UPMC Eye Center 2013 Year in Review

30 25 20 15

60 54 48 42 8000000 36 30 24 7000000 18 12 6000000 6 sources) Gross0Professional

UPMC Eye Center by the Numbers 10 5

0 Consolidated Revenues (from all 35

25 300

26

28

32

51

50

3000000

23

20 250 15 200 10

2000000

41

40

44

46

FY 11

FY 12

36

30 20

1000000

10

150 5 0 100

Charges

60

4000000 Millions

Millions

30

30

5000000

FY 09

FY 10

FY 11

FY 12

0

FY 13

FY 09

FY 10

FY 13

50

Total Transactions Billed 0

Research Funding

300

273

250

225

150

4

4.8

4.7

6.0

4.6

4.3

3.8

3 2

100

6.5

5.4

5

174

6.9

6.7

6

Millions

Thouands

211 200

7

252

1.6

2.0

2.0

1.9

1.7

FY 10

FY 11

FY 12

FY 13

1 50 0

0 FY 09

FY 10

FY 11

FY 12

FY 09

FY 13

Direct

Indirect

Total

UPMC Eye Center Locations UPMC Eye Center Eye & Ear Institute 203 Lothrop St. Pittsburgh, PA 15213 Director: Joel S. Schuman, MD, FACS

Children’s Eye Center Children’s Hospital of Pittsburgh of UPMC 45th St. and Penn Ave. Pittsburgh, PA 15201 Director: Kanwal K. Nischal, MD, FRCOphth

UPMC Eye Center Eye Care & Optical 3616 Forbes Ave. Pittsburgh, PA 15213 Director: Amy C. Nau, OD

UPMC Eye Center Children’s at Pine Center 11279 Perry Highway, Suite 202 Wexford, PA 15090 Director: Christin Sylvester, DO

UPMC Eye Center Bethel Park 1300 Oxford Drive, Suite 1-A Bethel Park, PA 15102 Director: Ian Conner, MD, PhD

UPMC Eye Center McKeesport 3021 Jack’s Run Road Pittsburgh, PA 15131 Director: Shyam Kodati, MD UPMC Eye Center Mercy 1400 Locust St., Suite 3103 Pittsburgh, PA 15219 Director: Evan L. Waxman, MD, PhD

UPMC Eye Center Monroeville 125 Daugherty Drive, Suite 320 Monroeville, PA 15146 Director: Shyam Kodati, MD UPMC Eye Center St. Margaret 100 Delafield Road, Suite 201 Pittsburgh, PA 15215 Director: Marshall W. Stafford, MD UPMC Eye Center Wexford 1603 Carmody Court, Suite 104 Sewickley, PA 15143 Director: Alexander Anetakis, MD

Chairman’s Message I am delighted to share with you the UPMC Eye Center’s Year in Review. In 2013, we advanced our mission to improve quality of life through the preservation and restoration of vision, with important developments across the spectrum of activities in which the Eye Center is involved. Inside, you’ll learn more about our noteworthy achievements, which include the following: • James L. Funderburgh, PhD, has made a fundamental scientific discovery that paved the way for an international collaboration to advance the first human clinical trials of stem cell therapy for corneal opacity. This work exemplifies not only translational science at its purest, but also the vast potential of regenerative medicine to preserve and restore vision. • Noninvasive magnetic resonance imaging techniques being developed by Kevin Chan, PhD, and Ian Conner, MD, PhD, are adding to a new understanding of glaucoma as a disease that originates in the brain, and also facilitating the development and evaluation of potential neuroprotective therapies. • Ellen Mitchell, MD, is one of only a few ophthalmologists in the country to have completed fellowships in both neuro-ophthalmology and pediatric ophthalmology. Dr. Mitchell’s work is contributing to the development of novel strategies for evaluating visual pathway dysfunction in pediatric patients with idiopathic intracranial hypertension. Along with these advances in research and clinical applications, the UPMC Eye Center has had a number of additional significant achievements in 2013: • Despite the extreme challenges of the current federal research funding environment, three of our assistant professors, Shivalingappa (Shiva) Swamynathan, PhD, Matthew A. Smith, PhD, and Ian A. Sigal, PhD, successfully obtained their first independent investigator (R01) awards from the National Institutes of Health (NIH).

Joel S. Schuman, MD, FACS

• We are taking steps to address changes in health care delivery brought about by the Patient Protection and Affordable Care Act — specifically, changes aimed at maintaining the highest quality of care with reduction in cost — by introducing pathways to help clinicians treat eye diseases. • The outstanding work of our faculty members has been recognized with several prestigious awards. In particular, Evan L. “Jake” Waxman, MD, PhD, received multiple accolades for his work on behalf of the medically underserved in the Pittsburgh area through the Guerrilla Eye Service, as well as for his passion and skill as an educator. As I reflect on and take pride in these achievements, I look forward to leading this organization into another year as we continue to put into practice our vision to be a leader in the delivery of eye care; advance the frontiers of eye research; educate the next and current generations in the fundamentals, as well as state-of-the-art knowledge, of eye health, disease, and treatment; and bring innovations in science and technology from the laboratory to our patients.

Joel S. Schuman, MD, FACS Eye & Ear Foundation Professor and Chairman, Department of Ophthalmology Professor of Bioengineering Professor of Clinical and Translational Science Director, UPMC Eye Center Director, Louis J. Fox Center for Vision Restoration

UPMC Eye Center 2013 Year in Review

The promise of stem cells as a Cure for Corneal Blindness Approximately 8 million people worldwide have corneal opacities, and corneal transplantation is currently the only treatment that can prevent them from losing their vision. Transplantation has limitations, however, including graft failure, immune rejection, and limited access to donorquality tissue. In addition, countries with the highest rates of corneal blindness often lack the infrastructure to treat all those with corneal disease.

James Funderburgh, PhD

UPMC Eye Center

For more than a decade, James Funderburgh, PhD, and his colleagues in the Corneal Cell Biology Laboratory at the UPMC Eye Center have worked at the forefront of research to advance stem cell-based technologies into clinical therapies that can cure corneal blindness without the need for surgery. Early in the research process, Dr. Funderburgh and his team derived stem cells from human corneal stromal

tissue and demonstrated that they were capable of differentiating into keratocytes. The team went on to show that, even after many rounds of expansion in the lab, these cells continued to produce components of the corneal matrix, including the protein lumican, which is critical to making the cornea transparent.

The Corneal Cell Biology Laboratory, led by Jim Funderburgh, PhD, is studying the possibility of stem cells developing into keratocytes.

In 2009, the team proved that stem cells collected from human corneas restored transparency and did not trigger an immune response when injected into the eyes of mice with corneal scarring and haziness. Most recently, they demonstrated that stem cells derived from both human adipose tissue and human embryonic stem cells can be induced to differentiate into keratocytes in vitro.

“It may not always be possible to derive stem cells from corneal tissue, especially if the cornea is diseased,” says Dr. Funderburgh. “So it is promising that we can make keratocytes from stem cells derived from other body tissues.” Dr. Funderburgh has collaborated with L.V. Prasad Eye Institute in Hyderabad, India, since 2011. Sayan Basu, MBBS, MS, a corneal surgeon from that institute, spent a year working in Dr. Funderburgh’s laboratory, and returned to India to conduct the first human clinical trial using the stem cells that his mentor discovered. The trial, planned to start in spring 2014, will address whether the stem cells will clear corneal scarring in opacities in people, as they have been shown to do in mice. Here in Pittsburgh, Dr. Funderburgh’s team is currently investigating whether stem cells derived from dental pulp cells will develop into keratocytes — literally, making eyes from teeth. “We have reason to believe that dental pulpderived stem cells will make excellent keratocytes, because eyes and teeth develop from the same embryonic source — the neural crest — and the cells of the two tissues are similar in many ways,” explains Dr. Funderburgh. As the U.S. population ages, demand for corneal transplants likely will increase, notes Joel S. Schuman, MD, director of the UPMC Eye Center. However, the current popularity of laser vision correction surgery may substantially reduce the availability of donor corneal tissue, because corneas treated in this way are unsuitable for transplantation. “Stem cell transplantation holds out the promise of one day providing a permanent solution to corneal blindness without surgery,” says Dr. Schuman.

Using MRI to understand glaucoma as a Brain Disease Research conducted at the UPMC Eye Center is providing new evidence to challenge the belief that glaucoma can be characterized as a disease of the eye alone. Evidence that the early signs of glaucoma can be detected in the brain is leading to a new understanding of this disease as primarily a neurodegenerative condition. Kevin Chan, PhD, and Ian Conner, MD, PhD, assistant professors of ophthalmology at the UPMC Eye Center, are developing new, noninvasive magnetic resonance imaging (MRI) techniques to identify and evaluate early brain changes associated with glaucoma and investigate potential neuroprotective therapies. Thinking about glaucoma as a disease involving the brain represents a paradigm shift in ophthalmology, according to Dr. Conner. In the new paradigm, glaucoma-related vision loss is secondary to the loss of neural tissue in the optic nerve, as well as in the neurons that connect the thalamus, midbrain, and visual cortex at the back of the brain.

Ian Conner, MD, PhD

UPMC Eye Center

Kevin Chan, PhD

“With MRI, we can see evidence of impairments in these visual brain regions at an earlier stage than most people would expect, based on established thinking about glaucoma as a disease that begins in the eye,” explains Dr. Chan. “We are finding significant, measurable changes in the structural, metabolic, physiological, and functional aspects in these brain regions in both clinical studies in patients, as well as preclinical studies in experimental glaucoma models.”

Research being conducted by Kevin Chan, PhD, and Ian Conner, MD, PhD, suggests glaucomarelated vision loss is secondary to the impairments of the brain’s visual system.

One key goal of Dr. Chan and Dr. Conner’s work is to develop noninvasive indicators that can be used to track and assess the effects of glaucoma on the brain’s visual system over time. Another objective is to facilitate the development and evaluation of new interventions that could slow or stop the progression of changes in the visual system and prevent glaucoma from advancing to the point that vision is compromised. No currently available therapy for glaucoma treats the condition as a brain disease. “Reconceptualizing glaucoma as a neurodegenerative disease allows us to open our minds to novel treatment strategies,” says Dr. Conner. “The imaging tools we are developing will enable us to

assess the effectiveness of new or existing agents that might be used systemically or topically to stabilize the loss of neural tissue.” In the new glaucoma paradigm, intraocular pressure (IOP) may reflect a separate constellation of findings that cause neurodegeneration to occur more rapidly. Management of IOP will continue to have a significant role in glaucoma treatment for the foreseeable future, Dr. Conner believes. However, for patients who have glaucoma without elevated IOP, reducing IOP to a point that halts disease progression can be incredibly challenging. “My hope is that the new tools we are developing will ultimately lead to better treatment options, especially for this group of patients,” he says.

Pediatric neuro-ophthalmologist Brings Pediatrics and Ophthalmology Together For Ellen Mitchell, MD, specializing in pediatric neuroophthalmology was the obvious way to bring together her interests in pediatrics and ophthalmology. “My interest in ophthalmology began in medical school when I shadowed a neuro-ophthalmologist,” she says. “I was drawn to pediatric neuro-ophthalmology because it enabled me to combine my interest in neuro-ophthalmology with my desire to work with children.” Dr. Mitchell is one of only a few ophthalmologists in the country to have completed fellowships in both neuro-ophthalmology and pediatric ophthalmology. She completed her neuro-ophthalmology fellowship at Harvard Medical School in 2009 before completing her second fellowship, in pediatric ophthalmology, at Children’s Hospital of Pittsburgh of UPMC in 2010. She joined the faculty of the Department of Ophthalmology in 2010 as a clinical assistant professor of ophthalmology. One of Dr. Mitchell’s clinical interests is the diagnosis and treatment of pediatric idiopathic intracranial hypertension (IIH), also known as pseudomotor cerebri. Defined by increased intracranial pressure with no identifiable underlying systemic cause, IIH can result in double vision, visual field defects, and — if not diagnosed and treated in a timely fashion — irreversible vision loss.

UPMC Eye Center

Ellen Mitchell, MD, with David Cain, who has a brain tumor that, because of its position in his brain, caused hydrocephalus and papilledema in both eyes. Dr. Mitchell participates in David’s care in partnership with Children’s Hospital of Pittsburgh of UPMC pediatric neurosurgeon Ian Pollack, MD.

The Division of Pediatric Ophthalmology is a regional referral center for pediatric IIH. This condition is most frequently seen in adolescent women who are overweight; however, Dr. Mitchell and her colleagues at Children’s Hospital have treated patients with this condition who are of normal body habitus. Her experience treating these patients has led Dr. Mitchell to believe that the association between IIH and obesity is not as established in prepubertal children as it is in adolescents and adults, and female predominance is also less common among younger children with this condition.

The care of pediatric patients with IIH is now guided by evidence-based pathways that were created in collaboration with the Children’s Hospital Neurology Department. In response to the Patient Protection and Affordable Care Act of 2010, which encourages the implementation of strategies to deliver the highest quality of care while keeping costs in check, the UPMC Eye Center

has introduced pathways to guide the diagnosis and treatment of a range of eye diseases. “The pathways help ensure that all patients are evaluated in a comprehensive, standardized way,” explains Dr. Mitchell. “They are aids to physician decision making that help promote a consistently high level of care for all patients.”

Ellen Mitchell, MD

UPMC Eye Center Clinical Faculty Joel S. Schuman, MD, FACS Eye & Ear Foundation Professor and Chairman, Department of Ophthalmology Professor of Bioengineering Professor of Clinical and Translational Science Director, UPMC Eye Center Director, Louis J. Fox Center for Vision Restoration

Denise S. Gallagher, MD Clinical Assistant Professor of Ophthalmology, Retina Service Jean C. Harwick, MD, FACS Clinical Assistant Professor of Ophthalmology, Comprehensive Eye Service Alethea Hein, MD Clinical Assistant Professor of Ophthalmology, Oculoplastics, and Comprehensive Eye Service

Swati Agarwal, MD Clinical Instructor of Pediatric Ophthalmology

Roheena Kamyar, MD Clinical Assistant Professor of Ophthalmology, Comprehensive Eye Service, Cornea, Cataract and External Disease Service

Alexander J. Anetakis, MD Clinical Assistant Professor of Ophthalmology, Retina and Vitreoretinal Surgery Service

Shyam Kodati, MD Clinical Assistant Professor of Ophthalmology Comprehensive Eye Service

Gabrielle R. Bonhomme, MD Assistant Professor of Ophthalmology Director, Neuro-Ophthalmology Service

Nils A. Loewen, MD, PhD Assistant Professor of Ophthalmology Director, Glaucoma and Cataract Service Director, Electronic Health Record

Ian Conner, MD, PhD Assistant Professor of Ophthalmology, Glaucoma and Cataract Service Deepinder K. Dhaliwal, MD, LAc Associate Professor of Ophthalmology Director, Cornea, Cataract and External Disease Service Director, Refractive and Laser Surgery Center Director and Founder, Center for Integrative Eye Care Scott P. Drexler, OD Assistant Professor of Ophthalmology, Contact Lens and Low Vision Service Andrew W. Eller, MD Professor of Ophthalmology, Retina and Vitreous Service Director, Ocular Trauma Service Thomas R. Friberg, MD, FACS Professor of Ophthalmology Director, Medical and Surgical Retinal Diseases

UPMC Eye Center

Lee Ann Lope, DO Clinical Assistant Professor of Ophthalmology, Pediatric Ophthalmology Service Craig A. Luchansky, OD Clinical Assistant Professor of Ophthalmology, Contact Lens and Low Vision Service, and Pediatric Ophthalmology Alex Mammen, MD Clinical Assistant Professor of Ophthalmology, Cornea Service Joseph Martel, MD Assistant Professor of Ophthalmology Retina and Vitreoretinal Surgery Service Kimberly V. Miller, MD Assistant Professor of Ophthalmology, Glaucoma and Cataract Service

Ellen Mitchell, MD Clinical Assistant Professor of Ophthalmology, Pediatric and Neuro-Ophthalmology Service Amy C. Nau, OD Assistant Professor of Ophthalmology Director, Contact Lens and Low Vision Service Kanwal K. Nischal, MD, FRCOphth Professor of Ophthalmology Director, Pediatric Ophthalmology, Strabismus, and Adult Motility Leela Raju, MD Assistant Professor of Ophthalmology, Cornea, Cataract and External Disease Service Vice Chair for Clinical Services Marshall W. Stafford, MD Clinical Assistant Professor of Ophthalmology, Glaucoma and Cataract Service S. Tonya Stefko, MD, FACS Assistant Professor of Ophthalmology Director, Orbital, Oculoplastics, and Aesthetic Surgery Service Director, Ophthalmology Consult Service Cholappadi V. Sundar-Raj, OD, PhD Clinical Assistant Professor of Ophthalmology, Contact Lens and Low Vision Service Christin Sylvester, DO Clinical Assistant Professor of Ophthalmology, Pediatric Ophthalmology Evan L. Waxman, MD, PhD Associate Professor of Ophthalmology Vice Chair, Medical and Resident Education Director, Comprehensive Eye Service Director, Inpatient Consult Services Jenny Y. Will, MD Assistant Professor of Ophthalmology, Orbital, Oculoplastics, and Aesthetic Surgery Service Associate Program Director, Residency Program

UPMC Eye Center Research Faculty Richard A. Bilonick, PhD Assistant Professor of Ophthalmology Kevin Chan, PhD Assistant Professor of Ophthalmology and Bioengineering Yiqin Du, MD, PhD Assistant Professor of Ophthalmology Valeria Fu, PhD Assistant Professor of Ophthalmology Director, Electrophysiological Testing Service James L. Funderburgh, PhD Professor of Ophthalmology, Cell Biology and Physiology Associate Director, Louis J. Fox Center for Vision Restoration Stephen A. K. Harvey, PhD Research Associate of Ophthalmology Robert L. Hendricks, PhD Joseph F. Novak Professor and Vice Chair for Research Director, Ophthalmology and Visual Sciences Research Center Hiroshi Ishikawa, MD Assistant Professor of Ophthalmology and Bioengineering Director, Ocular Imaging Center Lawrence Kagemann, PhD Assistant Professor of Ophthalmology and Bioengineering Paul (Kip) R. Kinchington, PhD Professor of Ophthalmology, Molecular Genetics, and Biochemistry The Campbell Laboratory for Infectious Eye Diseases Regis P. Kowolski, MS, [M]ASCP Research Professor of Ophthalmology Executive Director, Charles T. Campbell Ophthalmic Microbiology Laboratory

Kira L. Lathrop, MAMS Research Instructor Co-Director, Imaging Module Kyle C. McKenna, PhD Assistant Professor of Ophthalmology Laboratory of Ocular Tumor Immunology Igor Nasonkin, PhD Dr. E. Ronald Salvitti Assistant Professor of Ophthalmology Research Assistant Director, Louis J. Fox Center for Vision Restoration Michelle Sandrian, PhD Assistant Professor of Ophthalmology In-Vivo Optical Imaging Lab Robert M.Q. Shanks, PhD Associate Professor of Ophthalmology, Microbiology and Molecular Genetics The Campbell Laboratory for Infectious Eye Diseases Ian A. Sigal, PhD Assistant Professor of Ophthalmology Laboratory of Ocular Biomechanics

UPMC Eye Center Residents and Fellows UPMC Eye Center Fellows Tenley Bower, MD – Cornea Service Margarita Cardenas, MD – Pediatric Service Libby Houle, MD – Oculoplastics Service Evan Lagouros, MD – Glaucoma Service Victor Neamtu, MD – Retina Service Tarek Shazly, MD – Neuro-Ophthalmology Service Kiran Turaka, MD – Pediatric Service Third-Year Residents Victoria Chang, MD Jared Knickelbein, MD Jacek Kotowski, MD John Legarreta, MD Alison Zambelli, MD Second-Year Residents Ashkar Abbott, MD Salwa Abdel-Aziz, MD Roxana Fu, MD Ahmara Gibbons, MD Carrie Happ, MD Nisreen Mesiwala, MD Amanda Way, MD

Michael Steketee, PhD Assistant Professor of Ophthalmology

First-Year Residents Shilpa Kodati, MD Anton Kolomeyer, MD Deborah Parish, MD Colin Prensky, MD Benjamin Strauss, MD John Swogger, MD

Shivalingappa (Shiva) Swamynathan, PhD Assistant Professor of Ophthalmology Laboratory of Ocular Surface Development

How to contact the UPMC Eye Center:

Matthew A. Smith, PhD Assistant Professor of Ophthalmology Visual Neuroscience Laboratory

Xiangyun Wei, PhD Associate Professor of Ophthalmology, Microbiology, and Molecular Genetics, and Developmental Biology Retinal Development Laboratory Gadi Wollstein, MD Associate Professor of Ophthalmology Director, Ophthalmic Imaging Research Laboratories  

For more information about our clinical programs, a physician referral, or consult, please call 1-800-446-3797, or visit UPMC.com/EyeCenter. For information about clinical programs, research activities, and continuing medical education, visit UPMCPhysicianResources.com/ Ophthalmology.

UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, gender identity, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

UPMC Eye Center Eye & Ear Institute 203 Lothrop St. Pittsburgh, PA 15213

UPMC Eye Center Services Aesthetic Surgery Cataract Contact Lens and Vision Enhancement Cornea Glaucoma Laser Center Louis J. Fox Center for Vision Restoration Neuro-Ophthalmology Ocular Orbital and Oculoplastics Surgery Pediatric Ophthalmology Laser Vision Correction (Refractive Surgery) Retina and Vitreoretinal Visual Electrophysiology and Psychophysics

About the Eye & Ear Foundation For more than 100 years, the Eye & Ear Foundation of Pittsburgh has had a single goal: to advance medical care and research for patients with disorders of the eye, ear, nose, throat, head, and neck. From its beginnings in 1895 as a charitable dispensary, the foundation has evolved into an organization that provides essential philanthropic support for the academic, research, and outreach programs of the Eye & Ear Institute.

UPP411902  JA  05/14

In 2013, the Eye & Ear Foundation contributed nearly $1.56 million to support research and education at the Departments of Ophthalmology and Otolaryngology at the University of Pittsburgh School of Medicine. Its efforts improve the lives of patients and bring closer the day when cures for these debilitating conditions are possible. To learn more about the foundation or to contribute to support its work, please visit www.eyeandear.org.

© 2014 UPMC