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Dr. Mu published in Proceedings of the National Academy of Sciences
October 29, 2014

Dr. Mu, part of the Ross Eye Institute Vision Research Center, was recently published in Proceedings of the National Academy of Sciences for his study that provides clues to early retinal development.

The study shows how two related transcription factors, a class of specific proteins regulating gene activity, redundantly regulate cellular diversity in the retina, meaning they have overlapping responsibilities for the same cells. The results also suggest how cellular formation is driven in other parts of the nervous system, since the particular transcription factors involved in this study are expressed in other tissues during development, including in the spinal cord.

“Transcription factors are the most important regulators in development of various organs, including the vision system in mammals,” explains Xiuqian Mu, PhD, senior author and assistant professor in the Department of Ophthalmology, Ross Eye Institute and the Department of Biochemistry in the UB School of Medicine and Biomedical Sciences. “They turn on and off the genes in the genome that are required for normal development.”

Mu and his co-authors were studying the transcription factors called Onecut1 and Onecut2 using knockout mice, which lacked either or both of the transcription factors.  Previously, they had discovered that Onecut1 and Onecut2 were responsible for normal development of horizontal cells, which make it possible for eyes to adjust to see well in both bright and dim light conditions. 
- See more at: http://www.buffalo.edu/news/releases/2014/10/057.html#sthash.wttF80iq.dpuf

Read the full paper here:

Onecut1 and Onecut2 redundantly regulate early retinal cell fates during development.
Sapkota D, Chintala H, Wu F, Fliesler SJ, Hu Z, Mu X.
Proc Natl Acad Sci U S A. 2014 Sep 30;111(39):E4086-95. doi: 10.1073/pnas.1405354111. Epub 2014 Sep 16
 

Jiaxi's grand rounds presented at the AAO
October 22, 2014

AAO

Jiaxi Ding, MD, an Ophthalmology resident at The Ross Eye Institute, had her grand rounds selected to be presented at the American Academy of Ophthalmology 2014 (AAO) grand rounds on Sunday, October 19, 2014. She did a fantastic job of presenting in front of a few hundred people. She spoke to, and debated with, some of the giants in retina including Dr. Lee Jampol, Chairman of the Diabetic Retinopathy Clinical Research Network (DRCR.net), and Dr. Alexander Brucker, Editor-In-Chief of Retina.

Dr. Jung treats Kerataconus in young patient
June 23, 2014

We see through the cornea, which is the clear, central part of the front surface of the eye. Normally, the cornea has a dome shape, like a ball. Sometimes, however, the structure of the cornea is just not strong enough to hold this round shape, and the cornea bulges outward like a cone. This condition is called keratoconus.

Dr. Hoon Jung first met patient Joseph Terranova a couple of years ago when he joined The Ross practice. Dr. Jung describes him as a nice, pleasant young man, interested in science. Terranova was in his mid-20s, suffering from keratoconus.

With keratoconus, the cornea takes such an abnormal shape that it is severely degraded “like you’re looking through a tilted pair of glasses,” explains Dr. Jung. “It affected him to the extent that he was legally blind in one eye and slightly impacted in the other.”

Terranova developed this condition in his teenage years, and it became worse into his 20s. His condition was much more severe in one eye than the other, which is not uncommon. One eye has reasonably functional vision with corrective lenses alone.

Dr. Jung recommended a form of corneal transplantation to reconstruct the geometry and optics of the diseased eye.

“It was a fairly big commitment from all parties, especially the patient,” said Jung. “It’s a lifelong commitment once you cross the bridge of transplantation for several reasons.”

Dr. Jung had multiple consultations with the family where he addressed their questions regarding the condition, treatment, risks and benefits. The stakes were high.

“We wanted the young man to be functional in society and pursue his dream of higher education in math or science,” said Jung.

Popularized in Anwar, India, the transplant takes a cookie cutout of the clear cap of the eye. Then the harvested donor cornea is placed in the cookie cutout with a new cookie. It’s a special form of partial thickness Deep Anterior Lamellar Keratoplasty (DALK).

DALK refers to a partial thickness replacement of the structural layer of the cornea, retaining the healthy cells. The deep structural layer of the cornea remains, resulting in a thicker cornea after surgery, which may influence the visual outcome.

Terranova had his own native cornea on his back layer, which was attached with sutures. “By retaining your own back layer, your risk of rejecting the tissue goes down dramatically over 5, 10, 15, 20 years.”

Dr. Jung added that the surgery takes twice as long as older-style methods, “But in my mind, it’s worth the investment.”

The two-hour procedure was cancelled the first time, as Dr. Jung was not happy with the suitability of the donor cornea. He describes it as a speed bump in the road.

“I rescheduled twice. I explained that we need this to last decades, not five years,” explained Jung. “As you get closer to 30, the condition starts to plateau, and it’s less likely it would get worse. So it’s not likely that we will have to require the same level of surgical intervention.”

It’s a fairly technical surgery, and recovery involves the whole package... patient, medicine, donor, social circumstances. The recovery, according to Dr. Jung, is a journey.

“It’s day-by-day, week-by-week, month-by-month... a gradual removing of stitches every 6 weeks and lots of eye drops,” he said. “Family support is critical to help keep the recovery on track.”

Today, Terranova is well on his way. “He sees me once every few months. He’s stabilized, and all the stitches have been removed. He now has legal driving vision, I would say slightly less than 20/20. He uses a mild prescription for corrective lenses.

“What made his treatment successful was his strong family support. His father almost always comes to his appointment, and his mother is involved, as well. That support helps connote long-term success, having these people engaged with the young man.”

There is one more important factor, according to Dr. Jung. “Let’s not forget to give credit to the donor through Upstate New York Transplant Services (UNYTS).”

Helping AcROSS the world
June 23, 2014

Doctors Everett and Imbrogno join Eyecare mission to Nicaragua

Nicaragua is about the size of New York state. It’s also the 2nd poorest country in the Western Hemisphere next to Haiti. Unemployment is 65%. There are no social programs, such as Medicare and Medicaid.

It is this dire medical situation for the Nicaraguan people that attracted Arnie Edelman, and then Dr. Sandra Everett and Dr. Vincent Imbrogno, to lend their eyecare skills from February 2-9, the second week of a two-week mission in Central America. It was the first trip there for both doctors.

Unfortunately, Arnie never made the trip–for him, a return trip. An optician with UB for many years– first at ECMC, then at The Ross–Arnie passed away unexpectedly a few months before the trip.

Dr. Imbrogno has been a resident at The Ross for three years and is currently the cornea fellow. “Every day I’d walk past and Arnie’d ask, ‘Hey, do you want to go to Nicaragua with me?’ I’d never heard of Hopeful Ways before Arnie.”

Hopeful Ways is a Western New York charitable organization that, along with the Lions Club, coordinated this eyecare mission to Camoapa, Nicaragua. The 30-person Hopeful Ways brigade partnered with the Camoapa Lions Club, who contributed significantly to the project’s success. They landed in Managua, then made the 2.5 hour trip to Camoapa, a much poorer area with a 20-bed hospital.

They were put up at the local hotel... very basic, one room, no hot water. There is no hot water anywhere in the region.

Camoapa is located 114 kilometers (about 70 miles) north of Managua in the mountains of central Nicaragua (population about 40,000). Agriculture is the economy’s largest industry, but Camoapa has one of the lowest employment rates in Central America.

These poor ranching communities rarely have an opportunity for proper medical care. Some traveled more than eight hours and over 50 miles to receive eyecare services. They came... guided by their relatives, by bus, on horseback, or on foot.

Working without proper equipment, Drs. Everett and Imbrogno were only able to perform minor surgical procedures for pterygia, tumors and minor eyelid lesions. Everett said that some patients were referred to Managua for cataract surgery or to see an oculoplastic specialist. They mostly used a local anesthetic and worked in one operating room. “Occasionally general surgery was performed in the same room where we were treating people’s eyesight,” said Imbrogno.

The average patient Dr. Imbrogno treated was between the ages of 60 and 80, with some type of growth on the eye. Pterygium, an abnormal benign growth of the conjunctiva, is very common near the equator among people who are out in the sun all day with little eye protection. The sun rays hit the tissue over the white of the eye, causing UV damage. This can cause a benign growth which then extends onto the cornea, the clear dome over the front of the eye. Symptoms can include blurry vision, astigmatism and a feeling of there being something in the eye. The growth then requires removal.

People who needed corrective lenses were well served. Physicians checked each prescription, wrote it down and handed it to Drew, an optician who was Arnie's partner in the optical shop at The Ross.

“We were lucky to have so many donated,” said Imbrogno. “It was great for the kids... but try and tell a 9-year-old girl she looks good in eyeglasses!”

Patients ranged in ages from 18 months to 103 years. Many people waited over eight hours, and some waited multiple days to be seen. In the end, nearly a third could not be seen due to the volume of patients.

“One day they had an emergency at the hospital, so we had to stop working. Patients would smile and say, ‘No problem, we’ll come back tomorrow. We appreciate anything you can do,’” said Dr. Everett.

A corneal specialist, Dr. Everett is an attending physician at The Ross, having worked with the department for over 22 years. She recalls one very special patient.

“They had a little boy that I took care of, and he was just very, very special, probably about 9 years old, shy and quiet, just so sweet, and he had an infection in his nasal system,” she said. “He was such a trooper. I took him to surgery and irrigated that, then I gave antibiotics to his mom, so he’d have some coverage afterwards. We saw him post-operatively, and his mom came up to me insisting that he wanted his picture taken with me.”

Dr. Imbrogno was also moved by the experience.

“It was an eye opener as to how people live and a realization of just how much this charitable work is needed. Some of these people, many in their 80s, have never had an eye exam nor seen an eye doctor. This was my biggest lesson, and it fueled my desire to go back.”

Both doctors plan to return next year.

“The people are friendly and welcoming,” added Everett, “but they have few resources and they work hard to scrape a meager living for their families. But for how little they have, material-wise, they have so much more in so many ways! Their happiness is on a much more basic level.

“It changed my life. I put in 100% and I got 1,000-fold back. I am already planning on going back next year, this time for the full two weeks.”

Dr. Everett wants to start a walk-a-thon to support this mission trip in Arnie’s name, since he was so involved with it. “That’s how profound an effect it had on those of us who went. You just want to keep doing more.”

The Ross wishes to extend thanks to all who donated eyeglasses, sunglasses and financial support, including 11 WNY Lions Clubs. The mission could not have been as successful without them. The 14-day mission to Camoapa, Nicaragua provided:

  • eyecare services to 2,656 patients,
  • over 2,300 prescription eyeglasses, sunglasses and safety glasses,
  • 81 surgeries for cataracts, pterygium and other vision ailments,
  • the gift of sight for some cataract patients, who were almost completely blind in both eyes, and
  • 15 people, who had been disfigured by accidents, were fitted with prosthetic eyes.
Patient Referrals at The Ross Eye Institute
November 6, 2013

Betsy Milward has been taking patient referral calls at the Ross Eye Institute’s Buffalo location for the past three years. Referring physicians call Betsy directly at 881-7972.

Betsy has a strong medical background, having been a certified medical assistant for over 20 years. She has the general medical knowledge to get referred patients the help they need...including ordering prescriptions, setting up tests and scheduling appointments.

“It can be anybody from the doctor, physician’s aid or nurse practitioner to a staff person,” said Betsy. “If it’s an urgent case, the doctor will call to speak with me directly.” Optical shops and optometrists also often refer patients.

Betsy has access to all updated physician schedules. If there are obvious openings on a doctor’s schedule, she is free to make the appointment. “My role is to get patients in as soon as possible,” she said.

She does take a lot of calls directly from patients. “Some people just know me, and they want to talk to me,” said Betsy. “Others aren’t as aware of their conditions, only that their eyes hurt. Those calls involve me being a detective, trying to elicit more information from the patient so we can take care of them properly. Also, The Ross phone directory Option 1 message says ‘if you have an urgent problem...’ Those all come to me.”

Ideally, the caller will have all the basic patient information handy: address, phone number, date of birth and insurance coverage. Betsy records the information, makes the appointment, and gives the referring office The Ross fax number to fax their report. She will advise the doctor what the patient needs to bring in, what time to report, and provide the address and directions so the patient knows where to go.

“That’s all we need to register for a visit or appointment,” said Betsy. “Additional medical information will be taken when the patient comes in.“

The referring physician may want to have a patient seen that day. Betsy asks them to fax an “office note” which includes their findings: what they’ve done for the patient, whether or not they’ve written any prescriptions, and any other pertinent information. This provides a basis for treatment.

Prior to the appointment, Betsy will get The Ross physicians up to speed. “Once I make the appointment, I watch for the office note fax to come in, put the patient account number on the fax, then scan them into the EMR. Our doctors open the chart and there’s the referring note right there.”

Referring physicians can also go online at RossEye.com/referral, or use the preprinted referral pads.

Betsy deals with insurance companies as well. “Ophthalmology sometimes calls for specialty drugs. I also get prior authorization from insurance companies for CAT scans, MRIs and other tests.”

Betsy can talk “in pharmacy,” and also takes calls for prescription refills. “If they tell me F-M-L 1% B-I-D-O-U, I understand what that means,” she said. “I will write it up as a phone message, have a resident review the chart and sign off on the message. Most of the time it comes back to me, and I will then call the pharmacy and document in the EMR that it was done.”

Betsy enjoys her role at The Ross. “We have amazing physicians (who are) phenomenal clinicians as well as awesome people. I feel very fortunate about my position here at The Ross,” added Betsy. “It’s a great place to work.”

P.S.: American history aficionados will have already put together the “Betsy” and “Ross” combination. Has she ever had to deal with that?

“All my life,” she laughs. “Even more, of course, since I’ve come here.”

We've expanded into the Southtowns
November 6, 2013

The Ira G. Ross Eye Institute in Buffalo has merged with the WNY Eye Center, 301 Sterling Drive, in Orchard Park, NY.

The merger will strengthen the center’s eyecare by adding nationally-recognized ophthalmologists from the Ross Eye Institute (“The Ross”) with increased access to state-of-the-art technology.

Many of the current physicians and staff have remained in Orchard Park under the Ross Eye Institute name. The expanded clinic can now offer specialized diagnosis and treatment of virtually any eye condition or disease.

Because of the merger, patients will benefit by the close affiliation with The University at Buffalo’s UB/MD Department of Ophthalmology. That partnership puts The Ross right on the front lines with the latest research into diagnosis and treatment of all eye conditions and diseases.

Revised Recommendations on Screening for Chloroquine & Hydroxychloroquine Retinopathy
June 15, 2012

Chloroquine and hydroxychloroquine can cause degeneration of the retina and retinal pigment epithelium, resulting in decreased visual acuity, paracentral scotoma and bull’s eye maculopathy. It is of serious concern, because there is limited visual recovery and, at times, progression of visual loss even after cessation of the drug. Therefore, it is imperative that toxicity is discovered as early as possible, before significant visual loss occurs.

New guidelines
New guidelines recognize that toxicity is higher than once believed, stressing the need for regular examinations, and recommend the use of new objective tools that allow for an earlier detection than was possible in the past.

Recommended timeline:
    • Baseline examination within first year of use.
    • Annual screening after 5 years of use.
More frequent examinations may be required in certain cases. Risk of toxicity is associated with duration (>5 years), dose (for hydroxychloroquine >1000g total, or >400mg/day (lower for individuals of short stature)), age (elderly), kidney or liver dysfunction, and onset of retinal disease.

Recommended screening procedures:
Each of the following can show damage earlier than visible on routine retinal exam or visual field testing†:
    • Dilated retinal examination (should not be solely relied upon)
    • Automated visual field (Humphrey 10-2-tests central vision)
    • One or more of the following:
          o Spectral Domain Optical Coherence Tomography (SD-OCT)
          o Fundus autofluorescence (FAF)
          o Multifocal electoretinogram (mfERG)

At the Ross Eye Institute, we have the technology and expertise to provide screening and monitoring examinations according to these new guidelines. The Ross’ Ausra Selvadurai, MD and Deepa Yoganathan, MD are trained retinal specialists who use the latest diagnostic technology to screen patients who have been administered these drugs.

Our state-of-art Heidelberg Spectralis imaging system allows us to obtain SD-OCT and FAF images in a comfortable and timely manner for the patient. We also are able to do mfERG, as well as automated visual field examinations.

To facilitate timely communication between the professionals who provide eye care for patients, we provide easy referral cards, with our direct MD referral line, as well as timely and organized reports of our findings. Contact the scheduling desk at 716-881-7900 to make an appointment.

† Marmor MF, Kellner U, Lai TY, et al. “Revised Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy.” Ophthalmology 2011;118:415-422.

Dr. Patel Awarded $50,000 ARI Young Investigator Grant
June 1, 2012

Sangita P. Patel, MD, PhD, has been named one of only eight individuals worldwide to receive an Alcon Research Institute (ARI) Young Investigator Grant for 2012.

The prestigious ARI Young Investigator Grant is intended to encourage and promote the early career development of clinicians and scientists entering research in vision science and ophthalmology.

Eight grants of $50,000 each are awarded annually to early-stage vision scientists who demonstrate exceptional promise for making significant contributions toward advancing eye research and eye health.

The $50,000 award will support research that Dr. Patel is conducting at the University at Buffalo that focuses on the physiology of the cornea, as it relates to both normal health and diseases that affect corneal function.

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