Download DEPARTMENT OF OPHTHALMOLOGY AND VISION SCIENCES

DEPARTMENT OF
OPHTHALMOLOGY AND
VISION SCIENCES
Departmental Report 2015
CONTENTS
INTRODUCTION
Chief’s Message
5
Mission Statement
7
Who We Are
INTRODUCTION
RESEARCH
EDUCATION
CLINICAL
HOW TO HELP
The Foundations of
Innovative Care
17
Training the Next
Generation of Leaders
39
Clinical Care
Changes Lives
53
Your Support
Changes Lives
67
Research Programs
19
Educational Programs
41
Clinical Services
55
Equipment Needs
69
Impact Factor
33
Fellowship Program
43
Your Support
Drives Innovation
71
Residency Program
47
What Comes Next
73
11
4
A MESSAGE
FROM OUR CHIEF
When a fundamental commitment to give the best
and most compassionate care to children is combined
with an ambitious, talented research and teaching
agenda, set in a global environment as dynamic
and diverse as ours, the impact of that commitment
multiplies, benefitting countless children and their
families—not only in Toronto, but across Canada and
around the globe.
Vision is our window to understand and
appreciate the world. From the feeling we
get when we see a loved one’s smile, to the
way it helps us perform complex tasks, vision
is one of the essential senses that drives
human life. We seem to assume that children
are innocent, that they are too young to have
eye problems that adults commonly face,
other than perhaps a few who need to wear
glasses. Unfortunately, eye diseases do not
discriminate between the young and the old,
and when children develop an eye problem,
it affects not only their sight, it also deprives
them of many opportunities in the most
crucial time of their lives to grow, to learn,
and to play.
The doctors and the eye care team in SickKids Ophthalmology believe that every child
has the right to the best healthcare. With
this commitment in mind, we lead a clinical
program that is one of the best and largest in
the world, serving over 20,000 children every
year. We are the only centre in Canada that
offers comprehensive services dedicated
to children, providing the most complex eye
care that covers all subspecialties and
advanced surgical interventions. Many of our
INTRODUCTION
In the following pages, you will learn more
about our achievements and successes.
Through carefully selected images, we
want to illustrate how when a fundamental
commitment to give the best and most
compassionate care to children is combined
with an ambitious, talented research and
teaching agenda, set in a global environment
as dynamic and diverse as ours, the impact
of that commitment multiplies, benefitting
countless children and their families—not
only in Toronto, but across Canada and
around the globe. We also want to convey the
depth and sophistication of our programs,
and how satisfying it is to be part of a
department that is as vibrant as SickKids
Ophthalmology.
You will also learn about the challenges
we face. We rely on the support of donors,
partners, and interested parties like you to
continue our mission to promote children’s
eye health and treat eye diseases by integrating excellent clinical care, rigorous research,
and world-class education. Children deserve
the best care because they are our future.
They are like canaries in the coal mine to
remind us to be present, to pay attention
to what is important in life and do the right
thing. I hope that this report will reaffirm your
commitment to our cause and the importance of our mission. The contribution you
make to our mission truly changes lives, no
matter what form it takes.
Sincerely,
Dr. Agnes Wong
talented and experienced physicians have
formal training in multiple disciplines, and
they are supported by an equally dedicated
and compassionate team of allied health
professionals.
We also have an internationally renowned
research program, with an excellent track
record of productivity. We strive to bring
children the newest, safest, and state-ofthe-art clinical care through research and
innovation. Many of our physicians and
scientists are engaged in basic and clinical
research, and are expert leaders in their
fields. We are affiliated with the University of
Toronto and offer one of the best and largest
paediatric ophthalmology training programs
in the world. We train all levels of students
and future generations of doctors who go on
to work in many communities within Canada
and across the globe. Our physicians and
scientists have received multiple teaching
awards and are sought-after lecturers at
major universities and institutions around the
world. We have also launched a Global Care
and International Ophthalmology initiative
that is driving the development of collaborative healthcare solutions worldwide.
6
Dr. Agnes Wong, Ophthalmologist-in-Chief
MISSION STATEMENT
Our goals are: to promote children’s
eye health and treat eye diseases
through excellent clinical care; to create
new scientific and clinical knowledge
through rigorous research; and to
train future generations of healthcare
professionals through our world-class
educational programs.
We are committed to providing the
best and most innovative care to the
children we treat, by integrating clinical
care with research and education.
We are also committed to fostering
a multidisciplinary, collaborative, and
respectful team environment, so that
each team member enjoys opportunities
for educational advancement, work
satisfaction, and personal growth.
INTRODUCTION
8
“It is a privilege to be a member of this talented
and supportive group of practitioners and
scientists, whose dedication to improving eye care
for children will continue to make an impact in
Canada and abroad.”
—DR. STEPHEN KR AF T
INTRODUCTION
10
Left to right: Drs Buncic, Wong, Vincent, Mireskandari, Héon, Kraft, and Ali
WHO WE ARE
OPHTHALMOLOGIST-IN-CHIEF
Agnes Wong, MD, PhD
Neuro-Ophthalmology, Strabismus
STAFF OPHTHALMOLOGISTS
Asim Ali, MD
Anterior Segment, Glaucoma, Uveitis,
Strabismus
Andrew Budning, MD
Retinoblastoma
Ray Buncic, MD
Neuro-Ophthalmology, Craniofacial
Anomalies
Dan DeAngelis, MD
Oculoplastics, Orbit
Brenda Gallie, MD
Retinoblastoma
Elise Héon, MD
Ocular Genetics, Retinoblastoma
Peter Kertes, MD
Retina
Stephen Kraft, MD
Strabismus
Wai-Ching Lam, MD
Retina
Kamiar Mireskandari,
MBChB, PhD
Anterior Segment, Glaucoma, Uveitis,
Strabismus, Retinopathy of Prematurity
Rajeev Muni, MD
Retina
Nasrin Najm-Tehrani,
MBBCh, MSc
Anterior Segment, Glaucoma, Uveitis,
Strabismus, Retinopathy of Prematurity
Robert Pashby, MD
Oculoplastics
David Smith, MD
Strabismus
Ajoy Vincent, MBBS, MS
Ocular Genetics, Visual Electrophysiology
SCIENTIST
Carol Westall, OD, PhD
INTRODUCTION
Visual Electrophysiology
12
Dr. Nasrin Najm-Tehrani using a slit lamp to examine a patient
RESEARCH
THE FOUNDATION OF
INNOVATIVE CARE
Drs. Elise Héon and Ajoy Vincent working in the Ocular Genetics Laboratory
Surgical Innovation
Led by Drs.
Ali, Mireskandari,
and Najm-Tehrani
Ocular Genetics
Led by Drs. Héon
and Vincent
NeuroVision
Led by Drs. Wong,
Westall, and Kraft
Our high-impact research programs allow for rapid
translation of innovative methods to the bedside, and
provide unparalleled research training opportunities
for residents, fellows, and graduate students from
local, national and international institutions.
RESEARCH
Telemedicine
and Retinopathy
of Prematurity
Led by Drs.
Najm-Tehrani and
Mireskandari
Retinoblastoma
Led by Dr. Gallie
SICKKIDS OPHTHALMOLOGY
IS INTERNATIONALLY
RECOGNIZED FOR
CUTTING-EDGE RESEARCH.
We collaborate with other divisions and departments
at SickKids on numerous research projects, using
a multidisciplinary approach that provides new perspectives on old problems. We also have an excellent
track record of research productivity and funding,
including having two endowed research chairs.
We offer six major research programs, led by physicianscientists, scientists, and clinicians—all global leaders
in their areas of expertise.
Child Eye Care
Advocacy
Led by Dr. Wong
RESEARCH
18
RETINOBLASTOMA
FIGHTING RETINOBLASTOMA AROUND THE GLOBE
The One Retinoblastoma World (1RBW) program is a collaborative research initiative designed to bring together caring
persons from around the world to develop strategies to fight
retinoblastoma. This emerging consortium held its second
meeting in Toronto in October 2014. 1RBW is a forum to
encourage innovation and sharing of ideas. Under the global
health science leadership of Drs. Brenda Gallie and Helen
Dimaras, 1RBW now offers four models for innovation:
High Income
627 survivors (7.8%)
13 deaths (0.2%)
Global Retinoblastoma
Disease Burden
Low Income
1,760 survivors (22%)
5,600 deaths (70%)
Retinoblastoma is a rare but critical form of
cancer that affects the eyes of 8,000 children
around the world each year.
2009–2014
National Retinoblastoma Strategies and Guidelines:
We started in Canada with the first National Retinoblastoma
Strategy and Guidelines for care, which has now been
adopted in Kenya. With Daisy’s Eye Cancer Fund International,
we have supported the seven-year Kenyan National Retinoblastoma Strategy, to improve care for affected children and
families across Kenya.
2014
Global mapping of retinoblastoma treatment centres:
Based on our mapping resources and expertise, we launched
a survey collecting information on the availability of retinoblastoma care around the world. We are developing a
web-based platform that will visually illustrate this complex
data, connect global caregivers to each other, and ultimately
strengthen the ability to care for the global retinoblastoma
population by increasing research capacity and improving
collaboration. This will accelerate the translation of results
from labs to clinics.
2015
Open data on retinoblastoma: To actualize the national
guidelines we developed for retinoblastoma care, we are
housing our research and clinical data on a Telus cloud
server, so that it is accessible to each practitioner globally
in the circle of care of each affected child. We are studying
how this communication tool impacts quality of care, outcomes for patients, and quality of communications between
professionals and families.
2020
Real-time global analysis of outcomes: Analyzing treatment
outcomes is key to improving clinical care for retinoblastoma.
We are developing algorithms to analyze data for similarly
staged and treated patients while maintaining patient privacy,
to generate an evidence-base for management of future
cases. This revolutionary, first-of-its-kind concept in healthcare will use emerging technology to tap into the “brain”
of our global network of experts, to optimize personalized
medicine for each child. Due to the rarity and broad global
distribution of retinoblastoma, randomized clinical trials have
not been successful. Global sharing will allow doctors and
scientists to research extremely detailed, real-life data, to
advance treatment in ways previously not possible.
Unfortunately, 70% of children with retinoblastoma worldwide
die, particularly those born in lower income countries, where
access to specialized care is limited.
Although 98% of children in developed countries survive,
the impacts of treatment are significant: removal of an eye,
chemotherapy and many rounds of laser treatments are often
required, as well as long-term repeated monitoring for cancer
progression, recurrence and new cancers.
Expert care for retinoblastoma is available in a limited
number of centres around the world. The 8% of children born
in high-income countries have potential to access expert
care. By collaborating through our One Retinoblastoma World
program, we’re opening a clear path to optimized care for
children worldwide, with the goal of making retinoblastoma a
“Zero Death Disease.”
SickKids is a major international leader in retinoblastoma
research, focusing on three key areas:
1
Translation of molecular
knowledge to save
vision in the next
generation of children.
RESEARCH
2
Collaborative effort
to optimize outcomes
for all children with
retinoblastoma.
3
A global cloud-based
database system
collecting point-of-care
data for caregivers
that supports clinical
choices.
20
“Vision impacts all aspects of a child’s life. I see the
profound impact of the work we do on our patients
every day, and I am proud to be part of a team
that is deeply committed to serving their needs.”
—DR. ASIM ALI
RESEARCH
22
Electrophysiological tests help to decipher and characterize retinal and
visual pathway disorders. SickKids Ophthalmology offers a wide array
of electrophysiological tests to aid diagnosis and management of patients.
Jeff Locke (orthoptist) and Elizabeth Gomes (ophthalmic assistant)
performing a visual evoked potential test on Dr. Ajoy Vincent.
TELEMEDICINE
AND RETINOPATHY
OF PREMATURITY
ONTARIO ROP TELEMEDICINE PROGRAM
Timmins
Timmins and
District Hospital
NICU
Retinopathy of Prematurity (ROP) is a disorder that
primarily affects premature babies. The smaller
a child is, the more likely they are to develop ROP,
typically in both eyes. ROP is one of the most
common causes of vision loss for children, and can
lead to lifelong vision impairment or blindness.
Screening for ROP has traditionally been performed using a
technique called binocular indirect ophthalmoscopy. However,
this is a difficult skill to learn, and there is a shortage of
ophthalmologists who are adequately prepared to perform
these examinations on at-risk, premature infants.
As neonatal care advances and more premature infants
survive, the demand for ROP screening is increasing. While
these children may receive effective overall care from remote
facilities, a shortage of ophthalmologists with ROP expertise
poses difficulties for children in need of screening. Under
the leadership of Drs. Najm-Tehrani and Mireskandari, our
Ontario ROP Telemedicine program is working to improve
these conditions.
This program has ensured that infants from NICUs in Sudbury
and Barrie no longer need to be transferred to SickKids for
eye examinations. Additionally, infants at risk of ROP can be
transferred a shorter distance to Sudbury, from the NICU at
Timmins. Our model has also been used as a template to
start a second telemedicine network between the McMaster
Children’s Hospital in Hamilton and the Grand River Hospital
NICU in Kitchener.
Expansion of the program to provide coverage for other
remote NICUs is being planned, and the location of the next
screening site will be confirmed by the fall of 2015.
Sudbury
Health
Sciences North
NICU
The program was a recipient of the Ontario Ministry of Health
and Long-Term Care’s achievement award for improving
access to care at the Celebration of Innovation in 2010.
Through our research and clinical practice, SickKids Ophthalmology has driven the alternative use of a specialized
camera to capture photographs of the interior surface of
the eye, which can then be sent to expert ophthalmologists
for diagnosis. While ophthalmic imaging is a skill that
requires specialized training, SickKids Ophthalmology has
been successful in using live, two-way audiovisual connections
to train nurses to capture these images, even if they have
no experience in ophthalmology or ophthalmic photography.
This research has been a cornerstone for the development of
the Ontario ROP Telemedicine Program, which helps train
neonatal intensive-care unit (NICU) nurses already working in
remote hospitals to learn this new skill, helping optimize the
use of nursing resources across Canada.
Barrie
Royal Victoria
Hospital
NICU
These research-based programs have not only created
significant reductions in health care costs, they have
improved access to care and largely eliminated the need
for transfer of these fragile infants to specialized hospitals
in the province for their critical eye examinations, thus
avoiding morbidity associated with travelling long distances.
Toronto
SickKids
Kitchener
Grand River Hospital
NICU
RESEARCH
24
Hamilton
McMaster Children’s
Hospital
RESEARCH
26
Cone photoreceptor dysfunction is the underlying cause of several retinal
disorders. Dr. Westall’s Retinal Imaging Laboratory focuses on imaging
single cone cells in vivo and studying the retinal micro-vasculature. Drs.
Westall and Vincent discussing findings with lab members.
NEUROVISION
NEUROVISION DRIVES INNOVATION
NeuroVision is an innovative, multidisciplinary
research program that brings together clinicians
and scientists to assess different aspects of
visual function.
NeuroVision’s multidisciplinary approach creates opportunities
for exciting collaborations among a wide range of SickKids
departments, as well as with local, national and international
experts. Here are just some of the innovations that have
been driven by the NeuroVision program’s research:
The goal of the program is to understand how vision develops
in normal infants and children, in comparison to children
with different eye diseases. NeuroVision investigates how
vision is received from the retina and optic nerve, through to
the visual cortex and higher levels of brain processing. Our
research also examines the basis of eye movement control
and the associated development of binocular vision and
depth perception.
SickKids Ophthalmology is one of the few paediatric centres
around the world with all of the expertise and technology
needed to study visual processing in children under one roof.
Clinical questions guide our research, while new knowledge
revolutionizes the assessment and treatment of visual and
neurological disorders in children, which can then be applied
directly at the bedside. Ultimately, NeuroVision seeks to
optimize visual outcomes by better understanding visual
functions and dysfunctions.
Papilledema due to large arachnoid cyst
A large arachnoid
cyst displacing the
right temporal lobe
Normal left
temporal lobe
Pons
Cerebellum
RESEARCH
Apparatus in a soundproof chamber for testing
audiovisual integration in patients with lazy eye.
• New and important knowledge about the
underlying mechanisms, diagnosis and
management of disorders such as “lazy
eye” and eye misalignment.
• New ways to test for the earliest signs
of diabetes in adolescents’ eyes, which
will guide diagnosis and treatment before
vision is affected.
• How poor vision affects the development
and integration of other motor and
sensory systems, including eye and limb
movements, as well as hearing.
• Knowledge of the effects of seizure medications on retina that led to a change in
position from the FDA regarding protocols
when using vigabatrin.
• Improving surgical planning for children
with eye muscle problems.
• How neurological syndromes affect the
development of vision in children.
• Determining optimal goals for aligning
eyes, in relation to several different
eye muscle conditions, in order to give
children the best chance for long-term
successful results.
28
“We create new knowledge by implementing
a rigorous strategy of integrating clinical
care with research and education.”
—DR. ELISE HÉON
RESEARCH
30
The genetic basis of eye disorders is intriguing with over 300
disease-causing loci. Dr. Héon’s Ocular Genetic Laboratory focuses
on characterization of known and unknown genetic eye diseases.
OCULAR GENETICS
The field of Ocular Genetics has grown significantly in the last
decade, with over 300 genes now associated with diseases of
the eye. We are one of the largest users of genetic testing in
Canada. This has allowed us to decipher the basis of several
eye disorders through our research. Dr. Héon leads numerous
genetic studies of eye disorders that are present at birth and
deteriorate over time, known as retinal dystrophies. Our patients
have benefitted from access to the earliest clinical trials of new
therapeutic interventions, such as gene replacement therapy.
The application of innovative therapies to treat inherited forms
of blindness is rapidly evolving, and we are prepared to be active
players in this exciting new era.
SURGICAL
INNOVATION
Surgical Innovation is a research program that focuses on techniques to improve the management of various kinds of vision
loss, including trauma, severe retinal damage, and deformities of
the eye existing at birth. This means introducing new techniques
and instrumentation, improving ways of planning surgery using
imaging, and reviews of surgical outcomes. The goal of the program is to improve care for these patients, many of whom have
very complex problems that demand unconventional solutions.
Innovative techniques developed and studied in our department
include conventional and selective corneal transplantation,
ocular surface reconstruction and corneal neurotization surgery.
CHILD EYE
CARE ADVOCACY
Children are not small adults—their eyes are different and
require proper development to be healthy. Our Child Eye Care
Advocacy research program develops unique and effective eye
care strategies that are critical for promoting excellent vision.
Research on strategies that improve overall health is of growing
interest for decision makers when allocating resources. Our
long-term goal is to devise the best and most cost-effective eye
care strategies for children of all ages in Ontario.
RESEARCH
32
Seeing the world from a shifted perspective: Jaime Sklar, MSc adapts
to laterally-shifting prism goggles in Dr. Wong’s Eye Movement & Vision
Neuroscience Laboratory.
FACULT Y PUBLICATIONS BY IMPACT FACTOR (IF) 2014
IF
PUBLICATION
8.3
Neurology
6.5
Canadian Medical
Association Journal
6.4
Modern Pathology
6.3
Annals of Surgery
5.6
Journal of Medical
Genetics
AA
RB
DD
BG
EH
PK
WL
KM
NT
AV
2
4.5
JAMA Ophthalmology
4.2
European Journal
of Human Genetics
3.7
Investigative
Ophthalmology and
Visual Science
CW
AW
1
1
2
1
IF
PUBLICATION
AA
RB
DD
BG
EH
PK
1.9
Eye
1.3
Canadian Journal
of Ophthalmology
2
1.3
Ophthalmic Surgery,
Lasers and Imaging
Retina
1
1.2
Ophthalmic Genetics
1.1
Documenta
Ophthalmologica
1.1
Journal of the
American Association for Paediatric
Ophthalmology and
Strabismus
N/A
Practical Radiation
Oncolocy
N/A
Neuroimage: Clinical
WL
KM
NT
AV
CW
AW
1
2
1
1
1
1
1
1
3.5
Journal of Plastic
and Reconstructive
Surgery
3.5
PLoS One
3.2
Retina
2.8
British Journal of
Ophthalmology
2.8
Journal of
Biomedical Optics
2.6
Virchows Archiv
1
2.5
Vision Research
1
2.0
American Journal
of Medical Genetics
Part A
2.0
Brachytherapy
1
2.0
Journal of Ovarian
Research
1
1.9
Ophthalmologica
1.9
Canadian Urological
Association Journal
1
1.9
Clinical & Experimental Ophthalmology
1
1
4
1
1
1
1
1
2
1
RESEARCH
BG: BRENDA GALLIE
EH: ELISE HÉON
PK: PETER KERTES
AA: ASIM ALI
RB: RAY BUNCIC
DD: DAN DEANGELIS
1
1
1
WL: WAI-CHING LAM
KM: KAMIAR MIRESKANDARI
NT: NASRIN NAJM-TEHRANI
AV: AJOY VINCENT
CW: CAROL WESTALL
AW: AGNES WONG
1
1
“In the evolution of our department over the last
40 years, we have developed an enviable academic
culture, in which service to our patients is rendered
with outstanding quality, our teaching is the best
among the academic hospitals, and our research
is active, growing and world-class.”
1
—DR. R AY BUNCIC
34
EDUCATION
TRAINING THE
NEXT GENERATION
OF LEADERS
Dr. David Smith during a teaching session for trainees
SUMMARY OF MAJOR EDUCATIONAL PROGRAMS
Number of
students per year
~190
15–20
Medical Students
Dr. Najm-Tehrani
Residents
Dr. Mireskandari
6
Fellows
Dr. Ali
6
Graduate Students
Drs. Gallie, Héon, Westall, Wong
2–3
International Medical Graduates
Drs. Ali, Wong
1–2
Nursing Students
Beverly Griffiths, RN
EDUCATION
WHILE OUR RESEARCH
PROVIDES THE FOUNDATION
FOR THE INNOVATIVE
CARE WE DELIVER TO
PATIENTS, IT IS ALSO
INTEGRAL TO OUR
EDUCATIONAL EFFORTS.
SickKids Ophthalmology is internationally recognized
for its high-quality educational programs. These
programs provide cutting-edge clinical training
in general paediatric ophthalmology and various
subspecialties to different levels of medical trainees,
as well as to non-ophthalmologists.
Students and trainees within the department are
also actively engaged in our research programs, so
that their learning is informed by the latest innovative
thinking. By providing opportunities for students to
participate in research development, we ensure that
they become global thought leaders in their field.
Our teaching practices are also integrated into our
daily patient clinics and surgical sessions, to offer
students the hands-on experience they need to
become leaders within their fields. Our mandate also
extends to the education of parents and families
dealing with eye disorders, both in the clinical setting
and through our support groups.
40
Dr. Ray Buncic educating a patient and family member
THESE PROGRAMS INCLUDE
Weekly one-hour formal department rounds on a range
of subject matter, from research findings by department
members and external colleagues, to instructive case
presentations to research proposals for prospective or
retrospective analyses.
Regular sub-specialty teaching rounds and journal clubs,
held by members of the department, covering all the major
subspecialty areas. These rounds vary in format, including
case-based teaching, reviews of recent literature, and
research talks on design, statistics, and study proposals.
Education of families on an ongoing basis in the clinic,
through patient examinations and proposed treatments, as
well as formal encounters such as ocular genetics counselling. The department is also involved in many support groups,
such as the Canadian Retinoblastoma Society, Paediatric
Glaucoma and Cataract Family Association, and Brandan’s
Eye Research Foundation, either as board members or as
participants in educational initiatives.
Frequent formal research rounds, arranged by our director
of research, Dr. Carol Westall. Fellows and vision science
students (including undergraduate and graduate students)
present their research proposals and periodic progress
reports in this forum. These sessions also include teaching
of research methods.
EDUCATIONAL
PROGRAMS
Teaching clinics at the Orthoptic Clinic, which has been
a valuable resource for training of residents, fellows,
undergraduate medical students, and elective students
from other disciplines for many years. Orthoptists—allied
health-professionals specializing in ocular motility and
visual development—are integrated into the teaching clinics,
where they instruct trainees in examination methods and
non-surgical treatment of various eye disorders.
Our educational programs include several initiatives
that integrate research and clinical practices, with
emphasis on translational research that drives new
treatments for patients.
EDUCATION
42
40 YEARS, 123 ALUMNI, 25 NATIONS
The SickKids Ophthalmology fellowship program
is one of the world’s largest fellowship programs
focused on paediatric ophthalmology and strabismus.
18
27
1
1
6
1
27
1
5
1
2
2
1
4
1
1
1
1
3
1
1
3
1
3
2
FELLOWSHIP
PROGRAMS
Our Paediatric Ophthalmology and Strabismus Fellowship program has trained well
over 100 fellows since its inception more
than 40 years ago, and is accredited by
the Association of University Professors
of Ophthalmology.
countries, with over 20 nations represented
by our alumni community. Many become
department heads and are involved in
fellowship education themselves, making the
impact of our training both multigenerational
and multinational in scope.
We train four fellows every year, making
it one of the world’s largest fellowship
programs focused on paediatric ophthalmology and strabismus. Our goal is to
provide comprehensive training in paediatric
ophthalmology, as well as adult and childhood
strabismus. Most of our graduates move
on to academic positions in their home
A key strength of our program lies in our
faculty’s depth and breadth of experience,
with all major subspecialties represented. All
staff physicians take an active role in teaching
fellows and are engaged in continuously
improving the program. As a major referral
centre, the range of diseases and disorders
that are seen by our fellows is unparalleled.
EDUCATION
8
Canada
Iran
USA
Saudi Arabia
Mexico
Kuwait
Colombia
Oman
Guyana
Pakistan
Chile
India
United Kingdom
Sri Lanka
Ireland
Malaysia
Netherlands
Singapore
Germany
The Philippines
Nigeria
South Korea
Egypt
Australia
Israel
New Zealand
44
LEGEND
=5
=1
RETINOBLASTOMA CLINICAL FELLOWSHIP
Preceptors: Drs. Gallie and Héon
NEURO-OPHTHALMOLOGY FELLOWSHIP
Preceptors: Drs. Buncic and Wong
The Retinoblastoma Clinical Fellowship is a
one-year program that recruits fully trained
ophthalmologists who will focus their life’s
work on retinoblastoma—a form of eye cancer.
The Neuro-Ophthalmology Fellowship program
is one of a few in the world that offers
training dedicated exclusively to children.
We provide extensive exposure to the complete
spectrum of paediatric neuro-ophthalmologic
conditions. Organized around the principle
of graduated responsibility, fellows develop
knowledge, competence, and confidence
in diagnosis, as well as skills for medical
and surgical management of common and
rare neuro-ophthlamologic conditions under
the close supervision of staff physicians.
Through multidisciplinary consultations and
co-management of patients, we offer numerous opportunities for educational interactions
with related specialties, including neurology,
neurosurgery, neuro-oncology, neruoradiology,
neuropathology and craniofacial anomalies.
Fellows may enter the program based on
funding they have received, or the department
will seek out funding for them on a case-bycase basis when we determine that the
training will play a key role in equipping the
fellow to enhance global retinoblastoma care.
We also welcome ophthalmologists, who
are already leaders in retinoblastoma in
their country, to join us for three-to-six month
observerships.
Past fellows continue to consult with us on
difficult cases, using innovative digital tools for
sharing care decisions, and actively participate in One Retinoblastoma World initiatives.
EDUCATION
PAEDIATRIC CORNEA AND EXTERNAL
DISEASES FELLOWSHIP
Preceptors: Drs. Ali and Mireskandari
We are the only department in the world to
have two staff physicians specially trained in
both paediatric ophthalmology, as well as in
cornea and external diseases, which includes
developmental, infective and inflammatory
diseases that lead to scarring and need for
corneal transplantation.
Our unique expertise and the wide variety
of cases allow us to offer the world’s only
dedicated training fellowship in paediatric
cornea and external diseases. The aim of the
fellowship is to train ophthalmologists who
will become national leaders for children’s
corneal disease in their home country. Our
first fellow, Dr. Uri Elbaz, came from Israel in
2012 and is expected to become a national
expert in this field upon his return.
Another unique feature of the fellowship is
a strong component of research training,
with ample protected time for fellows to complete rigorous research under the guidance
of experienced clinician-scientists and
clinicians. Upon completion of their training,
fellows are expected to become a leader
in this field.
Dr. Steve Kraft, Dr. Ray Buncic, and Heather
MacDonald (ocular genetic counsellor) during
Friday morning Ophthalmology rounds
46
OCULAR GENETICS FELLOWSHIP
Preceptors: Drs. Héon and Vincent
The Ocular Genetics Fellowship program
involves a combination of both clinical activity
and laboratory exposure in the field, tailored
to the educational needs of the fellow, through
a one-to-three year program. Trainees are
expected to return to an academic position,
apply their newly gained knowledge and
contribute to advancing the field forward.
Through the program, we help trainees acquire
the knowledge and skills needed to diagnose
a wide range of genetically determined eye
disorders. These include inherited retinal
dystrophies, genetically determined complex
syndromes with ocular manifestations, and
metabolic disorders. Knowledge underlying
genetics of anterior segment disorders
and cancer is also gained. Our fellows gain
a deep understanding of the mechanism
underlying the diseases, and learn about
evolving treatment approaches in the field
including gene therapy. The trainee gains
good exposure to interpretation of visual
electrophysiology and genetic results. They
learn to analyze exome/genome data and to
provide ethical genetic counseling.
Teaching session for residents and fellows
RESIDENCY PROGRAM
SickKids Ophthalmology is responsible for the clinical and
surgical training of all residents in paediatric ophthalmology
at the University of Toronto (U of T). We are unique in North
America as the only residency program to provide a total of
eight dedicated months of training in paediatrics for residents.
There are four residents at SickKids Ophthalmology during
each rotation. Our commitment to training involves individualized education in clinics. We also have a comprehensive
syllabus of teaching, covering all vital topics in paediatrics
as part of the Toronto Ophthalmology Residency Introductory
Course, and the U of T teaching series for residents. Our
physicians have received numerous teaching awards from
residents at U of T.
In the last three years, we are proud to have inspired a third
of the graduating residents to develop a specialized interest
in paediatric ophthalmology. There is a great shortage of
paediatric ophthalmologists, not only in the Greater Toronto
Area, but also across Canada. We strive to continue to guide
residents into this field by equipping them with knowledge
and skills to treat children throughout their career.
OUR CONFERENCES
Jack Crawford Day, named after our former department chief,
is an annual full-day paediatric ophthalmology conference that
provides opportunities for practitioners to receive continuing
medical education credits through our partnership with
the University of Toronto, as well as keynote lectures by
department staff and visiting faculty on the latest research
in vision sciences.
The Lloyd Morgan Lectureship Series was initiated in 2003
to honour the first Chief of Paediatric Ophthalmology at SickKids. We invite experts from ophthalmology or allied health
fields on a periodic basis for a formal program involving a site
visit and a number of lectures. The subject matter generally
focuses on evolving research with clinical applications.
EDUCATION
Friday morning Ophthalmology rounds provide a forum
for guest speakers, medical and clinic staff, as well as
trainees to exchange knowledge and ideas.
48
CLINICAL
CLINICAL CARE
CHANGES LIVES
Dr. Dan DeAngelis performing and teaching surgeries to residents and fellows
CHANGING LIVES FOR
THE BETTER IS OUR
MISSION AT SICKKIDS.
Cataract
Visual
Electrophysiology
Cornea and
External
Diseases
Uveitis
Glaucoma
CLINICAL
SERVICES
Strabismus
NeuroOphthalmology
Retinopathy
of Prematurity
Ocular
Genetics
Retinoblastoma
Oculoplastics
Retina
CLINICAL
While our educational programs help train the next
generation of leaders, and our research ensures that
we are developing more effective treatments, the
clinical care we provide allows us to directly improve
health outcomes for children.
Children are not just small adults—in fact, the
field of paediatric ophthalmology is a subspecialty
because it deals with unique children’s eye diseases.
The visual system continues to develop after birth
and well into adulthood as the brain matures, so early
diagnosis and treatment of eye diseases is critical
for best visual outcomes. The management of
paediatric eye diseases requires intricate knowledge
of embryology, eye and brain development, and genetics. Special skills and equipment are also required
for examining and treating children and small infants.
Many children with eye problems have other related
health problems or developmental issues. Paediatric
ophthalmologists contribute to multidisciplinary teams
by examining children to confirm or exclude signs of a
multi-system disorder affecting the eye. They also work
closely with allied health-professionals and schools
to help care for children with visual impairments.
54
Traumatic cataract
CATARACT SERVICE
Drs. Mireskandari, Ali, Najm-Tehrani
A cataract is a cloudy lens in the eye that
disrupts the amount and quality of light
entering the eye. Cataract surgery requires
specialized care and consideration for
children. A baby’s visual system is not
fully developed, which means that cataract
surgery must be accompanied by extensive
rehabilitation to ensure they can develop
vision later in life.
Our Cataract Service provides the majority
of paediatric cataract surgery in Ontario.
Through a multidisciplinary approach to
performing surgery, providing specialized
contact lenses, glasses or lens implants,
and the dedication of parents to their
children’s visual rehabilitation, outcomes
for surgery are continuing to improve.
Optic nerve cupping
Optic nerve drusen
permanent impairment of vision. Treatment of
cornea scarring demands specialized expertise and can require corneal transplantation.
not fully developed, a child’s eye can grow
out of proportion because of the increase in
pressure. Treatments including medication
and surgery are used to reduce this pressure.
problem. Our monitoring of the visual status
of a child is also critical for other services
when making management decisions.
Our Glaucoma Service provides the specialized care required for children with glaucoma.
The majority of paediatric glaucoma surgery
in Ontario is performed at SickKids. Prevention
of glaucoma from injury or disease is vitally
important to our team, and improved management of conditions like cataracts and uveitis
should reduce the incidence of glaucoma and
the burden of the disease on patients.
OCULAR GENETICS SERVICE
Drs. Héon, Vincent, Gallie
Our Cornea and External Diseases Service
consists of experts in areas such as corneal
transplantation and implantation of artificial
corneas. We provide innovative treatments
including reconstruction of eye abnormalities,
regenerating nerves connected to the cornea,
and improving the shape of the cornea.
We provide autologous serum tears for our
patients struggling with loss of tear production, and specialized contact lenses for
patients with irregular corneas, which can act
as an alternative to surgery. Both members
of the team have a strong research interest
in the use of imaging to improve outcomes
for our patients.
GLAUCOMA SERVICE
Drs. Ali, Mireskandari, Najm-Tehrani
CORNEA AND EXTERNAL DISEASES SERVICE
Drs. Ali, Mireskandari
The cornea is the clear portion of the eye in
front of the iris that acts as its window to the
world. Problems with cornea clarity will impair
sight directly, and it can easily be affected by
infections or injury. A number of conditions
can cloud the cornea from birth and cause
CLINICAL
Glaucoma is a condition that damages the
optic nerve. Some children are born with
it, while others develop it during childhood.
Irregularities in the eye’s drainage system
cause a build up of pressure within the eye
that can lead to loss of vision. Glaucoma
requires specialized care and consideration
in children. Not only is a baby’s visual system
NEURO-OPHTHALMOLOGY SERVICE
Drs. Wong, Buncic
Our Neuro-Ophthalmology Service provides
highly specialized care to patients experiencing impaired vision as a result of diseases
of the brain. These include conditions such
as inflammation of the optic nerve, optic disc
swelling, brain tumors and strokes.
The service works very closely with other
services at SickKids, including the Visual
Electrophysiology Unit, neurology, neurosurgery, neuro-oncology, neuroradiology,
and ocular genetics. We are often the first
doctors to discover that there is a problem in
the brain when a child presents with a vision
56
Stargardt Disease
(juvenile macular degeneration)
Ocular Genetics is fast becoming an
increasingly essential part of ophthalmology,
as most eye disorders are determined by
variations in our genes. The Ocular Genetics
program at SickKids is unique in the country
and one of very few in the world.
Identifying the genetic basis of an eye condition
allow us to offer better counseling to our
patients and helps us assess the eligibility of
treatment. We provide comprehensive care and
counseling for all our patients, and provide
genetic testing for most of them, leveraging
our state of the art facilities. Some of our
patients were the first to access a genereplacement therapy trial for a blinding disorder
in children. This is a stepping-stone to improve
the outcome of many other conditions.
Drs. Héon and Vincent care for a large
referral population of inherited non-cancerous
disorders, while Drs. Héon and Gallie care
for our retinoblastoma patients—the most
common form of eye cancer, which is genetically determined.
TREATING THE
WORLD’S FIRST
TRIPLETS WITH
RETINOBLASTOMA
CASE STUDY
Hemangioma
OCULOPLASTICS SERVICE
Drs. DeAngelis, Pashby
The Ophthalmic Plastic and Reconstructive
Surgery Service—commonly referred to
as “oculoplastics”—provides treatments for
patients that are born with or develop disorders related to the tear ducts, eyelids and
eye sockets. The unit consists of both clinical
and surgical divisions that deal with a wide
range of disorders.
Our oculoplastic patients come from across
Canada with complex cases, often requiring
collaboration with other surgical experts
within SickKids, including specialists in
neurosurgery, craniofacial surgery, head and
neck surgery, and interventional radiologists
that use minimally invasive image-guided
procedures to diagnose and treat diseases.
RETINA SERVICE
Drs. Lam, Kertes, Muni
Our Retina Service provides clinical consultation, care for patients requiring specialized
diagnosis, and leads surgical treatments for
retinal disorders. Although the majority of our
patients come from Ontario, complex cases
from across Canada and the world are often
referred to our service.
CLINICAL
Retinoblastoma
The Retina Service treats a wide range of
retinal disorders that threaten loss of vision,
including eye traumas, retinal detachment,
and Coats disease. We use cutting-edge
technologies to treat these complex cases,
including specialized cameras that improve
diagnosis, and instruments that make retinal
surgery minimally invasive.
RETINOBLASTOMA SERVICE
Drs. Gallie, Héon, Budning
Retinoblastoma is a form of cancer that
rapidly develops from a child’s retina cells,
and is the most common form of malignant
tumor found in children’s eyes. Unfortunately,
70% of cases worldwide lead to death, with
a disproportionate number of deaths occurring
in developing countries where access to early
detection is unavailable.
In 2013, Edmonton’s Low family was
happily surprised to discover they were
about to welcome triplets into their life.
Thomas, Mason and Luke Low were all
born healthy at 34 weeks. Unfortunately,
the Low family had another surprise
coming—and this one was terrifying.
When the boys were just a few months old,
their father Richard noticed that Mason
had an abnormally shaped pupil. A retinal
specialist in Edmonton who examined the
boys reached out to SickKids’ Dr. Gallie, who
suggested images be captured of Thomas
and Luke’s eyes as well. These photos, along
with further examinations, illustrated that
all six of the triplet’s eyes were affected by
retinoblastoma, an aggressive form of cancer.
Our Retinoblastoma Service manages the care
of 80% of the newly diagnosed Canadian
children each year, with 22 new cases predicted annually. We work in collaboration with
referring doctors, so that afflicted children can
travel to SickKids to receive active care. This
unit is made up of a wide range of healthcare
professionals, including ophthalmologists,
oncologists, social workers, nurses, imaging
specialists and genetic counselors. Treatment often involves use of highly specialized
equipment and innovative therapies.
58
However, each child had one eye with good
prospects for visual development and their
tumours were small. Through support from
the Alberta government, and the goodwill of
numerous Toronto citizens that have donated
financially and provided local accommodations,
the Low’s are receiving ongoing treatment and
support from SickKids’ retinoblastoma team.
Today, the prognosis for all three boys is positive, and the SickKids team continues to work
with the Low family to save as much of the
triplet’s vision as possible, while stopping the
spread of their cancer. Our team is committed
to continuing to monitor their treatment to
ensure the best possible visual outcomes for
the Low triplets.
Neovascular tufts in
retinopathy of prematurity
Strabismus surgery
We strive to deliver care for children and
families struggling with retinoblastoma
as close to home as possible, while ensuring
they receive optimized treatment. In cases
where the disease can be stabilized, ophthalmologists within the child’s community can
perform follow-up examinations. Due to the
screening training for ophthalmologists
across northern Ontario, in some cases
patients need to be transported to SickKids
for examination. Our success in the timely
detection and treatment of ROP has resulted
in a remarkable decrease in the number
of cases in Ontario that require surgery.
This allows our retinal surgery specialists
to focus on providing care to out-of-province
and international patients.
in Alberta—where there is a young population
with a high birth-rate—Dr. Gallie now works
on staff at the Alberta Children’s Hospital.
Every other month, she consults with children
at the Alberta clinic and assesses whether
they need to receive care from the SickKids
team in Toronto. This saves Albertan families
time and money, while reducing the emotional burden of leaving their community to
receive specialized care.
RETINOPATHY OF PREMATURITY SERVICE
Drs. Mireskandari, Najm-Tehrani
Retinopathy of Prematurity (ROP) is a
potentially blinding disease that affects
premature newborns. It is associated
with abnormal growth in the retina’s blood
vessels that leads to retinal scarring or
detachment. Infants who are born at least
ten weeks early, or that weigh less than
1250 grams, are at risk of developing ROP.
The ROP Service unit is committed to
ensuring screening for at-risk infants. We
have a mandate to provide ROP screening for
the premature infants in our own neonatal
intensive-care unit, as well as all other NICUs
in the Greater Toronto Area. While we provide
CLINICAL
STRABISMUS SERVICE
Drs. Kraft, Smith, Wong, Mireskandari,
Najm-Tehrani, Ali
Strabismus is a condition where the eyes are
not properly aligned, causing adverse effects
on vision. Our Strabismus Service also treats
a wide-range of related issues, including
problems with depth perception, double
vision, eye muscle problems and “lazy eye.”
The Strabismus Service handles approximately 70% of the complex childhood
strabismus cases in the Greater Toronto
Area. We also house the only eye movement
laboratory and diagnostic facility in Ontario.
SickKids offers a comprehensive diagnosis
and treatment base for strabismus problems
in children, driven by a multidisciplinary
approach that sees us collaborate with
including Ocular Genetics and Neurology.
The Strabismus Service is supported by
the orthoptic staff, who are allied health
personnel who perform the eye muscle v
Iris adhesions
balance tests to detect and measure eye
misalignment. Orthoptists test the child’s
vision in order to detect amblyopia (“lazy
eye”), and they also evaluate binocular
vision, including tests of stereovision and
tests of the ability of the eyes to work
together. They are certified by written and
oral examinations of the Canadian Orthoptic Council. They are integrated into the
clinical, teaching, and research activities
of the Department of Ophthalmology and
Vision Sciences. Until recently, the department housed one of only 4 accredited
orthoptic training programs in Canada, and
we hope to reopen the school to prospective
students within the next couple of years.
UVEITIS SERVICE
Drs. Najm-Tehrani, Ali, Mireskandari
middle layer of the eye—that can lead to
permanent loss of vision. Screening for
is a complex clinical problem that requires
a multidisciplinary approach.
progress in improving care for these patients
by creating a network of ophthalmologists
with specialized knowledge, collaborating with
ophthalmology nurses, and coordinating care
with rheumatology physicians and nurses. We
are developing new pathways for the safe
management of patients with the potential to
develop uveitis, and optimizing interventions
60
Choroideremia
to lower the likelihood of irreversible vision
loss. This has also enabled us to offer better
outcomes for patients with uveitis undergoing
cataract surgery.
VISUAL ELECTROPHYSIOLOGY SERVICE
Drs. Vincent, Westall
Our Visual Electrophysiology Unit (VEU)
performs a wide array of tests to assess the
health of different components of the visual
system. These tests allow us to examine the
integrity the retina and the optic pathway,
as well as the macula, a highly specialized
region in the retina that we are now able to
study in great detail. Additionally, we offer
various methods of assessing colour vision,
clearness of vision, and 3D depth perception.
Depending on the demands of the situation,
the unit offers specialized tests under
sedation and in operating room conditions,
making us the only site in Ontario that
provides this service. As such, we receive
many out-of-province referrals. The unit aims
to provide excellent visual function evaluation
to all patients and lead paediatric visual
assessments internationally. The VEU has a
history of improving testing techniques and
applies newly devised techniques to enhance
patient care. Since electrophysiological tests
are essential in the monitoring of novel
gene replacement therapies currently being
tested, the importance of the VEU will
continue to increase.
THE WORLD’S FIRST
NERVE GRAFT
TRANSPLANTATION
TO RESTORE EYE
SENSATION
CASE STUDY
Abby Messner lost feeling in her left eye after a non-malignant
tumour in her brain was removed at age 11. As a result of this
condition—called corneal anaesthesia—her eye would not blink
to protect against dust and debris. Despite her best efforts to
care for her eye, this led to a scar forming on her cornea that
doctors worried would lead to permanent vision loss.
Her condition also prevented her from enjoying her favourite
activities, such as playing competitive sports like hockey and
swimming, or just entering the dry air of a mall. Even a windy
day posed a danger to Abby’s eye.
This led SickKids’ ophthalmologist, Dr. Ali, to propose an
innovative new surgery for Abby—a nerve graft that would
restore feeling to her left eye.
Working with plastic and reconstructive surgeons at the
hospital, Dr. Ali developed a treatment that took a nerve from
Abby’s calf, transplanted it into her functioning right eye, and
connected it to her left eye.
Within three months, sensation was restored. This new
treatment addressed the root problem of the condition rather
than its complications, in a less invasive fashion than other
surgeries used to treat corneal anaesthesia.
SickKids Ophthalmology has since used this surgery in
seven other cases and continues to study the effects of this
innovative treatment.
CLINICAL
Dr. Asim Ali with Drs. Gregory Borschel and Ronald
Zuker from Plastic and Reconstructive Surgery
at SickKids examining the first patient who has
undergone corneal neurotization surgery.
62
HOW TO HELP
YOUR SUPPORT
CHANGES LIVES
YOUR SUPPORT
CHANGES LIVES.
The wide range of diseases and disorders
that can impact a child’s vision pose
considerable challenges to healthcare
providers, but even bigger challenges to
the child and their family. We are still
working to understand the full scope of
the visual system and the ailments that
affect it. When you support SickKids
Ophthalmology, you are helping change
lives.
We work to provide the most comprehensive clinical care to our patients here
in Toronto, while developing innovative
new treatments that save eyes and lives
around the world.
In this section you will learn about the
challenges we still face and how your
support can help us in our mission.
HOW TO HELP
Dr. Arun Reginald reviewing and
examining a patient with a resident
68
EQUIPMENT NEEDS
The speed of innovation in ophthalmology is
tremendous and new technologies constantly
emerge to improve the diagnosis and management
of eye diseases. We strive to constantly improve
the instruments and diagnostic equipment we use
for the care of our patients.
Here are some examples of equipment we need to
help us improve outcomes for the children we treat.
The total cost for all of this equipment would be
more than $1,000,000. Every dollar you contribute
to SickKids Ophthalmology helps.
1. Next generation optical coherence tomographer (OCT)
with autofluorescence (Heidelberg Spectralis): The OCT
is part of the standard of care for imaging of the retina,
and has widespread applications in all areas of ophthalmology. The improvements in OCT technology allow us
to make diagnoses of retinal disorders earlier than ever
before, and are much more child-friendly, with lower light
levels and eye-trackers.
2. Handheld optical coherence tomographer (Bioptigen
Envisu): This allows the use of the OCT in infants under
general anaesthesia.
3. Collagen cross-linking light source: Cross-linking is a
technique which is used to stop the progression of keratoconus, a condition of the cornea in which there is thinning
and irregularity resulting in decreased vision, requiring
a corneal transplant. This would allow us to provide this
treatment for young children affected by the disease, as
well as those who are developmentally delayed.
4. Flare meter (Kowa): This allows precise measurement of
inflammation inside the eye, in children with uveitis and
after eye surgery. This is much more accurate than manual methods of estimation and would allow us to accurately
evaluate the effect of our therapies.
5. Widefield retinal imaging (Optos): This allows a complete
photographic scan of the retina with minimal light, which
is normally very uncomfortable, especially for younger
children. This will speed up and allow for more complete
examinations, while also reducing the discomfort experienced by patients.
6. Adaptive optic imaging system: This revolutionary
technology permits images of the individual photoreceptor
cells, which sense light in the eye. This allows us to
capture images of disorders in these cells at the highest
possible resolution.
7. Anomaloscope: The most accurate way to assess colour
vision, a standard in all research protocols.
8. Dark adaptometer: Allows assessment of visual function
in dim lighting conditions.
HOW TO HELP
70
YOUR SUPPORT
DRIVES INNOVATION
Our world-leading research is the foundation that allows
us to deliver innovative care to our patients. Below are
some examples of our ongoing research projects and our
needs that your support will help push forward.
NEW TECHNIQUE TO IMAGE CORNEAL CELLS IN LIVE PATIENTS
Corneal endothelial cells are vital to maintaining the clarity
of the cornea and preserving normal vision. They cannot
regenerate and can become permanently damaged or
destroyed by disease or surgery. Endothelial cell loss can
eventually lead to corneal swelling, pain and loss of vision.
This has its greatest impact in childhood when the visual
system is immature.
applied to patients. Since its inception in 1994, the Ocular
Genetics Program at SickKids Ophthalmology has served
over 20,000 patients afflicted with all kinds of inherited eye
diseases from diverse genetic backgrounds. It is uniquely
positioned to lead in this exciting new era of gene replacement therapy. Your contribution will accelerate new discovery
so that blind children can see again.
RECRUITING CLINICIAN-SCIENTIST
Clinician-scientists function as bridges between the clinical and the scientific worlds by interacting with patients,
observing the clinical features of their diseases, and then
developing basic science experiments to test new ideas
that stem from their observations. As clinical and scientific
knowledge continues to increase exponentially, recruitment
of the best and brightest clinician-scientists is critical to
our long-term success. However, clinician-scientists require
extensive training, infrastructural support, and “protected
time” for them to perform research. Funding to support their
salary and research—in the form of an endowed Chair or
Professorship—is crucial for us to train, recruit and retain
talented clinician-scientists who recognize the relevance of
scientific discovery and how it changes patients’ lives. Your
contribution can help us create this important endowment.
We are now able to look at these cells with a specular microscope in young children, using techniques developed in our
department, either awake or under general anaesthetic. This
enables us to establish normal ranges in children under the
age of five and to assess the damage that occurs in a variety
of eye disorders and following surgery. Your support will help
us find new ways to prevent corneal blindness and reduce the
need for corneal transplants in children.
UNDERSTANDING NOVEL RETINAL GENES TO PREPARE FOR
THE FIRST GENE THERAPY
More than 60 percent of blindness among infants is caused
by inherited eye diseases. With advances in large scale
genetic testing, novel candidate genes are being identified at
a very rapid pace. Before these novel candidate genes can be
manipulated for therapeutic purpose, we need to first verify
their significance in causing diseases through meticulous
investigation. Once verified, the correct copies of the genes
can be experimentally injected into eyes with the goal to
effect a cure. These treated eyes will need to be assessed
for functional and structural improvement following treatment,
and when results are encouraging, new therapy could then be
HOW TO HELP
72
Dr. Dan DeAngelis performing surgery
WHAT COMES NEXT
In the next five years, SickKids
Ophthalmology will continue to build on
our existing strength to achieve a
new level of excellence, by developing
themes that unify our clinical, research,
and educational activities.
This will include use of an evidencebased approach to evaluate and
determine the health services that
we provide, making a real impact
on national and global health, and
enhancing knowledge translation from
research into practical application.
The support of philanthropic leaders like
you is more important than ever, so that
we can continue to set our sights high
and keep working to advance children’s
eye health in profound new ways.
For further information please contact Adam Starkman at The SickKids
Foundation | 416-813-2942 | [email protected]
Or, visit www.sickkidsfoundation.com and specify your donation
to “SickKids Ophthalmology”.
HOW TO HELP
Dr. David Smith with a patient
74
Jennifer Colaco, RN, and Margaret Horie, RN, with a patient and mother
SICKKIDSOPHTHALMOLOGY.COM