Leadership Development Program (LDP) XII, Class Of 2010 Graduates

One of 19 Graduates from the American Academy of Ophthalmology (AAO) Leadership Development Program, William Barry Lee, MD, FACS.

William Barry Lee, MD, FACS, was recognized at the American Academy of Ophthalmology’s (AAO) Joint Meeting with the Middle Africa Council of Ophthalmology (MEACO) in Chicago for his participation in the Leadership Development Program XII, Class of 2010. Dr. Lee was among a select group of nineteen participants chosen from among a large group that was nominated by state and subspecialty societies throughout the world. The class also included one international from Israel who was representing the Israel Ophthalmology Society.

In January 2010, Dr Lee took part in a 2 ½ day interactive session in San Francisco covering a wide variety of leadership and association management topics. The meeting also included a visit to AAO headquarters to hear from the AAO Executive President and Vice Presidents on key priorities for the Academy. Next was a trip in April 2010 to attend the AAO’s Mid-Year Forum in Washington D.C. where Dr. Lee visited congressional staff to discuss issues important to the medical profession as part of Congressional Advocacy Day. During a special session, Dr. Lee and the LDP class also heard from US Congressman Michael K. Simpson (R-ID) about building effective relationships with legislators and how best to advocate on behalf of patients. During the final LDP XII session at the Joint Meeting, Dr. Lee heard from leadership of the AAO and the Pan American Association of Ophthalmology on global collaborative efforts and was encouraged to put his leadership skills to good use.

Participants in the Leadership Development Program XII, Class of 2010
1. American Association for Pediatric Ophthalmology and Strabismus
Katherine A. Lee, MD, PhD
2. American College of Surgeons – Advisory Council on Ophthalmic Surgery
Sarwat Salim, MD, FACS
3. American Osteopathic College of Ophthalmology
Ann Ranelle, DO
4. American Society of Retina Specialists
Gaurav K. Shah, MD
5. Association of Veterans Affairs Ophthalmologists
Michael E. Sulewski, MD
6. Connecticut Society of Eye Physicians
Edward S. Lim, MD
7. Delaware Academy of Ophthalmology
Pecos T. A. Olurin, MBBS
8. Eye Bank Association of America
William Barry Lee, MD, FACS
9. Florida Society of Ophthalmology
Stephen G. Schwartz, MD, MBA
10. Hawaii Ophthalmology Society
Joseph M. Zobian, MD
11. Iowa Academy of Ophthalmology
Christopher L. Haupert, MD
12. Israel Ophthalmology Society
Shahar Frenkel, MD, PhD
13. Macula Society
Michael S. Ip, MD
14. Nebraska Academy of Eye Physicians and Surgeons
David D. Ingvoldstad, MD
15. New Mexico Academy of Ophthalmology
Arlene Bagga, MD
16. North Carolina Society of Eye Physicians and Surgeons
Odette Margit Houghton, MD
17. Oklahoma Academy of Ophthalmology
Diana Hampton, MD
18. Utah Ophthalmology Society
David B. Petersen, MD
19. Wisconsin Academy of Ophthalmology
Aaron C. Holtebeck, MD

Cornea Day: Going 'Rogue'; Chicago, Illinois

The American Academy of Ophthalmology hosted its annual meeting in October 2010 in Chicago, Illinois. The successful meeting started out with full days devoted to eduction at both the Cornea Day and Refractive Day Sessions.

Cornea Day Program

Cornea Day: Going 'Rogue'

By Michelle Dalton EyeWorld Contributing Editor

Four sessions at the Cornea Subspecialty Day promise jam-packed education

Since 2007, the Cornea Society and the American Academy of Ophthalmology have joined forces to co-sponsor Cornea Subspecialty Day, a one-day meeting immediately prior to the AAO's annual conference. This year's topic ("The Cornea: Going Rogue") is aimed at both intermediate- and advanced-level corneal surgeons and comprehensive ophthalmologists who have a specific interest in the anterior segment.

"Subspecialty days have become one of the most successful educational events for the American Academy of Ophthalmology. They serve as an annual update of what is new and emerging in the individual fields. This year's Cornea Subspecialty day follows by only six months the highly successful World Cornea Congress VI held in Boston (preceding the American Society of Cataract and Refractive Surgery meeting)," said Michael W. Belin, M.D., one of the co-chairs of Cornea 2010, being held on Saturday, Oct. 16 in the Grand Ballroom.

The day will be broken into four sessions—one each on endothelial replacement, irregular cornea correction, innovations, and infectious/inflammatory disease and cross-linking. The day is peppered with opportunities to meet with colleagues and peers as well during its numerous refreshment and exhibit breaks.

LASIK FOUND TO BE SAFER THAN CONTACT LENS WEAR

The Journal of Ophthalmology printed a study on LASIK surgery that had encouraging results for future LASIK patients. Furthermore, one of the main researchers for the study, a Dr. Gary Varley, even went as far as conjecturing that the prolonged use of contact lenses could pose a greater risk than the complications of LASIK surgery.

This is sobering news for people who have held off on LASIK because of their fear of the technology. The study results showed that the rate of all complications in LASIK patients, including vision loss, was no more than one in 10,000. A similar study done on the rate of complications in people regularly wearing contact lenses showed the risk to be as high as one in 2,000, or 5X more likely than complications in LASIK patients.

The LASIK Advantage

It might seem counter-intuitive that a surgical procedure could be safer than corrective equipment, but the study holds true. Dr. Varley expounded on the factors that contribute to the increased risk for lens wearers. Most of the factors involved hygiene or improper care. For example, many patients did not clean their hands thoroughly before putting their contacts in. Other patients fell asleep with their contacts in. Many lens wearers do not get the routine eye care that they need, and may be using prescriptions that have long since expired or are no longer accurate for their eyes. Some patients that had prescription lenses also had conditions that prevented them from using them as directed.

Other problems may stem from improper contact lens cleaning habits. When the lenses are not kept sterile, their wearers risk exposing their eyes to bacteria. Very few patients develop the same relationship with their eye doctor as they do with their medical doctor, and thus there is very little follow up between eye exams. Conversely, LASIK surgeons make it a regular practice to check up on former patients and ensure that the recovery is without complications.

If you are one of the many contact lens wearers that suffer from lax habits and imperfect usage, perhaps you should consider LASIK eye surgery. The cost will likely be significantly less than a lifetime’s supply of your prescription lenses. After the initial recovery period you will no longer have to worry about losing a contact, leaving one in, or following long care and storage rituals. Furthermore, you don’t have to worry about a ragged lens cutting your eye or a dirty lens infecting it. You won’t have to pull the car to the side of the road when you drop a contact, or search frantically for your contact case before work. You can go to sleep with perfect vision at night and wake up with it again in the morning, no contacts or eyeglasses required!

IMPLANTABLE CONTACT LENS AN OPTION FOR VISION CORRECTION

A report from New Zealand Implantable contact lens (ICL) results. Study published in July of 2010 in Clinical and Experimental Ophthalmology.

A large study on the implantable contact lens (ICL)results at 1 year showed 99% of patients in the study (76/77) had postoperative best-corrected visual acuity (BCVA) better than or equal to preoperative values, whereas 78% (60/77) gained up to one line BCVA and 1% (1/77) lost one line BCVA. Nearsightedness (myopia) ranged from -2.50 to -15.00 Diopters and astigmatism ranged from 1.00 to 7.00 Diopters of correction. Indications for ICL were: myopia too high for LASIK (73%), cornea too thin for LASIK (44%) and contact lens intolerance (33%). Night halos were reported in 10% (8/77) of eyes at 12 months. One ICL was removed due to unrecognized preoperative glaucoma.

This study is the largest reported series of toric ICL implantation in New Zealand. It supports the safety, efficacy and predictability of toric ICLs to treat myopia and astigmatism.

BIOSYNTHETIC CORNEAS - A MAJOR BREAKTHROUGH

Eyegenix™ Artificial Cornea Achieves Major Advancement Towards Curing Corneal Blindness




Dr May Griffith of the research team inspects a biosynthetic cornea that can be implanted into the eye to repair damage and restore sight






Read more: http://www.dailymail.co.uk/health/article-1306134/Artificial-corneas-restore-sight-partially-blind-patients-grown-lab.html#ixzz0ytTV7HNA


Eyegenix™, the ophthalmic division of Cellular Bioengineering, Inc. (CBI), announced that the results of a pilot clinical trial using a synthetic cornea for which Eyegenix™ holds the exclusive global license for transplantation were published in the peer-reviewed journal, Science Translational Medicine (Volume 2, Issue 46, August, 25, 2010). The publication reported two year results of a clinical trial that transplanted bioengineered corneas into 10 patients who were visually impaired on the transplantation wait list. All patients regained nerve sensation and tear formation without the prolonged use of anti-rejection drugs, and six of the patients improved to best corrected post-operative acuity of 20/40 with contact lenses. As a group, this improvement was comparable to a cohort treated with traditional human allograft transplant.

Eyegenix™ has the exclusive worldwide commercial corneal transplantation rights to this biosynthetic material, which holds the potential promise to cure blindness in the estimated 10 million people who suffer from corneal disease but have no access to a donor for transplant. Invented at the University of Ottawa and the National Research Council of Canada by Drs. May Griffith, David Carlsson and their colleagues, it is under collaborative development by CBI / Eyegenix™, the University of Ottawa Health Research Institute, and Dr. Per Fagerholm from University of Linkoping, Sweden, the surgeon who conducted the transplants and lead author of the publication.

Although corneal transplantation is a successful procedure that is performed more often than all other types of organ transplants combined, it is only able to impact less than 2% of patients with corneal blindness worldwide due to a lack of donors. The material under exclusive license to Eyegenix™ is unique in its approach of replacing a human donor with a completely synthetic, transplantable cornea designed to promote tissue regeneration, which can be an off-the-shelf solution to a huge access problem.

"CBI is extremely proud to be part of this effort," said Mark Mugiishi, M.D., Medical Director of CBI. "Our inventors, scientific and development team members, and clinical champions have emerged from all parts of the world. We have positioned ourselves as forerunners in the race to bring vision back to 10 million blind people in the world, and that's something all of us are incredibly passionate about."

Biosynthetic cornea used for transplantation in a patient with severe keratoconus

Regeneration of the Cornea: Stem cells and the Eye

Stem Cell Transplantation / Regeneration of the Cornea

A regenerative treatment that uses stem cells taken from the patient's own eyes is helping some blind patients see again.

Italian researchers report that the stem cell procedure resulted in successful corneal transplantation in three-fourths of patients with blindness in one or both eyes, caused in most patients by chemical or thermal burns.

Vision was at least partially restored in patients who did not have major damage to other parts of the affected eye, says study researcher Graziella Pellegrini, PhD, of the University of Moderna's Center for Regenerative Medicine.

Pellegrini and colleagues have performed corneal transplants in around 250 patients over the last decade using the stem cell technique, but it remains experimental and is not being done in the U.S.

Their latest study is published in the New England Journal of Medicine. The findings were also reported last week in San Francisco at a meeting of the International Society for Stem Cell Research.

"We followed the patients in this study for an average of three years and as long as a decade," she tells WebMD. "We have shown that the results can last for many years."

Regeneration of Corneas
The study included 112 patients with damaged corneas who received the stem cell treatment between 1998 and 2006.

The procedure involved extracting healthy stem cells from the limbus, which is located between the colored and white part of the eye.

Pellegrini says the procedure can be done even when only a tiny portion of the limbus remained undamaged.

Stem cells taken from the biopsied limbus tissue grew into healthy corneal tissue in a little over two weeks, she says, and the healthy tissue was then grafted onto the damaged eye.

When the procedure was successful, the damaged, opaque cornea became clear again and the eye looked normal.

In all, 77% of patients had a successful first or second graft, while the procedure was considered a partial success or failure in 13% and 10% of cases, respectively.

People with corneal damage from chemical and thermal burns often have symptoms including light sensitivity, itching, and pain. These symptoms went away or were much less severe in the successfully treated patients.

Following successful transplant, about half of the patients had further surgeries to improve visual acuity and most showed at least some improvement in vision. One patient achieved normal vision with the stem cell grafting alone.

Regenerative Treatments for Heart and Liver
University of California, Davis ophthalmology professor Ivan Schwab, MD, was among the first to perform the stem cell transplant procedure, based on Pellegrini's early work, almost a decade ago.

He treated about 15 patients, and while many showed early responses, the benefits did not last.

"This study is remarkable because these researchers have shown not only that this technique works, but that it works for up to 10 years in some cases," he tells WebMD.

He adds that regenerative treatments show promise for a wide range of illnesses, including those involving the bladder, liver, and the heart.

"We are not talking about regenerating the entire liver or heart," he says. "The concept that you have to grow a whole liver or a whole heart is not correct."

He points out that researchers are already working on a heart "patch" that can help a damaged heart function better.

Read more about this study in the New England Journal of Medicine or the internet at the following address:

http://www.webmd.com/eye-health/news/20100623/stem-cell-treatment-restores-vision

Potential New Link to Keratoconus

The most common and severe contraindication to LASIK eye surgery has been linked to eye rubbing. This non-inflammatory condition affects approximately 1 in 1000 patients and leads to progressive corneal thinning and protrusion (Severe coning of the cornea as seen above).

Mechanisms of rubbing-related corneal trauma in keratoconus.

Published in the journal, CORNEA, by McMonnies CW.

Experts link keratoconus to eye trauma, in particular, eye rubbing as a potential culprit for worsening keratoconus. This article is published in the journal of Cornea and concludes the following: CONCLUSIONS: For some forms of keratoconus, a reduction in shear strength and cone-forming deformation may be responses to rubbing trauma. Some of the mechanisms for corneal rubbing trauma may be relevant to post-laser-assisted in situ keratomileusis ectasia or complications following other types of corneal surgery. There appear to be indications for the control of chronic habits of abnormal rubbing.

Eye rubbing must be avoided for patients considering LASIK eye surgery as Keratoconus remains a major contraindication to laser vision correction.

New Study shows All Laser (Bladefree) LASIK safer than conventional LASIK with a blade

New study shows all laser LASIK decreases the risk of dry eyes after LASIK. We are proud to offer the All-Laser (Femtosecond) LASIK to all our patients at Piedmont Better Vision. An abstract of the published article can be seen below.

Dry eye associated with laser in situ keratomileusis: Mechanical microkeratome versus femtosecond laser published by Salomão MQ et al, from the Cleveland Clinic.

Abstract of published article in the Journal of Cataract and Refractive Surgery.

PURPOSE: To compare the incidence of laser in situ keratomileusis (LASIK)-associated dry eye and the need for postoperative cyclosporine A treatment after flap creation with a femtosecond laser and a mechanical microkeratome. SETTING: Cole Eye Institute, Cleveland, Ohio, USA. METHODS: Eyes were randomized to flap creation with an IntraLase femtosecond laser (30 or 60 kHz) or a Hansatome microkeratome. No patient had signs, symptoms, or treatment of dry eye preoperatively. Flap thickness was determined by intraoperative ultrasonic pachymetry. Slitlamp assessments of the cornea and need for postoperative dry-eye treatment were evaluated preoperatively and 1 month postoperatively. RESULTS: The flap was created with the femtosecond laser in 113 eyes and with the microkeratome in 70 eyes. The difference in mean central flap thickness between the femtosecond group (111 mum +/- 14 [SD]) and the microkeratome group (131 +/- 25 mum) was statistically significant (P<.001). The incidence of LASIK-associated dry eye was statistically significantly higher in the microkeratome group (46%) than in the femtosecond group (8%) (P<.0001), as was the need for postoperative cyclosporine A treatment (24% and 7%, respectively) (P<.01). In the microkeratome group, there was no correlation between thick flaps and a higher incidence of LASIK-induced dry eye. CONCLUSIONS: Eyes with femtosecond flaps had a lower incidence of LASIK-associated dry eye and required less treatment for the disorder. In addition to neurotrophic effects from corneal nerve cutting, other factors may be important because no correlation was found between flap thickness (or ablation depth) and the incidence of LASIK-induced dry eye.

International Summer School in Lecce, Italy

The International Summer School in Lecce, Italy. Hosted by the University of Bologna, Dept. of Ophthalmology. Professor Sergio Scalinci hosted a great session! An honor to be a part of the faculty for the superb meeting.

1st European Cornea Society (EUCornea Meeting) in Venice, Italy

What an honor to speak at the inaugural annual European Cornea Society Meeting in Venice, Italy. This was my first time in Venice. What a beautiful and amazing city!! Excellent meeting and the Italians clinician scientists were perfect hosts.





Spent a few days before the meeting in Florence to learn about the amazing history of Italy and its Florentine artists like Michelangelo. Also took a tour of the countryside in Tuscany. Magnificent views!

Dr. Lee honored by Premier Surgeon

Premier Surgeon, a new monthly journal publication developed by Ocular Surgery News and published by Slack, Inc, has selected 250 of the nation's top innovators and leaders in vision correction using multifocal and accommodative lens implants. I am honored to be selected in this esteemed group of specialists throughout the United States. You can view the PS 250 list at the following link:
http://www.eyeconsultants.net/PDF%20downloads/premier-surgeon-list-ps250.pdf

Annual Meeting for America's Leading Corneal Transplant Surgeons

Just returning from the annual Eye Bank Association of America's Annual Meeting in Hilton Head. Congratulations to Bruce Varnum, CEO and President of the Georgia Eye Bank, for completing his term as Chair of the Eye Bank Association of America (EBAA). While I spend a good proportion of my time doing cataracts and LASIK, I also serve as one of the medical directors to the Georgia Eye Bank and perform a large number of corneal transplants to patients in Tennessee, Georgia, and adjacent states in the southeast. It is truly an honor to work with Bruce and the EBAA, the organization that provides corneas to people all over the country who are blind and need cornea transplants to see. Bruce is a true example of "paying it forward". After receiving cornea transplants at a young age after going blind, he has paid it forward to pave the way for many others to receive sight through the gift of cornea transplantation. Myself and all of Georgia should thank Bruce!! We are very fortunate to have him here in Georgia as the head of OUR eye bank!!

The World Cornea Congress VI- Meeting of World's Elite Cornea Specialists

World Cornea Congress VI was held in Boston this year. This is a 2 day meeting that is held every 5 years and involves presentations of new research and cutting edge cornea and refractive topics from the best cornea specialists all over the world. I was asked to present data on correction of astigmatism after corneal transplantation. This included my data on laser vision correction for astigmatism in these patients using our state-of-the-art technology at Piedmont Better Vision.



This was my first visit to Boston. What a great city!! I was able to visit some historical places between meeting days including the countries oldest restaurant.

Focal Points Interview with Dr. Lee on Laser Vision Correction

Focal Points is a quarterly publication by the American Academy of Ophthalmology for teaching and training of ophthalmologists on various topics. I was interviewed in this edition (Feb. 2010) focusing on "Innovations in Advanced Surface Laser Refractive Surgery" along with several other experts across the country. A very nice review of "Advanced Surface Ablation (ASA)" indications and outcomes. For those of you who do not know what ASA is, it is a refractive procedure for vision correction of patients who are not candidates for LASIK. Usually these patients have thin corneas or prescriptions that are too high for LASIK. ASA affords a safer form of vision correction in these situations. If the cornea is too thin, a phakic lens or implantable contact lens is sometimes needed over LASIK or ASA.

American Society of Cataract & Refractive Surgery Winter Meeting

A wonderful meeting at the American Society of Cataract & Refractive Surgery on the Mexican Riviera in Playa del Carmen. What an honor to speak at this great meeting! Great to see old friends and meet new colleagues. Also had time to visit the ruins of Tulum. Spectacular!!