Eye - DURING COVID-19 EDUCATING OTHERS - Emory Eye Center
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A P U B L I C AT I O N O F E M O R Y E Y E C E N T E R
eye 2021
EDUCATING
OTHERS
DURING
COVID-19
Mentoring Giant 8 A Saving Grace 22 Children and COVID 18
FROM THE DIRECTOR TECHNOLOGY MEETS OPHTHALMOLOGY
W
ELCOME TO THE 2021 ISSUE OF EMORY
EYE MAGAZINE. We hope you enjoy the
latest edition of our magazine, as it is filled
with lots of exciting stories and updates on
what's happening at the Emory Eye Center.
2020 has been an unprecedented year for
all of us. As we reflect on last year, we have endured many abrupt changes
including a large part of the country being forced to shut down due to the 14
COVID-19 pandemic. The state of Georgia declared a Public Health State
of Emergency and as a result, Emory University / Emory Healthcare made
the tough decision to treat only essential and urgent patients and stop
elective care last spring. This was done to limit the spread of COVID-19
and keep the members of our community—but, most importantly, our
patients as safe as possible. Since then, we have carefully increased our
clinical care to include all prior services with extra precautions (and now
with vaccinations as well) to keep our patients, staff, and providers safe.
Despite the impact of the COVID-19 pandemic, Emory Eye Center has
continued to excel in what we do best: education. Although the pandemic 2 24
caused us to temporarily pause in-person clinical care services, this time
has provided us with the opportunity to shift our approach on how we
educate and train our residents and fellows—tomorrow's ophthalmolo-
gists. We have shifted the way we taught, educated, and trained our fellows
COVER STORY COMMUNITY NEWS
and residents including conducting lectures and seminars—to a virtual � LEADING THE WAY 14 CREATING A NET- 24 ARTIFICIAL
environment. We used this enhanced virtual approach to compliment Faculty continue to educate WORK OF CARE INTELLIGENCE
our outstanding clinical and research training. others during the pandemic An inside look at the Georgia Research team conducts
Many of our faculty members have continued to serve as mentors and Vision Network ground-breaking research
train others, especially in the area of research. One such faculty member is
John M. Nickerson, PhD, research scientist and director of research, who
PROFILES 17 REMOTE AREA 26 RESEARCH
has been with the Emory Eye Center since 1991. You'll read more about 8 MENTORING GIANT: MEDICAL HIGHLIGHTS
him on page 8. JOHN M. NICKER- Mary S. Carlton, OD, and How does covid affect the
We're also excited to share the story of Tymeisha French, a patient at SON, PHD Kristen Thelen, OD, FAAO, eye, plus other research
CORONAVIRUS DISEASE
Emory Eye Center, who now has a promising future. Since a very young Celebrating the career of a give back updates
2019 (COVID-19) STATEMENT
age, Miss French has lived with keratoconus, a condition in which the mentoring giant
All work was completed in
cornea of the eye thins and bulges outward into a cone shape. You'll read 18 WORKING THROUGH 28 FUNDING NEWS
accordance with the CDC,
about her journey with corneal cross-linking treatment, a new surgical �� A SAVING GRACE A NEW NORMAL Sidra Tree Foundation and
federal, state, local, and
procedure for individuals with keratoconus. It is stories like these that A young patient gets a new Caring for children during NIH grants support faculty
healthcare facility guidelines
make us most proud of what we do. look on life COVID research
for practicing preventive
We thank you for supporting the Emory Eye Center and for trusting us
actions to reduce the risk of
to be your primary eye care and vision provider. 30 CENTER NEWS
virus transmission, including
Conferences, top docs, and
daily health screenings and
celebrating EEC’s 150th
temperature checks, and EMORY EYE MAGAZINE
Allen D. Beck, MD anniversary
proper social distancing. Director Allen D. Beck, MD
Chair and Director, Emory Eye Center
Portions of this magazine
F. Phinizy Calhoun Sr. Chair of Ophthalmology Director of Development Karla Ruggiero Writer/Editor Tiana Conner 35 FACULTY NEWS
contain images that were
Design Susan Siracusa Photographers Soroosh Behshad, Donna Price, Awards, recognitions and
taken prior to the COVID-19
Lisa Tierra, Natalie Weil EEC welcomes a new faculty
pandemic. The Emory Eye Center is part of Emory University School of Medicine and Emory Healthcare, both of which are
components of Emory's Woodruff Health Sciences Center. Website eyecenter.emory.edu Email eyecenter@emory.edu member
2021 | EMORY EYE | 1
FEATURE EDUCATING OTHERS
LEADING
Emory Eye Center residents and fellows
adjusted to the way they worked and
learned. This included wearing surgical face
masks during wet labs and social distancing
WAY
when possible.
the
department’s education program for
an opportunity to learn and train
under the leadership of EEC faculty.
However, in March 2020, the corona-
W
virus pandemic halted the way ophthal-
mic education had been previously
hen the novel The COVID-19 pandemic also taught. Prior to the pandemic, medical
coronavirus changed ophthalmic education, in students were given the opportunity to
(SARS-CO-V2), efforts to keep faculty, staff and learn about the field of ophthalmology
the virus that medical students safe. Despite this, by studying under Emory Eye Center
causes the the faculty of Emory Eye Center faculty, participating in seminars and
disease COVID-19, caused a nationwide (EEC) continued to teach and educate conferences, and gaining exposure to
and worldwide pandemic in March others in a safe way through virtual the field by being in hospitals and
2020, much of the world stopped. Due education and learning–which is in interacting with patients.
to the virus’s high level of transmis- line with the Emory Eye Center One prime example of the faculty’s
sion and severity of the disease, many mission–proves that education is at commitment to education was the
countries around the world tried to stop the forefront of what we do. shift to online ophthalmic education
the spread of the virus with unprec- for medical students in the early part
EDUCATING OTHERS DURING edented responses such as travel
restrictions, limited in-person interac- Preparing for the
of the COVID-19 pandemic.
Emily Graubart, MD, director of
Alternative
THE COVID-19 PANDEMIC tions and social distancing measures,
curfews and quarantines, and forced
many schools and other educational
Each year, Emory University School of
Medicine students, residents, fellows,
comprehensive ophthalmology and
director of medical student education,
Yousuf Khalifa, MD, chief of service of
institutions to shift to remote learning. and doctoral candidates enroll in the ophthalmology at Grady Memorial
2 | EMORY EYE | 2021 2021 | EMORY EYE | 3
FEATURE EDUCATING OTHERS
Hospital, and the help of two learn about the field of Ophthalmol-
fourth-year medical students, Sarah ogy and become familiar with major
DeVaro and Ogul Uner developed a eye conditions and diseases, partici-
four-week, teleophthalmology pate in our weekly Grand Rounds
elective for medical students to sessions, and attend lectures dedi-
continue their education remotely cated to them that would help them
to reduce the spread and risk of confirm that ophthalmology was a
contracting the coronavirus. field they were interested in and
“The teleophthalmology elective passionate about,” Graubart says.
was created as a novel elective for all The course was especially valuable
of our medical students so they could for third- and fourth-year medical The residency program’s success is attrib-
uted to Terri Trotter, residency program
continue to be engaged in the field students. Because these medical coordinator, who deeply cared about the
of ophthalmology, since we were students are nearing the end of their career of every student that enrolled the
program and alumni. She retired from her
unable to involve them in traditional program, they traditionally gain role as coordinator after 31 years of ser-
preclinical and clinical activities,” valuable, hands-on experience by vice to Emory Eye Center in January 2021.
Graubart says. being in hospitals and interacting
The course consisted of online with patients. For example, prior to
self-study materials, student presen- the COVID-19 pandemic, students appointments. Using technology such
tations, chart review assignments, participated in clinical activities such as Zoom—a video communications
case-based discussions with faculty, as conducting eye exams for patients tool used for video and audio confer-
and a telehealth experience with a while being observed by a faculty encing—medical students can collab-
patient, which was a valuable part of member and observing during orate with Emory Eye Center faculty
the core curriculum. surgical procedures. during remote appointments with
“We wanted to make sure the However, EEC faculty found an the patients and conduct screening
elective was structured so our alternative way for this to be possi-
medical students could continue to ble: through telehealth patient Continued
EMORY EYE
CENTER RESIDENT
GRADUATION
Emory Eye Center held its first
ever virtual scientific session
in June 2020. The session was
conducted virtually. Residents
and fellows presented their final
projects to participants while
faculty served as preceptors.
Valerie Biousse, MD, vice chair
of faculty development, diver-
sity, and inclusion delivered the The class of 2020 residents celebrate their gradua- Face-to-face interactions with patients as shown here were
Henry F. Edelhauser Translational tion (l-r): John Paul Gorham, MD; Robert Bjerregaard, limited during the coronavirus pandemic; however the quality
MD; David Levine, MD; Sara Branson, MD; Julia Kang, level of care stayed the same. Emory Eye Center faculty resorted to
Research Lectureship entitled, MD; Alexandria Li, MD; and (center) Jeremy Jones, creative ways to interact with and treat patients, including virtual
“Don’t miss opportunities!” MD, residency program director. and telehealth appointments.
4 | EMORY EYE | 2021 2021 | EMORY EYE | 5
FEATURE EDUCATING OTHERS
eye exams, and even diagnose some virus and implications with personal duty to care for the patient without will help our systems evolve from a
eye conditions without being in the Before the pandemic, many residents protective equipment, understanding that patient feeling stigmatized. This big-picture, vision-health system
benefited from the hands-on training
same room as the patient. from faculty like comprehensive oph- telemedicine cases, learning how to took up much of the discussion. By standpoint,” Yeh says.
Tanya O’Donnell, training specialist thalmologist Maria Aaron, MD, (right) treat patients with COVID-19 cases having these conversations, it allowed “Understanding the virus is highly
and glaucoma specialist Jeremy
and telehealth/telemedicine facilitator Jones, MD, (second from left). and/or persons under investigation us to really frame the issue with what transmissible and the potential for viral
for the Emory Eye Center, is one of the and understanding surgical consider- was to come up next.” residence in the tear film are key factors
staff members who helped to start up ations that are related to COVID-19 as that emphasize the importance of
the telehealth elective with the team. well as learning how to correctly wear rigorous protocols that include PPE
“Dr. Soroosh Behshad and I worked PPE during patient interactions. Learning From management. These are considerations
together to try out the different plat- Besides the didactic and practical the Past Dr. Shantha and I have worked on in
forms to see which one worked best discussion of the COVID-19 town Yeh and Shantha also have consider- detail from 2015 because of Ebola virus.”
and created a presentation for the hall, Jessica Shantha, MD, Rachel able experience treating patients with “Even through the pandemic, we have
physicians to help better understand Shah, MD, and Yeh developed proto- highly transmissive viruses. Both to learn how to have our health systems
telemedicine’s place in ophthalmol- cols and guidance for ophthalmolo- doctors treated patients during the continue to function. We want to be
ogy and working within EMA to meet gists and staff to follow when Ebola virus crisis in 2014 and treated mindful of safety but as healthcare
all of the rapidly changing telemedi- interacting with adult and children Ebola virus disease patients during providers, we all have a role to play in
cine requirements,” she explains. “I patients with COVID-19 and Persons the Ebola outbreak in Sierra Leone, managing infectious disease threats,
provided one-on-one training to most Under Investigation. Liberia, and more recently in the overcrowding and important lessons we
of the physicians to set up their virtual “The feedback from the retina Democratic Republic of the Congo. all must think about. We don’t want to
rooms and had a practice visit with community was very positive,” Yeh says. “There’s a number of important stigmatize patients and we still want
almost each one. I did a lot of trouble- “There was so much uncertainty at lessons learned. Unless a health system to provide a high level of care—and
shooting with the physicians in the the time. Together we learned how to has been prepared for a wide-scale keep the patient comfortable.”
early days while we were working out students the triumphs and challenges uveitis service team organized a navigate patient care, which is impor- infectious disease threat it is difficult “We have a responsibility to utilize
the kinks and created the workflow to of telemedicine in ophthalmology.” virtual EEC COVID-19 town hall to tant to think about since there are so to fully understand the issues.” our expertise to inform our colleagues
get the physicians started and trained “This may be something we can do connect with other providers in the many issues to be concerned about.” “Understanding emerging infectious and the community about best practices
with telemedicine.” in the future or at least portion in the region. Many of the participants “A patient may have an emergency diseases, patient and provider needs and continue the discussion about how
“I also worked with Dr. Graubart to future by offering them a virtual included retina and uveitis providers or pre-operative concern and it is our and learning these lessons on the fly to lead these efforts,” Yeh says.
raise awareness with the faculty of elective they can complete on their own from around the world.
the need for inclusion of the medical time as well as see patients in clinic “One thing that I thought was unique
students to observe telemedicine or virtually when care continues.” about a virtual COVID-19 town hall for
visits in the department,” O’Donnell When asked about some of the the community, was that it was a good
says. “I worked with elective coordi- lessons learned, Graubart says, way for us to communicate about the
of Harvard’s PhD program in virology and an
nator Rose Smith, patient access “There are certain parts of online science, cases and lessons learned for COLLABORATING WITH expert in cornea and external disease at
operations manager Leanne Roberts, learning resources that allowed us, all of us while caring for patients during
and medical student clerkship teach- as faculty, to interact in a more the pandemic and throughout,” Steven
THE AMERICAN ACADEMY Massachusetts Eye and Ear, to develop clinical
and scientific communications to roll out to oph-
ing assistant Ogul Uner, to keep in-depth manner than we normally Yeh, MD, uveitis and retina specialist, OF OPHTHALMOLOGY thalmologists all over the world on how to keep
everyone apprised of which physi- do with our students. There are parts says. “In addition, the town hall was a
cians had telemedicine visits they of the curriculum we can incorporate great opportunity for the retina and Emory Eye Center ophthalmologists Steven Yeh, their practices, patients and staff safe during
could attend.” into our overall ophthalmic educa- uveitis service team to connect with MD, and Purnima Patel, MD, served on committees the pandemic.
The telehealth educational program tional program in the future.” other retina providers in the region and for the American Academy of Ophthalmology During the pandemic, AAO has shared important
was the first of its kind in the nation and give a situation report on COVID-19.” (AAO). Both Yeh and Patel were involved in devel- ophthalmology-specific information related to
was rated very highly by the 18 students The EEC COVID-19 town hall was oping communications around COVID-19 safety COVID-19. Many of these communications were
who were enrolled in the course. Leading By Example organized by Yeh with Allen Beck, protocols and reviewed scientific and clinical referred to as guidelines on resuming ophthalmic
care and ophthalmic preparedness protocols for
“Although there were other programs In addition to educating medical MD, director and chair of the Eye content on COVID-19 that was published on
that offered exposure to medical Center, and several members of the AAO’s website. COVID-19.
students, residents and fellows, and
ophthalmology, we were the only They also collaborated with AAO leadership, To date, there have been more than 1 million
doctoral students, EEC faculty are often retina team including G. Baker
James Chodosh, MD, MPH, the Edith Ives Cogan views worldwide by ophthalmologists on the
program in the country that added the sought out by other experts in the field Hubbard, III, MD, Ghazala O’Keefe,
Professor of Ophthalmology at Harvard Medical AAO website (www.aao.org/covid-19) which has
component for our students to see due to their experience and expertise. MD, and Purnima Patel, MD.
School’s Department of Ophthalmology, a member continued to increase during the pandemic.
patients in a virtual platform,” Graubart In March 2020, several members of During the town hall, some of the
says. “It was important to show our the Emory Eye Center’s retina and topics included: understanding the
6 | EMORY EYE | 2021 2021 | EMORY EYE | 7
FEATURE FACULTY
John M. Nickerson, PhD, is director of
research for Emory Eye Center. His interests
are in retinal degenerative diseases and the
genetics behind them.
ON THE
SHOULDERS OF A
MENTORING
GIANT:
JOHN M. NICKERSON, PHD
8 | EMORY EYE | 2021 2021 | EMORY EYE | 9
FEATURE FACULTY
This image was taken prior to the
PARTNERING FOR SUCCESS
COVID-19 pandemic. From its inception in 1964, Emory Eye
Center’s scientific research laboratory has
been home to award-winning scientists who
dedicate their lives to understanding cata-
strophic eye diseases that affect people
worldwide. Their scientific discoveries have
significantly contributed to treatments for
patients with conditions such as eye cancer,
hereditary cataracts, diabetic retinopathy,
age-related macular degeneration, idiopathic
intracranial hypertension, and more. To
support this ongoing work, visit eyecenter.
emory.edu/giving.
focus area is to study pharmacological and gene therapy
Dr. Nickerson thrived on working
approaches to slowing or preventing these degenerations. with students and explaining the
As of late, Nickerson’s research interest areas are under- complexities of vision research.
standing retinal proteins and their expression in normal
animals and in animal models exhibiting characteristics
of human eye diseases.
In 2013, the Association for Research in Vision and
Ophthalmology (ARVO) awarded Nickerson, PhD, the Training Future Research
Scientists
M
prestigious Gold Fellow status and served as the ARVO
Awards Committee chair later that year. In 2009, he was However, despite all of his training, awards and accolades, it
tapped as an ARVO Silver Fellow, having served on several all comes back to what he enjoys doing most: mentoring junior
ARVO committees and in leadership roles over the years. and senior research scientists. For many research scientists,
ost know the value of a post-doctoral fellowship with Dr. Piatigorsky studying the Nickerson is a founding and current editor-in-chief of a part of their job is to transition from obtaining a degree to
great mentor. When it biology of the lens. I examined all the various sorts of ways Molecular Vision, a peer-reviewed journal dedicated to the learning the skills necessary to manage a lab and becoming
comes to Emory Eye lenses of the human eye turned cloudy. From there, I started dissemination of research results in molecular biology, cell a member of faculty, either as an assistant and associate
Center (EEC) faculty working on my dissertation and looking at how plotting biology and the genetics of the visual system. The journal professor. Nickerson is right there to help them along the way.
mentoring others, one proteins were being synthesized and how lens crystallin is rated in the top five of a field of 32 competing journals “The most satisfying thing to me is when the mentee
name stands out: John proteins were being synthetized for one system to another.” and is routinely used as an open access exemplar by the manages me better than I manage them. Then, I know they
M. Nickerson, PhD. Nickerson attributes much of his training to Piatigorsky, National Library of Medicine and The National Institutes are truly ready,” Nickerson says.
Nickerson, professor and who was a highly regarded scientist in the field of research at of Health Library. Throughout the span of 30 years, he has mentored more
director of research and vice director of the Atlanta Vision the time. “Dr. Piatigorsky was a brilliant and creative scientist He also currently serves on the editorial boards of The than 20 pre- and post-doctoral students while at NIH and,
Research Community, has mentored a number of students and that was my other real attraction to the program; he was Journal of Ocular Biology, Diseases, and Informatics and today, he continues to mentor students at EEC. In fact, one
who seek a career in the field of vision research. thinking in ways that was different from other people in the Clinical Optometry. He is active on numerous national of his first mentees was current EEC faculty member and
field. It struck me as an opportunity to go to NIH and change and international committees and has served institution- researcher, Jeffrey Boatright, PhD. “Dr. Boatright—right
from studying the liver to the lens.” ally as well as at Emory on the University’s Library Policy from the get-go—has always been a valued colleague. It was
Setting the Foundation He received his bachelor’s degree at Massachusetts Insti- Committee. He is a prolific manuscript reviewer for numer- obvious immediately that he was a rising star. All I had to
But, before he knew he’d become a mentoring giant at EEC, tute of Technology, his master’s degree from Michigan State ous scientific publications. do was to get out of the way,” Nickerson says.
Nickerson got his start in 1981 by serving as a senior fellow University, his PhD from the University of Texas Medical A sought-after lecturer and visiting professor, Nickerson “I always look forward to the opportunity to mentor, grow
and biologist at the National Institutes of Health (NIH). Branch and completed a postdoctoral fellowship at the NIH. has been an invited speaker to universities across the and develop the careers of junior and senior researchers, all
“I got my start in vision research at NIH as a senior fellow He joined Emory Eye Center in 1991. United States as well as to international conferences. He while helping to reinvigorate the research program,” Nicker-
under the leadership of Joram Piatigorsky, PhD, who Nickerson’s core research area focuses on retinal has published more than 80 research articles, and numer- son says. “We have great opportunities to not only grow
suggested I study DNA technologies. I, then, completed my degenerative diseases and the genetics behind them. His ous book chapters and abstracts. the department, but to grow the area of vision research.”
10 | EMORY EYE | 2021 2021 | EMORY EYE | 11
FEATURE FACULTY
This image was taken prior to
the COVID-19 pandemic.
Expanding Vision Research “I am excited that we are spiffing up this new space
With so many exciting changes happening in the future for that hasn’t been renovated since the building was built
vision research, Nickerson thinks it is a great time for others 40 years ago. As for progress on the renovation, we
to get involved in the field. As the current director of completely gutted our existing area and created some-
research at EEC, Nickerson plays a role in not only thing completely from scratch for a better, more collab-
mentoring pre- and post-doctoral students, but he also orative work and research space. We are encouraging
oversees growing the research department, which is researchers to not only work by themselves, but to work
housed on the second floor of clinic building B on the in groups and teams. Over the next few years, we also
Emory University’s main campus. want to highlight the work that we are doing in several
The area has been renovated to welcome future key areas: Age-related macular degeneration (AMD),
researchers and ultimately grow the department’s diabetic retinopathy, glaucoma, ocular oncology, uveal
research program (see page 33). Over the next 5 years, melanoma. It is my hope that we can build upon what we
he has plans to grow the department to include six new have and create teams for each of these great projects,”
junior and senior faculty members. Nickerson says.
INSPIRING OTHERS
Allen D. Beck "Dr. Nickerson came from the National "Dr. Nickerson has been an amazing men- based on who you want to be because “John was my lab supervisor and men- “John was tenured at the National Eye
MD, director of Emory Eye Center Institutes of Health (NIH) to the Emory tor and my success as a PhD student is 1) they reflect the things you value in your tor during my stay at the NEI from 1990 Institute (NEI) in the mid-1980s when
and chair of ophthalmology Eye Center several years after I arrived. really the product of his mentorship. He science and 2) they will help guide your until he moved to Emory. I was sorry to I was a young post-doctoral student
“John has been a vital and productive He had already established himself as is an incredible scientist who is invested professional development’. Under Dr. see him go. His calm, common sense, there, at the dawn of ocular molecular
member of the Emory Eye Center research the world’s expert on interphotoreceptor in the lives and careers of his personnel Nickerson's mentorship and leadership, dry good humor, and excellent research biology. He had been recruited from
team for many years. Dr. Nickerson is now retinoid binding protein (IRBP). and is flexible with his time and expecta- I've learned the things that he values, both vision helped me along my own path to the NEI laboratory of Joram Piatigor-
our director of research, having served John has accomplished many things tions. This flexibility has allowed me to in his research and in the members of his becoming an independent researcher. sky, a true pioneer of ocular molecular
for ten years as our vice director in his during his career, including establish- grow independently as a vision scientist, lab. His brand of leadership puts emphasis His overall understanding of the eye biology, and his project was to clone
very capable way. ing—with Drs. Jeffrey Boatright and while still being able to go to him anytime I on the power of listening and reflection, research field has never failed to impress interphotoreceptor retinoid binding
He has made innumerable contribu- Bob Church—the first all-digital medical need help. Under his guidance, I have been the importance of elegant but simple me, and during my earlier years, I never protein (IRBP), an important protein of
tions to our knowledge of the basic journal, Molecular Vision, leading a weekly able to obtain independent grant funding, experiments in the discovery of complex talked with John without learning some- the retina. I was a protein biochemist
mechanisms of ocular disease states meeting on data session for all labs at the contribute to several publications, develop interactions and learning from those who thing relevant about how to navigate the working on the biochemistry of IRBP
and has come up with innovative strate- Eye Center, leading the Biology of the Eye skills both inside and outside of the lab and may have a different perspective on a world of Academic research. in another group, but I wanted to learn
gies for effective interventions. Course, training numerous PhD students ultimately fall in love with vision science.” concept than you do. We have remained friends, and I molecular biology to expand my skill-
But, Dr. Nickerson’s most obvious and fellows, including Dr. Boatright, obtain- As a mentor, Dr. Nickerson recognizes treasure his friendship. John is never set. John and his group were welcom-
accomplishment is founding Molecular ing virtually continuous NIH funding, estab- my accomplishments, encourages me impressed with power, only with the wis- ing and, most importantly, fun to work
Vision, an electronic journal that ranks lishing a Southeastern Vision Research to challenge my comfort zone, gives me dom of the person who wields it, and is with! So, for my part, I determined IRBP
among the top vision research journals. Seminar and now leading our departmental room to make mistakes, gives me the himself an excellent researcher, lab chief, protein sequences to guide and validate
However, I think the training and mentor- Core Grant and Training Grant. freedom to follow my ideas, and con- and director of students. As a lab chief his group’s IRBP gene sequencing, and
ship of many pre-doctoral candidates and John’s research is insightful and impec- structive criticism when I need it. All myself, I often try to use his approach in in return John trained me in the tech-
post-doctoral fellows is what stands out cable; he freely shares his time and exper- these things have enhanced my experi- dealing with students and in the lab, and niques of molecular biology.
in my mind. Our own Dr. Jeffrey Boatright tise; and he is a wonderful colleague. ence as a researcher in visual sciences, I am amazed that what seems so easy for At the time, IRBP was the largest
is a prime example of his wonderful men- He has greatly helped me with research and I'm sure will propel me forward in my him, is actually a delicate dance of un- protein ever whose gene was cloned.
torship abilities.” and professional advice, including critiqu- career ambitions.” derstanding people’s personalities and As a testament to John’s well-known
ing grants, and ensuring scientific rigor. I sensitivity to their needs. Emory is lucky generosity in training/mentorship, this
thank John for all he has done for me and to have him.” training has stood me in good stead in
Hans E. Grossniklaus the Emory Eye Center.” Steven L. Bernstein my career. These early interactions cer-
MD, MBA, vice chair of translational res MD, PhD, professor and vice chair of tainly have extended into a fruitful col-
earch, director of the L.F. Montgomery Bre Shelton research, department of Ophthalmol T. Michael Redmond laboration and friendship: over the past
Pathology Laboratory, and founding Salma Ferdous MA, pre-doctoral research scientist, ogy and Visual Sciences, Anatomy and PhD, senior investigator and chief, 30 years we have shared co-authorship
director of ocular oncology and path PHD Candidate, laboratory of Dr. laboratory of Dr. Nickerson Neurobiology, University of Maryland Laboratory of Retinal Cell & Molecular on 15 papers, and many, many good
ology service at Emory Eye Center Nickerson “I've always been told to, ‘choose a mentor School of Medicine Biology, National Eye Institute times in science!”
12 | EMORY EYE | 2021 2021 | EMORY EYE | 13
COMMUNITY
care
CREATING A NETWORK OF Emory Eye Center partners with vari-
IT IS ESTIMATED
THAT …
ous eye care organizations to establish 13% OF PATIENTS
CURRENTLY LACK ACCESS TO
an eye care network to prevent blind- AFFORDABLE VISION CARE
52
ness for those who need it most.
I
GA COUNTIES CUR-
magine needing vision care “Everyone deserves access to RENTLY LACK AN EYE HEALTH
but not being able to get the quality vision care. The state of PROVIDER
33%
care you need because you Georgia is very spread out and has a
don't know where to find an very poor public transportation
ophthalmologist or struggle system. Just because someone lives in OF GEORGIAN COUN-
to find reliable transporta- a rural area shouldn’t mean they can’t TIES LACK EYE CARE SERVICES
220%
tion to get to an eye care center. be provided with a basic level of care
Additionally, many healthcare from an eye professional,” O’Banion
organizations conduct vision screen- says. “Another issue we’ve noticed is THERE WILL BE A
ings but oftentimes lack the resources that many patients can’t drive to the INCREASE IN VISION IMPAIRMENT
to get their patient to a provider for eye doctor especially if they have a IN GEORGIA BY 2050
52%
follow-up treatment. The patient is debilitating condition such as diabetes
left with a known vision condition or age-related macular degeneration.
that needs to be diagnosed, cared for, This places a limit on how they can INCREASE IN
and treated but has no method of receive the care they need.” CONDITIONS SUCH AS DIABETIC
finding that care. Two graduate students began laying RETINOPATHY
Unfortunately, these are some of the groundwork for the program with
the common challenges many rural
Georgians or low-income, at-risk
individuals experience.
projection studies. In 2016, Laney
Williams, then a medical student at the
Donald and Barbara Zucker School
IN 2018, 13.7%
GEORGIANS WERE UNINSURED
OF
Emory Eye Center (EEC), in part- of Medicine at Hofstra/Northwell, (3RD HIGHEST IN THE U.S.)
nership with Georgia Vision 2020, completed a projection study that
aims to bridge these gaps and help examined how many Georgians will
Georgians get the vision care and be visually impaired or blind and IN APRIL 2020, THE UNEMPLOY-
MENT RATE REACHED AS HIGH AS
12.6%
treatment they need—through a determined the leading causes of these
network-based, telehealth program conditions through the year 2050.
called the Georgia Vision Network. Using those projections, in 2018,
Developed by Jacquelyn O'Banion, Alexandrea Williams, Rollins
MD, MSc., a comprehensive ophthal- School of Public Health Class of SOURCES: 1. Kelly E, Wen Q, Haddad D, O'Banion
mologist at EEC and director of Global 2019, and a graduate assistant J. Effects of an Aging Population and Racial Demo-
graphics on Eye Disease Prevalence: Projections
Ophthalmology Emory, the Georgia development coordinator, collected
for Georgia Through 2050. American Journal of
Vision Network seeks to create a web available eye care services (in both Ophthalmology. 2020;210:35-40. 2. Williams A,
of care—connecting patients in need ophthalmology and optometry) and O’Banion J. Through the Lens of Spatial Access
of eye care services with eye care coupled the results with access to to Care: The State of Georgia’s Vision. Submitted.
3. Lynch MG, Maa AY. The Use of Telemedicine to
professionals and organizations Extend Ophthalmology Care. JAMA ophthalmol-
equipped to provide those services. Continued ogy. 2016;134(5):543-544.
14 | EMORY EYE | 2021 2021 | EMORY EYE | 15
COMMUNITY
public transportation by county–and
This image was taken prior to
cross-mapped that information with the COVID-19 pandemic.
Laney’s projections to create a “Map
of Need” by county.
“My project examined the county-
level availability of eye health profes-
sionals—ophthalmologists and
Emory Eye Center Faculty Give Back at Community
optometrists—and public transporta-
tion in Georgia in relation to projected
increase in the prevalence of blindness
Health Clinic With Remote Area Medical
E
and visual impairment in Georgia
residents, aged 40 years and older,” mory Eye Center optom-
says Alexandrea Williams. etrists Mary Carlton, OD,
“I spent a couple of months identify- and Kristen Thelen, OD,
ing certified ophthalmologists and PREVENTING VISION LOSS FOR ALL GEORGIANS FAAO, are dedicated to
licensed optometrists in Georgia and Georgia Vision 2020 is a network of vision service providers collabo- ensuring their patients have healthy
conducted extensive Google searches rating to prevent visual impairment and helping Georgians achieve vision. Outside of their work at Emory,
to locate each practitioner's office, as their full visual potential through health promotions and education, they provide eye care to underserved
well as counties with public transporta- service delivery, and advocacy. and uninsured men, women and
tion. This project highlighted that there The organization’s vision is to create a world in which no Georgian is children at nationwide healthcare
may be reduced availability of both needlessly blind or visually impaired and where those with unavoidable clinics sponsored by Remote Area
resources in Georgia's rural counties, vision loss can achieve their full potential through universal access to Medical (RAM). Mary S. Carlton, OD Kristen Thelen, OD, FAAO
which may impact Georgia's rural resi- comprehensive eye care services. RAM is a Knoxville, Tennessee-
dents' ability to access timely eye care.” The Georgia 2020 Network is made up of the following organizations: based nonprofit provider of free mobile in Virginia. I was hesitant at first, but Thelen or another optometrist, at a
Through the Georgia Vision • Atlanta Lions Club medical clinics. Their mission is to once there, I was amazed at the num- designated station. A thorough eye
Network, patients will go through a • Center for the Visually Impaired prevent pain and alleviate suffering by ber of volunteers at the clinic, both pro- examination is performed to deter-
vision screening offered by certified • Emory Eye Center providing free, quality healthcare to fessionals and members from the mine the presence of vision-related
vision screening organizations like • The Georgia Lions Lighthouse Foundation those in need. community,” Carlton says. problems. For simple cases, patients
Prevent Blindness Georgia, Georgia • Georgia Eye Bank Many volunteer professionals provide “The clinics were extremely well are given medicine or an eyeglasses
Lions Lighthouse Foundation, and • Georgia Optometric Association free dental, vision and medical services organized. All the necessary equip- prescription and can pick up a free
others. The screening will also include • Georgia Society of Ophthalmology to underserved and uninsured men, ment was set up and optometrists, pair of eyeglasses the same day.
a needs assessment to determine if • Prevent Blindness Georgia women and children. The RAM website ophthalmologists and optometry “After the patients receive the
they qualify for any existing patient • Savannah Center for the Blind and Visually Impaired mentions 155,000 volunteers—licensed students participated in patient care,” exams, they are sent to a full-service
assistance programs. The information For more information about Georgia Vision 2020, visit: dental, vision and medical profession- Carlton says. on-site optical lab to have their
is stored in a HIPAA-secured portal www.gavision2020.org. als—have treated more than 800,000 The day begins with the clinic parking eyeglasses made,” Carlton explains.
and database which will be used to individuals and delivered more than lot opening to the public no later than “For continued care, we were provid-
connect the patient with a network of $150 million worth of free care. midnight on the first night of the event. ed a list of community eye doctors
local eye care providers who can EEC partnering with Georgia Light- are visually impaired and another “Volunteering with RAM brings a Each incoming patient is assigned a who would follow up with the patients
perform routine eye services or more house, who developed a fully outfitted 100,000 that are blind,” O’Banion says. special level of fun and fulfillment to my ticket and served by their ticket at no additional cost.”
complex eye care if necessary. van to perform comprehensive exami- “This is a 220% increase in visual life,” Thelen says. “The highly-supported number when clinic doors open. Doors “I enjoyed the experience so much, I
“Through this program, we eventu- nations but lacks the professional and impairment which significantly outpaces clinics are organized and efficient. We usually open for patients at 6 a.m. signed up for my second trip to Tennes-
ally can treat our patients in one place technological help to enhance capacity the anticipated U.S. increase of 150%.” can provide high-quality eye care while Dental, vision and medical services see,” Carlton says. "I love to give back
instead of having to send them to five ophthalmic care. Partnerships like this “Georgia also ranks third in the U.S. for getting to know an entirely new commu- are provided to patients on a first- to patients that are in need."
different places to get the care they would allow the program to function as those without health insurance, which nity. It’s always fun connecting with new come, first-serve basis. Due to time Mission trips are made possible by
need," O’Banion says. a mobile eye clinic and bring services can only be expected to increase due to people and lending a helping hand.” constraints, patients may opt to Emory through the Shared Operating
Although in its development stage, ranging from routine vision screenings the impact of COVID. It will take a Thelen began volunteering with choose between dental and vision and Unit Performance (SOUP) pro-
O’Banion anticipates the program will to comprehensive eye care directly to concerted and collaborative effort to RAM as an optometry student in 2011. services, although medical services gram. Each year, Emory University and
eventually incorporate a mobile the patient. bring services to those in need and She later invited Carlton to join. are offered to all patients. Emory Healthcare support additional
ophthalmology service. “Without intervention, Georgia is prevent Georgia residents from “Dr. Thelen approached me in 2018 When a patient chooses the vision individual and programmatic clinical
One such opportunity would involve expected to have 226,000 people who becoming visually impaired.” to volunteer with her for a RAM clinic option, they are seen by Carlton, and academic initiatives.
16 | EMORY EYE | 2021 2021 | EMORY EYE | 17COMMUNITY
WORKING
THROUGH
A NEW
NORMAL:
Providing vision care,
treating children
during COVID
E
mory Eye Center pediatric ophthal- for Emory Eye Center and Children’s Healthcare of Atlanta
mologists are expertly trained to work (CHOA) at Egleston. “In the beginning, we didn’t know
with children. Working with young how extensive the impact from COVID-19 would be, so
patients can bring its own set of we restricted visits to patients that needed emergency or
challenges on a normal day as children urgent care.”
require an extra level of care, but when The pediatric ophthalmology service at Emory Eye
the coronavirus pandemic—a novel coronavirus (SARS- Center provides comprehensive, compassionate care for
CO-V2), the virus that causes the disease COVID-19— children and their vision ranging from general eye exams
swept the country in March 2020 eye and vision care for to treatment of the most complex childhood eye diseases
young patients added a new level of complexity.
“For the first time ever, we essentially closed our clinic,”
says Amy K. Hutchinson, MD, a pediatric ophthalmologist Continued
18 | EMORY EYE | 2021 2021 | EMORY EYE | 19COMMUNITY
The Emory Eye Center's Pedi-
atric Ophthalmology service
provides comprehensive,
and disorders. They are uniquely situated to collaborate She continues, “Working with the pediatric ophthal- compassionate care of chil-
with other Center specialists on the diagnosis and treat- mology team has been great as everyone has been helpful dren's vision, from birth-17
ment of children's visual problems. and worked as a team to get these children the best care years of age, that range from
general eye exams to treat-
Hutchinson provides outpatient (office visits, short possible and point me in the right direction of where to send ment of the most complex
clinical visits) vision care at the Center and inpatient the children. I don’t have any experience working at Emory childhood eye diseases and
disorders.Our pediatric oph-
consultations (medical eye exams and treatment admin- that hasn’t included COVID-19, so this is my normal.” thalmologists are uniquely
istered to patients who are currently hospitalized) at A few months later the clinic began to reopen, Hutchin- situated for collaboration
with other Eye Center spe-
CHOA. In addition, Dr. Hutchinson performs weekly son and her team began to see patients that required cialists on the diagnosis and
and time sensitive retinopathy of prematurity screening more routine care. However, because of the coronavirus treatment of children's visual
problems.
exams in the neonatal ICU, which continued uninter- pandemic, the team raised a new level of caution for
rupted during the pandemic. themselves and for their patients. (left) Physician Phoebe Len-
hart, MD, shares a smile with
Retina specialist Baker Hubbard III, MD, provides care “We understood the major decisions we had to make a young patient adjusting to
for young patients with retinoblastoma (RB), a kind of eye as our clinic reopened for business. If we thought it was his new corrective lenses.
cancer. “RB patients must have regular laser treatments, or safe for a patient to postpone a routine exam, we did.”
they risk progression of tumors that may threaten their Hutchinson says. All images were taken before
the COVID-19 pandemic.
The pediatric ophthalmology service at Emory Eye
Center provides comprehensive, compassionate care
of children's vision ranging from general eye exams
to treatment of the most complex childhood eye dis-
eases and disorders.
vision or even their lives,” he says. “With that in mind, we “The waiting room looked different—with seats blocked
carefully continued care for patients with active RB even off and spaced at least 6 feet apart. We had to be mindful
during the weeks when most things were completely shut of how we kept the exam rooms occupied—this meant
down. We would examine them under anesthesia in the keeping the patients isolated in exam rooms or spaced out
operating room and then they would go to the oncology as much as possible in the main waiting room to allow for cleaned and sanitized, and our exam instruments are wiped
unit for chemotherapy. This was our usual routine and social distancing measures.” down,” Hutchinson explains.
we never stopped.” Due to the new patient and visitor guidelines put in place “It is still is very strange to not be able to give high fives
Pediatric specialist Sarah Dille Lee, OD, MSPH, FAAO, by Emory, one adult could accompany a child patient during or hugs to my patients, but that will probably be the norm
joined the Eye Center’s faculty in April 2020. Due to her an office visit. “During a slit lamp exam, we required the for a while now,” Lee says.
expertise managing complex eye conditions in children, doctor, patient and their visitor to wear a mask to reduce the Despite the changes that took place during the corona-
she began to see patients whose appointments were chances of spreading the virus,” Hutchinson says. “Most virus pandemic, EEC doctors continued to adapt and care
canceled early on during the pandemic. adult patients will wear a mask to their visit—for children, for those who need it most, oftentimes putting their own
“As a new provider without an established patient base, my however—it is difficult for them to keep their mask on health on the line.
role was to see the children that needed to be seen sooner. because they don’t fully understand what’s going on.” “The CHOA nursing staff is amazingly effective at making
However, the hardest part has been figuring out all the “If the waiting room got too crowded, we were prepared children and families comfortable and at reducing stress,”
appropriate referrals and how a new clinic operates while to ask patients to wait in their cars, but, luckily, we did not Hubbard says. “We owe these nurses a huge debt of grati-
the operation seems to be changing weekly for everyone have to resort to those measures,” Hutchinson says. “Just tude for their work under normal circumstances and that
based on the changing health recommendations,” Lee says. before the patient enters the exam room, each room is is even more true during COVID.”
20 | EMORY EYE | 2021 2021 | EMORY EYE | 21FEATURE PROFILE
A
s a young girl, (left) During the CXL procedure, vitamin b2 drops
grace
A SAVING
are applied and a controlled ultraviolet-A light
Tymeisha French shines directly onto Tymeisha's eye. (below)
and her mother, Cornea specialist Soroosh Behshad, MD, MPH,
performs the corneal collagen cross-linking
Emmalee Cooper, procedure on one of Tymeisha’s eyes.
noticed her eyes
looked different and she struggled
with poor vision. “I couldn’t see
anything—a person’s eyes, nose,
mouth or ears. I could only see the
outline of a person standing there
and the rest of it was blurry,” French
says. “I was bullied at school because
of the shape of my eye.”
The 16-year-old high school student
also works as a cashier at a local restau-
rant to help pay for her family’s bills.
Though French now confidently uses CXL procedure strengthens and family to share news that her CXL The recovery phase usually takes
the small computer screen to complete stabilizes the cornea by creating new procedure was paid for in full by a about one week for the eye to heal.
orders and check out customers just collagen fibers within the cornea.” generous donation to the Emory Eye “Patients commonly experience ocular
last year these tasks were impossible During the CXL procedure, liquid Center. “The room filled with screams discomfort and potentially light
due to her worsening vision. riboflavin (vitamin b2) drops are of joy, mixed with tears of happiness sensitivity for the first one to three
After several visits to multiple eye applied and a controlled ultraviolet-A and relief. This was truly a moving days,” Behshad says. “To help reduce
doctors and no formal diagnosis, a light shines directly on to the patient’s and memorable experience for our this discomfort, a bandage contact lens
friend referred French and her mother eye. This causes new corneal collagen entire team,” Smith says. is placed on the eye after the proce-
to the Emory Eye Center to meet with cross-links to develop. Those cross- dure, which stays in place for the first
cornea specialist Soroosh Behshad, MD, links cause collagen rod-like struc- two to four days and is removed at the
MPH, who also serves as the Center tures, or fibrils, to shorten and thicken, first post-operative visit. Their vision
Chief at Emory St. Joseph’s. French was leading to a stiffer, stronger cornea. continues to improve each day and
diagnosed with a progressive eye “The procedure takes about one hour, typically stabilizes around one week.”
disease called keratoconus—a condition and we numb the patient’s eye ahead of “The room filled “Tymeisha was seen four days
in which the clear tissue on the front of time so there is no pain or discomfort,” following the procedure, a second time
the eye (also known as the cornea) thins Behshad says.
with screams of joy, the following week, and every month
and bulges outward into a cone shape. All potential candidates with corneal mixed with tears of since her first procedure,” Behshad
Treatment for keratoconus involves
placing a specialty contact lens on the
conditions are thoroughly evaluated
by a cornea specialist. This evaluation
happiness and says. “Her vision has continued to
improve every visit. In addition, we
eye while a corneal specialist moni- includes a routine eye exam; a detailed relief. This was hoped the outcome of Tymeisha’s
tors the condition of the cornea. corneal mapping of the cornea; and truly a moving and procedure would stabilize her cornea
However, the disease later advances measurement of corneal thickness, and keep her keratoconus from getting
to a stage where specialty contact which determines if they’re a candi- memorable experi- worse, but—the great news is—since
lenses are ineffective, and the patient date for the CXL procedure. ence for our entire the procedure, her cornea and vision
must undergo a corneal transplant. As for the cost, the CXL procedure have both improved.”
In 2016, the Food and Drug is not covered by insurance compa-
team.” –Melanie Smith French is now enjoying life with her
Administration approved a new nies. Patients must often pay the full improved vision.
treatment technique called corneal cost—about $5,000-$10,000 per eye— If a patient requires surgery on both “It’s been great to hear about her new
A NEW TECHNIQUE collagen cross-linking (CXL). “CXL
is a minimally invasive outpatient
out of pocket.
French required CXL treatment in
eyes, a cornea specialist recommends
treating one eye at a time. This gives
successes, both in school and at work,"
Behshad says. "Since the procedure on
HELPS RESTORE A YOUNG procedure designed to treat progres-
sive keratoconus and other similar
both eyes.
In late 2019, Melanie Smith, the
the eye time to stabilize and minimize
risk of infection during the healing
her first eye, she has become so much
more confident. I’m looking forward to
PATIENT’S VISION conditions causing weakness of the
cornea,” Behshad explains. “The
Center’s CXL coordinator, set up a
conference call with French and her
process. French’s first procedure was
completed in January 2020.
proceeding with her second eye, thanks
to the support from our donors.”
22 | EMORY EYE | 2021 2021 | EMORY EYE | 23RESEARCH NEWS
PICTURE PERFECT
USE OF
N
ew findings published by Emory employ,” Newman explains. “However, just taking these
Eye Center neuro-ophthalmolo- photographs is not enough. Currently, someone must inter-
gists, Nancy J. Newman, MD pret the optic nerve appearance either on-site or via telemedi-
and Valérie Biousse, MD, along with cine, potentially delaying correct diagnosis and management.
an international consortium of This artificial intelligence deep-learning system automati-
researchers from the Brain and cally and immediately correctly classifies the appearance of
Optic Nerve Study with Artificial the optic disc without any additional clinical information.”
Intelligence (BONSAI) group and Singapore National Eye The research used 15,846 photographs from individuals
Centre show that an artificial intelligence deep-learning system of multiple ethnicities. The study showed that a deep-learn-
can accurately detect papilledema and other non-papilledema ing system can accurately differentiate between abnormal
optic disc abnormalities from ocular fundus photographs. optic discs and normal optic discs 99% of the time, and
Their research, “Artificial intelligence to detect papill- between papilledema and normal optic discs 98% of the
edema from ocular fundus photographs” was published in time. Further studies will investigate the use of this system
the New England Journal of Medicine in April 2020. The in a web-based application that can be used for immediate
work was a collaborative effort between Emory Eye Center interpretation of photographs obtained in real-life settings.
neuro-ophthalmologists and a group of researchers repre- “With more testing, our hope is that the Singapore
senting 24 centers in 15 countries around the world, led by engineers will eventually create a simple screening tool
Singapore Professor Dan Milea, MD, PhD, and Singapore that is low-cost, easy to use and only requires photographs
engineers under the direction of Professor Tien Yin Wong, of a person’s eyes in a clinic or emergency department,”
MD, PhD. says Biousse. “This screening could allow serious neuro-
The study examines the use of a deep-learning system, or logic problems to be quickly identified and treated, and
a special computer algorithm, to detect the optic disc, the potentially save a patient’s vision or life. Such a tool would
visible portion of the optic nerve, and classify it as normal, help diagnose patients without having them travel to an
papilledema (swelling of the optic disc specifically due to eye clinic – a particularly important concern now, consid-
increased pressure in and around the brain) or another optic ering the COVID-19 pandemic.”
disc abnormality, using photographs of the back of the eye Newman currently serves as director of the Neuro-
(ocular fundus). Ophthalmology service at the Emory Eye Center, where
Emory Eye Center neuro- “Examining the ocular fundus is an integral part of the she maintains the LeoDelle Jolley Chair of Ophthalmology.
ophthalmologists Valérie physical examination that should be performed in many She also holds the positions of professor of Ophthalmology
Biousse, MD, and Nancy
Newman, MD, were part clinical settings where expert eye-care specialists are and Neurology and instructor in Neurological Surgery at
of the research team that frequently not immediately available,” says Newman. the Emory University School of Medicine.
led the groundbreaking
research. “Recognizing abnormalities of the optic nerve is particularly Biousse is a professor in the Neuro-Ophthalmology
This image was taken prior
important in emergency departments and neurologic and service at the Emory Eye Center. She is the Cyrus H. Stoner
to the COVID-19 pandemic. primary care clinics, where detection of papilledema can professor of Ophthalmology, and she also holds the position
reveal vision- and life-threatening conditions of elevated of professor in the department of Neurology. She serves as
intracranial pressure such as brain tumors and clots in the the department of Ophthalmology’s vice-chair for Faculty
veins of the brain.” Development, Diversity, Equity, and Inclusion.
Research team uses artificial intelligence “Ocular fundus photographs can remove the need for direct
examination of the eye using an ophthalmoscope—an instru-
The research was funded by the Singapore National Medi-
cal Research Council and the SingHealth Duke-NUS Ophthal-
to detect abnormalities in the optic nerve
ment non-ophthalmologists find difficult to use and rarely mology and Visual Sciences Academic Clinical Program.
24 | EMORY EYE | 2021 2021 | EMORY EYE | 25You can also read
