains RD, Elbaz U, Zuker RM,Ali A, Borschel GH. Corneal neurotization from the supratrochlear nerve with sural nerve grafts: a minimally invasive approach. Plast Reconstr Surg. 2015; 135(2): 397e-400e.
Basilious A, Buys YM. A woman with a family history of glaucoma. CMAJ. 2015 Jan 5. [Epub ahead of print]
Bedell HE, Pratt JD, Krishman A, Kisilevsky E, Brin T, González EG, Steinbach MJ, Tarita-Nistor L. Repeatability of Nidek MP-1 Fixation Measurements in Patients with Bilateral Central Field Loss. Invest Ophthalmol Vis Sci. 2015 Mar 18. [Epub ahead of print]
Belliveau MJ, Johnson D. Orbital compartment syndrome after head trauma. Lancet Neurol. 2015; 14(2): 136-7.
Belliveau MJ, Thorner PS, DeAngelis DD. Lateral canthus choristoma. Ophthal Plast Reconstr Surg. 2015; Mar 13. [Epub ahead of print]
Berk TA, Tam DY, Werner L, Mamalis N, Ahmed II. Electron microscopic evaluation of a gold glaucoma micro shunt after explantation. J Cataract Refract Surg. 2015 Feb 13. [Epub ahead of print]
Braakman ST, Read AT, Chan DW, Ethier CR, Overby DR. Colocalization of outflow segmentation and pores along the inner wall of Schlemm's canal. Exp Eye Res. 2015; 130: 87-96.
Budenz DL, Barton K, Gedde SJ, Feuer WJ, Schiffman J, Costa VP, Godfrey DG, Buys YM; Ahmed Baerveldt Comparison Study Group. Five-year treatment outcomes in the Ahmed Baerveldt comparison study. Ophthalmology. 2015; 122(2): 308-16.
Campbell RJ, Gill SS, Ten Hove M, El-Defrawy SR, Strube YN, Whitehead M, Campbell EL, Bell CM. Strabismus Surgical Subspecialization: A Population-Based Analysis. JAMA Ophthalmol. 2015; Feb 26. [Epub ahead of print]
Carpenter AC, Smith AN, Wagner H, Cohen-Tayar Y, Rao S, Wallace V, Ashery-Padan R, Lang RA. Wnt ligands from the embryonic surface ectoderm regulate 'bimetallic strip' optic cup morphogenesis in mouse. Development. 2015; 142(5): 972-82.
Chiu H, Steele D, McAlister C, Lam WC. Delivery recommendations for pregnant females with risk factors for rhegmatogenous retinal detachment. Can J Ophthalmol. 2015; 50(1): 11-8.
Chow DR, Chaudhary KM. Optical coherence tomography-based positioning regimen for macular hole surgery. Retina. 2015 Jan 19. [Epub ahead of print]
Goldich Y, Showail M, Avni-Zauberman N,Perez M, Ulate R, Elbaz U, Rootman DS. Contralateral eye comparison of descemet membrane endothelial keratoplasty and descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2015; 159(1): 155-9.
Gordon K, Bonfanti A, Pearson V, Markowitz SN, Jackson ML, Small L. Comprehensive vision rehabilitation. Can J Ophthalmol. 2015; 50(1): 85-6.
Huang-Link YM, Al-Hawasi A, Oberwahrenbrock T, Jin YP. OCT measurements of optic nerve head changes in idiopathic intracranial hypertension. Clin Neurol Neurosurg. 2015; 130: 122-7.
Kelly KR, DeSimone KD, Gallie BL, Steeves JK. Increased cortical surface area and gyrification following long-term survival from early monocular enucleation. Neuroimage Clin. 2014; 7: 297-305.
Lei S, Goltz HC, Chandrakumar M, Wong AM. Test-retest reliability of hemifield, central-field, and full-field chromatic pupillometry for assessing the function of melanopsin-containing retinal ganglion cells. Invest Ophthalmol Vis Sci. 2015; 56(2): 1267-73.
Lenassi E, Vincent A, Li Z, Saihan Z, Coffey AJ, Steele-Stallard HB, Moore AT, Steel KP, Luxon LM, Héon E, Bitner-Glindzicz M, Webster AR. A detailed clinical and molecular survey of subjects with nonsyndromic USH2A retinopathy reveals an allelic hierarchy of disease-causing variants. Eur J Hum Genet. 2015 Feb 4. [Epub ahead of print]
Leung VC, Singh H, Ahmed II. Inter-Eye Differences in Patients with Pseudoexfoliation Syndrome Presenting with Intraocular Lens Dislocation. Ophthalmology. 2015; 122(3): 480-5.
Lin A, Guo X, Inman RD, Sivak JM. Ocular Inflammation in HLA-B27 Transgenic Mice Reveals a Potential Role for MHC Class I in Corneal Immune Privilege. Mol Vis. 2015; 21: 131-7.
Mandelcorn ED, Mandelcorn MS, Manusow JS. Update on pneumatic retinopexy. Curr Opin Ophthalmol. 2015 Mar 16. [Epub ahead of print]
Micieli JA, Margolin E. A 55-year-old man with severe papilledema. JAMA 2015; 313(9): 963-4.
Micieli JA, Tsui E. Ophthalmology on social networking sites: an observational study of Facebook, Twitter, and LinkedIn. Clin Ophthalmol. 2015; 9: 285-90.
Narinesingh C, Goltz HC, Raashid RA, Wong AM. Developmental trajectory of McGurk effect susceptibility in children and adults with amblyopia. Invest. Ophthalmol Vis Sci. 2015 Mar 5. [Epub ahead of print]
Noel CW, Fung H, Srivastava R, Lebovic G, Hwang SW, Berger A, Lichter M. Visual impairment and unmet eye care needs among homeless adults in a Canadian city. JAMA Ophthalmol. 2015. [Epub ahead of print]
Pradhan ZS, Dalvi RA, Lai T, Kranemann C, Boyd S, Birt CM. Prostaglandin agonist effect on matrix metalloproteinase aqueous levels in glaucoma patients. Can J Ophthalmol. 2015; 50(1): 6-10.
Raashid RA, Wong AM, Blakeman A, Goltz HC. Saccadic adaptation in visually normal individuals using saccadic endpoint variability from amblyopia. Invest Ophthalmol Vis Sci. 2015; 56(2): 947-55.
Shehadeh Mashor R, Nasser O, Sansanayudh W, Rootman DS, Slomovic AR. Changes in macular thickness after descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2015; 159(3): 415-418.
The AJCC Ophthalmic Oncology Task Force, Simpson ER, Gallie BL, Saakyan S, Amiryan A, Finger PT, Chin KJ, Seregard S, Fili M, Wilson M, Haik B, Caminal JM, Catala J, Pelayes DE, Folgar MA, Jager M, Dogrusöz M, Singh A, Schachat A, Suzuki S, Aihara Y. International Validation of the American Joint Committee on Cancer's 7th Edition Classification of Uveal Melanoma. JAMA Ophthalmol. 2015 Jan 2. [Epub ahead of print]
Yeung SN, Lichtinger A, Kim P, Elbaz U, Ku JY, Teichman JC, Amiran MD, Slomovic AR. Efficacy and safety of patching vs bandage lens on postoperative pain following pterygium surgery. Eye (Lond). 2015; 29(2): 295-6.
