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Cole Eye Institute 2012 Outcomes Measuring Outcomes Promotes Quality Improvement Measuring and understanding outcomes of medical treatments promotes quality improvement. Cleveland Clinic has created a series of Outcomes books similar to this one for its disease-based institutes. Designed for a physician audience, the Outcomes books contain a summary of many of our surgical and medical treatments, with data on patient volumes and outcomes and a review of new technologies and innovations. The Outcomes books are not a comprehensive analysis of all treatments provided at Cleveland Clinic, and omission of a particular treatment does not necessarily mean we do not offer that treatment. When there are no recognized clinical outcome measures for a specific treatment, we may report process measures associated with improved outcomes. When process measures are unavailable, we may report volume measures; a relationship has been demonstrated between volume and improved outcomes for many treatments, particularly those involving surgical techniques. In addition to these institute-based books of clinical outcomes, Cleveland Clinic supports transparent public reporting of healthcare quality data and participates in the following public reporting initiatives: • Joint Commission Performance Measurement Initiative (qualitycheck.org) • Centers for Medicare & Medicaid Services (CMS) Hospital Compare (hospitalcompare.hhs.gov) • Ohio Department of Health (ohiohospitalcompare.ohio.gov) • Cleveland Clinic Quality Performance Report (clevelandclinic.org/QPR) Our commitment to transparent reporting of accurate, timely information about patient care reflects Cleveland Clinic’s culture of continuous improvement and may help referring physicians make informed decisions. We hope you find these data valuable, and we invite your feedback. Please send your comments and questions via email to: [email protected] or scan here. To view all our Outcomes books, please visit Cleveland Clinic’s Quality and Patient Safety website at clevelandclinic.org/outcomes. Dear Colleague: Welcome to this 2012 Cleveland Clinic Outcomes book. We distribute Outcomes books for more than 14 specialties. These publications are unique in healthcare. Each one provides a summary overview of medical or surgical trends, innovations, and clinical data for a Cleveland Clinic specialty over the past year. Cleveland Clinic uses data to manage outcomes across the full continuum of care. Clinical services are delivered through patient-centered institutes, each based around a single disease or organ system. Institutes combine medical and surgical services, along with research and education, under unified leadership. The individual institute defines quality benchmarks for its specialty services and reports longitudinal progress. All Cleveland Clinic Outcomes books are available in print and online. Additional data are available through our online Quality Performance Report (clevelandclinic.org/QPR). The site offers process measure, outcome measure, and patient experience data in advance of national and state public reporting sites. Our practice of releasing annual outcomes reports has received favorable notice from colleagues, media, and healthcare observers. We appreciate your interest and hope you find this information useful and informative. Sincerely, Delos M. Cosgrove, MD CEO and President what’s inside Chairman’s Letter 04 Institute Overview 05 Quality and Outcomes Measures Cataract Surgery 08 Cornea Surgery 12 Glaucoma Surgery 15 Oculoplastic Surgery 18 Ocular Oncology Surgery 20 Refractive Surgery 22 Vitreoretinal Surgery 26 Strabismus Surgery 30 Institute Patient Experience 33 Cleveland Clinic — Improving Quality, Safety, and the Patient Experience 34 Innovations40 Selected Publications 42 Staff Listing 48 Contact Information 50 Institute Locations 51 About Cleveland Clinic 52 Resources 54 Prefer an e-version? Visit clevelandclinic.org/OutcomesOnline, and we’ll remove you from the hard copy mailing list and email you when next year’s books are online. Chairman’sLetter Letter Chairman Dear Colleagues, I am pleased to share the 2012 Outcomes from Cleveland Clinic Cole Eye Institute with referring physicians, alumni, and potential patients across the country. The future of electronic health records (EHR) is now. Cole Eye Institute continues to be a national leader in EMR implementation, and current versions offer physicians and patients robust access to ophthalmic imaging and clinical data. In 2012, we began to use our EMR to report integrated outcomes data. Our goals for the EMR are to optimize clinical efficiency and to use it as a tool to implement quality measures and best practices systemwide. Our world-class EMR system is further proof of our commitment to innovation, discovery, and the best in patient care. Our staff and services continued to grow last year. We welcomed a new retina specialist and a pediatric ophthalmologist to our practice, and 2012 saw an increased migration of our retina and other subspecialists in to our community locations. This geographic expansion of our ophthalmology practice increases patient access to our services — another example of Cleveland Clinic’s dedication to putting patients first. In 2012, we had our most productive year ever. Across Cleveland Clinic in Northeast Ohio, we conducted 241,264 physician visits and performed 12,742 surgeries. In reporting our outcomes data, we relied on two key assessment measures: visual acuity, using Early Treatment of Diabetic Retinopathy Study protocol refraction, and surgical complication rates. On behalf of my colleagues, I hope that you find this edition of the Cole Eye Institute Outcomes book informative and useful. Daniel F. Martin, MD Chairman, Cole Eye Institute 4 Outcomes 2012 Institute Overview Cleveland Clinic Cole Eye Institute is a center of excellence for highly specialized ophthalmologic care and research, with a reputation for innovation and superior outcomes. Its patient volume is among the highest of any eye program in the United States. Cleveland Clinic’s ophthalmology program is rated No. 9 in the U.S. News & World Report “America’s Best Hospitals” survey. Spearheading Research, Innovation Cole Eye Institute staff members aggressively pursue research to bridge the gap between laboratory and patient care. The institute’s ophthalmologists are national leaders in clinical trials for age-related macular degeneration and have pioneered comparative effectiveness research in heading the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). Vitreoretinal Conditions Surgical procedures developed by the institute’s vitreoretinal faculty are used worldwide for the treatment of retinal detachments, diabetic macular edema, diabetic traction detachments, macular holes, and pediatric retinal surgery. Cole Eye Institute experts are also helping develop the next generation of vitreoretinal surgical devices. They utilize advanced retinal imaging devices such as next-generation spectral domain optical coherence tomography. Cole Eye Institute retina specialists provide access to the latest clinical trials for patients who are in the early stages of age-related macular degeneration, those who have failed standard medical therapy, and those with macular edema from diabetes or vein occlusion. Glaucoma Cole Eye Institute is among the first academic centers to customize an electronic medical record for ophthalmic use. The two-year project allowed Cole Eye Institute staff across the system to share this type of record by the end of 2012. The electronic medical record integrates ophthalmic imaging and provides full access to patient histories for maximal clinical efficiency. It also streamlines data collection and allows quality measures to be adopted systemwide. Cole Eye Institute glaucoma specialists employ automated visual field testing, retinal nerve fiber layer photography, stereoscopic disc photography, and computerized optic disc analysis in the diagnosis of primary, secondary, or complicated glaucoma. They offer patients of all ages access to the latest treatments: topical medications, glaucoma implants, mitomycin C, glaucoma filtration surgery, cataract surgery, combined glaucoma/cataract surgery, and laser surgery (argon, Nd:YAG, and pulsed-dye). Cornea and External Diseases Keratorefractive Surgery The Cornea and External Diseases staff performs more than 1,800 cataract surgeries each year. They also offer advanced procedures such as Descemet’s stripping automated endothelial keratoplasty, deep anterior lamellar keratoplasty, and highly specialized transplant procedures. Cole Eye Institute surgeons use a leading-edge excimer laser system for customized treatment of myopia, hyperopia, and astigmatism. The institute’s keratorefractive surgeons rely on advanced laser technologies that offer increased accuracy and faster healing, including all-laser or “bladeless” LASIK and photorefractive keratectomy. Cole Eye Institute 5 Institute Overview Neuro-Ophthalmology Ophthalmic Oncology The institute’s neuro-ophthalmologists are experts in optic nerve disorders, visual field loss, unexplained or transient vision loss, diplopia, nystagmus, thyroid eye disease, ocular myasthenia gravis, unequal pupil size, and eyelid abnormalities. They collaborate with Cleveland Clinic Neurological Institute specialists on patient care when needed. Cole Eye Institute oncologists treat uveal melanoma and other ocular tumors using advanced techniques such as radioactive plaque therapy to preserve vision. A technique they have developed for resecting circumscribed iris tumors utilizes gentle aspiration through a small corneal incision to reduce morbidity. Ophthalmic oncologists collaborate with Taussig Cancer Institute and other Cleveland Clinic specialists on research projects to improve the outlook for these diseases. Pediatric Ophthalmology/Strabismus Cole Eye Institute pediatric specialists offer expert treatment for strabismus, retinopathy of prematurity, and congenital cataracts. They perform about 200 surgical procedures annually for esotropia, exotropia, thyroid eye disease, cranial nerve palsies, dissociated deviations, hypertropia and hypotropia, Duane and Brown syndromes, nystagmus, and related conditions. Oculoplastics Cole Eye Institute oculoplastic specialists perform more than 900 eyelid, lacrimal (tear duct), and orbital surgery procedures annually. Complex procedures performed include repairs of orbital fractures, ptosis, and lacrimal obstruction. 6 Uveitis Cole Eye Institute specialists are international leaders in the diagnosis and management of uveitis. They collaborate with rheumatologists and other Cleveland Clinic specialists when uveitis signals a systemic immune disorder, offering topical therapy, antibiotics, or other medications along with careful follow-up to prevent/ manage relapses and to minimize vision damage. Genetic Eye Diseases Cole Eye Institute’s Center for Genetic Eye Diseases is an international referral center for multidisciplinary diagnosis, treatment, and research. Specialists care for patients with inherited corneal and retinal dystrophies and microphthalmia, as well as patients with inherited systemic disorders that involve the eye such as neurofibromatosis, albinism, neurodegenerative disorders, and Marfan syndrome. Outcomes 2012 Serving the Northeast Ohio Community Cole Eye Institute offers comprehensive specialty ophthalmic care in a modern building equipped with advanced technology and designed for patient comfort. High-quality ophthalmic care is also offered at five Cleveland Clinic community locations. Comprehensive general ophthalmology and retina services are provided at Hillcrest Hospital in Mayfield Heights and at Twinsburg Family Health and Surgery Center. Ophthalmologists are on call 24/7 for emergency care across the system. Cole Eye Institute specialists also provide all retina services for MetroHealth Medical Center in Cleveland. Research Cole Eye Institute is heavily engaged in research, with an aggregate annual grant level of $10,617,150 for 2011–2012, including $5,843,450 from federal sources for basic research and $1,650,000 annually for clinical research. This funding helps both basic and clinical researchers better understand ophthalmic conditions and pioneer new treatments and techniques that will improve visual outcomes. Major research initiatives underway include those in the areas of age-related macular degeneration, diabetic retinopathy, retinal degeneration, and retinopathy of prematurity. In 2012, Cole Eye Institute researcher Brian Perkins, PhD, received the prestigious Jules and Doris Stein Professorship for the study of the genetics of retinal ciliopathies. The award, bestowed by Research to Prevent Blindness, helps attract exceptionally talented basic scientists to careers devoted to eye research. 2012 Cole Eye Institute Key Statistics Total Clinic Visits | 182,663 Total Surgeries | 8,054 Total Surgical Procedures | 10,020 (surgeries in operating rooms and all outpatient procedures) Total Laser Procedures | 1,807 Cole Eye Institute 7 Cataract Surgery Cataract Surgery Cataract Surgery Cataract Surgery 8 Cataract surgery is the most commonly performed surgical procedure in ophthalmology and thus represents a significant proportion of the surgical caseload at Cleveland Clinic’s Cole Eye Institute. From October 2011 through September 2012, a total of 1,882 cataract extraction procedures were performed. The goal of cataract surgery is improvement of visual acuity, which is accomplished for the vast majority of patients at Cole Eye Institute. There was a 94% improvement with ≥ 15 letter improvement in ETDRS (Early Treatment Diabetic Retinopathy Study) protocol refraction visual acuity in 42% of patients at their one-month follow-up, and 52% of patients had a 1 to 14 letter improvement. The remaining 5.7% had no change or a decrease from baseline status. The overall improvement in vision was seen in patients with a cataract condition; some also may have had other disorders of the eye, such as glaucoma, retina disease, or anterior segment disease. A significant number of the institute’s cataract patients have multiple clinical morbidities. In patients without other eye disease, the mean visual acuity score with best glasses correction following surgery was 79 ETDRS letters, corresponding to nearly 20/20 vision. Outcomes 2012 Complications During Cataract Surgery (N = 1,882) October 2011 – September 2012 1.87% Complications: 0.64% Posterior Capsule Tear 0.11% Zonular Dialysis 0.48% Vitreous Loss 0.21% Retained Lens 0.11% Choroidal Hemorrhage 98.13% None 0.32% Iris Trauma Intraoperative complications during cataract surgery were uncommon, occurring in only 1.87% of patients. The most common complication was a capsular tear, reported in 0.64% of patients, most of whom ended up with excellent vision. Postoperative Complications (N = 844) October 2011 – September 2012 0.36% Complications: 0.24% Retina-Related 0.12% Pressure-Related 99.64% None Postoperative complications also were rare, occurring in less than 1% of patients. The most common complication was cystoid macular edema. Cole Eye Institute 9 Cataract Surgery Difference Between Actual and Target Refractive Error October 2009 – September 2010 October 2010 – September 2011 October 2011 – September 2012 Patients (%) 80 Most patients achieved a refractive outcome following cataract surgery that was near the anticipated refractive error. Despite the large number of patients with other conditions that can influence refractive outcome, or the accuracy in measuring the final refractive error, 88% of patients achieved a final spherical equivalent refractive error within 1 diopter of the expected result. 2009-10 (N = 696) 2010-11 (N = 763) 2011-12 (N = 595) 60 40 20 0 < -2 -2 to -1 -1 to 0 0 to +1 +1 to +2 > +2 Diopters Visual Acuity by Ocular Comorbidity October 2009 – September 2010 October 2010 – September 2011 October 2011 – September 2012 ETDRS* Visual Acuity Score 100 2009-10 Preop 2009-10 Postop 2010-11 Preop 2010-11 Postop 2011-12 Preop 2011-12 Postop 80 60 40 20 0 None Cornea Glaucoma Retina Other Ocular Comorbidities N= 857 623 600 47 29 26 51 55 24 125 69 37 31 15 14 *Early Treatment Diabetic Retinopathy Study 10 Outcomes 2012 ETDRS Vision Improvement October 2009 – September 2010 October 2010 – September 2011 October 2011 – September 2012 Patients (%) 60 2009-10 2010-11 2011-12 50 40 30 20 10 0 N= Cole Eye Institute 1–14 Letters Improvement Vision Improvement No Change or Worse 35 27 36 395 379 332 ≥ 15 Letters Improvement 342 301 265 11 Cornea Surgery Corneal transplant surgeons at Cleveland Clinic’s Cole Eye Institute perform state-of-the-art procedures for numerous conditions that distort or cloud the normally transparent cornea. Traditional full-thickness procedures, also known as penetrating keratoplasties (PK), make up the majority of the grafts performed in recent years. From October 2011 to September 2012, 65 PKs were performed, and 89% of these grafts remained clear at three to six months. Cole Eye Institute surgeons also are contributing to the development of cutting-edge lamellar corneal transplant procedures in which only the diseased portion of the cornea is replaced. Using a procedure called Descemet’s stripping automated endothelial keratoplasty (DSAEK), surgeons selectively transplant the endothelium for conditions such as pseudophakic bullous keratopathy and Fuchs endothelial dystrophy. These patients experience faster visual recovery and more stable and predictable refractive outcomes than those who undergo traditional PK. During the interval described above, 114 DSAEKs were performed at Cole Eye Institute, and 99% of these grafts remained clear at three to six months. In deep anterior lamellar keratoplasty for corneal scars and keratoconus, the recipient’s anterior cornea is replaced but the patient’s healthy endothelium is retained, eliminating the risk of endothelial rejection. In 2008 to 2009, equivalent numbers of PKs and DSAEKs were performed. In the past year, DSAEK cases outnumbered PKs, reflecting an international trend toward less invasive corneal transplant procedures for endothelial disease. Highly specialized transplants are performed in smaller numbers for uncommon sight-threatening corneal conditions. For patients with end-stage corneal disease who are not candidates for other forms of transplantation, synthetic corneas (Boston keratoprostheses) are implanted to allow them to regain their visual function. A total of 190 corneal procedures were performed last year, and most patients had no complications. Of the 176 who were tracked for outcomes, the intraoperative complication rate was 1.2% and included one case each of capsular rupture and vitreous prolapse. After three to 12 months of follow-up, the postoperative complication rate was 5.7% and included seven episodes of graft rejection and three patients with corneal ulcers. Corneal transplant surgeons at Cole Eye Institute have integrated intraoperative optical coherence tomography into their approach to lamellar transplant surgeries such as DSAEK and deep anterior lamellar keratoplasty to better identify surgical endpoints in real time and to study the effect of enhanced intraoperative visualization on postoperative outcomes. Eye surgeons across the institute are participating in a comprehensive prospective study of this technology in a variety of applications. 12 Outcomes 2012 Intraoperative Complications (N = 176) October 2011 – September 2012 1.2% Complications: 0.6% Capsular Rupture 0.6% Vitreous Prolapse 98.8% None Postoperative Complications (N = 176) October 2011 – September 2012 5.7% Complications: 4.0% Graft Rejection Episode 1.7% Corneal Ulcer 94.3% None Cole Eye Institute 13 Cornea Surgery Visual Acuity by Procedure October 2011 – September 2012 ETDRS* Visual Acuity Score 80 Preop Postop 60 40 20 0 DSAEK Penetrating Keratoplasty Changes in visual acuity by the type of corneal transplant procedure are shown in the graph. For patients who completed a three- to 12-month follow-up, the mean improvement in ETDRS visual acuity score in DSAEK patients was 28.49 letters, corresponding to an improvement of about five lines of visual acuity. PK patients had worse preoperative vision than DSAEK patients and gained 38 letters, equivalent to seven lines of vision. Type of Procedure N= 83 35 *Early Treatment Diabetic Retinopathy Study Graft Clear at Three to 12 Months October 2011 – September 2012 Surgeries (%) 100 Yes No 80 60 40 20 0 DSAEK Penetrating Keratoplasty Type of Procedure N= 14 114 65 Outcomes 2012 Glaucoma Surgery Glaucoma is the second most common cause of irreversible blindness in the United States, after age-related macular degeneration. While visual loss from glaucoma cannot be reversed, adequate control of eye pressure can halt the progressive loss of vision. The keys to preserving vision in glaucoma are early detection and good intraocular pressure (IOP) control. Glaucoma can be managed with eyedrops, laser treatment, or surgery. Medication can help patients avoid the need for laser treatment or surgery to control glaucoma, but medication, usually in the form of eyedrops, entails long-term cost and some potential for local and systemic side effects. Laser surgery for glaucoma is generally quick, safe, and convenient but has only a relatively small effect in reducing eye pressure in many patients, and the effect may wear off over time. For some patients, surgery to control glaucoma is the best option. Trabeculectomy is the most frequently performed glaucoma surgical procedure in the United States. For some patients with more difficult-to-control glaucoma or who have had previous other eye surgery or trauma, a glaucoma implant (glaucoma drainage device) is used instead. From January 2006 through September 2012, 1,895 glaucoma surgeries were performed at Cleveland Clinic’s Cole Eye Institute. These included 973 trabeculectomies, 694 glaucoma implants, and 141 revisions of other glaucoma surgeries. Volume of Glaucoma Surgeries October 2009 – September 2010 October 2010 – September 2011 October 2011 – September 2012 Surgeries (%) 60 50 2009-10 (N = 313) 40 2011-12 (N = 276) 2010-11 (N = 313) 30 20 10 0 Trabeculectomy Glaucoma Implant Revision of Trabeculectomy Revision of Glaucoma Implant Other Type of Surgery Cole Eye Institute 15 Glaucoma Surgery Intraoperative trabeculectomy complications were low (0.4%). The total postoperative complication rate was 3.6%, which included hypotony (IOP < 5 mm Hg), bleb leak, choroidal effusion, and shallow flat anterior chamber. Intraoperative Complications (N = 275) October 2011 – September 2012 0.4% Scleral Perforation 99.6% None Postoperative Complications at Three-Month Follow-up (N = 140) October 2011 – September 2012 3.5% Complications: 0.7% Hypotony (IOP < 5 mm Hg) 1.4% Bleb Leak 0.7% Choroidal Hemorrhage 0.7% Shallow Flat Anterior Chamber 96.5% None 16 Outcomes 2012 Change in IOP at Three-Month Follow-up (N = 140) October 2011 – September 2012 Intraocular Pressure (mm Hg) 30 Preop Postop 20 10 0 Trabeculectomy Glaucoma Implant 85 55 N= In procedures performed at Cole Eye Institute in the 12-month period from Oct. 1, 2011, to Sept. 30, 2012, trabeculectomies reduced IOP in patients from a mean of 21.0 mm Hg to 15.5 mm Hg, and glaucoma implant surgery reduced IOP from 25.8 mm Hg to 16.1 mm Hg. A normal range of eye pressure is approximately 10 to 21 mm Hg. Change in Visual Acuity at Three-Month Follow-up (N = 140) October 2011 – September 2012 ETDRS Visual Acuity Score 80 Preop Postop 60 40 20 0 Trabeculectomy Glaucoma Implant 89 51 N= Cole Eye Institute The goal of glaucoma surgery is to preserve the current level of vision. Glaucoma surgery usually does not improve visual acuity unless combined with cataract surgery. In surgeries at Cole Eye Institute, the mean level of visual acuity, as measured on ETDRS (Early Treatment Diabetic Retinopathy Study) protocol visual acuity charts, improved slightly after trabeculectomy surgery. 17 Oculoplastic Surgery Oculoplastic surgery outcomes were divided into three categories: eyelid surgery, lacrimal surgery, and orbital surgery. There were 954 oculoplastic surgeries performed at Cleveland Clinic Cole Eye Institute from October 2011 through September 2012. Eyelid surgery outcome measures included intraoperative complications and postoperative eyelid symmetry. There were 157 lacrimal and 66 orbital procedures performed during this period, none of which resulted in any intraoperative or postoperative complications. Distribution of Oculoplastic Surgeries (N = 954) October 2011 – September 2012 6.9% Orbital 16.5% Lacrimal 100% 76.6% Eyelid 18 Outcomes 2012 Postoperative Complications — Eyelid (N = 630) October 2011 – September 2012 2.8% Complications: 1.4% Needed Reoperation 0.3% Failed Dacrocystorhinostomy 0.6% Worsened 0.8% Revision Needed Dry Eye 0.8% 0.3% Bleeding/Infection 97.2% None A total of 731 eyelid surgeries were performed during this period. In the 630 patients who returned for their follow-ups, postoperative complications included the need for reoperation in 1.4%, worsened dry eye in 0.8%, a failed dacrocystorhinostomy in 0.3%, and bleeding/infection in 0.3% of cases. Postoperative Eyelid Symmetry (N = 254) October 2011 – September 2012 30.3% Good 100% 72.0% Excellent 69.7% Cole Eye Institute Postoperative eyelid symmetry was excellent in 70% of cases and good in the remaining 30%. Excellent and good eyelid symmetry was defined by a marginal reflex distance within 0.5 mm and 1.0 mm of the desired position, respectively. 19 Ocular Oncology Surgery Uveal melanoma is the most common primary intraocular malignancy in adults and accounts for approximately 85% of all ocular melanomas. With current clinical examination techniques, the accuracy of clinical diagnosis of uveal melanoma exceeds 99%. A variety of imaging techniques have been used for differentiating uveal melanoma from other tumors or simulating conditions. The primary diagnostic modalities include slit-lamp examination, transillumination, digital photography, A-scan and B-scan ultrasonography, ultrasound biomicroscopy, angiography, and optical coherence tomography. Fine Needle Aspiration Biopsy In certain situations, such as atypical presentation or dense media opacity, or for diagnostic confirmation prior to the initiation of therapy, biopsy may be warranted. Fine needle aspiration biopsy may be performed for diagnostic or prognostic purposes. For iris tumors, entry into the anterior chamber can be accomplished using a 26- to 30-gauge needle under direct visualization with an operating room microscope. The needle is inserted bevel up and is swept gently over the surface of the tumor while approximately 0.5 ml of aqueous fluid is aspirated. Posterior-segment tumors can be biopsied via a trans-scleral or a transvitreal approach. The trans-scleral approach, by far the most common technique employed, is often preferred for tumors located within the ciliary body or the anterior choroid. Posteriorly located tumors are often more easily accessible through a transvitreal approach. Fundus photograph depicting a completely amelanotic tumor. 20 Fine needle aspiration biopsy revealed spindle cells lacking melanin, consistent with the clinical impression of amelanotic choroidal melanoma. A localized preretinal hemorrhage is seen overlying the needle biopsy site, which generally clears in several weeks. Outcomes 2012 Methods of Treatment for Uveal Melanoma (N = 87) 2012 27% Enucleation 100% 73.9%Plaque 73% Eyelid Uveal Melanoma Surgeries (N = 421) 2007 – 2012 Number of Surgeries 100 Enucleation Plaque Brachytherapy 75 50 25 0 2007 2008 2009 2010 2011 2012 Year Cole Eye Institute 21 Refractive Surgery Although Cole Eye Institute has two laser platforms and several surgeons, the outcomes of laser vision correction are summarized here for a single surgeon and single combined laser platform (WaveLight® Refractive Suite: Allegretto Wave® Eye-Q Laser and FS200 Femtosecond Laser). This is the first year the institute is reporting the combination of these two lasers as a single platform for the whole cohort, and the results are improved over last year. They are subdivided based on the type of surgery (defined below) and the patient’s preoperative refractive status (low/moderate myopia (0 to -7.00 diopters), high myopia (> -7.00 diopters), and hyperopia (0 to +4.00 diopters)). Both the type and magnitude of refractive error can affect the likelihood that uncorrected visual acuity (UCVA) of 20/20 or better will be achieved. Another important metric in assessing laser vision correction outcomes is the proportion of patients whose final refractive error falls within ± 0.5 diopter of the intended result. This section documents the outcomes for laser-assisted in situ keratomileusis (LASIK) with a femtosecond laser (FS200) flap (FemtoLASIK) and photorefractive keratectomy (PRK) (i.e., surface ablation) using the wavefront optimized ablation profile of the WaveLight Allegretto Wave Eye-Q excimer laser. The outcomes are reported as percentages of eyes with UCVA of 20/20 or 20/25, eyes with an exceptional outcome (UCVA of 20/16 or better), and eyes with UCVA meeting the requirements for driving without glasses (20/40 or better). This analysis includes the outcomes of 331 eyes treated in 2012. 22 Outcomes 2012 Distance Only LASIK for Low to Moderate Myopia (0 to -7 Diopters Sphere With Cylinder < 3 Diopters) (N = 221 at ≥ Three Months) 2012 Percentage 100 94% 97% 100% 100% 20/25 20/40 75% 80 60 40 20 0 ± 0.5D Refractive Predictability 20/16 20/20 Following FemtoLASIK to treat mild/ moderate myopia, 94% of eyes achieved UCVA of 20/20 or better and 100% achieved 20/25 or better. The refractive accuracy in achieving these excellent visual outcomes is 97% within ± 0.5 diopter of the desired target. Overall, 75% of eyes had an exceptional visual outcome of 20/16 or better. Visual Acuity Distance Only LASIK for High Myopia (> -7 Diopters Sphere With Cylinder < 3 Diopters) (N = 35 at ≥ Three Months) 2012 Percentage 100 80 95% 100% 86% 82% 63% 60 40 20 0 ± 0.5D Refractive Predictability Cole Eye Institute 20/16 20/20 20/25 20/40 Following FemtoLASIK to treat high myopia, 86% of eyes achieved UCVA of 20/20 or better and 95% achieved 20/25 or better. The refractive accuracy in achieving these excellent visual outcomes is 82% within ± 0.5 diopter of the desired target. All eyes achieved UCVA of 20/40 or better (legal driving vision), and 63% had an exceptional visual result of 20/16 or better. Visual Acuity 23 Refractive Surgery Refractive Surgery Refractive Surgery Refractive Surgery 24 Distance Only PRK Surface Ablation for Myopia (N = 61 at ≥ Three Months) 2012 Percentage 100 97% 80 97% 97% 100% 20/20 20/25 20/40 66% 60 40 20 0 ± 0.5D Refractive Predictability 20/16 Visual Acuity Following PRK to treat both low and high myopia, 97% of eyes achieved UCVA of 20/20 or better and the same number achieved 20/25 or better. The refractive accuracy in achieving these excellent visual outcomes is 97% within ± 0.5 diopter of the desired target. All eyes achieved UCVA of 20/40 or better (legal driving vision), and 66% had an exceptional visual result of 20/16 or better. Outcomes 2012 Distance Only LASIK for Hyperopia (N = 14 at ≥ Three Months) 2012 Percentage 100 86% 86% 93% 100% 80 60 43% 40 20 0 ± 0.5D Refractive Predictability 20/16 20/20 20/25 20/40 Visual Acuity For FemtoLASIK in hyperopic eyes, where a precise refractive outcome is known to be more difficult to achieve, 86% of eyes still achieved UCVA of at least 20/20 and 93% achieved 20/25. The refractive accuracy in achieving these visual outcomes is 86% within ± 0.5 diopter of the target outcome. Again, 100% had UCVA of 20/40 or better (legal driving vision), and 43% of eyes achieved an exceptional result with an uncorrected visual acuity of 20/16 or better. Cole Eye Institute 25 Vitreoretinal Surgery The Vitreoretinal Department at Cleveland Clinic Cole Eye Institute has assembled a dedicated surgical team of surgeons, nurses, and skilled technicians to deliver worldclass care for its patients. This team has developed several surgical procedures that are now used worldwide for treatment of retinal detachment, diabetic macular edema, diabetic traction retinal detachments, and myopic macular holes, and for microincision surgery and pediatric retinal surgery. Members of the team have also helped develop the next generation of vitreoretinal surgical devices including microincision surgical instruments and techniques. Finally, the Ophthalmic Imaging Center at Cole Eye Institute is a leader in the new field of intraoperative optical coherence tomography, developing new uses for this pioneering technology. In 2012, the team performed 635 surgical procedures. As in previous years, the following were excluded from the analysis: (1) emergency cases, (2) situations in which ETDRS (Early Treatment Diabetic Retinopathy Study) protocol visual acuity measurement could not be performed at baseline, and (3) cases in which patients received postoperative care at another facility. Detailed efficacy outcomes were available for 58 surgeries performed by the vitreoretinal team to close a macular hole. Anatomic closure of the macular hole was achieved in 100% of cases. Vision improved ≥ 3 ETDRS lines in 53% of cases, with an average improvement in vision of 17.4 ETDRS letters, or ≥ 3 lines. Another commonly performed macular procedure was epiretinal membrane removal, with detailed efficacy outcomes available in 111 cases. The mean visual acuity improvement after membrane peeling surgery was +11.2 ETDRS letters, with 22% of patients having a ≥ 3 line gain in vision. Primary rhegmatogenous retinal detachments are common, and primary retinal detachment repair was performed in 26 38 patients in 2012. In 89.4% of cases, the retina was reattached with one surgery. The mean change in vision after primary retinal detachment repair was an improvement of +14.8 ETDRS letters, with an improvement in vision of ≥ 3 lines in 40% of cases. Cole Eye Institute is a tertiary care facility, and the vitreoretinal team is called on to assist in difficult cases such as giant retinal tears and complicated retinal detachments that have proliferative vitreoretinopathy. Many of these patients are referred to this facility after having had vitreoretinal surgeries at other hospitals. Detailed efficacy outcomes for these types of surgery were available for 217 patients in 2012. Although most patients had a previous retinal surgery, the reattachment rate in these complicated cases was 97%. Seven patients had to return to the operating room after complicated retinal repair. Of these, five were referred from outside Cleveland Clinic and two were clinic patients who had undergone multiple previous surgeries. After the additional surgery, retinal reattachment was successful in all seven patients. The average improvement in vision after proliferative vitreoretinopathy retinal detachment repair was +15.2 ETDRS letters. A ≥ 3 line improvement in vision occurred in 35% of cases, while a ≥ 3 line loss in vision occurred in 8.8% of cases. Diabetic vitrectomy surgery is among the most complex surgeries performed by a vitreoretinal surgeon. The vitreoretinal team has developed new techniques for diabetic surgery, including pioneering the use of small-gauge surgery. In 2012, detailed efficacy outcomes analysis was available in 90 cases. In patients with traction retinal detachment, the mean improvement in visual acuity was +11.9 ETDRS letters, with 36% having a ≥ 3 line gain in vision and none having a ≥ 3 line loss in vision. In diabetic patients, with just a vitreous hemorrhage, the mean change in vision was +37.4 ETDRS letters or 7 lines, with 55% having a ≥ 3 line gain in vision and one patient having a ≥ 3 line loss in vision. Outcomes 2012 Category Definitions Groupings for Graphs DR 1 • Diabetic Macular Edema (DME) – Macular edema due to posterior hyaloidal traction Group 1: Diabetic Retinopathy (DR1 and Diabetic VH) DR 2 •Complicated Diabetic Retinopathy – Anterior hyaloidal fibrovascular proliferation – Traction retinal detachment (TRD) – Combined TRD and rhegmatogenous retinal detachment (RRD) RRD 1 •Rhegmatogenous Retinal Detachment (RRD) RRD 2 •Complicated Rhegmatogenous Retinal Detachment (RRD) – Recurrent Retinal Detachment – Proliferative Vitreoretinopathy Vitreous Hemorrhage (VH) Group 2: Complicated Diabetic Retinopathy Group 3: Primary Rhegmatogenous Retinal Detachment Group 4: Complicated Rhegmatogenous Retinal Detachment and GRT Group 5: Macular Hole Group 6: Epiretinal Membrane Note: For most emergency cases, especially RRD1, preoperative baseline ETDRS visual acuity cannot be performed and therefore the outcome results are not included in this analysis. Giant Retinal Tear (GRT) Macular Hole (MH) Epiretinal Membrane (EM) Vision Improvement by Indication for Surgery (N = 215) October 2011 – September 2012 Percentage 60 Group Group Group Group Group Group 50 40 1 2 3 4 5 6 (N (N (N (N (N (N = = = = = = 14) 25) 72) 34) 38) 32) 30 20 10 0 ≥-15 Letters Cole Eye Institute -14 to -5 Letters -4 to +4 Letters +5 to +14 Letters ≥ +15 Letters 27 Vitreoretinal Surgery Intraoperative Complications (N = 463) October 2011 – September 2012 Percentage 4 Iatrogenic Retinal Break Choroidal Hemorrhage Suture Microincision Sclerotomy 3 2 1 0 Group 1 Group 2 Group 3 Group 4 Group 5 Group 6 54 43 Indication for Surgery N= 32 54 174 96 An analysis of intraoperative complications for all surgical procedures revealed no complications in 97.8% of cases. Iatrogenic retinal breaks were the most common intraoperative complication, recorded in 1.3% of cases. 28 Outcomes 2012 Postoperative Complications October 2011 – September 2012 Group 1 (N = 36) IOP spike > 30 mm Hg Group 2 Group 3 (N = 64) (N = 124) 2% New retinal breaks Group 4 (N = 85) Group 5 (N = 30) 2% 1% 1% 1% Hypotony Visually significant cataract Vitreous hemorrhage 3% 2% Group 6 (N = 23) 4% 2% An analysis of patients who had at least three months of follow-up revealed that 97% of cases did not have any postoperative complications. The most prevalent postoperative complications were intraocular pressure (IOP) spike > 30 mm Hg (1.1%), hypotony (0.3%), and new retinal breaks (0.6%). Cole Eye Institute 29 Strabismus Surgery Cole Eye Institute considers the outcome of surgery for strabismus in adults to be good if there is: (1) disappearance of diplopia and/or anomalous head position in primary position of gaze or (2) in the absence of diplopia or anomalous head position, a constant deviation of less than 10 prism diopters. In children, a good outcome is defined as: (1) a constant deviation of less than 10 prism diopters in primary position or (2) the disappearance of anomalous head position in those in whom the surgery was done for that purpose, such as patients with a fourth nerve palsy, Brown syndrome, or Duane syndrome. The results here reflect reviews of follow-up visits during the period between October 2011 and September 2012. Hence, the follow-up data for some patients is not included here, nor are long-term outcomes. For the above-mentioned period, 212 strabismus procedures were performed by three surgeons; 127 procedures were performed on children and 85 on adults (defined as age 16 years or older). 30 Outcomes 2012 Adult Strabismus Cases (N = 85) October 2011 – September 2012 Surgeries (%) 40 30 20 10 0 Esotropia Exotropia 4th Nerve Palsy 6th Nerve Palsy Hypertropia Thyroid Duane Eye Disease Syndrome Slipped Muscle Diagnosis Adult Outcomes (N = 79) October 2011 – September 2012 27% Poor − Over- or undercorrected 100% 73% Good − Ocular alignment within 10 prism diopters of orthotropia if no diplopia, and/or diplopia disappeared and/or anomalous head position resolved Note: This graph excludes six patients for whom follow-up was not available. Cole Eye Institute 31 Strabismus Surgery Pediatric Strabismus Cases (N = 127) October 2011 – September 2012 Surgeries (%) 50 40 30 20 10 0 Esotropia Exotropia Dissociated Vertical Deviations 4th Nerve Palsy 6th Nerve Palsy Nystagmus Duane Syndrome 3rd Nerve Palsy Diagnosis Pediatric Outcomes (N = 110) October 2011 – September 2012 10% Poor − Over- or undercorrected 100% 90% Good − Constant deviation < 10 prism diopters in primary position and/or anomalous head position resolved Note: This graph excludes 17 patients for whom follow-up was not available. 32 Outcomes 2012 Patient Experience — Cole Eye Institute Cleveland Clinic is dedicated to delivering excellent clinical outcomes and the best possible experience for our patients and their families. Patient feedback is critical in driving priorities and assessing results. Based on this feedback, Cleveland Clinic’s Office of Patient Experience implements training programs to improve service and communication as well as educational initiatives to help patients understand what to expect when they are in our care. Outpatient Office Survey — Cole Eye Institute 2011 – 2012 Percent Best Response* 100 2011 (N = 4,414) 2012 (N = 4,141) 80 60 40 20 0 Appt Access/ Check-In Clinic Wait Times and Comfort Nurse and Assistant Physician Concern for Needs and Privacy Overall Assessment *Response options: Very Good, Good, Fair, Poor, Very Poor Each bar represents a composite score based on responses to multiple survey questions. Source: Press Ganey, a national hospital survey vendor Cole Eye Institute 33 Cleveland Clinic — Improving Quality, Safety, and the Patient Experience Overview Cleveland Clinic health system uses a scorecard approach to measure and monitor quality, safety, and patient experience. Real-time dashboard data are leveraged in each location to drive performance improvement. Although not an exact match to publicly reported data, more timely internal data create transparency at all organizational levels and support improved care in all clinical locations. The following measures are examples of health system 2012 quality and safety focus areas. Throughout this section, “Cleveland Clinic” refers to the academic medical center or “main campus,” and those results are shown. Cleveland Clinic Core Measures Appropriateness of Care All-Cause 30-Day Readmission Rate to Any Cleveland Clinic Hospital 2011 – 2012 2011 – 2012 Percent of Patients 100 Percent of Discharges 18 16 14 80 12 60 10 8 40 Cleveland Clinic Performance Cleveland Clinic Target 20 0 Q1 Q2 Q3 2011 Q4 Q1 Q2 Q3 Q4 2012 Cleveland Clinic’s goal is for all patients to receive all the recommended care for their condition. An aggregated “all or nothing” measurement approach to monitoring multiple publicly reported process-of-care measures for heart failure, acute myocardial infarction, pneumonia, and surgery patients yields results consistently above 94%. 34 Cleveland Clinic Performance 6 4 2 0 Q1 Q2 Q3 2011 Q4 Q1 Q2 Q3 Q4 2012 Cleveland Clinic monitors 30-day readmission rates for any reason to any of its system hospitals. Unplanned readmissions are actively reviewed for improvement opportunities. Strategies associated with communication, education, and follow-up have been implemented for several high-risk conditions, including heart failure and pneumonia. These practices are being expanded and enhanced to reduce overall avoidable readmissions. Outcomes 2012 Cleveland Clinic Deaths Among Surgical Patients With Serious Treatable Complications (PSI 4) Rate per 1,000 Eligible Patients Cleveland Clinic Overall In-Hospital Mortality Observed/Expected Ratio 2011 – 2012 2011 – 2012 O/E Ratio 1.2 Rate per 1,000 Patients 180 1.0 160 140 0.8 120 0.6 100 Cleveland Clinic Performance UHC* 50th Percentile (Academic Medical Center) 0.4 80 0.0 Cleveland Clinic Performance UHC* 50th Percentile (Academic Medical Center) 60 0.2 40 Q1 Q2 Q3 2011 Q4 Q1 Q2 Q3 Q4 2012 Cleveland Clinic’s observed/expected (O/E) mortality ratio outperformed the University HealthSystem Consortium (UHC) academic medical center 50th percentile throughout 2012 based on the UHC 2012 risk model. Ratios less than 1.0 indicate mortality performance “better than” expected in UHC’s risk adjustment model. 20 0 Q1 Q2 Q3 2011 Q4 Q1 Q2 Q3 Q4 2012 The Agency for Healthcare Research and Quality’s Patient Safety Indicator 4 (AHRQ PSI 4) reports deaths among patients with serious treatable complications. Cleveland Clinic performs in the top third of UHC’s academic medical centers for this measure. *These data are prepared using the University HealthSystem Consortium (UHC) Clinical Database. uhc.edu Cole Eye Institute 35 Cleveland Clinic — Improving Quality, Safety, and the Patient Experience Cleveland Clinic Postoperative Blood Clot Rate (PSI 12) per 1,000 Eligible Patients Cleveland Clinic Central Line-Associated Bloodstream Infection—ICU Rate per 1,000 Line Days 2011 – 2012 2010 – 2012 Rate per 1,000 Patients 20 18 16 14 12 10 8 Cleveland Clinic Performance 6 UHC* 50th Percentile 4 (Academic Medical Center) 2 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Rate per 1,000 Line Days 3.5 2011 2012 Cleveland Clinic continues to improve its performance with respect to postoperative blood clots (AHRQ Patient Safety Indicator 12). Improved screening and prevention strategies have led to a 45% reduction in these events over the past two years. Cleveland Clinic Performance Cleveland Clinic Target 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2010 2011 2012 Cleveland Clinic has implemented several strategies to reduce central line-associated bloodstream infections (CLABSI), including a central-line bundle of insertion, maintenance, and removal best practices. In 2012, Cleveland Clinic initiated focused reviews of every CLABSI occurrence and is introducing equipment and technology to support reductions in CLABSI rates in its high-risk critical care population. *These data are prepared using the University HealthSystem Consortium (UHC) Clinical Database. uhc.edu 36 Outcomes 2012 Cleveland Clinic Hospital-Acquired Pressure Ulcers Prevalence Cleveland Clinic Falls Rate per 1,000 Patient Days 2011 – 2012 2011 – 2012 Percent 5 Rate per 1,000 Patient Days 4.0 3.5 4 3.0 2.5 3 2.0 2 Cleveland Clinic Performance NDNQI®* 50th Percentile (Academic Medical Center) 1 0 Q1 Q2 Q3 2011 Q4 Q1 Q2 Q3 Q4 2012 A pressure ulcer is an injury to the skin that can be caused by pressure, moisture, or friction. These sometimes occur when patients have difficulty changing positions on their own. Cleveland Clinic caregivers have been trained to provide appropriate skin care and regular repositioning help while taking advantage of special devices and mattresses to reduce pressure for high-risk patients. In addition, they actively look for hospital-acquired pressure ulcers and treat them quickly if they occur. 1.5 Cleveland Clinic Performance NDNQI®* 50th Percentile (Academic Medical Center) 1.0 0.5 0.0 Q1 Q2 Q3 Q4 2011 Q1 Q2 Q3 Q4 2012 Nationally, falls are a leading cause of hospital patient injury. Cleveland Clinic fall prevention efforts include identifying patients who are at risk for falls, checking on them frequently, assisting them to the bathroom, and providing nonskid footwear. Caregivers make sure patients have all necessary items, including a call light, within easy reach. *The National Database of Nursing Quality Indicators® (NDNQI®) is owned by the American Nurses Association. The database collects and evaluates unit-specific nurse-sensitive data from hospitals domestically and globally, with > 1900 hospitals participating. The comparison data represented here are based on a third of all hospitals in the U.S. participating. © 2012, American Nurses Association, All Rights Reserved. www.nursingquality.org Cole Eye Institute 37 Cleveland Clinic — Improving Quality, Safety, and the Patient Experience Patient Experience The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a standardized national tool used to measure patients’ perspectives of hospital care. Results collected for public reporting are available at medicare.gov/hospitalcompare. Cleveland Clinic HCAHPS Overall Assessment 2011 – 2012 Percent Best Response* 100 84.9 84.0 80 80.0 80.8 60 2011 (N = 10,378) 2012 (N = 11,190) 40 National Average July 1, 2011 – June 30, 2012 20 0 Recommend Hospital (% Definitely Yes)* Hospital Rating (% 9 or 10) 0–10 Scale *Response options: Definitely Yes, Probably Yes, Probably No, Definitely No Source: Centers for Medicare & Medicaid Services and Press Ganey, a national hospital survey vendor 38 Outcomes 2012 Cleveland Clinic HCAHPS Domains of Care 2011 – 2012 Percent Best Response* 100 2011 (N = 10,378) 2012 (N = 11,190) National Average July 1, 2011 – June 30, 2012 80 60 40 20 0 Discharge Information % Yes Doctor Nurse Communication Communication Pain Management Room New Medications Responsiveness Clean Communication to Needs % Always (Options: Always, Usually, Sometimes, Never) Quiet at Night *Except for “Room Clean” and “Quiet at Night,” each bar represents a composite score based on responses to multiple survey questions. Source: Centers for Medicare & Medicaid Services and Press Ganey, a national hospital survey vendor The guiding principle of Cleveland Clinic is “Patients First,” and improving the patient experience is a major strategic organizational goal. The Office of Patient Experience collaborates with physician and nursing leadership to establish best practices and implement standardized protocols that ensure delivery of patient-centered care. Cole Eye Institute 39 Innovations Creating Next-Generation Electronic Health Record Tools to Care for Patients In 2012, Cleveland Clinic’s Cole Eye Institute completed a total migration to an electronic health records (EHR) system. This project took more than three years and $3 million in support to complete. Substantial modifications to clinic and billing workflows, hardware, image storage, and Epic content were required to optimize the system and ensure successful deployment. Now that the migration is complete, Cole Eye Institute has started reaping some of the rewards of customization, data collection, and streamlined workflow. There was little economic change from year-to-date values, whereas other ophthalmology peers showed significant declines. “EHR has allowed us to examine every aspect of patient care,” explains Rishi Singh, MD, who has served as physician leader for the project’s scope, design, development, and implementation. “We can track improvements following procedures, display summary reports that help physicians follow trends, and aggregate our collective experiences to assess our practice.” With the EHR, cross-communication among doctors who manage complex patients can occur with ease. For example, a patient who has both rheumatologic disease and eye disease and who requires care from multiple specialists now has the opportunity to take advantage of joint clinics, which allow him or her to see all providers in one day, at one location. Aside from being convenient for patients, joint clinics allow ophthalmologists and other physicians to provide coordinated multidisciplinary care. Cole Eye Institute has begun leveraging its experiences through an EHR Optimization Services Program. As part of this program, the team from Cole Eye Institute has been traveling to leading ophthalmic programs across the country and sharing best practices and advice on EHR system implementation. This program has been extremely well received, and multiple institutions have entered into agreements with Cole Eye Institute to provide EHR services from workflow optimization through complete implementation of the EHR system. The EHR system will be rolled out to Cole Eye Institute physicians throughout the year, and the next phase of EHR will offer decision-support tools for physicians, create a data repository or data mart for ongoing clinical research, and provide dashboards that will display the ongoing clinical, administrative, quality, and safety metrics at the institute. “Our work on EHR is giving Cole Eye Institute a monumental opportunity to contribute knowledge to and lead in the field of ophthalmology.” 40 Outcomes 2012 Refractive Laser Assisted Cataract Surgery Cataract surgery today has changed from what it used to be. It essentially began as a therapeutic procedure for older patients, but is now used on patients of all ages and expectations. Patients today not only want their cataracts removed but also want it to be done in a faster, better, and more technologically refined manner. Now that the laser is available at Cole Eye Institute and ReLACS is offered by a number of the institute’s surgeons performing cataract surgery, the results of ReLACS will be published in a subsequent Cleveland Clinic outcomes report once the procedure has been performed enough times to warrant comparison with the results of standard cataract surgery. So far, with the limited number of ReLACS cases performed at Cleveland Clinic, the results have been encouraging. With the introduction of refractive laser assisted cataract surgery (ReLACS), standard cataract procedure (which focuses on the removal of a cloudy lens for replacement with a synthetic lens implant) is now moving beyond the best lens implant calculation and aspheric, toric, or multifocal shape to refractive laser precision. ReLACS is changing modern-day cataract surgery into a refractive procedure, striving to achieve the same kind of refractive precision with cataract surgery as is experienced with LASIK. A growing number of “baby boomers” are reaching the age for cataract development and surgery, and this generation has high expectations for vision correction derived from their knowledge of LASIK. Thus, ReLACS represents the next big wave of refractive cataract surgery within a population wishing for not just cataract removal, but vision correction. Ronald R. Krueger, MD, as an early innovator and co-founder of one of the four commercial companies offering ReLACS, serves as the lead editor of and contributor to a textbook on the procedure.1 This first textbook on ReLACS summarizes the historical, technological, commercial, and early clinical aspects of laser assisted cataract surgery and how it can be used to enhance the visual outcomes and meet the expectations of patients seeking cataract surgery and a glasses-free result. Cole Eye Institute Krueger RR, Talamo JH, Lindstrom RL, Eds. Textbook of Refractive Laser Assisted Cataract Surgery (ReLACS). Springer; 2012. 289 pp. 1 41 Selected Publications For a complete list of Ophthalmology 2012 publications go to Ahmad BU, Barakat MR, Feldman M, Singh RP. Bilateral subcutaneous emphysema from pressurized infusion during pars plana vitrectomy: A case report. Retin Cases Brief Rep. 2012 Winter;6(1):22-24. clevelandclinic.org/outcomes. Alraiyes AH, Alraies MC, Almeida FA, Singh AD. Flashing lights, floaters, and reduced vision. Cleve Clin J Med. 2012 Sep;79(9):616-618. Ariss M, Natan K, Friedman N, Traboulsi EI. Ophthalmologic abnormalities in Mowat-Wilson syndrome and a mutation in ZEB2. Ophthalmic Genet. 2012 Sep;33(3):159-160. Aronow M, Sun Y, Saunthararajah Y, Biscotti C, Tubbs R, Triozzi P, Singh AD. Monosomy 3 by FISH in uveal melanoma: Variability in techniques and results. Surv Ophthalmol. 2012 Sep-Oct;57(5):463-473. Aronow ME, Nakagawa JA, Gupta A, Traboulsi EI, Singh AD. Tuberous sclerosis complex: genotype/phenotype correlation of retinal findings. Ophthalmology. 2012 Sep;119(9):1917-1923. Barbosa FL, Lin M, Santhiago MR, Singh V, Agrawal V, Wilson SE. Interleukin-1 receptor role in the viability of corneal myofibroblasts. Exp Eye Res. 2012 Mar;96(1):65-69. Biscotti CV, Singh AD. Uveal melanoma: diagnostic features. Monogr Clin Cytol. 2012;21:44-54. Browning DJ, Kaiser PK, Rosenfeld PJ, Stewart MW. Aflibercept for age-related macular degeneration: a game-changer or quiet addition? Am J Ophthalmol. 2012 Aug;154(2):222-226. Canton VM, Quiroz-Mercado H, Velez-Montoya R, Lopez-Miranda MJ, Moshfeghi AA, Shusterman EM, Kaiser PK, Sanislo SR, Gertner M, Moshfeghi DM. 24-Gy low-voltage x-ray irradiation with ranibizumab therapy for neovascular AMD: 6-month safety and functional outcomes. Ophthalmic Surg Lasers Imaging. 2012 Jan-Feb;43(1):20-24. Chappelow AV, Tan K, Waheed NK, Kaiser PK. Panretinal photocoagulation for proliferative diabetic retinopathy: pattern scan laser versus argon laser. Am J Ophthalmol. 2012 Jan;153(1):137-142. Chute DJ, Biscotti CV, Singh AD. Uveal lymphoma. Monogr Clin Cytol. 2012;21:31-43. Coussa RG, Traboulsi EI. Choroideremia: A review of general findings and pathogenesis. Ophthalmic Genet. 2012 Jun;33(2):57-65. Coussa RG, Kim J, Traboulsi EI. Choroideremia: Effect of age on visual acuity in patients and female carriers. Ophthalmic Genet. 2012 Jun;33(2):66-73. 42 Outcomes 2012 Dhoot DS, Kaiser PK. Ranibizumab for age-related macular degeneration. Expert Opin Biol Ther. 2012 Mar;12(3):371-381. Farag E, Sessler DI, Kovaci B, Wang L, Mascha EJ, Bell G, Kalfas I, Rockwood E, Kurz A. Effects of crystalloid versus colloid and the alpha-2 agonist brimonidine versus placebo on intraocular pressure during prone spine surgery: a factorial randomized trial. Anesthesiology. 2012 Apr;116(4):807-815. Folgar FA, Chow JH, Farsiu S, Wong WT, Schuman SG, O’Connell RV, Winter KP, Chew EY, Hwang TS, Srivastava SK, Harrington MW, Clemons TE, Toth CA. Spatial correlation between hyperpigmentary changes on color fundus photography and hyperreflective foci on SDOCT in intermediate AMD. Invest Ophthalmol Vis Sci. 2012;53(8):4626-4633. Gabriel LAR, Wang LW, Bader H, Ho JC, Majors AK, Hollyfield JG, Traboulsi EI, Apte SS. ADAMTSL4, a secreted glycoprotein widely distributed in the eye, binds fibrillin-1 microfibrils and accelerates microfibril biogenesis. Invest Ophthalmol Vis Sci. 2012;53(1): 461-469. Ghanem RC, Netto MV, Ghanem VC, Santhiago MR, Wilson SE. Peripheral sterile corneal ring infiltrate after riboflavin-UVA collagen cross-linking in keratoconus. Cornea. 2012 Jun;31(6):702-705. Ginat DT, Singh AD, Moonis G. Multimodality imaging of hydrogel scleral buckles. Retina. 2012 Sep;32(8):1449-1452. Gomes BAF, Smadja D, Espana EM, Ahn ES, Netto MV, Santhiago MR. Very late-onset corneal scar triggered by trauma after photorefractive keratectomy. J Cataract Refract Surg. 2012 Sep;38(9):1694-1697. Gomes BDAF, Santhiago MR, de Azevedo MNL, Moraes HV, Jr. Evaluation of dry eye signs and symptoms in patients with systemic sclerosis. Graefes Arch Clin Exp Ophthalmol. 2012 Jul;250(7): 1051-1056. Goshe JM, Lewis CD, Meine JG, Schoenfield L, Perry JD. Primary dermatofibrosarcoma protuberans invading the orbit. Ophthal Plast Reconstr Surg. 2012 May-Jun;28(3):e65-e67. Grunwald JE, Daniel E, Ying GS, Pistilli M, Maguire MG, Alexander J, Whittock-Martin R, Parker CR, Sepielli K, Blodi BA, Martin DF. Photographic assessment of baseline fundus morphologic features in the comparison of age-related macular degeneration treatments trials. Ophthalmology. 2012 Aug;119(8):1634-1641. Cole Eye Institute Gupta N, Singh RP. Resolution of a choroidal abscess in the setting of endophthalmitis in an immunocompetent host with noninvasive treatment. Retin Cases Brief Rep. 2012 Spring;6(2):184-186. Gupta PK, Ehlers JP, Kim T. Evaluation of clear corneal wound dynamics with contrast-enhanced spectral-domain optical coherence tomography. Ophthalmic Surg Lasers Imaging. 2012 May-Jun;43(3):222-228. Hall EF, Ahmad B, Schachat AP. Spectral-domain optical coherence tomography findings in acute retinal pigment epitheliitis. Retin Cases Brief Rep. 2012 Summer;6(3):309-312. Hallahan KM, Sood A, Singh AD. Acute episode of eyelid oedema. Br J Ophthalmol. 2012 Jun;96(6):909, 913. Heier JS, Brown DM, Chong V, Korobelnik JF, Kaiser PK, Nguyen QD, Kirchhof B, Ho A, Ogura Y, Yancopoulos GD, Stahl N, Vitti R, Berliner AJ, Soo Y, Anderesi M, Groetzbach G, Sommerauer B, Sandbrink R, Simader C, Schmidt-Erfurth U. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology. 2012 Dec;119(12):2537-2548. Ho AC, Prenner JL, Kaiser RS, Kaiser PK. Maximizing patient outcomes in AMD: A review of evolving, evidence-based therapeutic options for clinical practice. Retina Today. 2012 Sep;1-20. Hong CW, Sinha-Roy A, Schoenfield L, McMahon JT, Dupps WJ, Jr. Collagenase-mediated tissue modeling of corneal ectasia and collagen cross-linking treatments. Invest Ophthalmol Vis Sci. 2012;53(4):2321-2327. Kaiser PK. Choroidal imaging offers a new window on disease management: The technology is already in use for diagnosis and management of some conditions. Retina Today. 2012 Apr;60-63. Kaiser PK, Cruess AF, Bogaert P, Khunti K, Kelly SP. Balancing risk in ophthalmic prescribing: assessing the safety of anti-VEGF therapies and the risks associated with unlicensed medicines. Graefes Arch Clin Exp Ophthalmol. 2012 Nov;250(11):1563-1571. Kaiser PK, Boyer DS, Cruess AF, Slakter JS, Pilz S, Weisberger A. Verteporfin plus ranibizumab for choroidal neovascularization in age-related macular degeneration: Twelve-month results of the DENALI study. Ophthalmology. 2012 May;119(5):1001-1010. Khan N, Khan MK, Bena J, Macklis R, Singh AD. Plaque brachytherapy for uveal melanoma: a vision prognostication model. Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):e285-e290. 43 Selected Publications Koenekoop RK, Wang H, Majewski J, Wang X, Lopez I, Ren H, Chen Y, Li Y, Fishman GA, Genead M, Schwartzentruber J, Solanki N, Traboulsi EI, Cheng J, Logan CV, McKibbin M, Hayward BE, Parry DA, Johnson CA, Nageeb M, Poulter JA, Mohamed MD, Jafri H, Rashid Y, Taylor GR, Keser V, Mardon G, Xu H, Inglehearn CF, Fu Q, Toomes C, Chen R. Mutations in NMNAT1 cause Leber congenital amaurosis and identify a new disease pathway for retinal degeneration. Nat Genet. 2012 Jul 29;44(9):1035-1039. Lee BJ, Nelson CC, Lewis CD, Perry JD. External dacryocystorhinostomy outcomes in sarcoidosis patients. Ophthal Plast Reconstr Surg. 2012 Jan-Feb;28(1):47-49. Lee BJ, Nelson CC, Lewis CD, Perry JD. External dacryocystorhinostomy surgery in patients with Wegener granulomatosis. Ophthal Plast Reconstr Surg. 2012 Nov-Dec;28(6):389-392. Lima BR, Singh AD. Bevacizumab therapy for choroidal melanoma. Eur Oncol Haematol. 2012 May;8(2):101-104. Martin DF, Maguire MG, Fine SL, Ying GS, Jaffe GJ, Grunwald JE, Toth C, Redford M, Ferris FL, III. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: Two-year results. Ophthalmology. 2012 Jul;119(7):1388-1398. Marwaha G, Wilkinson A, Bena J, Macklis R, Singh AD. Dosimetric benefit of a new ophthalmic radiation plaque. Int J Radiat Oncol Biol Phys. 2012 Dec 1;84(5):1226-1230. Nicholson BP, Singh RP, Sears JE, Lowder CY, Kaiser PK. Evaluation of fluocinolone acetonide sustained release implant (Retisert) dissociation during implant removal and exchange surgery. Am J Ophthalmol. 2012 Dec;154(6):969-973. Ohr M, Kaiser PK. Intravitreal aflibercept injection for neovascular (wet) age-related macular degeneration. Expert Opin Pharmacother. 2012 Mar;13(4):585-591. Pasquali T, Krueger R. Topography-guided laser refractive surgery. Curr Opin Ophthalmol. 2012 Jul;23(4):264-268. Pasquali TA, Mehta MP, Perry JD. Conjunctival bleeding after ectropion repair due to paraneoplastic primary fibrinolysis. Ophthal Plast Reconstr Surg. 2012 Mar-Apr;28(2):e44-e45. Payne JF, Ray R, Watson DG, Delille C, Rimler E, Cleveland J, Lynn MJ, Tangpricha V, Srivastava SK. Vitamin D insufficiency in diabetic retinopathy. Endocr Pract. 2012 Mar-Apr;18(2):185-193. Pelayes DE, Zarate JO, Biscotti CV, Singh AD. Calibrated needle for ophthalmic fine needle aspiration biopsy. Br J Ophthalmol. 2012 Aug;96(8):1147-1148. Mello GR, Rocha KM, Santhiago MR, Smadja D, Krueger RR. Applications of wavefront technology. J Cataract Refract Surg. 2012 Sep;38(9):1671-1683. Perry JD. Dysfunctional epiphora: a critique of our current construct of “functional epiphora.” Am J Ophthalmol. 2012 Jul;154(1):3-5. Moshfeghi AA, Morales-Canton V, Quiroz-Mercado H, Velez-Montoya R, Zavala-Ayala A, Shusterman EM, Kaiser PK, Sanislo SR, Gertner M, Moshfeghi DM. 16 Gy low-voltage x-ray irradiation followed by as needed ranibizumab therapy for age-related macular degeneration: 12 month outcomes of a ‘radiation-first’ strategy. Br J Ophthalmol. 2012 Oct;96(10):1320-1324. Santhiago MR, Smadja D, Zaleski K, Espana EM, Armstrong BK, Wilson SE. Flap relift for retreatment after femtosecond laser-assisted LASIK. J Refract Surg. 2012 Jul;28(7):482-487. Natan K, Traboulsi EI. Unilateral rectus muscle recession in the treatment of Duane syndrome. J AAPOS. 2012 Apr;16(2):145-149. 44 Nguyen QD, Campochiaro PA, Shah SM, Browning DJ, Hudson HL, Sonkin PL, Hariprasad SM, Kaiser PK, Slakter J, Haller JA, Do DV, Mieler W, Chu K, Ingerman A, Vitti R, Berliner AJ, Cedarbaum J. Evaluation of very high- and very low-dose intravitreal aflibercept in patients with neovascular age-related macular degeneration. J Ocul Pharmacol Ther. 2012 Dec;28(6):581-588. Santhiago MR, Netto MV, Wilson SE. Mitomycin C: biological effects and use in refractive surgery. Cornea. 2012 Mar;31(3):311-321. Santhiago MR, Wilson SE, Netto MV, Ghanen RC, Monteiro MLR, Bechara SJ, Espana EM, Mello GR, Kara-Junior N. Modulation transfer function and optical quality after bilateral implantation of a +3.00 D versus a +4.00 D multifocal intraocular lens. J Cataract Refract Surg. 2012 Feb;38(2):215-220. Outcomes 2012 Saunthararajah Y, Triozzi P, Rini B, Singh A, Radivoyevitch T, Sekeres M, Advani A, Tiu R, Reu F, Kalaycio M, Copelan E, Hsi E, Lichtin A, Bolwell B. p53-independent, normal stem cell sparing epigenetic differentiation therapy for myeloid and other malignancies. Semin Oncol. 2012 Feb;39(1):97-108. Schein OD, Banta JT, Chen TC, Pritzker S, Schachat AP. Lessons learned: Wrong intraocular lens. Ophthalmology. 2012 Oct;119(10):2059-2064. Seregard S, Singh AD. Retinoblastoma: direct chemotherapeutic drug delivery into the vitreous cavity. Br J Ophthalmol. 2012 Apr;96(4):473-474. Singh AD, Dolan B, Biscotti CV. Future of ophthalmic fine needle aspiration biopsy. Monogr Clin Cytol. 2012;21:90-96. Singh AD, Pelayes DE, Brainard JA, Biscotti CV. History, indications, techniques and limitations. Monogr Clin Cytol. 2012;21:1-9. Singh AD, Pabon S, Aronow ME. Management of radiation maculopathy. Ophthalmic Res. 2012;48 Suppl 1:26-31. Singh AD, Biscotti CV. Fine needle aspiration biopsy of ophthalmic tumors. Saudi J Ophthalmol. 2012 Apr;26(2):117-123. Singh AD, Aronow ME, Sun Y, Bebek G, Saunthararajah Y, Schoenfield LR, Biscotti CV, Tubbs RR, Triozzi PL, Eng C. Chromosome 3 status in uveal melanoma: a comparison of fluorescence in situ hybridization and single-nucleotide polymorphism array. Invest Ophthalmol Vis Sci. 2012;53(7):3331-3339. Singh R, Alpern L, Jaffe GJ, Lehmann RP, Lim J, Reiser HJ, Sall K, Walters T, Sager D. Evaluation of nepafenac in prevention of macular edema following cataract surgery in patients with diabetic retinopathy. Clin Ophthalmol. 2012;6:1259-1269. Singh RP, Shusterman EM, Moshfeghi D, Danis R, Gertner M. Pilot study of the delivery of microcollimated pars plana external beam radiation in porcine eyes: 270-day analysis. J Ophthalmol. 2012;2012:615214. Cole Eye Institute Singh V, Agrawal V, Santhiago MR, Wilson SE. Stromal fibroblast-bone marrow-derived cell interactions: Implications for myofibroblast development in the cornea. Exp Eye Res. 2012 May;98(1):1-8. Smadja D, Santhiago MR, Mello GR, Roberts CJ, Dupps WJ, Jr., Krueger RR. Response of the posterior corneal surface to myopic laser in situ keratomileusis with different ablation depths. J Cataract Refract Surg. 2012 Jul;38(7):1222-1231. Smadja D, Colin J, Krueger RR, Mello GR, Gallois A, Mortemousque B, Touboul D. Outcomes of deep anterior lamellar keratoplasty for keratoconus: learning curve and advantages of the big bubble technique. Cornea. 2012 Aug;31(8):859-863. Smadja D, Santhiago MR, Mello GR, Espana EM, Krueger RR. Suction loss during thin-flap femto-LASIK: Management and beneficial refractive effect of the epithelium. J Cataract Refract Surg. 2012 May;38(5):902-905. Smadja D, Reggiani-Mello G, Santhiago MR, Krueger RR. Wavefront ablation profiles in refractive surgery: description, results, and limitations. J Refract Surg. 2012 Mar;28(3):224-232. Stacy RC, Jakobiec FA, Herwig MC, Schoenfield L, Singh A, Grossniklaus HE. Diffuse large B-cell lymphoma of the orbit: clinicopathologic, immunohistochemical, and prognostic features of 20 cases. Am J Ophthalmol. 2012 Jul;154(1):87-98. Steinle NC, Gupta N, Yuan A, Singh RP. Oral rifampin utilisation for the treatment of chronic multifocal central serous retinopathy. Br J Ophthalmol. 2012 Jan;96(1):10-13. Tarabishy AB, Hise AG, Traboulsi EI. Ocular manifestations of the autoinflammatory syndromes. Ophthalmic Genet. 2012 Dec;33(4):179-186. Teng K, Eng C, Hess CA, Holt MA, Moran RT, Sharp RR, Traboulsi EI. Building an innovative model for personalized healthcare. Cleve Clin J Med. 2012 Apr;79 Suppl 1:S1-S9. Traboulsi EI. Pigmented and depigmented lesions of the ocular fundus. Curr Opin Ophthalmol. 2012 Sep;23(5):337-343. 45 Triozzi PL, Singh AD. Blood biomarkers for uveal melanoma. Future Oncol. 2012 Feb;8(2):205-215. Triozzi PL, Achberger S, Aldrich W, Singh AD, Grane R, Borden EC. The association of blood angioregulatory microRNA levels with circulating endothelial cells and angiogenic proteins in patients receiving dacarbazine and interferon. J Transl Med. 2012 Dec 5;10 (1):241. Turell ME, Tubbs RR, Biscotti CV, Singh AD. Uveal melanoma: prognostication. Monogr Clin Cytol. 2012;21:55-60. Ventura BV, Moraes HV, Jr., Kara-Junior N, Santhiago MR. Role of optical coherence tomography on corneal surface laser ablation. J Ophthalmol. 2012;2012:676740. Ventura BV, Ventura M, Lira W, Ventura CV, Santhiago MR, Werner L. Microscopic analysis of opacification in Loflex® hydrophilic acrylic intraocular lenses. Rev Bras Oftalmol. 2012 May-Jun;71(3):149-154. Wang Y, Abu-Asab MS, Li W, Aronow ME, Singh AD, Chan CC. Autoantibody against transient receptor potential M1 cation channels of retinal ON bipolar cells in paraneoplastic vitelliform retinopathy. BMC Ophthalmol. 2012 Nov 13;12:56. Wilson SE, Santhiago MR. Flaporhexis: Rapid and effective technique to limit epithelial ingrowth after LASIK enhancement. J Cataract Refract Surg. 2012 Jan;38(1):2-4. Wilson SE. Corneal myofibroblast biology and pathobiology: Generation, persistence, and transparency. Exp Eye Res. 2012 Jun;99(1):78-88. Yoder JS, Verani J, Heidman N, Hoppe-Bauer J, Alfonso EC, Miller D, Jones DB, Bruckner D, Langston R, Jeng BH, Joslin CE, Tu E, Colby K, Vetter E, Ritterband D, Mathers W, Kowalski RP, Acharya NR, Limaye AP, Leiter C, Roy S, Lorick S, Roberts J, Beach MJ. Acanthamoeba keratitis: The persistence of cases following a multistate outbreak. Ophthalmic Epidemiol. 2012 Aug;19(4): 221-225. Yuan A, Ehlers JP. Crystalline retinopathy from primary hyperoxaluria. Retina. 2012 Oct;32(9):1994-1995. 46 Publications Selected Publications Outcomes 2012 Ophthalmology Research Bagheri N, Bell BA, Bonilha VL, Hollyfield JG. Imaging human postmortem eyes with SLO and OCT. Adv Exp Med Biol. 2012;723:479-488. Bell BA, Kaul C, Rayborn ME, Hollyfield JG. Baseline imaging reveals preexisting retinal abnormalities in mice. Adv Exp Med Biol. 2012;723:459-469. Bollinger KE, Crabb JS, Yuan X, Putliwala T, Clark AF, Crabb JW. Proteomic similarities in steroid responsiveness in normal and glaucomatous trabecular meshwork cells. Mol Vis. 2012;18:2001-2011. Grossman GH, Pauer GJ, Hoppe G, Hagstrom SA. Isolating photoreceptor compartment-specific protein complexes for subsequent proteomic analysis. Adv Exp Med Biol. 2012;723:701-707. Gu X, Neric NJ, Crabb JS, Crabb JW, Bhattacharya SK, Rayborn ME, Hollyfield JG, Bonilha VL. Age-related changes in the retinal pigment epithelium (RPE). PLoS One. 2012;7(6):e38673. Hagstrom SA, Watson RF, Pauer GJT, Grossman GH. Tulp1 is involved in specific photoreceptor protein transport pathways. Adv Exp Med Biol. 2012;723:783-789. Peachey NS, Pearring JN, Bojang P, Jr., Hirschtritt ME, Sturgill-Short G, Ray TA, Furukawa T, Koike C, Goldberg AFX, Shen Y, McCall MA, Nawy S, Nishina PM, Gregg RG. Depolarizing bipolar cell dysfunction due to a Trpm1 point mutation. J Neurophysiol. 2012 Nov;108(9):2442-2451. Samuels IS, Lee CA, Petrash JM, Peachey NS, Kern TS. Exclusion of aldose reductase as a mediator of ERG deficits in a mouse model of diabetic eye disease. Vis Neurosci. 2012 Nov;29(6):267-274. Stohr H, Anand-Apte B. A review and update on the molecular basis of pathogenesis of Sorsby fundus dystrophy. Adv Exp Med Biol. 2012;723:261-267. Sugimoto M, Cutler A, Grossman G, Anand-Apte B. Regulation of retinal vascular permeability by betacellulin. Adv Exp Med Biol. 2012;723:293-298. Yu M, Sturgill-Short G, Ganapathy P, Tawfik A, Peachey NS, Smith SB. Age-related changes in visual function in cystathionine-beta-synthase mutant mice, a model of hyperhomocysteinemia. Exp Eye Res. 2012 Mar;96(1):124-131. Yu M, Zou W, Peachey NS, McIntyre TM, Liu J. A novel role of complement in retinal degeneration. Invest Ophthalmol Vis Sci. 2012 Dec;53(12):7684-7692. Hollyfield JG. Manuscript fabrication, image manipulation and plagiarism. Exp Eye Res. 2012 Jan;94(1):1-2. Matsuoka RL, Jiang Z, Samuels IS, Nguyen-Ba-Charvet KT, Sun LO, Peachey NS, Chedotal A, Yau KW, Kolodkin AL. Guidance-cue control of horizontal cell morphology, lamination, and synapse formation in the mammalian outer retina. J Neurosci. 2012 May 16;32(20):6859-6868. Peachey NS, Sturgill-Short GM. Response properties of slow PIII in the Large (vls) mutant. Doc Ophthalmol. 2012 Dec;125(3):203-209. Peachey NS, Ray TA, Florijn R, Rowe LB, Sjoerdsma T, Contreras-Alcantara S, Baba K, Tosini G, Pozdeyev N, Iuvone PM, Bojang P, Jr., Pearring JN, Simonsz HJ, Van Genderen M, Birch DG, Traboulsi EI, Dorfman A, Lopez I, Ren H, Goldberg AFX, Nishina PM, Lachapelle P, McCall MA, Koenekoop RK, Bergen AAB, Kamermans M, Gregg RG. GPR179 is required for depolarizing bipolar cell function and is mutated in autosomal-recessive complete congenital stationary night blindness. Am J Hum Genet. 2012 Feb 10;90(2):331-339. Cole Eye Institute 47 Staff Listing Some physicians may practice in multiple locations. For a detailed list including staff photos, please visit clevelandclinic.org/staff. Institute Chairman Daniel F. Martin, MD Vice Chairman Quality Review Officer Andrew P. Schachat, MD Vice Chairman, Education Elias I. Traboulsi, MD Surgical Outcomes Team Peter K. Kaiser, MD Cornea and External Disease William J. Dupps Jr., MD, PhD Jeffrey M. Goshe, MD Roger H.S. Langston, MD Martin A. Markowitz, MD David M. Meisler, MD Sheldon M. Oberfeld, MD Allen S. Roth, MD Scott A. Wagenberg, MD Monica Jain, MBBS, MHA Steven E. Wilson, MD Comprehensive Ophthalmology Richard E. Gans, MD Glaucoma Jonathan A. Eisengart, MD Philip N. Goldberg, MD Shalini Sood-Mendiratta, MD Martin A. Markowitz, MD Edward J. Rockwood, MD Shari Martyn, MD Keratorefractive Surgery William J. Dupps Jr., MD, PhD Michael E. Millstein, MD Ronald R. Krueger, MD Sheldon M. Oberfeld, MD Michael E. Millstein, MD Allen S. Roth, MD Allen S. Roth, MD David B. Sholiton, MD Steven E. Wilson, MD Scott A. Wagenberg, MD Neuro-Ophthalmology Gregory S. Kosmorsky, DO Lisa D. Lystad, MD Oculoplastics and Orbital Surgery Julian D. Perry, MD 48 Outcomes 2012 Institute Overview Ophthalmic Oncology Arun D. Singh, MD Pediatric Ophthalmology and Adult Strabismus Fatema Ghasia, MD Optometry David Barnhart, OD Brian Perkins, PhD Anita Chitluri, OD Jonathan Sears, MD Heather L. Cimino, OD Priyadarshini Senanayake, PhD Jian Hua Qi, PhD Robert Engel, OD Andreas Marcotty, MD Vivek Singh, PhD Reecha Kampani, OD Paul Rychwalski, MD Abhijit Roy Sinha, PhD Rosemary Perl, OD Elias I. Traboulsi, MD Steven E. Wilson, MD William E. Sax, OD Jing Xie, PhD Mary Jo Stiegemeier, OD Minzhong Yu, PhD Vitreoretinal Justis P. Ehlers, MD Peter K. Kaiser, MD Daniel F. Martin, MD Andrew P. Schachat, MD Jonathan E. Sears, MD Rishi P. Singh, MD Sunil K. Srivastava, MD Alex Yuan, MD Diane Tucker, OD Ophthalmic Research Joe G. Hollyfield, PhD Chairman Ophthalmic Anesthesia Marc A. Feldman, MD, MHS Section Head Bela Anand-Apte, MBBS, PhD J. Victor Ryckman, MD Vera Bonilha, PhD Sara Spagnuolo, MD John W. Crabb, PhD William J. Dupps Jr., MD, PhD Uveitis Careen Y. Lowder, MD, PhD Lindsey Ebke, PhD Sunil K. Srivastava, MD Stephanie A. Hagstrom, PhD Gregory Grossman, PhD George Hoppe, PhD Geeng-Fu Jang, PhD Lisa Kuttner-Kondo, PhD Michelle Lin, PhD Neema Mayhugh, PhD Neal S. Peachey, PhD Cole Eye Institute 49 Contact Information General Patient Referral 24/7 hospital transfers or physician consults 800.553.5056 Cole Eye Institute Appointments 216.444.2020 or 800.223.2273, ext. 42020 Cole Eye Institute Referrals 216.444.2030 or 800.223.2273, ext. 42030 On the Web at clevelandclinic.org/eye Additional Contact Information General Information 216.444.2200 Hospital Patient Information 216.444.2000 General Patient Appointments 216.444.2273 or 800.223.2273 50 Referring Physician Center and Hotline 24/7 hotline to streamline access to our array of medical services and schedule patient appointments 855.REFER.123 (855.733.3712) Medical Concierge Complimentary assistance for out-of-state patients and families 800.223.2273, ext. 55580, or email [email protected] Cleveland Clinic Abu Dhabi clevelandclinicabudhabi.ae Or email [email protected] or visit clevelandclinic.org/ refer123 Cleveland Clinic Canada Request for Medical Records Cleveland Clinic Florida 216.444.2640 or 800.223.2273, ext. 42640 Same-Day Appointments 216.444.CARE (2273) Global Patient Services/ International Center 888.507.6885 866.293.7866 Cleveland Clinic Nevada 702.483.6000 For address corrections or changes, please call 800.890.2467 Complimentary assistance for international patients and families 001.216.444.8184 or visit clevelandclinic.org/gps Outcomes 2012 Institute Locations Cleveland Clinic Main Campus Independence Family Health Center 9500 Euclid Ave. Cleveland, OH 44195 Crown Centre II 5001 Rockside Road Independence, OH 44131 216.444.2020 216.986.4000 Cole Eye Institute, Beachwood 25101 Chagrin Blvd. Beachwood, OH 44122 216.831.0120 Strongsville Family Health and Surgery Center 16761 SouthPark Center Strongsville, OH 44136 440.878.2500 Cole Eye Institute, Hillcrest Hospital Atrium Medical Building 6770 Mayfield Road, Suite 326 Mayfield Heights, OH 44124 Twinsburg Family Health and Surgery Center 8701 Darrow Road Twinsburg, OH 44087 330.888.4000 440.461.4733 Cole Eye Institute 51 About Cleveland Clinic Overview Cleveland Clinic is an academic medical center offering patient care services supported by research and education in a nonprofit group practice setting. More than 3,000 Cleveland Clinic staff physicians and scientists in 120 medical specialties care for more than 5 million patients across the system, performing more than 200,000 surgeries and conducting 450,000 Emergency Department visits. Patients come to Cleveland Clinic from all 50 states and more than 132 nations around the world. Cleveland Clinic is an integrated healthcare delivery system with local, national, and international reach. The main campus in midtown Cleveland, Ohio, has a 1,450-bed hospital, outpatient clinic, specialty institutes, labs, classrooms, and research facilities in 46 buildings on 167 acres. Cleveland Clinic patients represent the highest CMS case-mix index in the nation. Cleveland Clinic encompasses 75 northern Ohio outpatient locations, including 16 full-service family health centers, eight community hospitals, an affiliate hospital, and a rehabilitation hospital for children. Cleveland Clinic also includes Cleveland Clinic Florida, Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Canada, and Sheikh Khalifa Medical City (management contract). Cleveland Clinic Abu Dhabi is a full-service hospital and outpatient center in the United Arab Emirates scheduled to begin offering services in 2014. Cleveland Clinic is the second-largest employer in Ohio with nearly 44,000 employees. It generates $10.5 billion of economic activity a year. The Cleveland Clinic Model Cleveland Clinic was founded in 1921 by four physicians who had served in World War I and hoped to replicate the organizational efficiency of military medicine. The organization has grown through the years by adhering to the model set forth by the founders. All Cleveland Clinic staff physicians receive a straight salary with no bonuses or other financial incentives. The hospital and physicians share a financial interest in controlling costs, and profits are reinvested in research and education. The Cleveland Clinic system began to grow in 1987 with the founding of Cleveland Clinic Florida and expanded in the 1990s with the development of 16 family health centers across Northeast Ohio. Fairview Hospital, Hillcrest Hospital, and six other community hospitals joined Cleveland Clinic over the past decade and a half, offering Cleveland Clinic institute services in heart and neurological care, physical rehabilitation, and more. Clinical and support services were reorganized into 27 patient-centered institutes beginning in 2007. Institutes combine medical and surgical specialists around specific diseases or body systems under single leadership and in a shared location to provide optimal team care for every patient. Institutes work with the Office of Patient Experience to give every patient the best outcome and experience. 52 Outcomes 2012 Cleveland Clinic Lerner Research Institute At the Lerner Research Institute, hundreds of principal investigators, project scientists, research associates, and postdoctoral fellows are involved in laboratorybased translational and clinical research. Total research expenditures from external and internal sources exceeded $265 million in 2012. Research programs include cardiovascular, oncology, neurology, musculoskeletal, allergy and immunology, ophthalmology, metabolism, and infectious diseases. Cleveland Clinic Lerner College of Medicine Lerner College of Medicine of Case Western Reserve University, which celebrated its 10th anniversary in 2012, is known for its small class size, unique curriculum, and full-tuition scholarships for all students. The program is open to 32 students who are preparing to be physician investigators. Graduate Medical Education In 2012, nearly 1,800 residents and fellows trained at Cleveland Clinic and Cleveland Clinic Florida, which is part of a continuing upward trend. U.S. News & World Report Ranking Cleveland Clinic is consistently ranked among the top hospitals in America by U.S. News & World Report, and our heart and heart surgery program has been ranked No. 1 in the nation since 1995. In 2012, Cleveland Clinic’s urology and nephrology programs were both ranked No. 1 in the nation. For more information about Cleveland Clinic, please visit clevelandclinic.org. Cole Eye Institute 53 Resources Referring Physician Center and Hotline 24/7 hotline to streamline access to our array of medical services and schedule patient appointments, call 855.REFER.123 (855.733.3712), email [email protected], or visit clevelandclinic.org/refer123 Remote Consults Online medical second opinions from Cleveland Clinic’s MyConsult® are particularly valuable for patients who wish to avoid the time and expense of travel. Cleveland Clinic offers online medical second opinions for more than 1,200 life-threatening and life-altering diagnoses. For more information, visit clevelandclinic.org/myconsult, email [email protected], or call 800.223.2273, ext. 43223. Request Medical Records 216.444.2640 or 800.223.2273, ext. 42640 Track Your Patients’ Care Online DrConnect® offers referring physicians secure access to their patients’ treatment progress while at Cleveland Clinic. To establish a DrConnect account, visit clevelandclinic.org/drconnect or email [email protected]. Medical Records Online Cleveland Clinic continues to expand and improve electronic medical records (EMRs) to provide faster, more efficient, and more accurate care by sharing patient data through a highly secure network. Patients using MyChart® can renew prescriptions and review test results and medications from their personal computers. MyChart provides a link to Microsoft HealthVault, a free online 54 service that helps patients securely gather and store health information. It connects to Cleveland Clinic’s social media and Internet site, currently the most visited hospital website in America. For more information, visit clevelandclinic.org/mychart. Critical Care Transport Worldwide Cleveland Clinic’s critical care transport team and fleet of mobile ICU vehicles, helicopters, and fixedwing aircraft serve critically ill and highly complex patients across the globe. To arrange a transfer for STEMI (ST elevated myocardial infarction), acute stroke, ICH (intracerebral hemorrhage), SAH (subarachnoid hemorrhage), or aortic syndrome, call 877.379.CODE (2633). For all other critical care transfers, call 216.444.8302 or 800.553.5056. CME Opportunities: Live and Online Cleveland Clinic’s Center for Continuing Education operates one of the largest and most successful CME programs in the country. The center’s website (ccfcme.org) is an educational resource for healthcare providers and the public. Available 24/7, it houses programs that cover topics in 30 areas. Among other resources, the website contains a virtual textbook of medicine (Disease Management Project) and myCME, a system for physicians to manage their CME portfolios. Live courses, however, remain the backbone of the center’s CME operation. Most live courses are held in Cleveland, but outreach plans are underway. Outcomes 2012 Clinical Trials Since its establishment in 1921, Cleveland Clinic has been an innovator in medical breakthroughs, with a mission of unlocking basic science and pursuing clinical research. Today, Cleveland Clinic is running more than 2,000 clinical trials of various types. Our researchers are focusing on an array of conditions, including breast and liver cancer, coronary artery disease, heart failure, epilepsy, Parkinson disease, chronic obstructive pulmonary disease, asthma, high blood pressure, diabetes, depression, and eating disorders. To learn more, go to clevelandclinic.org/research. Healthcare Executive Education Cleveland Clinic’s dynamic executive education program provides real-world insights into the highly competitive business of healthcare. The Executive Visitors’ Program is an intensive threeday program that provides a behind-thescenes view of our organization for the busy executive. The Samson Global Leadership Academy is a two-week immersion into the challenges of leadership, management, and innovation. The curriculum includes coaching and a personalized three-year leadership development plan. Learn more at clevelandclinic.org/execed. Cole Eye Institute 55 This project would not have been possible without the commitment and expertise of a team led by Peter K. Kaiser, MD, and Monica Jain, MBBS, MHA. Graphic design and photography were provided by Cleveland Clinic’s Center for Medical Art and Photography. © The Cleveland Clinic Foundation 2013 9500 Euclid Avenue, Cleveland, OH 44195 clevelandclinic.org 13-OUT-183