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  MAGAZINE   S C I E N T I F I C   H I G H L I G H T S   O F   AT L A N TA   2 0 0 8




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TABLE OF CONTENTS                                                             FROM THE EDITOR
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KEYNOTE SPEAKER

THE INSTITUTE OF MEDICINE’S HARVEY V. FINEBERG, MD, PHD: ADVANCING THE NATION’S HEALTH AGENDA

Seeing the...
KEYNOTE SPEAKER

Keynote Speaker, continued from page 4           $130 billion each year.2 IOM’s subsequent        a singl...
NOTABLE HONORS

SPECIAL AWARDS

The Academy Recognizes Contributions in the Field

T
       he Academy’s 2008 president, D...
NOTABLE HONORS


expertise in directing many of these clin-    DISTINGUISHED SERVICE AWARD                   States of Ame...
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Academy News from AAO 2008 Atlanta
Academy News from AAO 2008 Atlanta
Academy News from AAO 2008 Atlanta
Academy News from AAO 2008 Atlanta
Academy News from AAO 2008 Atlanta
Academy News from AAO 2008 Atlanta
Academy News from AAO 2008 Atlanta
Academy News from AAO 2008 Atlanta
Academy News from AAO 2008 Atlanta
Academy News from AAO 2008 Atlanta
Academy News from AAO 2008 Atlanta
Academy News from AAO 2008 Atlanta
Academy News from AAO 2008 Atlanta
Academy News from AAO 2008 Atlanta
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Academy News from AAO 2008 Atlanta

  1. 1. EyeNet MAGAZINE S C I E N T I F I C H I G H L I G H T S O F AT L A N TA 2 0 0 8 Sunday, Monday & Tuesday
  2. 2. TABLE OF CONTENTS FROM THE EDITOR Welcome to Atlanta. This IN THIS ISSUE: A chat with the Keynote Speaker . . . . . . . 4–6 year’s Joint Meeting is spon- In this second edition of The Carter Center saves vision . . . . . . . . .9–10 sored by the Atlanta’s Academy News, Best of Show videos . . . . . . . . . . . . . . .11–12 Academy and our colleagues from meet the Opening Session’s Make coding easy (or easier) . . . . . . . . . . . .13 the European Keynote Speaker, glimpse highlights of the Best of See the Museum of Vision exhibits . . . . . . .15 Society of Oph- thalmology, and Show Videos, and learn about Atlanta’s renowned San Francisco in 2009 . . . . . . . . . . . . . . . .16 that international Carter Center. Volunteer abroad with your colleagues . . . . .17 spirit is reflected in the depth and breadth of the presentations. Among the many excellent Symposia to which the EyeNet team is looking forward: Sunday, from 3:45 to 5:15 p.m.— “Infectious Disasters: Are We Seeing Fewer or Are We Treating Better?” Monday, from 3:30 to 5 p.m.—“War and Terror-Related Injuries: From Triage to Management to Rehabilitation.” Monday, from 4:15 to 5:35 p.m.— “Around the World in 80 Minutes: Inter- national Symposium on Devices for Complicated Cataract Cases.” (This is just one offering from the all-day Cataract Monday program.) Tuesday, from 10:45 a.m. to 12:15 p.m.—“Business, Ethical and Medical- Legal Aspects of Treating Glaucoma Patients.” Beyond taking in these presenta- tions, enjoy your stay in Atlanta, and make sure to meet new colleagues from around the world. Richard P. Mills, MD, MPH Chief Medical Editor, EyeNet Magazine ON THE COVER Penetrating Keratoplasty Photo by Marshall E. Tyler, CRA, FOPS Wake Forest University Eye Center CORRECTION The Academy Seniors Special Meeting and Reception takes place on Monday from 2:30 to 5 p.m. in Room B406. Archivist Ted Ryan will present the Keynote Speech, “10 Things You Might Not Know About Coca-Cola.” Nancy J. Newman, MD, will present “Mitochondrial Disease: It’s Not All Your Mother’s Fault.” This supersedes the agenda published in October’s EyeNet. e y e n e t ’ s a c a d e m y n e w s 3
  3. 3. KEYNOTE SPEAKER THE INSTITUTE OF MEDICINE’S HARVEY V. FINEBERG, MD, PHD: ADVANCING THE NATION’S HEALTH AGENDA Seeing the Trees and the Forest by annie stuart, contributing writer A s president of the Institute of Medi- any and all primary problems that appear knowledge and experience to this her- dents, breast cancer cine (IOM) of the National Acade- on the U.S. health agenda. Provost of Har- culean task. or AIDS.1 mies, Harvey V. Fineberg, MD, PhD, vard University from 1997 to 2001, dean Keynote Speaker at this year’s Joint Unmasking the has a job with mind-boggling scope. Any of the Harvard School of Public Health Meeting, Dr. Fineberg has special interests forces of legislation, attempt at encapsulation seems to do his for 13 years and recipient of five honorary in public health practice, the evaluation of regulation and work an injustice. He and the IOM tackle degrees, Dr. Fineberg brings a wealth of diagnostic and screening tests and the eth- market activity that ical and social implications of new med- influence quality ical technologies. He is coauthor of three of care, the report books, Clinical Decision Analysis, Innova- greatly increased tors in Physician Education and The Epi- public awareness DR. FINEBERG gives demic That Never Was, the last of which and led to the con- the Keynote analyzes the controversial 1976 federal vening of a White Address from 9:08 immunization program against swine flu. House conference to 9:28 a.m. dur- Dr. Fineberg’s address to the Academy by President Clin- ing the Opening is titled “Seeing the Future of Health ton and the appro- Session, which Care,” and it will describe some of the key priation of funds takes place from forces that will affect medical practice by Congress to the 8:30 to 10, this over the next 10 years. Rather than be Agency for Health- morning (Sunday) passive participants, Dr. Fineburg said, care Research and in Hall A-3 Ses- ophthalmologists and other physicians Quality. sion Room. have an opportunity to reexamine and Where medicine reinforce their professional roles and to had failed in the matter of hospital errors, shape the future of health care. said Dr. Fineberg, was by asking the The IOM is one of four organizations wrong questions—who was at fault, rather of the National Academies—which also than what system had created the condi- include the National Research Council, tions that enabled errors. In contrast, a the National Academy of Engineering and focus on the forest, not just the trees, is the National Academy of Sciences—that emblematic of the work of the IOM, are authorized by charter of the U.S. Con- which followed up with its blueprint for gress. Operating independently of govern- addressing the problem: Crossing the ment, the IOM is a private organization Quality Chasm: A New Health System for created in 1970 for the purpose of advis- the 21st Century (2001). Since its publica- ing policy makers, health care profession- tion, said Dr. Fineberg, some progress has als and the public on topics as wide-rang- been made at improving systems and ing as vaccine safety, health care delivery, tracking prescriptions, but errors are still nutritional standards and cancer preven- a significant problem. He said that tech- tion and management. nology could play a much greater role in “Everything from the quality, safety reducing transcription and dispensing and cost of health care; the availability errors. Computerized order entry, auto- of health insurance; the issues that foster mated pharmacy packaging, individual scientific progress; the conflicts of interest dosing and labeling, and bar-coding are among professionals in their roles as teach- just a few examples of ways to reduce ers, caregivers and researchers; to child- error. hood obesity and global health,” said Dr. Fineberg, “all of these are on our agenda.” THE EXPANDING ROLE OF TECHNOLOGY And each year the IOM produces dozens Dr. Fineberg is a measured proponent of of reports to contribute to informed deci- new technologies. He points, for instance, sion making. A sampling of this year’s to bipartisan agreement in Congress about includes reports on the topics of emer- the need for better information technolo- gency preparedness, foodborne disease gy investment. (In the case of IT, however, and genomic innovations in health and cultural resistance—getting doctors to medicine. embrace new technology—can be one of the biggest stumbling blocks.) SHEDDING LIGHT ON MEDICAL ERRORS Overall, Dr. Fineberg considers tech- Among the IOM initiatives with the biggest nology to be the proverbial two-edged impact was one leading to the publication sword. “I think that our challenge is both of the report To Err Is Human: Building a to encourage creative and innovative Safer Health System (1999). This unsettling advances that solve real health problems report revealed that close to 100,000 U.S. and to discourage marginally or negatively patients die annually from hospital errors —more than die from motor vehicle acci- Keynote Speaker, continued on page 6 T I M E C H A N G E S & C A N C E L L AT I O N S This publication was printed in advance of the Joint Meeting. Check the Ticket Sales area in Hall A-2 for cancellations or changes in meeting times. 4 s u n d a y ● m o n d a y ● tuesd a y e d i t i o n
  4. 4. KEYNOTE SPEAKER Keynote Speaker, continued from page 4 $130 billion each year.2 IOM’s subsequent a single-payer system,” he said. “You can important, in dealing with population- 2004 recommendations called for univer- see in places like France how access to ser- level health problems, to be open to solu- useful applications of technology,” he said. sal, continuous and affordable health care vices is very widely distributed in both the tions that are both medical and public “Technology is the pathway to progress for all individuals and families. cities and throughout the smaller towns health–oriented in character.” and at the same time it is a very substan- Dr. Fineberg called the current deficien- and villages. You can see in Scandinavia tial source of the high cost of health care cies in health coverage a travesty, with examples of integration of medical ser- GLOBAL HEALTH AND BIOTERRORISM in the United States.” progress largely stalled by a political stale- vices with public health systems. We can With the anthrax story back in the news He added that a variety of incentives mate between two entrenched camps— benefit from looking at a variety of other earlier this year, Dr. Fineberg reflected encourage overuse. It can be easier to order those who favor a single-payer, govern- countries and adapting to our particular on the risks of bioterrorism. Though tests than to take a thorough history. There ment-run program and those who oppose needs what works and avoiding the things bioterrorism is a serious threat, he cou- is pressure from patients to use what’s avail- expansion of government programs. The that haven’t worked very well.” pled it with natural biological threats— able. And currently, the more diagnostic presidential candidates comprise a third pandemics and other manifestations of tests and technology that physicians use, group and suggest building on our cur- PRESSING PUBLIC HEALTH ISSUES natural diseases—observing that nature the greater their reimbursement. A smarter rent system through mandates or incen- Dr. Fineberg said the principal driver for can be the worst terrorist of all. way, he said, would be to pay for both tives, or a mix of the two. U.S. public health challenges is the demo- “From the point of view of national value and efficiency, encouraging evi- Despite the historical failures, Dr. Fine- graphic and epidemiological transition preparedness, we are better prepared than dence-based guidance for optimal use berg is optimistic. “I believe that we’re in generated by the aging of the population. we were five or even three years ago,” said of technology. the strongest position of any time in the Though small in numbers, the fastest- Dr. Fineberg. “This recent investigation past decade to see genuine health reform,” growing segment of the population is over of the anthrax episode is a good example HEALTH CARE REFORM IMMINENT? he said. “All other industrialized countries age 100. Despite healthy older populations, of where advancing science enabled the While leading the world in health care —with widely disparate systems of govern- the total burden of chronic disease will detailed location or identification of the expenditures, the United States is the only ment, patterns of social interaction, and rise dramatically due to huge numbers of particular anthrax strain. That wasn’t pos- wealthy, industrialized nation that does levels of capitalism or socialism—have people living longer. “It means also that sible earlier, so there is progress. At the not ensure coverage for all citizens. In a solved this problem. So, I have no doubt features of behavior that are conducive to same time, the surveillance systems in the review of the hidden costs of uninsurance, the United States can do it, too.” chronic diseases like obesity and diabetes, world are still very much less than we the IOM found that if the 45 million While pointing to a need for a distinctly to pick prominent examples, are especially want, particularly in some parts of the uninsured U.S. citizens were to be covered, U.S. solution, Dr. Fineberg said there are problematic,” he said. “It means that we world where the natural disease problems the cost of insuring them would be far many lessons to learn from other countries. have to organize our health services to may occur earliest.” outweighed by the potential economic “You can see how Germany, for example, meet the needs of people in their homes Advancing global health is a matter of gain of better health outcomes from unin- has worked out a system of insurance that as well as in our clinics. It means we need enlightened self-interest for the United terrupted coverage—an estimated $65 to involves multiple participants, not simply to organize services that actually deliver States, he said, especially since borders are the care and the prevention that older becoming less of a barrier to the spread of Americans require.” disease. A global economy means people, Using cancer care as an example, Dr. goods, food—every imaginable form of Fineberg described the implications of the animal and plant—are coming from all fact that cancer is increasingly changing corners of the world. “We cannot assure into a manageable, chronic condition. and protect the health of the American “One of the key implications is that we people unless we have done more to pro- need to adopt a strategy of cancer care for tect the health of people everywhere,” said the whole patient,” he said. “We have to Dr. Fineberg. “And we need to have sys- look at advancing science, at treatment tems of cooperation in everything from and at better statistical and epidemiologic surveillance for potential outbreaks of analyses about what works and what the influenza, for example, to the manage- causes are. But we need to do it with a ment of ill travelers who may be moving framing that is healing in its intent and from one place to another across interna- looks to care for patients in the home as tional borders.” well as in the hospital and as human Because health represents an interna- beings, not merely as clinical material.” tional common aspiration, he added, Solving the challenges of health care advancing global health has indirect bene- for the elderly, while not neglecting the fits for the U.S. public as well. “The degree needs of children and other segments of to which we can exert our soft power the population, he said, will require a 21st through science and health is the degree century set of strategies to establish the to which America’s strength and projection preventive and curative services that an in the world will have benefits in a wide aging and growing population is going to array of interests, from our national secu- require. rity to our commercial success to our Mobilizing families, schools and health desire to promote good government and care providers—not to mention food pur- democratic principles around the world,” veyors, city designers, manufacturers and said Dr. Fineberg. “So America has many restaurant owners—will be required to interests in global health—both for our solve problems like childhood obesity and own health and for our national interests.” the remaining one in five adults who still smokes in this country, said Dr. Fineberg, 1 National Academies Press Web site. www.nap. who added that it’s sometimes said that edu/catalog.php?record_id=9728#description. the hardest problems often require the 2 Institute of Medicine Web site. www.iom. softest science. “And that’s why it’s very edu/CMS/3809/4660/12313.aspx. GLOBAL EYE M.D.S On Monday from 4:30, Brad Feldman, MD, will convene a course titled “Young Ophthal- mologists in International Ophthalmology” to identify the opportunities for reducing the global burden of eye disease. (Event Code 457, $35.) 6 s u n d a y ● m o n d a y ● t u e s d a y e d i t i o n
  5. 5. NOTABLE HONORS SPECIAL AWARDS The Academy Recognizes Contributions in the Field T he Academy’s 2008 president, David Dr. Aaberg was senior associate editor W. Parke II, MD, has extended an of the American Journal of Ophthalmology invitation to three individuals who from 1982 to 2002 and is past president of have made significant contributions to the Macula Society and of the Association ophthalmology and the Academy to be of University Professors of Ophthalmology. his Guests of Honor at this year’s Joint He is a member or past member of the Meeting. He also is pleased to announce American Ophthalmological Society, the recipient of this year’s Distinguished American Board of Ophthalmology, Asso- Service Award. These honorees and others ciation for Research in Vision and Oph- are recognized during the Opening Ses- thalmology, American Medical Association, sion, which takes place Sunday from 8:30 American Eye Study Club, Pan-American to 10 a.m. in the Hall A-3 Session Room. Ophthalmological Society, Club Jules HONOREES. The 2008 President’s Guests of Honor are Dr. Aaberg Sr., Dr. Koch and Gonin, Retina Society and American Soci- Dr. Parke Sr. This year’s Distinguished Service Award goes to the Knights Templar THREE GUESTS OF HONOR ety of Retina Specialists. Eye Foundation. THOMAS M. AABERG SR., MD, MSPH, The focus of Dr. Aaberg’s surgical and FACS research activities has been the manage- surgical instrument design. His engaging unit. He maintained an active compre- The Academy is pleased to recognize Dr. ment of complicated retinal detachment style, command of the literature and prag- hensive ophthalmology practice until Aaberg Sr. as a Guest of Honor for his and diabetic retinopathy, but he also has a matic approach to complex clinical prob- 1988. contributions to ophthalmology as an strong interest in medical retinal disorders. lems have made him an extraordinary In a brief “retirement,” he retrained in outstanding contributor to the art and sci- His main career interest, however, has been teacher and role model. low vision and has since devoted his life ence of vitreoretinal disease and surgery teaching. He has been honored with clini- Dr. Koch was associate editor of the to promoting low vision rehabilitation. and as a superb teacher and role model. cal teaching awards from residents at the Journal of Cataract and Refractive Surgery He is serving now as associate clinical pro- A graduate of Dartmouth College, Dr. Medical College of Wisconsin and at Emory from 1994 to 2001 and co-chief editor fessor at Yale University and as director of Aaberg received his medical degree from University School of Medicine, where in from 2001 to 2007. He is a past president low vision rehabilitation at both Yale Eye Harvard Medical School and completed 2006 the annual clinical teaching award of the American Society of Cataract and Center and Masonicare. his residency in ophthalmology at the was named the Thomas M. Aaberg Sr., Refractive Surgery and of the International Dr. Parke’s incisive analytical ability Massachusetts Eye and Ear Infirmary. He MD, Clinical Teaching Award. Intraocular Implant Club. He is now a and strong organizational skills have then worked in the U.S. Public Health Ser- The Academy expresses its admiration member of both the council of the Ameri- made him a popular choice for leadership vice for two years and graduated from the and gratitude for Dr. Aaberg’s many con- can Ophthalmological Society and the in every organization to which he has University of Oklahoma with a Master of tributions to ophthalmology and wel- executive committee of the American belonged, and his involvement in orga- Science in Public Health before starting comes him as a Guest of Honor in 2008. Society of Cataract and Refractive Surgery. nized ophthalmology has been extraordi- an 18-month fellowship in retinal disease Dr. Koch combines expertise in medi- nary. He has been an active member of the and surgery at Bascom Palmer Eye Insti- DOUGLAS D. KOCH, MD cine with expertise in music. He plays Academy for more than 50 years and has tute. While in Miami, he collaborated with Dr. Koch is honored by the Academy for trumpet in both the Houston Brass Band greatly enriched the Academy with his Robert Machemer in developing a primate his contributions to ophthalmology as a and a brass choir. Dr. Koch is president of knowledge and guidance through com- model to study the histopathology of reti- mentor, investigator and clinician. His the Bach Society of Christ the King Luther- mittee service on the Academy’s Council, nal detachment and giant retinal tears. colleagues hold him in the highest esteem an Church in Houston and a member of Committee on National Governmental They also worked together in developing for his professional leadership and his the boards of the Houston Brass Band and Relations, Academy Seniors (formerly the early instrumentation and techniques for personal traits of humanism, humility the Holocaust Museum in Houston. Senior Ophthalmologist Interest Group) vitreous surgery. Upon completing his fel- and integrity. Dr. Koch is honored today for his dedi- and Committee on State Affairs (which he lowship, Dr. Aaberg became assistant pro- Dr. Koch was born and raised in Port cation to our specialty. It is with pride and chaired for six years). He is currently edi- fessor of ophthalmology and director of Huron, Mich., and graduated from Har- pleasure that the Academy welcomes Dr. tor of Scope, an Academy quarterly for the retina service at the Medical College vard Medical School in 1977. He complet- Koch as a 2008 Guest of Honor. senior ophthalmologists. of Wisconsin, remaining on the faculty for ed residency training in ophthalmology at At the state level, Dr. Parke has served nearly 18 years. Under his direction, the the Cullen Eye Institute, Baylor College of DAVID W. PARKE SR., MD several terms as president of the Con- Milwaukee vitreoretinal fellowship train- Medicine, in 1981. He completed fellow- The Academy is proud of the accomplish- necticut Society of Eye Physicians as well ing program became one of the top-rated ship training in refractive and cataract ments of Dr. Parke Sr. and is delighted to as 10 years as chairman of the Committee programs in the country, with graduates surgery at Moorfields Eye Hospital and in welcome him as a 2008 Guest of Honor. on Legislation for the Connecticut State of the program directing vitreoretinal sec- the United States under the guidance of His dedication to education and advocacy Medical Society. He is a member or past tions and departments nationwide. David McIntyre, James Rowsey and Clif- has benefited not just his patients but all member of the editorial board of Con- In 1988, Dr. Aaberg was appointed ford Terry. of ophthalmology. necticut Medicine, the executive commit- chairman of ophthalmology at Emory In 1982, Dr. Koch joined the depart- Dr. Parke received his medical degree tee and ophthalmology advisor of Lions University School of Medicine, as well as ment of ophthalmology at the Cullen Eye from College of Medicine, Ohio State Low Vision Centers of Connecticut, the Phinizy Calhoun Sr. Professor of Ophthal- Institute, Baylor College of Medicine. He University and his residency in ophthal- board of Connecticut Lions Eye Research mology and director of the Emory Eye was promoted to associate professor in mology from the Wilmer Institute, Johns Foundation and the Committee on Access Center. He built on the work of his prede- 1991 and to full professor in 1998. In 1999, Hopkins Hospitals. His fellowship in to Care of Uninsured and Underinsured, cessors to develop the Emory department he received the Allen, Mosbacher and Law ophthalmic pathology was at the Armed State of Connecticut. of ophthalmology into a nationally respect- Chair in Ophthalmology. He served as Forces Institute of Pathology in Washing- Dr. Parke’s career reflects his involve- ed and highly ranked program in clinical director of residency training from 1992 ton, D.C. He served as chief of ophthal- ment and generosity in volunteering his ophthalmology, with an extensive scientif- to 1996. mology at Meriden-Wallingford Hospital time and talents to the development of ic faculty. He has personally been involved Dr. Koch’s clinical and research inter- (now MidState Medical Center) for 27 organized ophthalmology. He has been a in the training of 62 vitreoretinal fellows ests are in cataract and refractive surgery. years, was chief of medical staff there tireless champion of low vision patients in who are in academic or private practice His primary areas of interest have includ- as well, and later served as an elected regu- Connecticut and throughout the country. throughout the United States and Canada. ed astigmatism analysis and management, lar member of its board of directors. Through the Lions and Masonic organiza- These fellows revere him for his kindness, corneal topography, wavefront technology, While a consultant in ophthalmology tions, he has helped develop low vision clinical acumen, skill as a surgical instruc- surgical techniques, prevention of compli- at Gaylord Rehabilitation Hospital, Dr. clinics in Connecticut and has kept a reg- tor and unwavering concern for patients. cations, intraocular lens calculations and Parke cofounded its closed head trauma ular schedule as a volunteer, providing his e y e n e t ’ s a c a d e m y n e w s 7
  6. 6. NOTABLE HONORS expertise in directing many of these clin- DISTINGUISHED SERVICE AWARD States of America, was chartered in 1956 The Knights Templar is part of the ics. He also serves as a consultant on low KNIGHTS TEMPLAR EYE FOUNDATION in Maryland with the ultimate goal of pre- Masonic Fraternity, with members vision to several national organizations. The Academy recognizes the Knights venting blindness. Its mission is to pro- throughout the United States and many Dr. Parke continues to play an active Templar Eye Foundation as the recipient vide assistance to those who need sight- other countries. It has been funded by role in teaching and serving the commu- of the Distinguished Service Award for its saving surgical treatment. Assistance is annual assessments from the members nity and almost never refuses an opportu- contributions to the prevention of blind- provided without regard to race, color, of the Knights Templar, donations by the nity to speak on behalf of low vision reha- ness through its innovative foundation creed, age, sex or national origin to those individual Knights Templar, local fund- bilitation, medical professionalism or services available to patients and ophthal- who are unable to pay or who do not raising efforts by the Knights Templar, access to care for the uninsured. mologists. receive adequate assistance from govern- estates, trusts and insurance policies, and The Academy is pleased to acknowledge The Knights Templar Eye Foundation, ment or other agencies. The foundation some grants from charitable foundations. Dr. Parke’s many contributions and wel- the major charity of the Grand Encamp- also provides funds to support promising Since its inception, the Eye Foundation come him as a Guest of Honor. ment of Knights Templar of the United vision research projects. has handled in excess of 84,000 patient cases and disbursed more than $104 mil- lion to health care providers. Patient cases are sponsored by the local volunteer Knights Templar organizations. Seventy- five percent of all foundation expendi- tures are paid to health care providers, 13 percent fund vision research, and only 12 percent support administrative and printing expenses. Together with ophthal- mologists, hospitals and other health care professionals, the Eye Foundation contin- ues to provide critical assistance in the prevention of blindness. The Knights Templar Eye Foundation research grant program has a particular focus on pediatric ophthalmology. To date, the Eye Foundation has awarded in excess of $10 million to young investigators for both clinical and basic research to impact the care of infants and children. The Knights Templar Eye Foundation also supports America’s seniors as a co- sponsor with the Foundation of the Amer- ican Academy of Ophthalmology in its EyeCare America–Seniors EyeCare Pro- gram. The Academy is honored to present the Distinguished Service Award to the Knights Templar Eye Foundation. This award pays tribute to the foundation’s boundless con- tributions to ophthalmology and to its advocacy on behalf of patients worldwide. ETHICS COURSES Follow your ethical compass to these sessions. Each offers one hour of ethics- specific CME credit. Everyday Ethics: Practical Case Studies From the Ethics Committee Files Event Code 195, $35, Sunday, 11:30 a.m. to 12:30 p.m. Ethically Managing and Disclosing Con- flicts of Interest: A Case-Based Approach Event Code 206, $35, Sunday, 2 to 3 p.m. Breakfast With the Experts—International Ophthalmology and Codes of Ethics Event Code B111, $40, Sunday, 7:30 to 8:30 a.m. Breakfast With the Experts—Marketing Your Practice Ethically Event Code B282, $40, Monday, 7:30 to 8:30 a.m. Breakfast With the Experts—Expert Wit- ness Testimony: What You Should Know Event Code B474, $40, Tuesday, 7:30 to 8:30 a.m. 8 s u n d a y G m o n d a y G tuesd a y e d i t i o n
  7. 7. CARTER CENTER ATLANTA’S CARTER CENTER Saving Sight From U.S. president to Nobel in the Poorest laureate to elder statesman, of the Poor Jimmy Carter has been trying to reverse the inter- national tragedies of poverty, war and disease. by annie stuart, contributing writer STAGES OF TRACHOMA. Infection with BLINDING DISEASE UNDER SIEGE. Four years in the C. trachomatis may be mild and resolve within weeks. However, sometimes it White House and a Nobel Peace Prize were not enough for Jimmy Carter and leads to severe inflammation, causing his wife, Rosalynn. Now they are working to eliminate preventable blindness pain, photophobia and a white, watery discharge. Repeated reinfection forms a around the world. network of scars that contract, shortening the palpebral conjunctiva. Over time, the eyelid turns inward, transforming once pro- Founded in 1982 by former President are examples of The Carter Center’s work. tective eyelashes into lacerating “thorns.” Jimmy Carter and his wife, Rosalynn, The Here is a brief report on progress The The result is trichiasis—or, as the Ethiopi- Carter Center, in partnership with Emory Center has made, in alliance with other ans say, “hair in the eye.” Some pluck their University, nurtures no small goals. Its organizations, in battling these diseases. eyelashes to relieve the pain, but the respite mission is defined by a “fundamental is brief since bristly lashes quickly regrow. commitment to human rights and the TRACHOMA: The Leading Infectious And because they are stubble, they don’t alleviation of human suffering,” and Cause of Blindness bend easily, and abrade the cornea. “seeks to prevent and resolve conflicts, An infection caused by the bacterium Women are around three times as likely enhance freedom and democracy, and Chlamydia trachomatis, trachoma affects as men to develop trichiasis. “It’s generally improve health.” more than 80 million people in 56 coun- believed that children are the reservoir,” Although that task might seem Sisyph- tries. “Trachoma was a major problem said Dr. Emerson. “Because of their role as ean at times, The Carter Center has been in Europe and here in the U.S. until the caregivers—particularly sharing a bed with successful at identifying and intervening 1950s when it disappeared in the face of young kids who have trachoma—women in many health problems that are not only improved hygiene and sanitation,” said get more frequent, repeated infections and A “SAFE” APPROACH. Fortunately, a strat- treatable but also preventable—and doing Paul Emerson, PhD, director of The Carter more scarring.” Disabling pain makes it egy developed by the World Health Orga- T H E C A R T E R C E N T E R / E M I LY S TA U B , VA N E S S A V I C K so among some of the poorest people of Center’s Trachoma Control Program. But difficult to work and perform household nization and adopted by countries in which Asia, Africa and Latin America. Seventy in addition to the millions affected by chores—cooking over fires, collecting water the disease is endemic is helping to elimi- nations around the world have benefited active trachoma, another 500 million in in the sun, farming in dry, dusty environ- nate blinding trachoma. Implemented by from Carter Center initiatives. the developing world are living at risk of ments. This magnifies the disease’s annual The Carter Center and its partners, the Projects to fight trachoma and oncho- contracting trachoma. The Carter Center’s economic impact, estimated at $2.9 billion. strategy involves a four-pronged approach: cerciasis, diseases that have stolen the sight present goal is not to eradicate the disease “Blindness in trachoma is caused by a surgery, antibiotics, facial cleanliness and of nearly 8 million people and visited havoc completely but to eliminate blinding tra- combination of physical damage to the environmental improvements, or “SAFE.” on communities where they’re endemic, choma, the late stage of the disease. cornea from aberrant lashes and infection Dr. Emerson says the approach has been by many other opportunistic pathogens particularly successful in Ethiopia. And Above, a man in Ethiopia blinded by onchocerciasis (river blindness). Merck has donated because the corneal epithelium is compro- Ghana may become the first country in its microfilarcidal drug ivermectin for the treatment and prevention of river blindness mised by the scratching,” said Dr. Emerson. sub-Saharan Africa to apply for WHO since 1987. Right, to relieve the suffering and the risk of blindness associated with tra- Sight can only be restored by corneal trans- certification showing it has eliminated choma, fairly simple lid surgery can be performed in the community or at rural health plants—virtually unheard of in the devel- blinding trachoma. Following are some centers. oping world. details of the rationale behind SAFE. e y e n e t ’ s a c a d e m y n e w s 9
  8. 8. CARTER CENTER Above left, trichiasis results from advanced trachoma, which scars the upper eyelid, caus- ing the lid to fold inward, rubbing the lashes against the cornea with every blink and eventually leading to irreversible blindness. Above right, trained examiners assess eyelids to determine the grade of trachoma. G Surgery. Although surgery can’t undo Clubs International Foundation, millions corneal damage, it can relieve pain and of doses of azithromycin (Zithromax), stop further injury. Requiring little train- which is manufactured by Pfizer, have ing and only $10 in materials, a 15-minute been distributed to trachoma-affected operation can be performed by ophthal- communities. All told, Pfizer has donated mic nurses or trained health workers, said around 135 million doses. Dr. Emerson. After injecting the eyelid with G Facial cleanliness. Discharge from eyes local anesthetic and positioning a retrac- and noses attracts flies, which can transmit tor, the health worker makes a small inci- the infection, and wiping or rubbing faces sion along the tarsal conjunctiva at the lid with infected hands or materials can also margin. The side of the lid fringed with quickly transmit the disease. Therefore, eyelashes is lifted outward; then the two an essential part of the SAFE campaign is sides are stitched together in the outfrac- promotion of cleanliness. is spread through the bites of another fly Above, health workers in Latin America tured position. This relieves tension on G Environmental improvements. Among species, Simulium damnosum. The fly is distribute ivermectin in a campaign to the damaged eyelid and prevents eyelashes other changes, construction of pit toilets a host for Onchocerca volvulus, a parasite eradicate onchocerciasis. from scraping the cornea. is essential to eliminate Musca sorbens, a that takes up residence under the skin for G Antibiotics. With the help of the Lions fly that breeds in human feces and swarms seven to 15 years. The females can produce around eyes and noses, feeding on mois- thousands of offspring (microfilariae), 90 million are at risk, the goal is control ture and infecting eyelids and then trans- which migrate to the upper layer of skin, of onchocerciasis through annual drug mitting the infection. Reducing the vector’s where they cause intense itching when administration of ivermectin. In the breeding ground could stem the tide of they die. These tiny parasites also can Americas, where about 500,000 people are trachoma. In early 2002, The Carter Center migrate into the eye, causing inflamma- at risk in six countries, the goal is more began training masons, providing materi- tion, irritation and diminished vision. ambitious: The Carter Center is leading a als and supervising the construction of PATHOLOGY FROM PESTS. “The microfilariae multinational partnership, which includes household latrines. With sanitation a cause an immune response in the eye, Lions Clubs, to completely eliminate the national priority and the infrastructure which leads to an opaque cornea,” said disease by administering ivermectin every T H E C A R T E R C E N T E R / L O U I S E G U B B , VA N E S S A V I C K , PA U L E M E R S O N , P H D in place to deliver behavior change and Dr. Emerson. The second leading cause of six months. No new cases of blindness from hygiene promotion, Ethiopia increased infectious blindness, onchocerciasis results the disease have surfaced in the Americas latrine coverage on a district level from 4 from not just one but hundreds—some- since 1995.“It looks like blinding onchocer- to 60 percent within just a couple of years, times thousands—of bites by infected ciasis is history in the Americas now,” said Dr. Emerson. There and elsewhere, flies. Named for the fast-flowing streams said Dr. Emerson. “And with a concerted women have taken the lead, helping build where the black flies breed, river blindness and continuous effort, particularly in the hundreds of thousands of latrines. has infected 17.7 million people world- Amazon region of Venezuela, transmission G Added benefits. Although difficult to wide, visually impairing a half-million can be halted.” The goal is to declare the measure, the collateral benefits of SAFE and blinding more than a quarter million. disease in Latin America eradicated by are many, said Dr. Emerson. “It is not only Endemic in 37 countries—mostly in Africa 2012—and that appears to be right on taking care of trachoma, it’s like a guerilla —river blindness has forced farmers to schedule, said Dr. Emerson. action for development—freeing commu- abandon fertile bottomlands. Above, a Sudanese girl takes a dose of nities from a number of neglected tropical In the 1980s, Merck developed a micro- For more information on The Carter Center, banana-flavored azithromycin, donated by diseases,” he said. “I think the future is very filarcidal drug, ivermectin (Mectizan), and visit www.cartercenter.org. Pfizer, to protect herself from the bacterium bright for a world free of blinding tra- began donating it free for treatment and that causes trachoma. Young children carry choma, provided we can keep the pressure prevention of river blindness in 1987—for the highest burden of active infection and on and continue delivering the programs.” as long as is needed. The Carter Center VOLUNTEER annual mass distribution of antibiotics River Blindness Program has assisted in Want to help provide eye care in devel- is recommended for communities where ONCHOCERCIASIS: Blindness by a administering more than 100 million treat- oping nations? See page 17 for a list of more than 10 percent of young children Thousand Bites ments in both Africa and the Americas. events and other resources. suffer from the disease. Onchocerciasis, also called river blindness, REALISTIC GOAL SETTING. In Africa, where 10 s u n d a y G m o n d a y G tuesd a y e d i t i o n
  9. 9. BEST VIDEOS SURGEONS OF THE Silver Screen This year, seven videos from four subspecialties were chosen as “Best of Show” and will be honored at Monday’s awards ceremony. The full video program Glaucoma: Video V23 features 39 short films from nine subspecialties. In this film, Angunawela and colleagues Theater screening times: Sunday—3:36 ATTEND THE “BEST OF SHOW VIDEO AWARDS” CEREMONY. present a new fish-tail technique for the ■ p.m.; Monday—4:21 p.m. and Best of Show The highlight of this year’s video program will be the Best of Show awards insertion of a capsular tension ring in the screening (see intro). situation of capsular instability arising ceremony. It takes place in the Video Theater on Monday at 12:15 p.m., and from zonular insufficiency. CORNEA will be followed by a special screening of the seven Best of Show videos. Insertion of a capsular tension ring can Endothelial Keratoplasty: Please Don’t Fold at times be difficult and give rise to further (V14; 10 minutes) Video Theater hours. It will be open Sunday from 10 a.m. to 5 p.m., Mon- complications. The fish-tail technique The current method of donor insertion in day from 9 a.m. to 5 p.m. and Tuesday from 9 a.m. to 3 p.m. Check your allows placement of the tension ring Descemet’s stripping automated endothe- without the need for dialing or injection, lial keratoplasty requires folding and Final Program (page 281) for a full schedule of all 39 films. thereby avoiding further tangential stresses unfolding donor tissue, which damages on the zonules. endothelium. Where is the Video Theater? It is located in Hall A-3. ■ Theater screening times: Sunday—10:42 In this short video, Tan and colleagues Videos on Demand. Watch what you want, when you want. Look for the a.m.; Monday—9:27 a.m. and Best of Show present a pull-through, gliding technique screening (see intro); Tuesday—10:13 a.m. that is less traumatic to endothelium and monitors that are located in Halls A-2 and B-5. You can search the video reduces primary graft failure rates. program by subspecialty, video title, video number or key word. Understanding the Dropped Nucleus This method utilizes a purpose-designed (V1; 10 minutes) microforceps, which is employed to pull a It is well-known that the dropped nucleus previously dissected graft into the anterior CATARACT and suture knots are safely covered with is a serious complication of contemporary chamber over a viscoelastic-coated IOL Scleral Fixation Without Conjunctival the roof of the scleral pocket. cataract surgery. glide. Dissection ■ Theater screening times: Sunday—4:06 In this video, Osher and colleagues As a result, their experiences with pri- (V4; 10 minutes) p.m.; Monday—4:51 p.m. and Best of Show review a cadaver eye study designed to mary graft failures have decreased from In this film, Hoffman and colleagues show screening (see intro). understand why the nucleus drops. Fac- 20 to 1.7 percent, and endothelial counts how a new technique for scleral fixation tors evaluated include gravity, high infu- have improved. utilizes a scleral pocket originating from a Capsular Tension Ring Complications sion pressure, turbulence, pressure gradi- ■ Theater screening times: Sunday— clear corneal incision. and Fish-Tail Technique for Stress-Free ent, excessive manipulation, machine 11:15 a.m.; Monday—10 a.m. and Best Conjunctival dissection, scleral cautery Insertion parameters and the role of the vitreous, of Show screening (see intro); Tuesday— and sutured wound closure are eliminated (V11; 11 minutes) among others. 10:46 a.m. Cataract: Video V4 Cataract: Video V11 Cataract: Video V1 Cornea: Video V14 e y e n e t ’ s a c a d e m y n e w s 11
  10. 10. BEST VIDEOS Deep Anterior Lamellar Keratoplasty Hurler-Scheie syndrome. The big-bubble sion of the stromal layers. Finally, a 0.5- Using the “Big-Bubble Technique” in technique includes a 7.5-mm trephination mm oversized donor lenticule is secured. Hurler-Scheie Syndrome at a depth of 300 µm and a 27-gauge needle At three years, the patient’s best corrected (V19; 11 minutes) used to inject an air bubble between Des - visual acuity was 20/40 in both eyes. In this film, Sharma and colleagues per- cemet’s membrane and the host corneal ■ Theater screening times: Sunday—noon; form deep anterior lamellar keratoplasty stroma. After the debulking of the anterior Monday—10:45 a.m. and Best of Show using the big-bubble technique bilaterally two-thirds of the corneal stroma, an screening (see intro); Tuesday—11:31 a.m. in a patient with Hurler-Scheie syndrome. opening is created in the stromal tissue. Because of the sparing of Descemet’s Following air egression from the inci- GLAUCOMA membrane and a decreased chance of glau- sion site, viscoelastic is then injected in the Late Secondary Angle-Closure Glaucoma coma, deep anterior lamellar keratoplasty supernumerary space above the membrane Following DSEK and Its Management Cornea: Video V19 is one of the safest options in cases of along with quadrantic splitting and exci- (V23; 10 minutes) Basak and colleagues demonstrate a unique late complication of Descemet’s stripping endothelial keratoplasty. Five out of 104 patients presented with acute pain and visual loss in the operated eye three to 18 weeks after the procedure. There was 360-degree adhesion between donor lenticular edge and the iris in all cases, causing secondary angle-closure glaucoma. Endothelial cell density was measured after controlling the IOP. Sim- ple mechanical separation of the irido- donor lenticular adhesion was performed with Sinsky’s hook in two cases where the endothelial cell density was good. Donor replacement was done in three cases where the density was poor. ■ Theater screening times: Sunday— 12:45 p.m.; Monday—11:30 a.m. and Best of Show screening (see intro); Tuesday— 12:16 p.m. PEDIATRICS The Surgical Correction of the Palpebral Fissure Narrowing and the Vertical Devia- tion on Adduction in Duane Syndrome (V30; 11 minutes) In this film, Lee and colleagues introduce a new technique of correcting specific characteristics in Duane syndrome that is an efficient and less-invasive procedure for improving ocular alignment. They report two type 1 Duane syndrome patients with upshoot or downshoot on adduction. The lateral rectus muscle was disinserted and reattached to the adjacent posterior tenon. The patients were treated with partial tendon transposition of the vertical rectus muscles augmented with Foster fixation. Lateral rectus posterior tenon fixation markedly reduced co-contraction and globe retraction. Palpebral fissure widened on adduction. Also, all patients demon- strated a marked decrease in the upshoot or downshoot and improvement of abduction after surgery. ■ Theater screening times: Sunday—1:53 p.m.; Monday—2:38 p.m. and Best of Show screening (see intro); Tuesday—1:24 p.m. Pediatrics: Video V30 12 s u n d a y ● m o n d a y ● tuesd a y e d i t i o n

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