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AMD Awareness Month- Q&A with Dr. Amir Kashani

AMD blog photo

What is AMD?

Age-related Macular Degeneration (AMD) is a devastating retinal degenerative disease that affects the macula, the part of the eye that provides sharp, central vision. Those who suffer from this progressive disease are unable to drive, read or recognize faces. In AMD, vision loss is the result of the death or dysfunction of retinal pigment epithelial cells (RPE) that provide nutrients and support to the light sensing photoreceptor cells in the eye.

There are two forms of AMD: wet and dry. In the wet form of macular degeneration (known as choroidal neovascularization or CNV), abnormal blood vessels grow under the macula and retina. Fluid from leakage of these blood vessels accumulates and cause vision loss or distorted vision. In dry AMD (non-neovascular form) small yellow deposits form beneath the retina, which can ultimately lead to geographic atrophy (GA) or the advanced form of dry AMD. Dry AMD is the most prevalent form of macular degeneration and can be stable for many years without vision loss. Patients diagnosed with GA have severe loss of vision and a tangible impact on quality of life. To date, there is no cure or known treatment options for GA.

Who is at Risk?

In general the global burden of AMD remains substantial as a result of the aging population. Globally, the projected prevalence of AMD in 2020 is 196 million, increasing to 288 million in 2040. The main risk factors for AMD are age and race. Among Americans of European decent, the prevalence of AMD is projected to rise to nearly 5.44 million by 2050 according to reports from the National Eye Institute. A significant increase in the rate of AMD amongst minority populations has also been observed. Most notably, a six-fold rise of AMD has been reported in persons of Hispanic decent.

Other risk factors for AMD include positive family history, smoking, hypertension, high cholesterol and obesity.

How is AMD Diagnosed?

Pay attention to the signs of early disease including distorted vision and your risk factors for developing AMD. Please make an appointment to see your eye care specialist at least once a year if you are over 40 years of age, if you are at risk as a result of ocular and medical history, family history, age, or race and especially if you are noticing vision loss. Your ophthalmologist or optometrist will conduct a comprehensive eye exam, which will include dilated eye exams, visual acuity, and optical coherence tomography (OCT). Following a thorough assessment, your physician will work closely with you to determine the best course of action.

Are There Treatments for AMD?

RPE patch (white) implanted in the subretinal space.
RPE patch (white) implanted in the subretinal space.

In general there is no known cure for AMD. However, for the wet form of AMD, drug treatment options include anti-VEGF (vascular endothelial growth factor) therapies. Such therapies reduce the level of VEGF, a protein known to stimulate abnormal blood vessel growth in the retina and macula. These drugs are administered as injections directly into the eye.

Thus far there is no FDA approved treatment available for dry AMD. USC vision researchers, Dr. Mark Humayun and David Hinton, funded by the California Institute for Regenerative Medicine, have recently developed a novel stem cell-based therapy for the treatment of advanced dry AMD. The treatment consists of a patch of RPE cells derived from stem cells that is grown onto a polymer scaffold and implanted behind the diseased portion of the eye. A clinical trial is currently underway to evaluate this potential treatment at USC and is led by Assistant Professor of Clinical Ophthalmology, Dr. Amir Kashani. Enrollment in the phase I/IIa clinical trial is ongoing for this stem cell-based treatment.

To learn more, please visit: https://clinicaltrials.gov/ct2/show/NCT02590692?term=subretinal+implant+AMD +dry&rank=1.
 

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Dr. Kashani specializes in complicated retinal detachment repair, recurrent retinal detachment repair, macular degeneration, diabetic retinopathy, macular pucker, retinal vein occlusions, and hypertension related eye disease.

References

  1. Wong WL, Su X, Li X, et al. Global Prevalence of Age-Related Macular Degeneration and Disease Burden Projection for 2020 and 2040: A Systematic Review and Meta-Analysis. Lancet Glob Heal. 2014;2(2):106-116. doi:10.1016/S2214-109X(13)70145-1.
  2. Congdon N, O’Colmain B, Klaver CC, et al; Eye Diseases Prevalence Research Group. Causes and Prevalence of Visual Impairment Among Adults in the United States. Arch Ophthalmol. 2004;122(4):477-485.
  3. Varma R, Fraser-Bell S, Tan S, Klein R, Azen SP; Los Angeles Latino Eye Study Group. Prevalence of Age-Related Macular Degeneration in Latinos: The Los Angeles Latino Eye Study. Ophthalmology. 2004;111(7):1288-1297.
  4. http://www.visionaware.org/info/your-eye-condition/age-related-macular-degeneration-amd/risk-factors-for-amd/125
  5. https://www.aao.org/clinical-statement/frequency-of-ocular-examinations

OTEP Student Cristian Martínez Featured on Univision

Cristian Martínez is one of the students benefiting from the OTEP (Ophthalmic Technician Education Program). In this interview with Univision 34 – Los Angeles, he says the OTEP program allows him to study, work in clinic, and attain certification to continue a career in Ophthalmology.


Martinez

Source: USC Offers a Certification Program to Become Certified as an Ophthalmology Assistant
View the Video Here From Univision 34-Los Angeles
Originally published in Spanish: 11/30/2017 by Univision
English Translation: 12/5/2017
 

Univision Host: I present to you Cristian Martínez!

Cristian: [Shakes hand] Nice to meet you!

Univision Host: Welcome to the studio Cristian. So you are studying to be an Ophthalmology assistant. I actually did not know that Ophthalmologists required assistants.

Cristian: Many people do not know what an Ophthalmology assistant is. We help the doctor to perform all the exams – whatever the doctor might need.

Univision Host: How long does it take you to receive this certification?

Cristian: Less than two years, and later when you finish the program, you are given a certificate to work in Ophthalmology in various departments. There is a lot of work [In Ophthalmology].

Univision Host: There is a lot of work. You already have a job though you have not yet graduated?

Cristian: Yes, yes I have a job [in clinic] for 2 months.

Univision Host: How crazy! And you haven’t yet graduated! Tell us a bit about your story. You were studying in San Francisco and paying a lot of money for your career…

Cristian: Yes, it was a lot of money. Later, I returned here to Los Angeles to enter the program, and it was less money than in San Francisco.

Univision Host: A lot less money, and now you have a job!

Cristian: Yes, and now I have a job.

Univision Host: This is really interesting – [Shows photo slideshow of OTEP students] — So this an example of what you do at the USC Roski Eye Institute OTEP Program. Here we can see you working.

[Photo slideshow continues to play]

Cristian: Yes! Before the doctor comes, we help with part of the visual exams, checking in the patients, answering their questions and so on.

Univision Host: Do you want to be an ophthalmologist? And do you want to continue in this career path?

Cristian: Yes, When I finish the program, I would like to continue working at USC in Ophthalmology.

Univision Host: So after you get your certification, you start to work and build experience and continue with this career..

Cristian: Yes, yes [in agreement].

Univision Host: Wow – it would have been very different if you had stayed all this career time elsewhere [San Francisco]. And you haven’t paid as much here.

Cristian: No, what I like about the program is I can do the certification and get experience.

Univision Host: And there are a lot of young men studying this, or is this new?

Cristian: It’s not new, but there aren’t a lot of young men studying this.

Univision Host: And to be able to speak Spanish is also very helpful.

Cristian: Yes it’s very good. If you speak Spanish, it’s really good because you use Spanish every day, and with many patients.

Univision Host: And now you work in an office with real patients.

Cristian: Yes, at the hospital at USC.

Univision Host: So you work at USC, they pay you a salary, you study for your certification, and you can continue with this career?

Cristian: Yes!

Univision Host: It seems to me these are all very beneficial!

Cristian: Yes, absolutely.

Univision Host: Your parents will be very proud – are you the first generation to go to university?

Cristian: Yes, I am the first.

Univision Host: [Turns to audience] – and there it is for you to see – thank you so much!

Cristian: Thanks to you!

He’s Making a List and Checking it Twice…

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Deciding what to buy your children for the holidays is always challenging. Check twice before making a purchase and be mindful of age and potential toy safety hazards. From newborns to toddlers, a child’s vision continues to develop through early and middle childhood. From the first day you look into those precious eyes, your baby begins to create essential connections between the eyes and brain, which will allow their vision to develop focus, hand-eye coordination, depth-perception and color vision.

To Prevent Toy-Eye Injury

  • Read toy labels and purchase according to the advised age group
  • Always ensure the toys are safely assembled
  • Show the child how to play with them
  • Supervise playtime
  • In general, avoid hard objects with sharp, pointy edges

Holiday Toy List by Age

Newborns

Babies slowly begin to focus on objects, see contrast and are sensitive to light. Purchase plush textured toys and bright colored visual toys with contrast like mobiles. For mobiles, ensure they are correctly assembled and a safe distance away form the infant.
 

1-12 Months

Hand-eye coordination begins to improve at this stage. Progress in depth-perception and color vision are also occurring. Avoid sharp edges and heavy objects. They should be encouraged to crawl and reach for things. Toys like balls, stacking toys, musical toys, large piece puzzles are ideal at this age.
 

1-2 Year-Olds

Children can recognize objects and faces well. Their hand-eye coordination has developed and they should be able to scribble and color. Ideal toys include, finger paint, books, stuffed animals, blocks, and large lego. Near the end of this stage larger items, like kitchen sets, household toys, play-gyms are safe to play with.
 

3-6 Year-Olds

By now children become more independent, have greater depth-perception and can control their movements. Tricycle or bicycles with helmets, balls, board games, crayons etc. are suitable. Avoid toy-guns with soft pellets, which can cause serious eye injury and permanent vision loss. Recent incidents involving soft-pellet toy guns have been reported by the British Medical Journal where three children were treated for pain, blurred vision and even internal bleeding in the eye.
 

7-11 Year-Olds

Children at this age can enjoy a number of toys safely such as coloring sets, books, balls, puzzles, musical instruments, microscopes, telescopes, and sports equipment. When purchasing tablets, small video games or computers one should consider limiting screen time. Staring at screens up close like playing video games or watching shows or movies can result in poor vision. Incidence of childhood myopia (nearsightedness -inability to see objects at further distances) among American children has more than doubled over the last 50 years in large part due to the close work and use of mobile devices and screens on a daily basis, combined with a lack of outdoor activities and sunlight.

Have a safe and happy holidays from the USC Roski Eye Family!!

By Debbie Mitra
 
 
References

  1. https://www.sciencedaily.com/releases/2017/09/170918222238.htm
  2. http://eye.keckmedicine.org/incidence-childhood-myopia-rise/
  3. http://www.allaboutvision.com/parents/toysafety.htm
  4. https://www.preventblindness.org/safe-toy-checklist

USC Roski Eye Institute Clinic Grand Opening

 

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September 7th, 2017: In a lively ceremony held in the new, fourth-floor of HC4 location, USC Roski Eye Institute faculty, USC President Max C. Nikias, USC Provost Michael Quick, Keck Medicine of USC CEO Tom Jackiewicz and USC Trustees Gayle and Edward Roski to officially open the new USC Roski Eye Institute clinic.

“Together, we have celebrated many successes at the USC Roski Eye Institute, but today stands out as particularly special,” Nikias said. “This beautifully remodeled clinic is all about vision – saving it, preserving it and restoring it. You, the doctors and the staff who bring this clinic to life, stand at the fore of this important efforts and are the finest in the nation.”

“Dean Varma and Dr. Mark Humayun, the clinic’s co-directors, have assembled a team of doctors and staff who are expert at lifting the clouds from our vision,” Nikias continued.

Nikias then expressed his profound gratitude to the Roskis for their vision and generosity.

Gayle Roski, a noted artist in addition to her work as a philanthropist, was treated for cataracts by Keck Medicine ophthalmologists, and as a result, “she and Ed resolved to find an institute with the most ambitious goal possible – to eliminate blindness.”

“With their support, the USC Roski Eye Institute is stronger than ever. It’s one of the top-two funded eye institutes in the nation and a leader in research funding from the National Institute of Health,” Nikias continued. “Its residency program runs in the top ten nationwide, and it just expanded for the first time in years. And in 2016 this institute, my fellow Trojans, treated more than 100,000 patients.”

“It’s an honor to help support people who will be behind the new breakthroughs in the future of this field,” Gayle Roski said. “And I want you to know that Ed and I are grateful for your presence here today and thankful for the work you do each and every day.”

With the conclusion of remarks, Gayle Roski officially unveiled the clinic’s striking signage and invited attendees to tour the new, state-of-the-art facilities, which includes 31 patient rooms, an out-patient surgical area, labs, a staff lounge and more.

Blind USC Trojan, Jake Olson, Snaps His Way into History

USC Football 49 - WMU Broncos 31

Photo courtesy of John McGillen/USC Athletics

In a truly inspiring event that will no doubt go down as one of the best moments in USC Trojan football history, Jake Olson, the Trojans long snapper who has been blind since the age of 12, carried out a perfect snap to help USC defeat Western Michigan in the first football game of the 2017 season this past week.

Jake was diagnosed at a very early age with retinoblastoma, a rare cancer that is the most common ocular tumor in children causing blindness. Approximately one in 17,000 children are diagnosed with retinoblastoma each year. At the age of one month, Jake’s left eye was surgically removed as the disease had aggressively advanced. Over the next 12 years, Jake underwent ongoing treatment for his eyes at the Children’s Hospital of Los Angeles (CHLA); unfortunately, retinoblastoma was affecting his right eye as well. The tumor recurred more than a dozen times and was eventually removed – rendering him permanently blind.

As a young boy, Jake had a passion for football. Before losing complete vision, Jake fulfilled his dream of meeting the USC Trojan’s football team, which was initiated by former USC head coach Pete Carroll. Learning to live with his vision loss, Jake persevered to make his football dreams a reality by officially becoming a long snapper on the USC Trojan roster in 2015. Embodying the true spirit of a Trojan, Jake finally had the opportunity to snap his first ball in last week’s USC home opener, proving that anyone can overcome a disability and become an inspirational force.

“I just think there’s a beauty in it,” Olson said in the postgame wrap-up interview with the Los Angeles Times. “If you can’t see how God works things out, then I think you’re the blind one. I think to have a situation where a 12-year-old kid loses his sight and is going to have to face the rest of his life without seeing is just ugly, and to fast forward eight years and have that same kid be able to snap on the football field that really got him through that time, is just really just special and incredible.”

In addition to receiving the required clearance by the NCAA to play, Jonathan Kim, MD, associate professor of clinical ophthalmology and director of the Ocular Oncology Service at the USC Roski Eye Institute, also provided clearance for Jake to play college football. Kim examined Jake to ensure that the cancer had not returned and that he was healthy enough for the aggressive physical action of college football. He also reviewed with Jake the safety measures and guidelines to avoid injury when playing a high contact sport, such as college football, while also wearing ocular prostheses. Kim continues to see Jake as a patient on a regular basis for routine surveillance and care of any eye health issues that may arise.

“As part of the USC Roski Eye Institute and Trojan family, watching Jake snap that football was a proud moment for us all,” said Kim. “Jake accomplished something that few of us can only dream of with or without visual impairment, and he is a true inspiration to all patients suffering from retinoblastoma.”

Several researchers from the USC Roski Eye Institute and CHLA have made great strides in the pursuit to find a cure for Retinoblastoma. Among them, David Cobrinik, MD, PhD, USC associate professor of research ophthalmology, focuses on understanding the behavior of the cells that give rise to retinoblastomas. He has identified the cell of origin, which was published in Nature in 2014. Jesse Berry, MD, assistant professor of clinical ophthalmology is currently developing a minimally invasive method to diagnose retinoblastoma in the eye, known as “surrogate liquid biopsy” that provides earlier treatment intervention. USC Roski Eye Institute researchers hope to one-day develop novel approaches like retinal regeneration treatments to prevent retinoblastoma from forming in predisposed children.

by Debbie Mitra

Seven Faculty Selected 2017 Super Doctors – Rising Stars

 
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Seven USC Roski Eye Institute Faculty were named in the Super Doctors – Rising Stars.℠ This award, voted on by their peers in the field, recognizes their expertise and achievement in their first 10 years of practice. Please join us in congratulating our faculty for their well-deserved recognition!

Find out more about each awardee in the links below:

Jesse Berry, MD

J. Martin Heur, MD, PhD

Amir Kashani, MD, PhD

Alena Reznik, MD

Grace Richter, MD, MPH

Damien Rodger, MD, PhD

Sandy Zhang-Nunes, MD

Healthy Vision Month Eye Care Tips

Healthy Vision Month Tips

2017 Los Angeles Times Festival of Books

 
The 2017 Los Angeles Times Festival of Books was a huge success! Thank you to all of the USC Roski Eye Institute faculty and staff that came out to show their support. Here are some of the highlights from the event:

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International Society of Ocular Oncology 18th Annual Conference

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The International Society of Ocular Oncology (ISOO) 18th conference was held last week in Sydney Australia! It was a wonderful conference bringing together nearly 300 ocular oncologists, pathologists, ophthalmologists and systemic oncologists from around the globe. The USC Ocular Oncology team was present in full force. Director of Ocular Oncology, Jonathan Kim, MD, spoke on three important topics for the management of ocular tumors:

  1. Use of PDT laser for treatment of retinoblastoma
  2. Timing of laser treatment for small (Group B) retinoblastoma in the posterior pole of the eye
  3. Optic nerve imaging features on MRI after enucleation for retinoblastoma

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The associate director, Jesse Berry, MD, also presented on three important topics in the ocular oncology community:

  1. Sharing the very low rate of metastatic disease after treatment for Retinoblastoma at CHLA. CHLA manages about 1/5 of all new cases of retinoblastoma in the United States
  2. How to manage cases of retinoblastoma when the optic nerve cannot be seen
  3. Use of the aqueous humor, the clear fluid in the front of the eye, as a surrogate liquid biopsy for retinoblastoma

The director emeritus, A. Linn Murphree, MD, who established the service and directed it for 37 years also attended the conference to hear updates from around the world and share his experience from years of treating ocular oncology patients.

WOO Group
 
This was also the second gathering of the Women in Ocular Oncology Group (WOO!) which was founded after the Cleveland ISOO conference by Dr. Berry. She works to encourage collaboration and create community with her female colleagues in ocular oncology. About 12 women met for lunch at the last meeting in Paris and this year over 30 women joined! It demonstrates nicely the need for such a group and the great contributions women make in this field.

Aside from work, the team spent a little time playing as well! They enjoyed dinner at the Museum of Contemporary Art, a gala event at the Sydney Eye Hospital, taking in the views of Sydney Bridge, opera house and harbor, and Dr. Berry walked the Sydney Bridge!

ISOO Activities
 
At the end of the meeting USC & CHLA made a bid to host the next meeting of the international society of ocular oncology in Los Angeles! After the presentation it was voted on by the ocular oncology community at large and Los Angeles was chosen as the next venue! Look forward to lots of updates as we gear up to host this amazing conference March 22-26, 2019.

Srikiran Institute of Ophthalmology Adventure- Day 1

Assistant Professor of Clinical Ophthalmology, Jesse Berry, MD, and Co-Chief Resident, Philip Storey, MD, were fortunate enough to spend a week at the Srikiran Institute of Ophthalmology in Kakinada, Andhra Pradesh, India. Sankurathri Foundation was established by Dr. Chandrasekhar Sankurathri as a memorial to his wife, Manjari Sankurathri, son, Srikiran and daughter, Sarada who were killed in a terrorist bombing of Air India Flight 182 (Kanishka) on 23rd June 1985. The Foundation’s main mission is to empower the poor through better education, eye care and timely help to the needy. Drs. Berry and Storey assisted patients in the clinic, performed various OR procedures, conducted outreach, and enjoyed the local cuisine. Here is the first day of their journey:

Day 1 at Srikiran

We started out the first day with an amazing homemade Southern Indian breakfast of idli (cakes of urad dal – which are a type of lentils and rice), clarified butter (ghee) and two kinds of curries – a coconut base and a tomato base. Then Dr. Avanish, one of the head consultants, took us on a tour of the hospital. The hospital is more of a compound: there is a paid and unpaid wing, operating suites, every subspecialty in ophthalmology is represented and each specialist has a waiting room jam packed of men and women, dressed in gorgeous colored saris, waiting to be seen.

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The patients are kind and humble. They are very excited to see foreigners and were thrilled to have their photos taken. Each one wanted a photo and to see it after on the camera screen. They remained very serious for the photos but broke into a huge smile when they saw it on the screen. Overall, they were so excited and welcoming and it was very special.

We also were able to meet the entire staff of doctors in the hospital. There are two residents each year (for three), three fellows (retina, cornea and phaco) and the senior consultants. The trainees are so sharp! They are all great surgeons and used to triaging very complex eye conditions. In one morning we saw Parinaud’s syndrome, retinitis pigmentosa, multiple infections, mature and hypermature cataracts, globe and face trauma and tuberculous meningitis with papilledema. One young girl of 14 had idiopathic uveitis with severe inflammation in the eye and had now developed a cataract. Each patient carried their medical records with them, including CT, MRI and x-ray films to show the doctor. The girl’s father had forgotten hers so he left her alone so as not to lose her place in line while he returned home for them. She was young, alone and a little scared when her name was called and she was still without her father but she put on a brave face and came in the clinic to meet the doctor. By the time we were done with the exam her father had returned and she was scheduled for surgery.

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After clinic we went to the OR to observe cataract surgery and we able to each do a small incision cataract surgery! The skill set here is different from phaco and different even from regular extracap – so hard to jump into – but both patients did well and I am looking forward to a few more surgeries while here.

At the end of the day we joined Dr. Chandra and his sister Hema for a late dinner of okra, cauliflower, potatoes, and Roti (a round tortilla like bread). It was healthy and delicious. Then we made plans for tomorrow (more surgery!), turned the mosquito distractors on (yes, that is real) and turned in for the night!

Read about the second day of their adventure here
 
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Dr. Jesse Berry is an Assistant Professor of Clinical Ophthalmology at the Keck School of Medicine of USC and Associate Residency Program Director at LAC+USC Medical Center. She is residency and fellowship trained and a member of the Society of Heed Fellows.