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envision

Volume 1 , No. 2 Fall 2003 News from the University of California, Davis, Department of Ophthalmology

inside envision
meet our eye team ophthalmologists.......... 2 vision scientists ............ 2 optometrists................. 2 moving forward professional achievements............... 3 Ophthalmology faculty completes professional development program .. 3 faculty publications ...... 3 New book publications . 4 research clinical drug, device and research trials.............. 4 Grants to fund new research and training in ophthalmology and vision science .......... 4 education Profile of an Ophthalmologist.......... 5 PBS film crew visits UC Davis .......................... 5 Dear Friends and Colleagues:

A Vision for Our Future


Message from the Chair
It is a singular honor to assume the responsibility of leadership of the Department of Ophthalmology at UC Davis, now poised at an important crossroad after 26 years under the able leadership of my friend, mentor, and colleague, John Keltner. I With plans to expand our faculty in the coming am proud to note that our department, although year with a full time pediatric ophthalmologist, small when compared with many other prominent one of our significant problems remains physical academic programs, is distinguished in many space, already woefully inadequate. Thanks to ways: We were the first accredited residency the joint leadership of the UC Davis School of training program in our young medical school; Medicine and the UC Davis Health System, we Mark J. Mannis, M.D., Chair we have become a thriving regional referral center have garnered support for the next phase of Department of Ophthalmology in Northern California; we are one of the busiest, growth and accomplishment. This leadership, if not the busiest, outpatient clinic in our health system; and most visionary but pragmatic, has indicated its support for the UC Davis importantly, we have assembled a superb faculty of clinicians and Eye Centera project we hope to realize over the next several research scientists. years. Envisioned as a state-of-the-art regional center of excellence in eye care and research, the ...we will Eye Center project will, hopefully, join the UC The future for us is rife with challenges and continue to focus Davis Cancer Center and the M.I.N.D. Institute full of promise alike. At a time when creative on quality health as a regional and national institute of recognized academic life is difficult to sustain in the face care delivery quality. In partnership with the Health System, of ailing state budgets, poor reimbursements, and scientific industry, and our grateful patients, we hope to and the need to sustain significant clinical creativity. bring this project to fruition. productivity, the academic clinician can easily succumb to discouragement. At the same time, I wish to thank my outstanding faculty, my never before have academic faculty been blessed talented and devoted administrators and staff, and the leaders of with finer tools for creative research, effective teaching, and the School of Medicine and the Health System, for their support professional self-realization. Our department has assembled and hard work on behalf of our department. The coming months a fine clinical team coupled with a small but brilliant cadre will surely bring new opportunities, substantial obstacles, failures, of basic scientists in areas ranging from basic studies in and triumphs. However, we will continue to focus on quality proliferative vitreoretinopathy to the visual psychophysics health care delivery and scientific creativity. I hope you will enjoy of the aging eye to immunologic studies of cancer related reading about the accomplishments of our department. retinopathy. The eye department also participates in over 66 clinical trials and serves as the visual field reading center for the pacemaking Ocular Hypertension Treatment Study (OHTS). In 2003 alone, three new text books will be published by faculty in our department.

The ophthalmology residency at UC Davis.... 6 alumni news .............. 6 events the eye scene .............. 7 educational & event calendar ..................... 7 Unprecedented growth leads to Regional Eye Center Initiative. ........................ 8
Contributing Editors: Robert A. August, R.N., Phillip H. Choo, M.D., Barbara A. Holderreed, John L. Keltner, M.D., Mark J. Mannis, M.D. , Sharon E. McKee, and Diane Weeks. Design: Sharon E. McKee Photography: Emi Manning, Debbie Aldridge, and Robert A. August

by Esther Kim, M.D.

Cataract surgery may improve driving safety and more . . .


Numerous studies have shown that as many as 50% of all adults between 60 and 75 years old have cataracts. A cataract is the most common ailment of the aging eye and occurs when the natural lens in our eye becomes cloudy or opaque. Because of decreased visual acuity, contrast sensitivity, and glare problems, having a cataract can be much more than a nuisance; half of those with cataracts may experience difficulty with everyday visual tasks such as reading and driving. Communication may also become more difficult because a person with hearing problems may be unable to rely on reading lips or other facial features to help them out. Using driving an example, safety as numerous studies have been published indicating that older drivers with cataracts are more likely to have a history of recent automobile accidents when compared to older drivers without cataracts. Recently, a study was released indicating that cataract surgery can reduce the risk of automobile accidents by 50% if a cataract was responsible for reduction of vision to less than 20/40 (Owsley C, McGwin G, Sloane M, et al. Impact of Cataract Surgery on Motor Vehicle Crash Involvement by Older Adults. The Journal of the American Medical Association 288:841-849). Explanations for this phenomenon include the fact that decreased visual acuity makes street signs harder to read and taking longer to decipher the sign takes away from the scanning and peripheral vision that are so crucial for driving. Secondly, decreased contrast sensitivity makes it more difficult to distinguish objects of similar colors, like a pedestrian in dark clothing at night, and can make objects in a fog harder to see. Finally, glare can cause momentary blindness, which could decrease important time to see and respond to situations requiring split second decisions. The decision to have cataract surgery can improve the symptoms of poor visual acuity, contrast sensitivity, and glare problems.
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Innovative lens implants for use in cataract surgery


by Jeffrey Caspar, M.D.

Dr. Esther Kim performs cataract surgery.

When a cataract is surgically removed, the focusing power it provided must be replaced. Several decades ago, this was done with very thick coke bottle glasses or a thick contact lens. Today, the focus is provided with man-made lens implants. Implantable intraocular lenses were first used successfully in cataract surgery in 1949. Lens implants provide patients excellent vision quality without the inconvenience of contact lenses or thick glasses. The standard lens implants used in cataract surgery have the ability to correct for myopia or
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uc davis eye team...


ophthalmologists

Mark J. Mannis, M.D., FACS Chair


Cornea, External Disease/ Refractive Surgery

Phillip H. Choo, M.D. Vice Chair


Ophthalmic Plastic and Reconstructive Surgery

James D. Brandt, M.D.


Glaucoma

Comprehensive Ophthalmology and Refractive Surgery

Jeffrey J. Caspar, M.D.

Neuro-Ophthalmology/ Pediatric Ophthalmology/ Strabismus

John L. Keltner, M.D.

Esther S. Kim, M.D.


Comprehensive Ophthalmology

Michele C. Lim, M.D.


Glaucoma

Lawrence S. Morse, M.D., Ph.D.


Retina/Vitreous/Uveitis

Alan M. Roth, M.D.


Ophthalmic Pathology

Ivan R. Schwab, M.D., FACS


Cornea and External Disease/Uveitis

Volunteer Clinical Faculty


Barbara J. Arnold, M.D. Colin B. Arnold, M.D. Kevin A. Beadles, M.D. Craig E. Berris, M.D. Ronald J. Cole, M.D. Byron H. Demorest, M.D. Arthur T. Glover, M.D. Richard D. Grutzmacher, M.D. Daniel M. King, M.D. Jin H. Kinoshita, Ph.D. William J. Kohl, M.D. Philip L. Levy, M.D. Robert B. Miller, M.D. James B. Ruben, M.D. Denise Satterfield, M.D. Ernest F Tark, M.D. . John T. Tong, M.D. James L. Uhrhammer, M.D. Bruce A. Winters, M.D. John H. Zeiter, M.D.

Duva J. Appleman, M.D. Francisco J. Garcia-Ferrer, M.D.


V.A. Mather Glaucoma

V.A. Mather Cornea, External Disease/ Refractive Surgery

Linda J. Margulies, M.D.


V.A. Martinez Vitreo-Retinal Disease

vision scientists

Leo M. Chalupa, Ph.D. Leonard M. Hjelmeland, Ph.D. Charles E. Thirkill, Ph.D.


Visual Developmental Neurobiology
Biochemistry

Ocular Immunology

John S. Werner, Ph.D.


Visual Psychophysics

optometrists

Thomas B. Barnes, O.D.


Senior Optometrist

Shannon C. Lutz, O.D.


Senior Optometrist

Marcia Y. Nearing, O.D.


Senior Optometrist

Myhanh T. Nguyen, O.D.


Senior Optometrist

Kaaryn C. Pederson, O.D.


Senior Optometrist

moving forward...
professional achievements
John S. Werner, Ph.D. Visiting Professorships Colorado State University, Molecular and Integrative Neuroscience Stanford University, Psychology and Neuroscience Invited Speaker Center for Adaptive Optics, San Jose, CA Society for Philosophy and Psychology, California Institute of Technology, Pasadena, CA Association Internationale de la Couleur, Bangkok, Thailand Community Service Aging and Disease (Older Womens League of Sacramento), Sacramento, CA Charles E. Thirkill, Ph.D. Invited Speaker Immune-Mediated Retinal Degenerations, Annual meeting of the American Uveitis Society, Fort Lauderdale, FL John L. Keltner, M.D. Visiting Professorship CAR, MAR, and AARON Syndromes, Rich Lecture, University of Alabama, Birmingham, AL Appointment Director of Research, UC Davis Ophthalmology Department Phillip H. Choo, M.D. Courses Workshop on Endoscopic Forehead and Eyebrow Elevation. The American Academy of Ophthalmology 2003 Annual Meeting, Anaheim, CA. Associate Instructor Appointments Vice Chair, UC Davis Ophthalmology Department Chair, Ambulatory Care Work Group, Clinic Redesign Subcommittee Community Service Lake Wildwood Wellness Clinic, Cataracts and Glaucoma talk, Penn Valley, CA.
Ivan R. Schwab, M.D. Visiting Professorships UC San Francisco, San Francisco, CA New England Ophthalmological Society, Boston, MA Casey Eye Institute, Portland, OR University of Toronto, Toronto, Canada Invited Speaker Regenerative Medicine Conference, Washington, DC Bioengineered Ocular Surface Tissue Hawaii Ophthalmological Society, Honolulu, Hawaii Bohemian Grove, The Evolution of the Eye, Healdsburg, CA Appointments & Awards Director of Cornea Service American Academy of Ophthalmology (AAO), Hall of Volunteers AAO, Special Interest Team for Cornea & External Disease (4 members) Selected as one of The Best Doctors in America Woodward & White Publishers Miscellaneous Host of PBS special The Healthy Eye as part of their Healthy Body Series. Lawrence S. Morse, M.D., Ph.D. Invited Speaker Macular Degeneration: New Ideas for an Old Problem. UC Davis Center for Aging, Sacramento, CA Appointments & Awards Selected as one of The Best Doctors in America Woodward & White Publishers Guest editor for Investigative Ophthalmology & Visual Sciences. - Miscellaneous Instructor of Basic Science and Clinical Ophthalmology Course, Stanford University., Stanford, CA Mark J. Mannis, M.D. Visiting Professorship George Washington University, Washington, DC Appointment Chair, UC Davis Ophthalmology Department

Ophthalmology faculty completes professional development program


Practicing ophthalmology in the academic setting involves more than patient care. In addition to providing the most up-to-date treatment for our patients, our faculty are involved in many other facets of professional life related to teaching and research. Dr. Michele Lim, Assistant Professor of Ophthalmology and a specialist in glaucoma, recently completed a special professional development program sponsored by the UC Davis School of Medicine. The School of Medicine/UC Davis Extension Professional on program Development and Collaborative Mentoring is designed to help new faculty members succeed in their careers at UC Davis. The program covers a wide range of topics, including several classes on leadership and communication, as well as a primary emphasis on writing for publication. The program was designed and coordinated by the Associate Dean of Academic Affairs office headed by Dr. Lydia Howell. Other School of Medicine faculty interested in taking part in this important new program should contact Dr. Howells office. The Department of Ophthalmology is proud that Dr. Lim took the initiative to complete this very worthwhile program. In addition to her busy practice in glaucoma, Dr. Lim has assumed the leadership role in bringing the Electronic Medical Record to the Department of Ophthalmology.

Dr. Michele Lim (right) accepts certificate of completion of the Professional Development Program from Associate Dean Lydia Howell.

recent faculty publications

(Faculty authors name is in bold print) Keltner JL. (as a member of the Writing Committee and Director of the Visual Field Reading Center for the Optic Neuritis Study Group) High- and low-risk profiles for the development of Multiple Sclerosis within 10 years After Optic Neuritis. Archives of Ophthalmology 121:944-949. Miyamura N, Mishima K, Honda S, Aotaki-Keen AE, Morse LS, Handa JT, Hjelmeland LM. Topographic and age-dependent expression of heme-1 and catalase in the human retinal pigment epithelium. Investigative Ophthalmology and Visual Sciences. In press. Pfohler C, Haus A, Palmowski A, Ruprecht KW, Thirkill CE, Tilgen W, Reinhold U. Melanoma-Associated Retinopathy (MAR): High frequency of subclinical ophthalmologic findings in advanced stage cutaneous melanoma patients. British Journal of Dermatology 49(1):74-78. Pfohler C, Thirkill CE, Tilgen W. Rosette formation in melanoma: More frequent than suspected? American Journal of Dermatopathology 25(4):360-361. Pinna B, Spillmann L & Werner JS. Anomalous induction of brightness and surface qualities. Perception, in press. Pinna B, Werner JS & Spillmann L. The Watercolor Effect: A new principle of grouping and figure-ground organization. Vision Research 43:43-52. Schwab IR, et al. A Phase III Clinical Trial of 0.5% Levofloxacin Ophthalmic Solution versus 0.3% Ofloxacin Ophthalmic Solution for the treatment of bacterial conjunctivitis. Ophthalmology 110 (3):457-465. Shaikh S, Goldblum RS, Morse LS, Aslam R, Singh K. Setons and serum IgG titers to silicone. Journal of Glaucoma 11(6):508-510. Shinomori, K. & Werner, JS. Senescence of the temporal impulse response to a luminance pulse. Vision Research 43, 617-627. Suhler EB, Chan CC, ...Thirkill CE, et al. Presumed paraneoplastic retinopathy associated with teratoma. Archives of Ophthalmology 121:133-7. Werner JS & Spillmann L. Floyd Ratliff and the neural foundations of perception. In G. Kimble and M. Wertheimer (Eds.) Portraits of Pioneers in Psychology (Vol. 5). Hillsdale, NJ: Lawrence Erlbaum, pp. 332-343.

Awwal A, Baumann B, Gavel D, Olivier S, Jones S, Silva D, Hardy JL, Barnes T & Werner JS. Characterization and operation of a liquid crystal adaptive optics phoropter. Proceedings of SPIE. R. Tyson & M. Loyd-Hart (Eds.) Astronomical Adaptive Optics Systems and Applications. (Vol. 5169). Chen LZ, Mannis MJ, Salz J, Garcia-Ferrer FJ, Ge J. Analysis of IOL power calculation in post-radial keratotomy eyes. Journal of Cataract and Refractive Surgery 29(1):65-70. Choo PH, Rathbun JE. Cautery of the orbital septum during blepharoplasty. Ophthalmic Plastic and Reconstructive Surgery 19:1-4. Freitas D, Alvarenga L, Sampaio J, Mannis MJ, et al. An Outbreak of Mycobacterium Chelonae Infection after LASIK. Ophthalmology 110 (2):276-285. Ghanem VC, Mannis MJ. O professor e o estudante na facoemulsificaco: os dez principios para o sucesso. Os Arquivos Brasileiros de Oftalmologia 66:93-99. Ghanem VC, Mehra N, Wong S, Mannis MJ. The Prevalence of ocular signs in Acne Rosacea. Cornea 22 (3):230-233. Gerth C., Delahunt PB, Crognale MA & Werner JS. Topography of the chromatic pattern-onset VEP. Journal of Vision 3:171-182. Gerth C, Sutter EE, Werner JS. mfERG response dynamics of the aging retina. Investigative Ophthalmology & Visual Science 44:4443-4450. Gerth C, Hauser D, Delahunt PB, Morse LS & Werner JS. Assessment of multifocal electroretinogram abnormalities and their relation to morphological characteristics in patients with large drusen. Archives of Ophthalmology, 121: 1404-1414. Haus AH, Palmowski A. ....Thirkill CE, et al. Screening for melanomaassociated retinopathy in patients with cutaneous malignant melanoma. Neuro-Ophthalmology 27(1-3):121-137. Keltner JL. (as a member of the Data Safety and Monitoring Committee for the Pediatric Eye Disease Investigative Group) A randomized trial of patching regimens for treatment of moderate amblyopia in children. Archives of Ophthalmology 121:603-611.

new book publications


In addition to the steady flow of contributions to the scientific literature from members of our faculty, 2003 is a landmark year that will see the publication of three new texts by members of our faculty. Dr. Ivan Schwab, Director of the Cornea and External Disease Service, has compiled and edited an atlas, Diseases of the Eye and Skin, a project initiated some years ago by one of the great American scholars in cornea and external disease, the late Dr. Bruce Osler. The new text, authored by Dr. Schwab in collaboration with Drs. Howard Maibach and Axel Hoke, was published by Lippincott, Williams, & Wilkins this Fall. This atlas is the most contemporary and thorough text on this important topic and is the culmination of over three years of work by Dr. Schwab. It is an important resource for dermatologists, comprehensive ophthalmologists, and ophthalmic subspecialists who encounter skin diseases that affect the eye. Dr. Mark Mannis has collaborated with Dr. Karla Zadnik of Ohio State University to produce a new text entitled Contact Lenses in Ophthalmic Practice to be published this fall by Springer Verlag, New York. Dr. Mannis translated the text from the original Portuguese volume by Cleusa CoralGhanem and Newton Kara-Jose, two of the leaders in contact lenses in Brazil.

After the translation into English, Drs. Mannis and Zadnik completely revised the book, updating it, adding new authors and making it suitable for the English speaking readership. This will be the first book in the literature jointly produced by ophthalmologists and optometrists as a primer for contact lens practice and is designed to be an aid to ophthalmology residents, optometry students, ophthalmic technicians, and ophthalmologists returning to contact lens practice. Contributors to the book include other members of the UCD Department of Ophthalmology including Kaaryn Pederson, OD, and Dede Reyes, FCLSA of our Contact Lens Service.

Drs. Jack Werner and Leo Chalupa have co-edited the two volume text The Visual Neurosciences. This textbook consists of 114 chapters by leading figures in vision science from 13 different countries. Contributed to by leaders in the field, the book includes contributions by nine vision scientists at UC Davis. The Davis contributing authors are distributed across five university departments, attesting to the breadth as well as the recognition of our Vision Science Research Group.

The Visual Neurosciences will set the standard for state-of-the art basic vision science and reflects the remarkable growth of our vision science community at the University of California Davis. It will be available this fall and marketed throughout the world by both the neuroscience and cognitive science divisions at MIT press.

research . . .
clinical drug, device & research trials currently recruiting subjects
Comparison of Subconjunctival Injections of 100 mg. CAT-152 Human Anti-TGF2 Monoclonal Antibody with Intraoperative Sponge Application of 5-Fluorouracil Following First Time Trabeculectomy (CAT Study). PI: James D. Brandt, M.D.; Sponsor: Cambridge Antibody Technology. Purpose: To compare the efficacy of using CAT-152 vs. 5-fluorouracil during first time trabeculectomy to control the amount of scarring incurred by the surgery, which may eliminate further problems related to scarring. Deep Lamellar Endothelial Keratoplasty (DLEK Study). PI: Mark J. Mannis, M.D.; Sponsor: Department of Ophthalmology in collaboration with Devers Eye Institute. Purpose: To determine if DLEK is able to reduce the degree of corneal astigmatism (warping of vision), irregularity of the corneal surface (outside surface) and shorten the time of recovery compared with the current surgical procedure using a full thickness corneal transplant. Keratoprosthesis in Severely Diseased Corneas. PI: Mark J. Mannis, M.D.; Sponsor: Department of Ophthalmology in collaboration with Harvard Medical School/ Massachusetts Eye & Ear Infirmary. Purpose: To test a keratoprosthesis implant in patients who have experienced two graft failures previously. A Phase III, Multicenter, Randomized, Double-Masked, Sham InjectionControlled Study of the Efficacy and Safety of rhuFAB V2 (RANIBIZUMAB) in Subjects with Minimally Classic or Occult Subfoveal Neovascular AgeRelated Macular Degeneration. PI: Lawrence S. Morse, M.D., Ph.D.; Sponsor: Genentech. Purpose: This experimental drug, which is given by injection into the eye, is being tested for the treatment of neovascular (wet) age-related macular degeneration (AMD). Neovascular AMD is one of the leading causes of vision loss in people 65 years of age and over. Ocular Rosacea: Determining a Specific Diagnostic Test. PI: Mark J. Mannis, M.D.; Sponsor: Department of Ophthalmology. Purpose: To determine whether a new diagnostic tool can accurately provide a marker for early detection of ocular rosacea. Color Appearance Following Cataract Surgery. PI: John S. Werner, Ph.D.; Sponsor: National Institutes of Health. Purpose: To understand agerelated changes in human color and pattern vision. This study measures changes in color and pattern vision following cataract surgery. Personality Type and Pigment Dispersion Syndrome (PDS Study). PI: Michele C. Lim, M.D.; Sponsor: Department of Ophthalmology; Purpose: To compare prevalence of Type A Behavior (TAB) in Pigment Dispersion Syndrome patients to patients with other forms of glaucoma and age- and sex-matched controls. A higher incidence of TAB in PDS patients may suggest possible pathophysiologic mechanisms of pigment dispersion and therefore new forms of treatment.

Grants fund new research and training in ophthalmology and vision science
The National Eye Institute (NEI) has awarded funding for Dr. Jack Werner to develop new instrumentation for imaging single cells in the living human retina. Presently, it is not possible to photograph or see the photoreceptors or ganglion cells in the living eye. Yet, these are the cells of great importance for early diagnosis of retinal disease. Dr. Werner and his team propose to combine adaptive optics technology and optical coherence tomography to develop instruments that will be used in basic and clinical research designed to find the cellular origins of blinding diseases. The grant will involve collaborators at Indiana University and the Lawrence Livermore National Laboratory. NEI has also funded a UC Davis campus wide training program in vision science. Dr. Werner is the program director and principal investigator of a grant to provide interdisciplinary training of advanced graduate students and postdoctoral fellows. Trainees will come from disciplines as diverse as biomedical engineering, genetics, neuroscience and psychology in order to foster translational research with ophthalmology. The goal of the training program is to produce vision scientists who will be capable of establishing independent research programs that will address significant problems in vision science and ophthalmology.

JohnWerner, Ph.D.

education . . .

Passion is the word that comes to mind when meeting Dr. Barbara Arnold, an ophthalmologist in solo, private practice in Sacramento, California. As if managing her own practice isnt enough, Dr. Arnold channels her energy into volunteerism and political lobbying. Where does this commitment to people and issues beyond her immediate personal responsibilities come from? Perhaps it was her upbringing in Alliance, Nebraska, where

assion

Profile of an Ophthalmologist
by Michele Lim, M.D. medical community. She has travelled to China to help improve health care systems and eye care. While there, she performed cataract surgery under primitive conditions. Now, through her relationship with the Rotary Club of Sacramento, Dr. Arnold serves as host to doctors from less industrialized countries. Her most recent sponsorship was a physician from Indonesia. As for her political activism, Arnold recalls her high school American government teacher who eschewed the often seen attitude that They (the government) are doing it to us. He taught his students that, we can decide what happens to us, but we have to get in there and try to adjust things. Dr. Arnold is past president of the California Academy of Ophthalmology and of the Alta California Ophthalmological Society. She was a delegate in the California Medical Association and served on the board of directors for the Sacramento County Medical Society. The list goes on. You must have been one of those kids who ran for office as a high school student!, I exclaim after reviewing her list of political activities. Yes, she winks, but I was only Vice President back then. Her political activism began early in her residency when her department chairperson asked her to testify during a state hearing. This experience ignited an excitement within
Sterling Photograhy

career as a physician and continue to write. Role models came up many times during our conversation. Now, Dr. Arnold serves as a role model to up-and-coming physicians. She is a Volunteer Clinical Faculty member at U.C. Davis and spends her time teaching medical students. Family Practice residents also rotate with her in her busy private practice. Faculty should be positive role models to inspire the best and the brightest. Unfortunately, in todays managed care environment, this is becoming more challenging. Managed care has a negative effect on how physicians practice medicine and it seems that the focus is the bottom line and not the patient. You can have the brightest clinicians, but if they dont learn to listen to the patient, the patient will never develop trust. Dr. Arnold has never sacrificed the willingness to listen. She likes to connect with her patients, to listen to them and to truly address their needs. I just hope they (medical students and residents) see our collective sense of passion and even more importantly, our sensitivity to individuals. When Dr. Barbara Arnold attended medical school at the University of Colorado, she was one of only six women students in her class. Now, almost 50 percent of medical students and almost one-third of current

Barbara Arnold, M.D.


Volunteer Clinical Faculty, UC Davis

ophthalmology residents in the United States are women. Dr. Arnold was the founder of Women in Ophthalmology, an independent organization which holds an annual conference in Aspen, Colorado. It is an opportunity for women ophthalmologists to present their research and to build the bonds necessary for a successful career. Women in Ophthalmology also presents a conference at the American Academy of Ophthalmology annual meeting and its

You have to learn to give without compensation and you learn by example.
her family has owned a farm since 1887, which gave her a sense of community. When youre in a small town, you learn how everyone supports each other. It also comes from her parents who were important role models for her. They volunteered a great deal of their time. You have to learn to give without compensation states Arnold, and you learn by example. Though she now lives in the relatively large town of Sacramento, the idea of community is important to her. Community involvement is not restricted to the town she lives in. Dr. Arnold also plays a vital role in our international

her because her testimony was very influential and the legislature voted according to her recommendations. Dr. Arnold notes, to be influential you must be high energy, have a can-do attitude, and just show up! I asked why she and other lobbyists put long hours into what can often be a frustrating, bureaucratic process. The answer Because we care and we CAN. We have the passion to improve the community and health care, and we have the ability to know how to make a change. Dr. Arnold excelled in high school and was drawn to medicine because, I like to read. As a girl, she also identified with many women in science such as Madame Marie Curie and Elizabeth Blackwell, an early American woman physician. Her other talent was journalism, but she figured she could pursue a

...to be influential you must be high energy, have a can-do attitude, and just show up!
attendance has soared to 1,100 participants. When not serving as a political advocate, a role model to students, a caring physician to her patients, and a single mother to her daughter, Dr. Arnold returns to her farm in Alliance, Nebraska to recharge her batteries three times a year. Some people have a beach house or a mountain cabin as a retreat. I have my farm which reenergizes me! At the rate she is going, Dr. Arnold will continue to be well energized in the years to come to contribute in a positive way to our community and to our medical profession.

PBS film crew visits UC Davis


by Robert August
In early September 2003, Public Broadcasting Service (PBS) film producer Ed Lerner and his film crew visited the UC Davis Department of Ophthalmology to interview Dr. Ivan Schwab. The interview will be used for an upcoming PBS special entitled The Healthy Body in which Dr. Schwab narrates the segment featuring the Healthy Eye. In the Healthy Eye segment, Dr. Schwab and two other prominent ophthalmologists will describe the eyes anatomy and basic functions. In addition, various eye diseases and conditions will be discussed. The highlights of this segment are the personal stories from two of Dr. Schwabs patients, Lois Warren and Audrey Busi. Mrs. Warren relates a compelling story about her painful experience with recurrent corneal erosion syndrome, an eye condition that caused chronic pain and visual distortion. The eye condition severely interfered with Mrs. Warrens work as an artist. Following lengthy therapy using bandage contact lenses, medication and close follow-up care by Dr. Schwab,

(left to right) Dr. Ivan Schwab, artist Lois Warren and her husband, David Warren, during a break in the PBS filming of the Healthy Eye.

Once or twice a month, Audrey would spontaneously experience eye pain and swelling that lasted three to five days. The sensation was described as being similar to having a painful corneal abrasion. Between each episode Audrey was a happy, healthy four-year-old. However, it was difficult for Audrey to live a normal childhood during those times
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Mrs. Warren can now continue her lifes passions of designing and creating fine jewelry and painting water color landscapes. The second story features four-year-old Audrey Busi. It is difficult to imagine

that less than a year ago the spunky little girl was plagued by what was thought to be recurring eye infections. According to her parents, Audreys life was a series of painful visits to emergency rooms, ophthalmologists and her primary care physician.

Four-year-old Audrey Busis personal story will be featured in the PBS special.

Dr. Caspar leads a resident teaching conference (pictured clockwise from lower left): Drs. James Carolan, Huck Holz, Jason Darlington, Sean Adrean, Peter Yip, David Woods, Resident Director Jeffrey Caspar, Bonnie Quiroz, and Jason Dimmig.

education . . .
The ophthalmology residency at UC Davis
The residency training program in the Department of Ophthalmology at the University of California, Davis was the first accredited residency training program in the UC Davis, School of Medicine. Since its establishment, our program has graduated 70 residents who have gone on to productive careers both in the private practice of ophthalmology as well as academic ophthalmology. Our program has been at the center of educational innovation in ophthalmic training, and for a period of time, we spearheaded the effort to convert American Ophthalmology residency programs to four years. Although this effort was not ultimately successful nationally, our program moved to the forefront of innovation in training. The hallmark of the training program at UC Davis is the direct and individual instruction our residents receive from faculty, both in the clinic and the operating room setting. Beginning with the choice of residents-- a process in which all our faculty play a significant role-- and through to the completion of their training, our residents enjoy a close working relationship with the faculty on a day-today basis. Roughly 50% percent of our residents go on to fellowship training with the remainder becoming comprehensive ophthalmologists. The training program at UC Davis is complemented by a subspecialty lecture series given every Monday evening and a full series of regular conferences covering optics and refraction, Drs. Mark Mannis (left) and Jeffrey Caspar uveitis, and fluorescein angiography. The (center) instruct resident Dr. David Woods. residency program at UC Davis is one of the few programs in the country that benefits from two affiliated Veterans Administration hospitals. Our extraordinary VA teaching staff provide the residents with a quality clinical experience and a significant surgical experience in addition to their training at the UC Davis Medical Center directly. This year, we welcome three new residents to our programHuck Holz, Bonnie Quiroz and David Woods. Dr. Holz received his medical degree from the University of California, Davis and completed his medical internship at Kaiser, Santa Clara, California. Dr. Quiroz graduated from Loma Linda University where she also completed her medical internship. Finally, Dr. Woods graduated from the University of Washington and completed his internship at the University First year residents and their hometowns (left to right): Bonnie Quiroz, M.D., Jamul, CA; Huck Holz, M.D., San of Washington, Preliminary Diego, CA; and David Woods, M.D., Walla Walla, WA. Medicine Internship at the Veterans Affairs Medical Center, in Boise, Idaho. We look forward to an exciting and productive three years with them and all of our current residents. In addition to our residency training program, there are two active and high quality fellowship programs in the department. The fellow in cornea, external disease, and refractive surgery this year is Dr. Charles Reilly who came to us from Wilford Hall Medical Center at Brooke Army Medical Center in San Antonio, Texas, where he completed his general ophthalmologic training. Our fellow in vitreoretinal disease is Dr. Navid Khodadadi, Charles Reilly, M.D., who is spending two years with Dr. Lawrence Morse Cornea Fellow; hometown is Colorado Springs, CO. training in the medical and surgical retina subspecialty. The residency and fellowship training programs at UC Davis provide fertile ground for the training of quality practitioners as well as the development of new and innovative investigation in ophthalmology. Under the capable leadership of our Director of Residency Training, Dr. Jeffrey Caspar, we anticipate continued enhancement of our training program.

alumni news
Dr. Christopher Chapman (Retina Fellow 1992-1993) is an Assistant Professor at Dartmouth Medical School and a vitreoretinal specialist at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. Dr. Marina Chechelnitsky (Resident 1993-1997) practices general ophthalmology in San Jose, California. She participates in the annual medical missions to the Philippines and Nicaragua, primarily performing cataract surgeries. In her free time she sings opera. Dr. Andrea Gray (Resident 1996-1999) practices in Roseburg, Oregon, serves as Surgery Division Chief, Mercy Medical Center, as delegate to the Oregon Medical Association, and as board member of the Roseburg Rotary Club. She is hostess for the Miss Douglas County Scholarship Pageant, and is a Girl Scout leader for at-risk teens. In her spare time she enjoys scuba diving, hiking, and cooking. Dr. Erich Groos, Jr. (Cornea and External Disease Fellow 1991-1992) specializes in Cornea and External Disease at Cornea Consultants of Nashville in Nashville, Tennessee. He is a member of the American Academy of Ophthalmology (AAO) Leadership Development Program and is Assistant Medical Director of the DCI Middle Tennessee Eye Bank. Dr. Neil Kelly (Resident 1969-1972) retired on November 14, 2003. Dr. Martin McCarthy (Cornea and External Disease Fellow 1998-1999) practices Cornea and Cataract Surgery at the EyeCare Centre in Vancouver, BC, and the Surrey Eye Care Centre in Surrey, BC. He is a Clinical Associate Professor in the Department of Ophthalmology at the University of British Columbia. He also serves as Medical Director of the Eye Bank of British Columbia and serves as Head, Cornea and External Disease, Department of Ophthalmology, University of British Columbia. Dr. Michael Mizoguchi (Resident 1999-2002) is a comprehensive ophthalmologist in Eureka, California. Dr. William Rosen (Resident 1990-1994) practices Oculoplastics at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. Dr. Denise Satterfield (Resident 1989-1991) specializes in pediatric ophthalmology and adult strabismus in Sacramento, California. In addition, she serves on the UC Davis School of Medicine Board of Directors and as Associate Clinical Professor, Department of Ophthalmology. Dr. Michael Schermer (Resident 1973-1976) is a general ophthalmologist in Sacramento, California. He has two grandchildren, Max in Honolulu and Julia in San Diego. In the Fall of 2002 he traveled to Hue, Viet Nam to teach cataract surgery. Dr. Henry Semple (Retina Fellow 1989-1990) practices vitreoretinal surgery at the Premier Medical Eye Group in Mobile, Alabama. Dr. Christian Serdahl (Resident 1988-1991) is a comprehensive ophthalmologist in Sacramento, California. He is Chief of Ophthalmology at Mercy General Hospital, serves as National Medical Director of VSP is on the Board of Directors of , Communicare, and is CEO of Sight Savers International. He also enjoys windsurfing and golf. Dr. David Shapiro (Resident 1987-1990) practices Refractive Surgery in Ventura, Montecito, and San Luis Obispo, California. Dr. Ron Tamaru (Resident 1983-1986) is a comprehensive ophthalmologist in Folsom, California. He also is a member of the Alta Ophthalmology Society and serves as an American Board of Ophthalmology Examiner.

Want to share some news with your colleagues? Send your personal and professional updates to envision! Well help spread the news. robert.august@ucdmc.ucdavis.edu

Dr. Mark Mannis (left), Dr. Alan Roth and his wife, Barbara, enjoy a conversation in the Artesa Winery entrance.

events . . .
educational event calendar
Ophthalmology Visiting Professor Series
October 17, 2003 Comprehensive Ophthalmology Visiting Professor: ROBERT J. CIONNI, M.D. Cincinnati Eye Institute, Cincinnati, OH November 7, 2003 Special Cataract Surgery Rounds November 21, 2003 Cornea, External Disease, & Refractive Surgery Visiting Professors: DENISE A. DE FREITAS, M.D. and

THE EYE SCENE


The 26 annual Ophthalmology Symposium and Residents
th

Day took place in June at the Napa Valley Marriott Resort and Spa. Over 125 attendees participated in this exciting two-day continuing medical education program entitled, Eye on Napa 2003: Prevention and Management of Complications in Ophthalmic Surgery Invited speakers included Dr. Richard Parrish from the Bascom Palmer Eye Institute in Miami, Dr. Peter J. McDonnell from the University of California at Irvine, and Dr. Edward Holland and Dr. Robert Cionni from the Cincinnati Eye Institute. The latest information on the management of surgical complications in the subspecialty areas of cataract, cornea, glaucoma, retina, and refractive surgery was presented. Original research was presented by Ophthalmology residents, fellows, and graduate students. Dr. Greg Rabin, third year resident, and Dr. Joseph Hardy, post-doctoral graduate student, won departmental research awards for their presentations.

LUCIENE DE SOUSA, M.D.


Federal University of So Paulo, Paulista School of Medicine, So Paulo, Brazil December 5, 2003 Special Refractive Surgery Rounds February 6, 2004 Oculoplastics Visiting Professor: JULIAN D. PERRY, M.D. The Cole Eye Institute Cleveland Clinic Foundation, Cleveland, OH February 27, 2004 Retina Visiting Professor: SRINIVAS R. SADDA, M.D. Doheny Eye Institute, USC, Los Angeles, CA March 19, 2004 Neuro-ophthalmology Visiting Professor: ANTHONY C. ARNOLD, M.D. Jules Stein Eye Institute, UCLA, Los Angeles, CA April 23, 2004 Comparative Veterinary Medicine Director: STEVE R. HOLLINGSWORTH, D.V.M. School of Veterinary Medicine, UC Davis Campus May 7, 2004 Ocular Pathology Visiting Professor: MORTON E. SMITH, M.D. Washington University, St. Louis, MO May 14, 2004 Visiting Professor: Glaucoma

One highlight was the gala dinner and awards ceremony at the Artesa Vineyards and Winery in Napas beautiful Carneros region. Despite the 102-degree day in Napa, over 130 people dressed to impress at this sold-out event.
Clockwise from top Adrienne Graves, Ph.D., CEO of Santen Pharmaceuticals; Dr. Robert Cionni (left) and Dr. John Keltner; Dr. Peter McDonnell; Dr. Edward Holland; and Dr. and Mrs. Richard Parrish.

Dr. John Keltner, in his final duty as Chair of the Department of Ophthalmology, paid tribute to Dr. Alan Roth for his 26 years of service to the department as clinician and ocular pathologist.

Drs. Alan Roth (left) and Greg Rabin were award recipients.

The best-kept secret

in Sacramento on May 29th was the surprise tribute to Dr. John Keltner at the Sacramento Hilton. The entire Department of Ophthalmology faculty and staff, community ophthalmologists and alumni, and Dr. Keltners family succeeded in keeping Dr. Keltner in the dark until his arrival at the hotel. Dr. Mark Mannis hosted the event in honor of Dr. Keltners 26 years of service as chair of the Department of Ophthalmology. Over 200 people attended the tribute dinner, including many department alumni from across the country.
Drs. Mark Mannis and Lin Chen; Dr. Chen traveled from Philadelphia to attend.
Dr. John Keltner and his wife, Nancy, are pleasantly surprised upon their arrival.

PHILIP P. CHEN, M.D. University of Washington, Seattle, WA

For further information, please contact Wendy Walker at (916) 734-6060.

Clinical and Research Ophthalmology Symposium


Anecdote vs. Science: An Evidence-Based Review of Current Ophthalmic Practice

Nabil Musallam (above right), Senior Associate Director, warmly greets Dr. Keltner.

(above, from left) Dr. Lawrence Morse, Dr. Leonard Hjelmeland, Mrs. Debbie Morse, and Diane Weeks enjoy the celebration.

Friday, June 11, 2004, 7:30 a.m. - 5:00 p.m. and Saturday, June 12, 2004, 8:00 a.m. - 12:30 p.m. at the Lodge at Sonoma Resort and Spa, located in the beautiful town of Sonoma, CA.
Dr. Keltner (second from right) welcomes alumni (from the left) Drs. Esther Kim, Linda Margulies, and Claudia Pinilla.

Robert Chason (above right), CEO of UCDMC, and Dr. Keltner reminisce the past and contemplate the future.

SAVE THE DATE!

Alumni (from the left) Drs. Bradley Sandler, James Ruben, Daniel Rich, and Robert Wendel.

Dr. and Mrs. Mark Mannis (left) and Dr. and Mrs. John Keltner at the close of a memorable evening.

Look for a complete brochure and registration form in Spring 2004. To request this brochure go to: http://cme.ucdavis.edu. For more information, please contact Cheryl Nelson, Continuing Medical Education, (916) 734-2283.

PBS film crew visits UC Davis


Continued from page 5

when the painful eye symptoms reoccurred. Later as Audreys eye condition worsened, she was referred to Dr. Schwab who discovered that her eye symptoms were not the result of repeated infections, but was a type of erosion or slipping of the corneas epithelium, or outermost layer of cells. This abnormality of the cornea is caused by a rare congenital disorder, Reis-Buckler Dystrophy. Audreys eye condition was stabilized by a surgical procedure that helped anchor the cells to the cornea and occluding her tear duct with punctal plugs. The latter procedure allows Audrey to retain more of her natural tears, which helps moisten her eyes and

The Busi family (left to right) Darcie, Tom, and Audrey relax for a moment with Dr. Ivan Schwab during the filming of the PBS Healthy Eye segment.

protect the corneas. Audreys treatment continues with the use of eye drops and close follow-up care. Audreys parents, Tom and Darcie Busi, stated that prior to coming to UC Davis, life for their family was very stressful. It was painful to see Audrey suffer and prior to meeting Dr. Schwab, no one had any answers as to the cause of her condition. Tom Busi also stated, it was their faith in God and commitment to each other that helped their family remain strong throughout the ordeal, and that they are so thankful for Dr. Schwabs care and compassion. The PBS Series on The Healthy Body will air early in 2004.

Cataract surgery may improve driving safety and more


Continued from page 1

Fortunately, in the United States, cataract surgery is widely available and safe. Recent advances in technology and medications allow the surgery to be performed as an outpatient procedure with local anesthesia. Recovery time is relatively short allowing most patients to return to regular activities in one-to-two weeks. Although

the vast majority of patients will still require glasses after the surgery, new, exciting advances are being made with lens implant technology. Cataract surgery with lens implant can not only improve vision but the surgery may even significantly improve ones driving skills, sense of well being, and social capability.

Unprecedented growth leads to Regional Eye Center Initiative


In terms of clinical practice, research and personnel, the Department of Ophthalmology at UC Davis has nearly doubled in size during the past five years. In 1998, 22,000 patients were seen in our clinic annually with a staff of 64 people. Today we see over 38,000 patients with 126 staff. Our research has also expanded to include 42 new programs during the same time period. We now have 66 research projects and clinical trials. As one can imagine, this unprecedented rate of growth poses some very challenging problems that are beginning to affect our clinical practice and impede our research progress. Currently, our department resides within the Lawrence Ellison Ambulatory Care Center on the UC Davis Medical Center Campus (UCDMC) and there are no solutions to our space needs within this facility. Therefore, to maintain the highestlevel patient care and to ensure the continued progress of our research, the Department of Ophthalmology has made building a Regional Eye Center in Sacramento its top priority. We believe the new facility will allow the Department of Ophthalmology to meet the future needs of our patients in both clinical care and research. Currently the department is involved with the early phase of space needs planning. The most crucial step for the Eye Center project is to conduct a feasibility study and obtain University and UCDMC approval. Once approval has been secured, it is believed the project will be at least a five-year fundraising effort heavily dependent upon private support from the community. For more information, contact Robert August at (916) 734-6045 or robert.august@ucdmc.ucdavis.edu.

Robert A. August, RN, Nurse Manager and Development Officer, UC Davis, Department of Ophthalmology

Innovative lens implants for use in cataract surgery


Continued from page 1

near sightedness as well as hyperopia or farsightedness. This frequently allows people who have undergone cataract surgery to have good distance vision without glasses, despite having worn them their whole life. More than 2.5 million Americans undergo cataract surgery annually, with virtually all receiving a lens implant. Lens technology has improved dramatically since 1949 and today there are many exciting, new lens implants available for use in cataract surgery. These lenses offer exciting advantages not provided by standard lens implants. It is important to have a careful discussion with your cataract surgeon regarding the appropriateness of any of these lenses. The photo-protective lens implant was developed to provide additional protection to the retina because studies have demonstrated an association between blue light exposure later in life and the development of age-related macular degeneration. While a standard lens implant with a UV filter may only block 12% of blue light, the Acrysoft Natural IOL filters approximately 66% of it; this is roughly equivalent to the natural filtering ability of an adult human lens. Patients who have received standard lens implants need not panic, as yellow tinted blue blocker style sunglasses should provide similar protection from blue light. Toric lens implants have astigmatic correction built in and can correct for myopia or hyperopia as well. Astigmatism is usually caused by a corneal

surface that is steeper in one meridian than another, which prevents a sharp point focus on the retina. Additional incisions at the time of surgery can reduce or correct such astigmatism. The toric lenses are useful when the level of astigmatism is too high to correct with additional incisions. Currently, the STAAR Toric Lens Implantone implant is approved for use in this country. A careful evaluation by your surgeon is necessary to determine if you are a candidate, and there is a small risk of the lens rotating which may necessitate a second surgery to reposition the lens. The multifocal lens implant was developed to free many patients from glasses. One of the great rites of passage in life is the development of presbyopia, or inability to read without the aid of reading glasses or bifocals. This change is first noticed in our early-to-mid 40s and continues to progress. Presbyopia remains after cataract surgery because all lens implants are unable to change their focal points. Patients who see perfectly at distance after cataract surgery are dependent on glasses for reading. The Allergan Array lens multifocal lens implant incorporates five overlapping lenses that allow distance, near and intermediate vision. In the right patient, this lens can greatly reduce ones dependence on glasses. Multifocal lenses are not for everyone as they do induce glare for night driving, necessitate adequate pupil size and require a very precise match to the eye to work well.

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envision
UC Davis Department of Ophthalmology 4860 Y Street, Suite 2400 Sacramento, CA 95817
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