THE UNIVERSITY OF MICHIGAN KELLOGG EYE CENTER
ADVANCES IN OPHTHALMOLOGY
A New Era in Vitreoretinal Surgery Kellogg Hosts First Meeting of Argus II® Retinal Prosthesis System Investigators
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he U-M Kellogg Eye Center held the first meeting of Argus II® Retinal Prosthesis System (Argus II) Investigators this spring—drawing over 50 surgeons, researchers, and rehabilitation professionals from around the world to share experiences with the goal of improving patient outcomes. In 2014, Kellogg retina surgeons performed the first four Argus II procedures in the United States to implant an artificial retina, or “bionic eye,” since the U.S. Food and Drug Administration approved the device in 2013. To date, Kellogg has performed five additional procedures for patients with retinitis pigmentosa, a degenerative and blinding eye disease. Worldwide, Argus II has been implanted in over 130 patients in 29 centers in the United States, Europe, and Middle East. Initial experiences with the Argus II implant have delivered favorable results, as well as new challenges. The meeting focused on four areas of optimization— patient selection, surgical technique, device fitting, and visual rehabilitation. “This was a significant event, the first of its kind—
marking a critical juncture for all of us to share experiences, highlight challenges, and reflect on what we’ve learned,” says K. Thiran Jayasundera, M.D., Assistant Professor, Department of Ophthalmology and Visual Sciences. “The need for open communication is central—not just between different segments of people in one institution, but across institutions— so that as a group we can refine this process that will ultimately benefit our patients.” Jiong Yan, M.D., Associate Professor of Ophthalmology, Emory Eye Center, was among the attendees at the meeting. “The fact that Kellogg has implanted nine patients, as an institution, provides a model and a leadership for the rest of the country to move forward,” she says. Robert J. Greenberg, M.D., Ph.D., Chairman, Second Sight Medical Products, the device manufacturer, noted that the meeting marks an important milestone. “This is the first time that a critical mass from around the world is together sharing their great experiences with the technology,” says Dr. Greenberg. “There is a real sense of excitement.”
Kellogg Adds New Treatment for Dry Eye Disease
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ore than 33 million Americans suffer from dry eye disease. While permanent vision loss from this disease is uncommon, it is a chronic condition that can cause pain, scars and ulcers on the cornea, and loss of vision. Because this disease is so prevalent, Kellogg is offering a new treatment—intense pulsed light treatment or IPL—for dry eye caused by meibomian gland dysfunction. Meibomian glands are inside the lid near the lashes and they excrete the oily portion of the tear film. If tears don’t contain the right balance of oil, water, and mucus, they evaporate and fail to properly lubricate the eye. During this treatment, which was developed for dermatology, a wand-like instrument delivers short, intense pulses of light that rejuvenate blood vessels near the surface of the skin and lids. “With the eyes shielded, we treat the area across the upper cheek and lower lid,” says Kellogg cornea specialist Roni M. Shtein, M.D., M.S. “The light warms the lid, which reduces inflammation in the blood vessels of the lid that get irritated and prevent the meibomian glands from functioning correctly. When the brief treatment is complete, and while the lid is still warm, we perform a mild manipulation of the lid to remove the
Cornea specialist Roni Shtein, M.D., M.S.
oily secretions that are clogging the gland.” There are only a few academic eye centers offering this treatment, which was brought to Kellogg by the team of Dr. Shtein, Karen S. DeLoss, O.D., Shahzad I. Mian, M.D., and Sarah D. Wood, O.D., M.S. While most patients require at least three—and possibly up to six—treatments before they notice improvement, it has yielded positive results. Kellogg offers many options to treat dry eye, but finding the best option can often be a trial-and-error exercise. To pinpoint what works best for patients, Dr. Shtein runs a dedicated Ocular Surface Disease Clinic on Thursday afternoons. “This clinic allows us to do additional testing and evaluations with our dry eye patients. With options ranging from punctal plugs and serum tears to IPL and PROSE, our goal is to identify which treatments offer patients the best results.”
Kellogg Offers A New Option For Cataract Surgery
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ataract surgery is the most common surgical procedure in the United States with 95 percent of surgeries producing positive outcomes. In hopes of pushing this percentage even higher, Kellogg surgeons are offering a new option in cataract surgery—laser cataract surgery. This new technology allows surgeons to use a laser for many of the steps of cataract surgery, resulting in high levels of precision and accuracy, and often a quicker recovery period. Kellogg surgeons continue to perform traditional cataract surgery, which is highly effective, but also offer interested patients—at an out-ofpocket cost—the latest technology for cataract removal. “Laser cataract surgery involves some of the steps of cataract surgery being performed with a computercontrolled laser, as opposed to handheld tools,” says Kellogg comprehensive ophthalmologist Joshua P. Vrabec, M.D. “This potentially provides an extra layer of safety for some of the steps involved in surgery as well as faster recovery for the patient.” During cataract surgery, surgeons can use the laser to 1) create a 3D map of the eye which results in precise measurements for each step of surgery; 2) create a circular opening in the lens capsule, which allows for
Comprehensive ophthalmologist Joshua Vrabec, M.D.
precise placement of the new lens; 3) make specialized incisions to correct astigmatism; and 4) soften the cataract and break it into smaller pieces, which allows for gentler, easier removal. The surgery takes about 30 minutes from start to finish, with the laser portion taking just a few minutes. Once the cataract is removed, patients receive a new lens, which is selected to best suit their lifestyle. After surgery, patients have very few restrictions and can return to normal activities within a week.
Rare Mutation
Causes Vitamin A Deficiency and Eye Deformities Altered protein highlights unique form of genetic inheritance
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esearchers at the University of Michigan Kellogg Eye Center and the University of Oculoplastic surgeon Christine Nelson, M.D. California, Davis have partnered to solve a mystery that has afflicted generations of three unrelated developing embryo, and they also block the cell families with eye malformations, including small eyes surface receptor for RPB4 (called STRA6), keeping with poor vision and the absence of eyes. Until now, no healthy proteins from delivering their nutritional one could decode the genetic basis for these conditions. payload. The result is severe retinol deficiency and The study, published in Cell, began when Christine subsequent birth defects. C. Nelson, M.D., the Bartley R. Frueh, M.D., and Frueh “While further clinical research is needed, it Family Collegiate Professor in Eye Plastics and Orbital appears that we might be able to save a child from Surgery, discovered that two of her young patients with blindness with a simple and inexpensive treatment, similar eye malformations were related. an extra vitamin A pill,” says “We might be able to save Dr. Nelson. “This supplementation The research gained momentum when the family patriarch presented Dr. relies on an alternate pathway, a child from blindness Nelson with a hand-drawn family tree, independent of RBP, that delivers in which he noted eye abnormalities with a simple and inexpen- another form of vitamin A, called from generation to generation. retinyl ester, that bypasses the muta Dr. Nelson collaborated with Tom tions altogether.” sive treatment, an extra Glaser, M.D., Ph.D., formerly professor Dr. Nelson suggests that women of Human Genetics at U-M and now with a family history of eye malforvitamin A pill” professor of Cell Biology and Human mations, or those who learn that they Anatomy at UC Davis. By mapping carry the RBP4 mutation, speak with —Christine C. Nelson, M.D. and sequencing family DNA, a team of their obstetrician about taking vitaresearchers in Dr. Glaser’s laboratory found mutations min A supplements—in addition to prenatal vitamins— in a protein (RBP4) that transports a form of vitamin during pregnancy. Since major steps in eye development A—retinol—an essential nutrient for eye development. take place in the first two months of gestation, the best The mutated proteins fail to transport retinol to the time to have this discussion is before pregnancy.
Upcoming CME Programs Saturday, January 23, 2016 Mid-Winter Cornea Symposium Saturday, March 12, 2016 Tri-City Regional Update
Friday, June 10 and Saturday, June 11, 2016 88th Annual Spring Postgraduate Conference and 32nd Annual Research Day
#10
OPHTHALMOLOGY PROGRAM
IN THE NATION
For more information or to register, visit: www.kellogg.umich.edu/education The Regents of the University of Michigan Michael J. Behm, Mark J. Bernstein, Laurence B. Deitch, Shauna Ryder Diggs, Denise Ilitch, Andrea Fischer Newman, Andrew C. Richner, Katherine E. White, Mark S. Schlissel (ex officio)
2015 U.S. NEWS & WORLD REPORT’S “BEST HOSPITALS”
Department of Ophthalmology and Visual Sciences 1000 Wall Street, Ann Arbor, MI 48105 www.kellogg.umich.edu
NON-PROFIT ORG. U.S. POSTAGE PAID ANN ARBOR, MI PERMIT NO. 144
Welcome to Kellogg’s New Faculty Angela R. Elam, M.D., clinical lecturer, has joined the faculty of the Glaucoma, Cataract, and Anterior Segment Disease section and sees patients in Kellogg’s Northville and Ypsilanti offices. Dr. Elam earned her medical degree from Duke University and completed her residency at the University of Pittsburgh. She then completed her fellowship in glaucoma at the University of Michigan Kellogg Eye Center. Dr. Elam’s research focuses on disparities in eye care, eye care utilization, and health services. Yannis M. Paulus, M.D., assistant professor, has joined the faculty of the Retina and Uveitis section and sees patients in Kellogg’s Grand Blanc office. Dr. Paulus earned his medical degree and completed his residency at Stanford University. He then completed a medical and surgical vitreoretinal fellowship at the Wilmer Eye Institute at Johns Hopkins University. Dr. Paulus holds a joint appointment in the U-M Department of Biomedical Engineering and his research focuses on the development of novel retinal imaging systems and therapeutic techniques and technologies, including photoacoustic imaging, molecular imaging, restorative retinal laser therapy, and surgical techniques.
Julie M. Rosenthal, M.D., clinical instructor, has joined the faculty of the Retina and Uveitis section and sees patients in Kellogg’s Grand Blanc office as well as at the VA Ann Arbor Healthcare System. Dr. Rosenthal earned her medical degree from the University of Pennsylvania and completed her residency at the Wills Eye Institute at Thomas Jefferson University. She completed her fellowship in vitreoretinal surgery at the Casey Eye Institute at the Oregon Health and Science University and, before joining Kellogg, Dr. Rosenthal served as a retina specialist at Retinal and Ophthalmic Consultants, P.C., in Northfield, New Jersey. Manjool Shah, M.D., clinical instructor, has joined the faculty of the Glaucoma, Cataract, and Anterior Segment Disease section and sees patients in Kellogg’s Ann Arbor and Grand Blanc offices. Dr. Shah earned his medical degree from Washington University in St. Louis and completed his residency at the Casey Eye Institute at the Oregon Health and Science University. He then completed a fellowship in glaucoma and advanced anterior segment surgery at the University of Toronto.
Since July 2014
43 INTERNATIONAL VISITORS TRAVELED FROM 16 DIFFERENT COUNTRIES 18 FACULTY MEMBERS TRAVELED TO 20 COUNTRIES WORLDWIDE