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Department ofOphthalmologywww.NYEE.eduS P E C I A LT Y R E P O R T FA L L 2 0 1 8www.NYEE.eduResearch Breakthrough:Gene TransferTherapy RestoresVision in Mice

Icahn School of Medicine atMount Sinai DepartmentalLeadershipJames C. Tsai, MD, MBAPresident, NYEESystemof3 Chair, DepartmentMessageOphthalmology, MSHSMedical DirectorsNeuro-OphthalmologyMark Kupersmith, MDSystem Chief,Neuro-Ophthalmology,MSHSAvnish Deobhakta, MDMedical Director, NYEE East 85th StreetUveitis and Ocular ImmunologyDouglas Jabs, MD, MBASystem Chief, Uveitis and OcularImmunology, MSHSStephanie Llop, MDN. Ginsburg,From the RobinSystemChairMDof the Departmentof OphthalmologySophia Saleem, MDValerie Elmalem,MDMedical Director, NYEEEast 102nd StreetJoel Mindel, MDBreakingNew Ground in Gene Transfer Therapy to Restore VisionLouis4R. Pasquale,MDSite Chair, Department ofOphthalmology, MSH and MSQ6This i-DoctorSystem Vice Chair, TranslationalOphthalmology Research, MSHSIsGennady Landa, MDMedical Director, NYEETransformingtheFieldWilliamsburg andTribecaInside FeaturePaul A. Sidoti, MDSite Chair, Department of ImagingOphthalmology, NYEESystem Chief, Glaucoma, MSHSOcular OncologyPaul Finger, MDof OphthalmologyKira Manusis, MDMedical Director, NYEEMidwoodOphthalmic PathologyJodi Sassoon, MDSite Chair, Pathology, NYEENada Farhat, MDIs a Pivotal Part of NYEE's Rich HistoryPaul A. Sidoti, MDMedicalDirector,andNYEERetinalImagingtheEast 14th StreetAlan Friedman, MDCodrin Iacob, MDAffiliated LeadershipEbby Elahi, MD, MBAPresident, NYEE/MSHOphthalmology AlumniSocietyRobert Fischer, MDDirector of Ophthalmology,Elmhurst Hospital What DoHubble Telescope Share?David Goldman, MDDouglas Fredrick, MDOculoplastic andMedical Director, NYEE-WestThe Unique Technology of Adaptive Optics.Deputy Chair for Education, MSHSReconstructive SurgeryPalm BeachAngie E. Wen, MDSystem Chief, PediatricRobert Della Rocca, MD An UnprecedentedLookatAcuteSolarRetinopathyMedical Director, NYEEOphthalmology and Strabismus,System Chief, OculoplasticMichelle Rhee, MDColumbus CircleMSHSand Reconstructive Surgery,Associate Director ofMSHS Targeting Macular Degeneration ThroughState-of-the-Art ImagingOphthalmology, ElmhurstClinical Divisions atDouglas A. Jabs, MD, MBAHospitalMount Sinai HealthDeputy Chair for Research, MSHSDavid Della Rocca, MDSystemFacultyAn NYEE-MountSinaiEye PracticesStroke ProtocolSavesa YoungWoman’s SightDirector, Eye and Vision ResearchMonicaDweck,MDInstitute, MSHSValerie Elmalem, MDCornea, External Diseases,Alexander Rabinovich, MDNYEE DiagnosticImagingAdvances: 198HarshaYearsof Innovationand RefractiveSurgerySalvatore Loiacono, Jr. MPAReddy,MDNYEE New York Eye and EarJohnSeedor,MDDeputy Chair for Finance andInfirmary of Mount SinaiSystem Chief, Cornea andAdministration, MSHSPediatric Ophthalmology9NYEE Uses a Rare RetinalTransplant to Close a Patient’s Macular HoleMSHS Mount Sinai Health SystemExternal Diseases, MSHSVice President for Ophthalmologyand StrabismusMSH The Mount Sinai HospitalServices, NYEEDouglas Fredrick, MDMSQ Mount Sinai QueensDavidMDSystemByChief,PediatricIntravitreal Injections Less Painful11A Clinical Trial Seeksto Ritterband,Boost PatientSatisfactionMakingSystem Chief, RefractiveRichard B. Rosen, MDOphthalmology andSurgery, MSHSDeputy Chair for Clinical Affairs, MSHSStrabismus, MSHSNewofPediatricVice12Chair and DirectorOphthalmic Ophthalmology Fellowship Program Is Broadening NYEE’s Patient ServicesSumayya Ahmad, MDResearch, NYEETamiesha Frempong, MD,Priti Batta, MDMPH14FacultyAnita Gupta, MDChristopherT. Spina,MS News: PromotionsEdward Raab, MDNoga Harizman, MDSenior Vice President and ChiefSteven Rosenberg, MDRichard Koplin, MDOperating Officer, NYEEErin Walsh, MD15Faculty News: AppointeesKira Manusis, MDAngie Wen, MDTamiesha Frempong, MD, MPHPrimary CareVice16Chair for Diversityand Inclusion,Departmentof Ophthalmology at a GlanceEye TraumaMSHSJohn Aljian, MDRonald Gentile, MDSandra K. Masur, PhDHarsha Reddy, MDVice Chair for Mentoring, MSHSAffiliated TeachingInstitutionsJames J. Peters VAMedical Center130 West Kingsbridge RoadBronx, NY 10468NYC Health Hospitals/Elmhurst79-01 BroadwayQueens, NY 11373Mount Sinai Union Square10 Union Square EastNew York, NY 10003Donna J. Gagliuso, MDResidency Program Director, MSHAnita Gupta, MDResidency Program Director, NYEEDirector, ComprehensiveService, NYEEPaul S. Lee, MDAssociate Residency ProgramDirector, MSHChief of Ophthalmology, James J.Peters VA Medical CenterGlaucomaPaul Sidoti, MDSystem Chief, Glaucoma,MSHSNisha Chadha, MDDonna Gagliuso, MDNoga Harizman, MDTsontcho Ianchulev, MDNathan Radcliffe, MDRobert Ritch, MDTania Tai, MDJames Tsai, MD, MBAKateki Vinod, MDOphthalmology/OptometryKaren Hendler-Goldberg, MDBessie Abraham, ODJared Hayashi, ODVanessa Hernandez, ODCaitlin Morrison, ODElena Schmidt, ODRetinaNazanin Barzideh, MDAvnish Deobhakta, MDRobin Ginsburg, MDMeenakashi Gupta, MDGennady Landa, MDJessica Lee, MDGareth Lema, MD, PhDRichard Rosen, MDR. Theodore Smith, MD, PhD173

M E S SAG E FR O M T H E SYST E M C H A I R O F T H E D E PA R T M E N T O F O P H T H A LM O LO GYJames C. Tsai, MD, MBAThe New York City metropolitan regiondeserves to have one of the world’s leadingcenters for ophthalmology and vision research.I am delighted to highlight the many stepsthat New York Eye and Ear Infirmary of MountSinai (NYEE) has taken over the past year tomove ever closer to that goal. Rather than reston our laurels as the oldest specialty hospitalin America, founded in 1820, we are focusedon extending our longstanding reputation forclinical excellence to that of innovation anddevelopment of exciting new treatments andapproaches for complex blinding eye diseases.New York Eye and Ear Infirmary(Founded August, 1820)Recruiting top scientific talent is an integralpart of our overall strategy, as evidenced byour recent appointment of Louis Pasquale,MD, FARVO, as Vice Chair of TranslationalJames C. Tsai, MD, MBA, President, New York Eye and Ear Infirmary of Mount Sinai,Ophthalmology Research for the Mount SinaiSystem Chair, Department of Ophthalmology, Delafield-Rodgers Professor of Ophthalmology,Health System and Site Chair of Ophthalmology Icahn School of Medicine at Mount Sinaiat The Mount Sinai Hospital. Dr. Pasquale, whohas gained international recognition for hisresearch, will focus on integrating NYEE into the cutting-edge,Program. Together, these programs are helping to ensure we workinterdisciplinary clinical and translational research network ofsynergistically with such well-established academic departmentsthe Icahn School of Medicine at Mount Sinai. Our commitment toand research centers at Mount Sinai as The Friedman Braineducation complements our research initiatives, which is one of theInstitute, the Icahn Institute for Genomics and Multiscale Biology,reasons we have recruited Douglas Fredrick, MD, as Deputy Chairand The Black Family Stem Cell Institute.for Education in the Department of Ophthalmology and SystemOur research and clinical efforts rest on another powerful pillarChief of Pediatric Ophthalmology. Among Dr. Fredrick’s prioritieswith a rich history at NYEE: imaging. We are home to one of thewill be consolidating and combining the already outstandingleading imaging laboratories in the world under the directionophthalmology residency programs at NYEE and The Mount Sinaiof Richard Rosen, MD, Vice Chair and Director of OphthalmicHospital into one of the largest residency programs in the nation.Research at NYEE. As the articles in this Specialty ReportIn addition, our pursuit of clinical excellence is highlighted by theillustrate, this extraordinary imaging team, working with the mostappointment of Paul Sidoti, MD, as Site Chair of Ophthalmologysophisticated equipment anywhere, is allowing us to explore andat NYEE.understand diseases like glaucoma and macular degeneration at aThe many accomplishments of our researchers and clinicians thislevel we never could before.past year underscore the breadth of NYEE’s capabilities—andAs we approach our bicentennial in 2020, it’s important to notetheir enormous potential. For example, a team of scientists ledthat 2018 marks the centennial of The American Journal ofby Bo Chen, PhD, who heads up our Ocular Stem Cell Program,Ophthalmology (AJO). A recent article in that journal1 describesrestored vision in congenitally blind mice by activating andhow the histories of AJO and NYEE have been inextricablyreprogramming retinal stem cells. This breakthrough process,bound. Indeed, in its venerable role as recorder of institutionaldescribed in the August 15, 2018 issue of Nature, could unveil ahistories, AJO has consistently documented how a coterie ofpromising and long-awaited new pathway for treating degenerativeearly ophthalmic hospitals such as NYEE has moved the field ofretinal disease in humans. Our scientists also developed aophthalmology forward. This is a legacy embraced today by ourrevolutionary micro-interventional device, miLOOP , which has theclinicians, scientists, educators, trainees, and staff, all of whompotential to transform cataract surgery and dramatically reduceare dedicated to improving and advancing patient care throughblindness around the world.innovation and collaboration.Helping us push the boundaries of discovery in the visual sciences1is the recently created Mount Sinai/NYEE Eye and VisionPathipati AS, Tsai JC. The Influence of Early Ophthalmic HospitalsResearch Institute and the Ophthalmic Innovation and Technologyon the Journal. Am J Ophthalmol. 2018 Aug; 192:xxiii-xxvii.3

Breaking New Ground in Gene TransferTherapy to Restore VisionFueled by a 2 million grant from the McGrawFamily Foundation, the recent arrival of BoChen, PhD, and his research lab is giving theDepartment of Ophthalmology at New YorkEye and Ear Infirmary of Mount Sinai (NYEE) apowerful platform to explore the exciting fieldof retinal regeneration to potentially restorevisual function in people with degenerativeglaucoma, macular degeneration, and retinitispigmentosa. The grant is enabling the new labto expand its work through the purchase of aBeckman ultracentrifuge to make AAV virusesfor retinal gene transfer, and a Zeiss confocalmicroscope to evaluate that process as wellas the effects of therapeutic intervention onretinal tissue.mice and humans, photoreceptors do not havethe ability to regenerate on their own whenretina cells are destroyed by diseases likemacular degeneration or retinitis pigmentosa,causing irreversible blindness. However, theMüller glial (MG) cells of the zebrafish haveregenerative potential whereby they divideand turn into photoreceptors and other retinalneurons, establishing a powerful self-repairmechanism.To see if MG cells could be programmedto become rod photoreceptors in a livingmouse, Dr. Chen induced the cells to divideby injecting ß-catenin into the eyes of miceMacro view of retinal stem cells in processas a first step and, weeks later, injectingof division.three transcription factors—Otx2, Crx andDr. Chen, Associate Professor ofNrl. This regenerative process, he found,Ophthalmology and Director of the Ocular Stem Cell Programnot only encouraged the newly divided cells to develop into rodat the Icahn School of Medicine at Mount Sinai, has madephotoreceptors, but structurally made them look no differentconsiderable progress over the past eight years in highlightingthan the real photoreceptors. Would the treatment actually work,the role of gene therapy. In his previous lab at the Yale Schoolthough, in restoring vision to mice with congenital blindness? Theof Medicine, Dr. Chen worked with mouse models to betterexciting finding by Dr. Chen was that light responses recordedunderstand the molecular and cellular pathways in major retinalfrom retinal ganglion cells—neurons that carry signals fromdegenerative diseases. In one major project—for which workphotoreceptors to the brain—and measurements of brain activitycontinues at the Mount Sinai/NYEE Eye and Vision Researchshowed that the newly formed rods were in fact integrating into theInstitute—he has demonstrated how the gene transfer of ß-cateninvisual pathway circuitry. “Mice who were blind from birth were nowand three transcription factors can successfully reprogram retinalable to see light for the first time in their lives following treatment,”glial cells into rod photoreceptors.he observes.Photoreceptors are light-sensitive cells in the retina in the back ofthe eye that signal the brain when activated. In mammals, includingMouse subject being tested foroptomotor response (OMR) toassess visual function followingan eye injection of Otx2, Crxand Nrl. The virtual stimulationcylinder tracks the animal s headposition as pattern on cylinderwalls changes to measure OMR.4Dr. Chen’s groundbreaking study, published August 15, 2018, in theonline issue of Nature, has received national attention for opening anew pathway for potentially treatingin humans retinal degenerativediseases, which currently haveno cure, by manipulating our ownregenerative capability to self-repair.“We’ve been able to show througha gene transfer technique usingAAV viruses that we could activateresident stem cells—the so-calledMüller glial cells—to re-enter thecell cycle to generate a populationof stem cells that differentiate intoretinal neurons,” Dr. Chen explains.The scientist is now working withMount Sinai’s patent office to file aprovisional patent based on theseFrom left: Postdoctoral Fellows Xinzheng Guo, PhD and Ye Xie, PhD, withBo Chen, PhD, examining the bacterial colonies growing on an agarose plate. findings.Bo Chen, PhD, examiningthe structural elements of aretinal slice at a cellular level .As a McGraw Family Vision Researcher, Dr. Chen says herelishes the ability to tap into a rich array of resources at MountSinai and NYEE to advance his groundbreaking work. Theyinclude a cutting-edge imaging capability under the leadershipof Richard Rosen, MD, Vice Chair and Director of OphthalmicResearch at NYEE; the nationally recognized Icahn Institute forGenomics and Multiscale Biology; and NYEE’s considerablepool of patients.“Dr. Tsai [President of NYEE] has given me a broad mandate topursue my work in retinal regeneration and neural protection,”emphasizes Dr. Chen, winner of the Pew Scholars in theBiomedical Sciences Award, given to young investigatorsshowing outstanding promise. “These fields represent unlimitedopportunities today for labs like mine, and we believe our findingsunderscore that we are closer than ever to major new therapiesfor people with severe degenerative eye disease.“We believe our findingsunderscore that we are closerthan ever to major newtherapies for peoplewith severe degenerative eyedisease.”—Bo Chen, PhD5

This i-Doctor IsTransforming theField ofOphthalmologyWhen a New York Eye and Ear Infirmary of Mount Sinai (NYEE)eye surgeon performed a complex anterior segment surgery thisJune on a patient with cataracts and glaucoma, he relied on threeinnovative and novel technologies. One was miLOOP , the firstmicro-interventional cataract fragmentation device for non-thermalcataract surgery. The second was intraoperative aberrometry, whichhas uprooted the 50-year-old standard for intraocular lens powerdetermination, and the third was CyPass , the first non-trabecularmicro-stent for glaucoma.Once the procedure was completed, the surgeon, TsontchoIanchulev, MD, could take pride in more than its successful surgicaloutcome. He had invented and pioneered all three U.S. Food andDrug Administration-approved devices, now becoming standard ofcare and widely used by ophthalmologists at NYEE. Dr. Ianchulevis a Professor of Ophthalmology at the Icahn School of Medicine atMount Sinai, but as an entrepreneur, he has reached well beyond theacademic bench: Through the years, his technologies have raisedclose to 200 million in venture financing, and have created morethan 1 billion in investor value.As a physician, inventor, and entrepreneur, Dr. Ianchulev has alwayshad his eye on the big picture—how paradigm-shifting innovationscan improve the lives of not just individual patients, but entirepopulations around the globe. Indeed, he became acutely awareduring his early years of medical training at Harvard University of“how much we can accomplish as clinicians if we leave our comfortzone and start to innovate and come up with solutions using ourscientific and technocratic minds.”There is no better window on the “disruptive” mindset of Dr. Ianchulevthan miLOOP. Instead of settling for incremental change to thetraditional way of doing cataract surgery, he set his sights on arevolutionary new process: an easy-to-use, hand-held, pen-likedevice that could bridge the yawning gap between developed anddeveloping health care systems and help all to fight the blindnessepidemic from cataracts that affects 25 million people worldwide.“Phacoemulsification has been extremely successful, but the factis, we’re still doing cataract surgery pretty much the way we did it50 years ago,” he explains. “It also introduces a lot of undesirableenergy and leads to corneal damage and endothelial cell loss,among other things. Also, it has not made a dent outside thedeveloped world because its complexity and cost are incompatiblewith the developing world.”› continued on page 3“Through our OphthalmicInnovation andTechnology Program,we’re creating an environmentwhere the best andbrightest ideasare not just taken out for a spin,but actually brought to life.”—Tsontcho Ianchulev, MD› continued on page 867

› continued from page 6This i-Doctor Is Transforming theField of OphthalmologyDr. Ianchulev’s path to changing the standard was to borrow fromcardiovascular surgery and interventional radiology. He recognizedthat some of the micro-invasive techniques that have revolutionizedthose fields in recent years are quite transferable to ophthalmology,particularly cataract surgery, where they have the ability to transformhow the procedure is done and potentially reduce blindness aroundthe world. So, he and his engineering team at the company he cofounded, Iantech, developed miLOOP, which allows for energy-freefragmentation of even the hardest cataracts without rupturing the4-micron-thin capsule enveloping the lens.Top: One of the patients treatedfor cataracts by Dr. Ianchulev andthe team of doctors taking partin the cataract blindnessprevention mission withHimalayan Cataract project andMiniCap Global Alliance, whodonated miLOOP devices. .Intraoperative aberrometry also started off as a problem in search ofa solution. While still a resident, Dr. Ianchulev realized “how impreciseand outdated our existing technology was in figuring out the correctIOL power in cataract surgery.” The flashing light inside his head madehim realize that “if you take out the lens before you put in the IOL, youhave this privileged state of the eye, this pure optical system from thecornea all the way to the retina. It’s almost like an optical biopsy of theeye that lets you figure out the total optical deficit.” From that insightevolved the first intraoperative biometry in ophthalmology, now knownas Optiwave Refractive Analysis (ORA) from Wave Tec.Left: Lenses of patents withcataracts removed usingmiLOOP.Today, Dr. Ianchulev is re-inventing one of the oldest ophthalmicdevices: the eyedropper. By shrinking inkjet printer technology to adevice the size of a smartphone, he can deliver medication to the eyein a precise and targeted way—something that conventional pipetteeyedropper technology has not been able to do, resulting in wasting oroverdosing the medication.Dr. Ianchulev is now putting his boundless creative energy andexpertise to everyday work at NYEE as Director of the OphthalmicInnovation and Technology Program. Specifically, he is buildinga whole ecosystem around innovation—exciting new therapies,technologies, and diagnostic modalities—that can be developed,commercialized, and pushed out to people suffering from eye diseasein every corner of the world. To that end, the Ophthalmic Innovationand Technology Program draws vital support from faculty, clinicians,and residents at both NYEE and The Mount Sinai Hospital, as wellas from a growing array of academic partners on the outside. Andthrough its collaboration with Mount Sinai Innovation Partners,the program is forging new commercial relationships that covereverything from licensing intellectual property to participating in newentities that can capitalize on our homegrown technology.“Through our Ophthalmic Innovation and Technology Program, we’recreating an environment where the best and brightest ideas are notjust taken out for a spin, but actually brought to life,” Dr. Ianchulevdeclares. “And more importantly, we’re training our residents andstudents not only to be excellent clinicians, but also how to staff thefront lines of innovation. Our patients need it just as much as their nextdoctor visit.”“ we now have animportant newprocedure in our toolbox,and won’t be afraid to roll it outfor patients who previouslyhad no good options.”—Ronald Gentile, MDNYEE Uses a Rare Retinal TransplantTo Close a Patient’s Macular HoleDr. Ianchulev teaching DuaaSharfi, MD, a NYEE resident,how to use the miLOOPdevice at Jorge N. Buxton, MDMicrosurgical Education Center.When 68-year-old Mary Benjamin came to Ronald Gentile, MD,at New York Eye and Ear Infirmary of Mount Sinai (NYEE), shehad a macular hole that three surgeries elsewhere had failed toclose. The retinal surgeon quickly recognized the severity of thecase. For one thing, Ms. Benjamin’s sight had deteriorated to thepoint where merely walking down the block became hazardous.“After the macular hole reopened, I could barely count thenumber of fingers in front of my left eye,” Ms. Benjamin recalls.“And the drops I was taking just weren’t doing the job they weremeant to.”On clinical examination, OCT imaging revealed that the macularhole registered nearly 800 microns, making standard closureusing the internal limiting membrane that was previously removedimpractical, by Dr. Gentile’s reckoning. Instead, he reached fora surgical technique that had only been performed a handfulof times in this country: autologous retinal transplantation. Thetransplant is used to close the hole and reattach the normalretina around the hole that was detached because of it. “It’s onlyapplicable to the very small number of patients who have failedmultiple procedures in attempting to close a very difficult macularhole,” explains Dr. Gentile, Clinical Professor of Ophthalmology atNYEE. “In Mary’s case, we realized it was our best chance to giveher something approaching a permanent fix.”› continued on page 1089

Groundbreaking workby the Advanced RetinalImaging Laboratoryat New York Eye andEar Infirmary of MountSinai (NYEE) intounderstanding theImaging Is aPivotal Part Of NYEE’sRich Historymicrostructure of thehuman retina rests on arich historical foundation.From the very firstphotographs of a retinain a living organism (arabbit), taken by HenryNoyes, MD, ExecutiveDirector of NYEE inthe 1860s, to currentImaging Is aPivotal Part of NYEE’sRich Historyefforts to unravel themolecular mystery ofretinal disease throughhigh-resolution imagingsuch as adaptive opticsand swept source opticalcoherence tomography(OCT), New York Eye andEar Infirmary has been inthe forefront.Technology called adaptive opticshas allowed mighty telescopes likeNASA’s Hubble to reach deep into timeand space and send back astonishingimages. Now, adaptive optics has beenturned inward to allow researchers toinvestigate the human eye and diseaseslike glaucoma, diabetic retinopathy, andretinal vein occlusion. “We’ve reversedthe direction. Instead of looking at outerspace, we’re using adaptive optics topeer into the retina,” explains Yuen PingToco Chui, PhD, Assistant Professorof Ophthalmology at the Icahn Schoolof Medicine at Mount Sinai, who ishelping this effort through softwareenhancements that she has developedin the David E. Marrus Adaptive OpticsImaging Laboratory at The Shelleyand Steven Einhorn Clinical ResearchCenter of New York Eye and EarInfirmary of Mount Sinai (NYEE).NYEE is one of a handful of sites in thecountry with adaptive optics scanninglaser ophthalmoscopy (AOSLO). Thissophisticated imaging technique—part of a translational researchcollaboration with Medical College ofWisconsin and Stanford University—isallowing researchers and cliniciansan unprecedented view of the retinalmicrovascular structure and blood flow.Adaptive optics, which producesimages that are high resolution andnoninvasive, is particularly well suitedfor retinal imaging. The technology wasbuilt into astronomical telescopes byU.S. government scientists nearly 30years ago to improve image resolutionNYEE DiagnosticImaging Advances:Background:Image of maculardeviation mapping ofnonperfused areasoverlaid with thesuperficial OCTAimage.198 Years ofInnovationlight to allow for resolutions of around2 microns, 10 times the resolutionof optical coherence tomography(OCT) imaging and sufficient to detectand count the individual rods in thephotoreceptor mosaic, which areapproximately 2.5 microns in diameter.What Do RetinalImaging and theHubble TelescopeShare?The UniqueTechnology ofAdaptiveOpticsby compensating for distortions causedby atmospheric turbulence. In the caseof ocular applications, adaptive opticshelps achieve cellular-level imagingby overcoming optical aberrations.This is accomplished by measuringthe distortions of the wavefront ofthe light reflected from the eye andcompensating for them by using aspecial mirror that corrects or “adapts”to those distortions, essentiallyeliminating them. Adaptive opticsimproves the optical transmission ofDr. Chui, for her part, has made adaptiveoptics an even more powerful toolby developing software that enablesusers to quantify the high-resolutionimages they receive. What motivatedher efforts, she explains, was the factthat AO, for all its strengths, does nothave a user-friendly interface to helpclinicians interpret the reams of datathey receive from its images. “Thesoftware we’ve developed provides analgorithmic analysis of the image data tohelp clinicians determine if a patient islikely to have early diabetic retinopathy,say, or glaucoma.”In a study reported in InvestigativeOphthalmology & Visual Science inJune 2015, Dr. Chui and other NYEEresearchers found that microscopic,noninvasive imaging of the fine retinalvasculature using split-detectionAOSLO allowed for quantification oflumen and wall thickness. Significantly,they learned that this techniquehas potential for early detectionof diabetic retinopathy, as well asaccurate monitoring of progression andtreatment response.Dr. Chui’s work with adaptive optics hasproduced improvements to anothermainstay of NYEE’s advanced imaging“For eye diseases where we really don’t understand theunderlying mechanism, imaging is a huge asset because itgives us a constructive pathway forward. And consistentwith our practice over the years, we continue to develop andrefine our imaging tools to complement the progress ourresearchers and clinicians are making in critical areas likegene therapy and breaking down ocular disease to itscellular components.”— Richard Rosen, MD, Director of Retina Service andOphthalmic Research, NYEE1862Henry D. Noyes, MD,Executive Director ofNYEE takes the firstphotographic imageof the retina in a livesubject, a rabbit.toolkit: optical coherence tomographyangiography (OCTA). Like AOSLO,the basic OCTA machine lacks thequantitative and qualitative software toenable physicians to know if the imagesthey’re viewing substantially deviatefrom the norm and, if so, by how much.Dr. Chui addressed that deficiency withsoftware enhancements that allow forprecise mapping of the progressionof diabetic retinopathy, glaucoma, andother vascular-related diseases. “Wehave preliminary data showing oursoftware is able to diagnose preclinicaldiabetic retinopathy, which is a hugedevelopment,” says Dr. Chui. “For thepatient, this means avoiding injectionof fluorescein dye, using noninvasiveimaging that provides a 3-D view of theretinal capillaries.”OCTA software enhancements fromDr. Chui and her team are also helping totransform the early detection of primaryopen-angle glaucoma and normaltension glaucoma. To that end, they arehelping physicians identify changes inthe retinal nerve fiber layer and its bloodsupply, the radial peripapillary capillarynetwork, much earlier using motioncontrast analysis for red blood cellmovement.“We intend to make the softwarewe’ve developed at NYEE a newaddition to our clinical care,” emphasizesDr. Chui. “And that will help us to bettermonitor the progress of eye disease,and allow clinicians to intercede at theearliest possible stage to benefitthe patient.”“New York Eye and EarAn Unprecedented Look at AcuteSolar RetinopathyClinicians at New York Eye and EarInfirmary of Mount Sinai (NYEE) wereon high alert when a 26-year-oldwoman walked through their doors justdays after viewing the solar eclipse ofAugust 2017, complaining of blurredvision and color distortion. Theirsuspicions were soon confirmed: acase of acute solar retinopathy andphotochemical burns, reinforced byimages that were unlike any they hadever seen before. Through the useof adaptive optics scanning laserophthalmoscopy (AOSLO), they wererewarded with a high-resolution,cellular-level view of damage to thepatient’s photoreceptor layer.“We were able to literally see thecrescent-shaped spatial damage to avery specific part of her retina,” recallsAvnish Deobhakta, MD, AssistantProfessor of Ophthalmology at theIcahn School of Medicine at MountSinai and a member of the NYEEclinical team that examined the patient.“We had never been able to see thatlevel of precision before, becauseimaging modalities like adaptive opticsweren’t even available until recentlyto examine solar retinopathy. We’rehopeful this kind of information will notonly help us to better understand thecondition, but lead to new therapies forsolar

Medical Director, NYEE-West Palm Beach An Unprecedented Look at Acute Solar Retinopathy Michelle Rhee, MD Associate Director of Ophthalmology, Elmhurst Hospital Neuro-Ophthalmology Mark Kupersmith, MD System Chief, Neuro-Ophthalmology, MSHS Valerie Elmalem, MD Joel Mindel, MD Ocular Oncology Paul Finger, MD Ophthalmic Pathology

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