Download Dana Center for Preventive Ophthalmology Annual Report

DANA CENTER FOR
PREVENTIVE
OPHTHALMOLOGY
ANNUAL REPORT
12/15/14
The Wilmer Eye Institute; Johns Hopkins
University School of Medicine
Dana Center for Preventive Ophthalmology’s
faculty, research, and educational activities:
Dana Center for Preventive Ophthalmology Annual Report
Dana Center for Preventive
Ophthalmology Annual Report
THE WILMER EYE INSTITUTE; JOHNS HOPKINS UNIVERSITY SCHOOL
OF MEDICINE
RESEARCH ACTIVITIES
Dana Center faculty have continued to carry out major research related to public health ophthalmology,
to publish those findings, and to train a wide range of students in this work.
Trachoma
Trachoma is still the leading infectious cause of blindness worldwide and Dana Center faculty have led
trachoma control programs for nearly three decades. We have carried out clinical trials in Tanzania,
Ethiopia and Niger and in collaboration with the World Health Organization; we have conducted
research on all facets of the SAFE strategy. We continue to provide technical assistance to partners and
countries about trachoma control. Current research in Tanzania is investigating approaches to reduce
infection and disease in communities, and to better screen and treat trichiasis in adults. We are
partnering in the development of alternative diagnostic/surveillance tools for trachoma control with
studies in Tanzanian and Nepal. Most recently, we have a new clinical trial to determine the added
benefit for communities with low levels of C. trachomatis infection of a program to identify and treat new
families who arrive after mass treatment, and travelers who leave and may bring back trachoma, as they
could be an important source of re-infection.
We have studies in Tanzania on improved screening methodologies for identifying trichiasis cases and
getting them to surgery. We continue to explore methods for improving trichiasis surgery outcomes in
developing countries. Dana Center faculty are part of a cooperative agreement with PAHO, and sit on
the technical expert committee of International Trachoma Initiative, and the Special Technical Advisory
Group for Neglected Tropical Diseases for WHO.
Diabetic Retinopathy
To address the fact that nearly half of adults with diabetes do not have their eyes screened on an annual
basis, we carried out research on an opportunistic model to screen individuals with diabetes in
pharmacies. This effort faced logistical obstacles and we instead shifted our work to charity hospitals
where screening efficiency was found to be substantially higher. This work, funded by the Centers for
Disease Control, is ongoing and manuscripts have been submitted.
In addition, in collaboration with Helen Keller International, we have been developing and expanding
diabetic retinopathy screening programs in Bangladesh and Indonesia. Both programs are now
established and the Indonesia program has been expanded to community health centers where even
more of the at risk population can be screened. Furthermore, we recently completed a trial (funded by
Sightsavers International) assessing strategies to improve patient follow-up after screening. With the
implementation of better educational programs and closer monitoring the Chittagong screening program
was able to achieve nearly 80% follow up of patients who screened positive for diabetic retinopathy.
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Dana Center for Preventive Ophthalmology Annual Report
Dana Center faculty continue their collaboration with researchers in England to develop an online system
for training and evaluation for fundus image grading centers. This is a core activity that will be needed
to sustain these burgeoning programs.
Glaucoma
Dana Center faculty continue to work on imaging techniques that will help distinguish those with angle
closure glaucoma from those without the condition. Recent investigations include the development of
automated algorithms for classifying the angle status of individuals using OCT. We also have assessed
novel components of angle closure including iris and choroidal volume change. This work is being
conducted at Hopkins as well as in China, Singapore, and India.
We have recently completed a study with investigators at the Aravind Eye Institute in India and found that
family members of angle closure glaucoma patients have a much higher risk of angle closure glaucoma.
This finding may lead to improved screening recommendations for angle closure disease. We also are
examining the genetic basis of angle closure glaucoma in this population to identify new potential targets
for disease treatment.
Finally, we have an ongoing large clinical trial underway in Guangzhou, China to determine if laser
iridotomy is beneficial for treating individuals with narrow angles. This study has enrolled over 800
people after screening more than 10,000 and is in its 4th year of follow-up with over 90% remaining in
the study. Results from this trial will guide the treatment of angle closure throughout the world.
Cataract and Refractive Error
The Dana Center is working closely with Aravind Eye Institute to develop new models for increasing
cataract surgical quality and volume in Africa. This work, funded by the Hilton Foundation, focuses on
partnering with existing eyecare programs to help them improve their service delivery and ultimately to
dramatically increase the volumes of surgery performed. The Dana Center is documenting the baseline
condition at these institutions, the inputs of the program, and the overall outcomes. This approach was
developed under the leadership of Alfred Sommer and in collaboration with leaders in African
ophthalmology. So far five hospitals are participating and after one year dramatic changes are already
taking place.
Dana Center faculty in collaboration with Helen Keller International, continue to support expansion of
cataract surgical training using novel methods in south China. Access to qualified clinicians who are
capable of providing high-quality cataract surgical care remains a significant problem in China. Most of
the cataract surgeons practicing in remote rural Chinese communities do not have the requisite skills and
equipment needed to ensure good visual outcomes. We continue to support surgical training and
outreach programs using a unique approach in which surgeons are trained in their local hospitals by
expert trainers. Furthermore, we have carried out several operational research projects to determine the
factors that determine who does and does not receive an eye exam and how best to encourage patients
who need surgery to take advantage of the services being offered.
Also in collaboration with HKI, Dana Center faculty support the expansion of refractive services in China,
Indonesia and Vietnam. We have shown that when carrying out school-based activities it is important to
screen teachers as well because they frequently need glasses. Our faculty have completed clinical trials
to document the effectiveness of the provision of ready-made spectacles and continue to publish data
from this work.
Finally, Dana Center faculty recently started a study of reading and vision in school children. This study
will determine if vision factors as opposed to dyslexia help to explain why some children read poorly.
This study will enroll 400 second graders, administer standardized reading and vision tests, provide
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Dana Center for Preventive Ophthalmology Annual Report
glasses as needed, and then re-evaluate children at 6 months for change in reading ability. If some poor
readers benefit from spectacles, magnification or other interventions, then we will pursue a larger clinical
trial to develop an approach that could be used widely in young children to improve overall school
performance.
Vision Loss and Function
A major focus of the Dana Center is to determine the magnitude of the problem of vision impairment and
to publicize our findings to help advocate for eyecare services to be provided to the populations who
need them. In the recent past we published a lead article in the Journal of the American Medical
Association (JAMA) on the prevalence of vision loss in the United States using data collected during the
National Health and Nutrition Examination Survey (NHANES). Dana Center faculty are also assessing the
impact of vision loss using population-based data (the Salisbury Eye Evaluation project) as well as data
collected on patients cared for at the Wilmer Eye Institute. A particular emphasis has been placed on
“real-world” measures of disability, such as testing of physical activity in the normal routine through the
use of accelerometers, assessing travel outside the home using remote tracking devices, and testing of
book reading through a validated test of sustained silent reading. We have continued to expand this
work and recently completed the recruitment for a prospective cohort study of Falls in Glaucoma (FIGS)
which is funded by the NIH. This 5-year grant will determine what factors lead glaucoma patients to fall
at much higher rates than those without glaucoma and will help in developing to interventions to prevent
falling and disability in these patients.
Retinal Degenerations
The Dana Center faculty run the Data Coordinating Center for a series of studies on Stargardt’s diseases,
determining the risk of progression using a variety of outcome measures. We are also the Data
Coordinating Center for a clinical trial of nutrition supplements in patients with ocular albinism.
Large Database Analysis
The Dana Center faculty are continuing their long tradition of health services research. Using the
Medicare billing database we have documented the volume of glaucoma care being delivered, types of
interventions and tests performed, their change over 2002-2009, and the cost of treatment. We also
have used NHANES to identify what factors are associated with not being screened for diabetic
retinopathy, and have just completed using the same database (with additional grading of optic nerve
images) to analyze glaucoma prevalence and associations as well as eyecare utilization among persons
with glaucoma. These manuscripts are in submission.
GRANTS AND AWARDS
Johns Hopkins Healthy Eyes Translational Research Center
U58DP002653
Centers for Disease Control
David S. Friedman (Principal Investigator), Sheila K. West (Co-Investigator), Beatriz Munoz (CoInvestigator), Sandra D. Cassard (Co-Investigator), Emily W. Gower (Co-Investigator)
Awarded to study public health interventions to improve eye health in the US.
Multi-Center Uveitis Steroid Treatment (MUST) Trial
1 U10 EY 014660
National Eye Institute
David S. Friedman (Co-Investigator/Glaucoma Outcomes Specialist)
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Dana Center for Preventive Ophthalmology Annual Report
Dr. Friedman is monitoring for glaucoma as an adverse outcome in this randomized trial of treatments for
uveitis.
Friends of the Congressional Glaucoma Caucus Foundation
5U50DP001134-05
Centers for Disease Control
Harry A. Quigley (Principal Investigator)
Provides support for Student Sight Savers vision screening program
Pathogenesis of Glaucomatous Optic Nerve Damage
National Institutes of Health/National Eye Institute
RO1 EY002120-32
Harry A. Quigley (Principal Investigator)
Studies retinal ganglion cell death and novel therapeutic approaches to preventing glaucoma blindness.
The Wilmer Mentored Clinical Research Scholar Program
EY015025-01
National Eye Institute-National Institutes of Health
Harry A. Quigley (Principal Investigator/Mentor)
This K12 award trains clinician-scientists in the Department of Ophthalmology in patient-oriented and
laboratory research in the Vision Sciences.
Direct Evaluation of Functional Impairment in Glaucoma
K23EY018595
National Eye Institute-National Institutes of Health
Pradeep Y. Ramulu (Principal Investigator), Harry A. Quigley (Mentor), David S. Friedman (Mentor)
Evaluate disability in individuals with glaucoma using direct, objective tests of functional impairment.
Longitudinal Assessment of Mobility Outcomes in Glaucoma
National Institutes of Health/National Eye Institute/National Institute of Aging
R01 11052234
Pradeep Y. Ramulu (Principal Investigator), David S. Friedman (Co-investigator)
Longitudinally analyzing mobility outcomes and risk factors for mobility problems in glaucoma.
Surveillance & Treatment of Community Newcomers & Travelers for Trachoma Control
National Institutes of Health/National Eye Institute
U10 EY022584
Sheila K West (Principal Investigator), Beatriz Munoz (Co-Investigator)
Determining the added benefits of a program to identify and treat new families who came after mass
trachoma treatment.
Partnership for Rapid Elimination of Trachoma (PRET)
Bill and Melinda Gates Foundation
Sheila K West (Principal Investigator), Beatriz Munoz (Co-Investigator)
Determining the impact of mass treatment of communities on ocular C. Trachoma infection.
Mortality Reduction after Oral Azithromycin (MORDOR)
Bill and Melinda Gates Foundation
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Dana Center for Preventive Ophthalmology Annual Report
Sheila K West (JHU principal Investigator), Christian Coles (co-investigator)
Determining the impact of oral azithromycin on mortality and morbidity in children under age 5 years
Progression of structural and functional measures in a longitudinal study of Stargardt’s
retinal degeneration
Foundation Fighting Blindness
Sheila K West (DCC principal Investigator), Ann Ervin (co-investigator)
Use of a novel antibody test for impact and surveillance surveys in Trachoma
Task Force for Global Health
Sheila K West (principal, Investigator)
Secondary Analysis of Four Trichiasis Surgery Clinical Trials to Inform Management
Strategies
National Institutes of Health/National Eye Institute
1R21EY023303
Emily Gower (Principal Investigator), Shannath Merbs and Beatriz Munoz (Co-Investigators)
To integrate data from four complementary trichiasis surgery trials to examine epidemiologic questions
that directly impact trachomatous trichiasis management.
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Dana Center for Preventive Ophthalmology Annual Report
CURRENT DANA CENTER FACULTY AND PUBLICATIONS
Full Time Faculty and Publications in 2014
David S. Friedman, MD, MPH, PhD
Director, Dana Center for Preventive Ophthalmology
Alfred Sommer Professor of Ophthalmology
Dr. Friedman is the Director of the Dana Center for Preventive Ophthalmology and the Alfred Sommer
Professor of Ophthalmology at the Wilmer Eye Institute of Johns Hopkins University School of Medicine
and in the Departments of Epidemiology and International Health at Johns Hopkins Bloomberg School of
Public Health. He graduated summa cum laude from Yale College, received his medical degree from
Harvard Medical School, and obtained a PhD in epidemiology from Johns Hopkins. He completed his
residency at Wills Eye Hospital and served as a glaucoma fellow with Dr. Harry Quigley.
Dr. Friedman is the recipient of clinician scientist awards from the NIH, Research to Prevent Blindness,
American Geriatric Society, and the Alcon Research Institute. Since joining the Wilmer faculty he has had
continuous funding from the NIH, as well as numerous other funding organizations. He co-edited a
definitive book on angle-closure glaucoma and has published over 200 peer-reviewed articles. He
serves on the editorial boards of the Cochrane Collaboration and the Journal of Glaucoma, and was on
the board of Ophthalmology for many years. He is on the Board of Governors of the World Glaucoma
Association and has a leadership role with the American Glaucoma Society. He has been invited as the
Edmund B. Spaeth lecturer in Philadelphia, the Hong Leung Visiting Professor in Singapore, the
Mohammed Aziz lecturer at Johns Hopkins and the Richard Ellis lectureship at Wills Eye Hospital. He also
is the Senior Ophthalmologist for Helen Keller International, a large non-profit organization dedicated to
alleviating blindness worldwide.
Dr. Friedman is known for his contributions to the study of the mechanisms, epidemiology and prevention
of angle-closure glaucoma. His current research in angle-closure glaucoma includes a definitive clinical
trial in South China, where the disease is common. In addition to his research, Dr. Friedman is listed on
Best Doctors as a leading glaucoma specialist. Dr. Friedman also trains glaucoma fellows and assists
residents with their clinics and in the operating room. His dedication to teaching extends to the medical
school where he is a co-director of the Scholarly Concentration program.
Friedman DS, Cassard SD, Williams SK, Baldonado K, White RA, Gower EW. Outcomes of a Vision
Screening Program for Underserved Populations in the United States. Ophthal Epidemiol. 2013; Aug;
20(4):201-211.
Gower EW, Silverman E, Cassard SD, Williams SK, Baldonado K, Friedman DS. Barriers to Attending an
Eye Examination after Vision Screening Referral within a Vulnerable Population. J Health Care Poor
Underserved. 2013; 24(3):1042-52.
Quigley HA, Cassard SD, Gower EW, Ramulu PY, Jampel HD, b. The Cost of Glaucoma Care Provided to
Medicare Beneficiaries from 2002-2009. Ophthalmology. 2013; 120(11):2249-57.
Jampel HD, Cassard SD, Ramulu PY, Friedman DS, Shekhawat NS, Whiteside-de Vos J, Quigley HA,
Gower EW. Trends Over Time and Regional Variations in the Rate of Laser Trabeculoplasty in the
Medicare Population. JAMA Ophthalmol. 2014 Jun; 132(6):685-90.
Owsley C, McGwin G, Lee DK, Lam BL, Friedman DS, Gower EW, Haller JA, Hark LA, Saaddine J.
Diabetes Eye Screening in Urban Settings Serving Minority Populations: Detection of Diabetic Retinopathy
and Other Ocular Findings Using Telemedicine. JAMA Ophthalmol. In press. Zhao D, Kim MH, PastorPage 6
Dana Center for Preventive Ophthalmology Annual Report
Barriuso R, Chang Y, Ryu S, Zhang Y, Rampal S, Shin H, Kim JM, Friedman DS, Guallar E, Cho J. A
longitudinal study of age-related changes in intraocular pressure: the Kangbuk Samsung Health Study.
Invest Ophthalmol Vis Sci. 2014 Sep 2;55(10):6244-50. doi: 10.1167/iovs.14-14151. PubMed PMID:
25183763.
Bourne RR, Stevens GA, White RA, Smith JL, Flaxman SR, Price H, Jonas JB, Keeffe J, Leasher J, Naidoo K,
Pesudovs K, Resnikoff S, Taylor HR; Vision Loss Expert Group. Causes of vision loss worldwide, 19902010: a systematic analysis. Lancet Glob Health. 2013 Dec;1(6):e339-49. doi: 10.1016/S2214109X(13)70113-X. Epub 2013 Nov 11. PubMed PMID: 25104599.
Kavitha S, Zebardast N, Palaniswamy K, Wojciechowski R, Chan ES, Friedman DS, Venkatesh R, Ramulu
PY. Family history is a strong risk factor for prevalent angle closure in a South Indian population.
Ophthalmology. 2014 Nov;121(11):2091-7. doi: 10.1016/j.ophtha.2014.05.001. Epub 2014 Jun 25.
PubMed PMID: 24974379.
Jiang Y, Chang DS, Zhu H, Khawaja AP, Aung T, Huang S, Chen Q, Munoz B, Grossi CM, He M, Friedman
DS, Foster PJ. Longitudinal changes of angle configuration in primary angle-closure suspects: the
Zhongshan Angle-Closure Prevention Trial. Ophthalmology. 2014 Sep;121(9):1699-705. doi:
10.1016/j.ophtha.2014.03.039. Epub 2014 May 15. PubMed PMID: 24835757.
Liu T, Ong EL, Yan X, Guo X, He M, Friedman D, Congdon N. Factors influencing the success of rural
cataract surgery programs in China: the study of hospital administration and relative productivity
(SHARP). Invest Ophthalmol Vis Sci. 2013 Jan 9;54(1):266-73. doi: 10.1167/iovs.12-10906. PubMed
PMID: 23249711.
Huang W, Ye R, Huang S, Wang D, Wang L, Liu B, Friedman DS, He M, Liu Y, Congdon NG. Perceived
difficulty of various steps of manual small incision cataract surgery among trainees in rural China. Clin
Experiment Ophthalmol. 2013 Sep-Oct;41(7):668-73. doi: 10.1111/ceo.12072. Epub 2013 Mar 3.
PubMed PMID: 23331340.
Liu T, Congdon N, Yan X, Jin L, Wu Y, Friedman D, He M. A randomized, controlled trial of an intervention
promoting cataract surgery acceptance in rural China: the Guangzhou Uptake of Surgery Trial (GUSTO).
Invest Ophthalmol Vis Sci. 2012 Aug 13;53(9):5271-8. doi: 10.1167/iovs.12-9798. PubMed PMID:
22789919.
Sheila K. West, PhD
Vice Chair for Research, Wiolmer Eye Institute
El-Maghraby Professor of Preventive Ophthalmology
Dr. West received her PhD in Epidemiology from the Johns Hopkins Bloomberg School of Public Health,
where she currently holds a joint appointment. She joined the Dana Center for Preventive Opthalmology
in 1984 as an Assistant Professor. Dr. West is the author of over 300 publications, and has served on
numerous Boards and Committees. She is a member of the National Advisory Eye Council, on the Scientific
Advisory Panel of Research to Prevent Blindness, the Technical Expert Committee of International
Trachoma Initiative, and a member of the STAG for NTD, advisory to The Director General of WHO. She
is the past president of the Association for Research in Vision and Ophthalmology. Her research interests
are in trachoma (ocular C. trachomatis infection), vision and functional outcomes, and the epidemiology of
ocular diseases.
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Dana Center for Preventive Ophthalmology Annual Report
Selected Publications from last two years:
Does mass azithromycin distribution impact child growth and nutrition in Niger? A cluster-randomized trial.
Amza A, Yu SN, Kadri B, Nassirou B, Stoller NE, Zhou Z, West SK, Bailey RL, Gaynor BD, Keenan JD, Porco
TC, Lietman TM. PLoS Negl Trop Dis. 2014 Sep 11;8(9):e3128. doi: 10.1371/journal.pntd.0003128.
eCollection 2014 Sep.
Non-participation during azithromycin mass treatment for trachoma in The Gambia: heterogeneity and
risk factors.Edwards T, Allen E, Harding-Esch EM, Hart J, Burr SE, Holland MJ, Sillah A, West SK, Mabey D,
Bailey R. PLoS Negl Trop Dis. 2014 Aug 28;8(8):e3098. doi: 10.1371/journal.pntd.0003098.
eCollection 2014 Aug.PMID: 25165994 [PubMed - in process] Free PMC Article
Longitudinal Relationships Among Visual Acuity, Daily Functional Status, and Mortality: The Salisbury Eye
Evaluation Study. Christ SL, Zheng DD, Swenor BK, Lam BL, West SK, Tannenbaum SL, Muñoz BE, Lee DJ.
JAMA Ophthalmol. 2014 Aug 21. doi: 10.1001/jamaophthalmol.2014.2847. PMID: 25144579
Does walking speed mediate the association between visual impairment and self-report of mobility
disability? The Salisbury Eye Evaluation Study. Swenor BK, Bandeen-Roche K, Muñoz B, West SK. J Am
Geriatr Soc. 2014 Aug;62(8):1540-5. doi: 10.1111/jgs.12937. Epub 2014 Jul 15.PMID: 25040870
[PubMed - indexed for MEDLINE]
Geospatial distribution and clustering of Chlamydia trachomatis in communities undergoing mass
azithromycin treatment.Yohannan J, He B, Wang J, Greene G, Schein Y, Mkocha H, Munoz B, Quinn TC,
Gaydos C, West SK. Invest Ophthalmol Vis Sci. 2014 Jun 6;55(7):4144-50. doi: 10.1167/iovs.1414148.PMID: 24906862 [PubMed - indexed for MEDLINE]
Longitudinal analysis of antibody responses to trachoma antigens before and after mass drug
administration. Goodhew EB, Morgan SM, Switzer AJ, Munoz B, Dize L, Gaydos C, Mkocha H, West SK,
Wiegand RE, Lammie PJ, Martin DL. BMC Infect Dis. 2014 Apr 22;14:216. doi: 10.1186/1471-233414-216. PMID: 24755001 [PubMed - in process] Free PMC Article
The effect of multiple rounds of mass drug administration on the association between ocular Chlamydia
trachomatis infection and follicular trachoma in preschool-aged children. Lee JS, Muñoz BE, Mkocha H,
Gaydos CA, Quinn TC, West SK. PLoS Negl Trop Dis. 2014 Apr 10;8(4):e2761. doi:
10.1371/journal.pntd.0002761. eCollection 2014 Apr. PMID: 24722392
Increased carriage of macrolide-resistant fecal E. coli following mass distribution of azithromycin for
trachoma control. Seidman JC, Coles CL, Silbergeld EK, Levens J, Mkocha H, Johnson LB, Muñoz B, West
SK. Int J Epidemiol. 2014 Aug;43(4):1105-13. doi: 10.1093/ije/dyu062. Epub 2014 Mar 21.PMID:
24659584 [PubMed - in process]
Impact of mass azithromycin distribution on malaria parasitemia during the low-transmission season in
Niger: a cluster-randomized trial. Gaynor BD, Amza A, Kadri B, Nassirou B, Lawan O, Maman L, Stoller
NE, Yu SN, Chin SA, West SK, Bailey RL, Rosenthal PJ, Keenan JD, Porco TC, Lietman TM. Am J Trop Med
Hyg. 2014 May;90(5):846-51. doi: 10.4269/ajtmh.13-0379. Epub 2014 Mar 10. PMID: 24615132
[PubMed - indexed for MEDLINE]
The efficacy of oral azithromycin in clearing ocular chlamydia: mathematical modeling from a communityrandomized trachoma trial.Liu F, Porco TC, Mkocha HA, Muñoz B, Ray KJ, Bailey RL, Lietman TM, West SK.
Epidemics. 2014 Mar;6:10-7. doi: 10.1016/j.epidem.2013.12.001. Epub 2014 Jan 8.PMID: 24593917
[PubMed - in process] Free Article
Cohort and age effects of mass drug administration on prevalence of trachoma: a longitudinal study in
rural Tanzania. Shekhawat N, Mkocha H, Munoz B, Gaydos C, Dize L, Quinn TC, West SK. Invest
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Dana Center for Preventive Ophthalmology Annual Report
Ophthalmol Vis Sci. 2014 Apr 11;55(4):2307-14. doi: 10.1167/iovs.13-12701. PMID: 24448262
[PubMed - indexed for MEDLINE] Free PMC Article
Is there evidence for resistance of ocular chlamydia trachomatis to azithromycin after mass treatment for
trachoma control? West SK, Moncada J, Munoz B, Mkocha H, Storey P, Hardick J, Gaydos CA, Quinn TC,
Schachter J. J Infect Dis. 2014 Jul 1;210(1):65-71. Epub 2014 Jan 19. PMID: 24446528 [PubMed indexed for MEDLINE]
A longitudinal study of the association between visual impairment and mobility performance in older
adults: the Salisbury eye evaluation study. Swenor BK, Muñoz B, West SK. Am J Epidemiol. 2014 Feb
1;179(3):313-22. doi: 10.1093/aje/kwt257. Epub 2013 Oct 22.PMID: 24148711 [PubMed - indexed
for MEDLINE]
Impact of dry eye on reading in a population-based sample of the elderly: the Salisbury Eye Evaluation.
van Landingham SW, West SK, Akpek EK, Muñoz B, Ramulu PY. Br J Ophthalmol. 2014 May;98(5):63944. doi: 10.1136/bjophthalmol-2013-303518. Epub 2013 Oct 11
Beatriz E. Muñoz
Associate Professor
Ms. Muñoz was trained at the Universidad Nacional de Colombia, Stanford University, Harvard University
Extension School, and Eaglesfield and Nash, Inc. In 1988 she received the Fight for Sight Award for
Clinical Research, and is on the Wilmer Data Processing Committee and the Dana Center Training and
Fellowship Committee. Ms. Muñoz has been a member of the Wilmer faculty since 1986.
Selected Publications from last two years:
Longitudinal Relationships Among Visual Acuity, Daily Functional Status, and Mortality: The Salisbury Eye
Evaluation Study.Christ SL, Zheng DD, Swenor BK, Lam BL, West SK, Tannenbaum SL, Muñoz BE, Lee DJ.
JAMA Ophthalmol. 2014 Aug 21. doi: 10.1001/jamaophthalmol.2014.2847. PMID: 25144579
Geospatial distribution and clustering of Chlamydia trachomatis in communities undergoing mass
azithromycin treatment.Yohannan J, He B, Wang J, Greene G, Schein Y, Mkocha H, Muñoz B, Quinn TC,
Gaydos C, West SK. Invest Ophthalmol Vis Sci. 2014 Jun 6;55(7):4144-50. doi: 10.1167/iovs.1414148.PMID: 24906862 [PubMed - indexed for MEDLINE]
Longitudinal analysis of antibody responses to trachoma antigens before and after mass drug
administration. Goodhew EB, Morgan SM, Switzer AJ, Muñoz B, Dize L, Gaydos C, Mkocha H, West SK,
Wiegand RE, Lammie PJ, Martin DL. BMC Infect Dis. 2014 Apr 22;14:216. doi: 10.1186/1471-233414-216. PMID: 24755001 [PubMed - in process] Free PMC Article
Increased carriage of macrolide-resistant fecal E. coli following mass distribution of azithromycin for
trachoma control. Seidman JC, Coles CL, Silbergeld EK, Levens J, Mkocha H, Johnson LB, Muñoz B, West
SK. Int J Epidemiol. 2014 Aug;43(4):1105-13. doi: 10.1093/ije/dyu062. Epub 2014 Mar 21.PMID:
24659584 [PubMed - in process]
Cohort and age effects of mass drug administration on prevalence of trachoma: a longitudinal study in
rural Tanzania. Shekhawat N, Mkocha H, Muñoz B, Gaydos C, Dize L, Quinn TC, West SK. Invest
Ophthalmol Vis Sci. 2014 Apr 11;55(4):2307-14. doi: 10.1167/iovs.13-12701. PMID: 24448262
[PubMed - indexed for MEDLINE] Free PMC Article
Is there evidence for resistance of ocular chlamydia trachomatis to azithromycin after mass treatment for
trachoma control? West SK, Moncada J, Muñoz B, Mkocha H, Storey P, Hardick J, Gaydos CA, Quinn TC,
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Dana Center for Preventive Ophthalmology Annual Report
Schachter J. J Infect Dis. 2014 Jul 1;210(1):65-71. Epub 2014 Jan 19. PMID: 24446528 [PubMed indexed for MEDLINE]
A longitudinal study of the association between visual impairment and mobility performance in older
adults: the Salisbury eye evaluation study. Swenor BK, Muñoz B, West SK. Am J Epidemiol. 2014 Feb
1;179(3):313-22. doi: 10.1093/aje/kwt257. Epub 2013 Oct 22.PMID: 24148711 [PubMed - indexed
for MEDLINE]
Impact of dry eye on reading in a population-based sample of the elderly: the Salisbury Eye Evaluation.
van Landingham SW, West SK, Akpek EK, Muñoz B, Ramulu PY. Br J Ophthalmol. 2014 May;98(5):63944. doi: 10.1136/bjophthalmol-2013-303518. Epub 2013 Oct 11
Harry A. Quigley, MD
Maumenee Professor of Ophthalmology
Director, Glaucoma Service
Dr. Quigley was born in St. Louis and is a graduate of Harvard College and Johns Hopkins Medical
School (Alpha Omega Alpha). After ophthalmic residency at the Wilmer Institute, he did a fellowship with
Douglas Anderson at the Bascom Palmer Eye Institute, Miami. He became the A. Edward Maumenee
Professor of Ophthalmology in 1994, directing the Glaucoma Center of Excellence and for 20 years was
director of the Dana Center for Preventive Ophthalmology at Wilmer. He was a founding member of the
American Glaucoma Society, serving for 8 years as its Secretary. He was elected to 5 year terms as chief
executive officer of the Association for Research in Vision and Ophthalmology (ARVO) and Editor-in-Chief
of Investigative Ophthalmology and Visual Science.
He has published over 350 peer-reviewed articles, and his reports are the most cited in the ophthalmic
literature over the last 30 years (Archives of Ophthalmology, 2007). He has been honored with the
Friedenwald Award by ARVO, the Doyne Medal by the Oxford Ophthalmological Congress, the Leslie
Dana Medal by the St. Louis Society for the Blind, and by research awards from Research to Prevent
Blindness, the Alcon Research Award (twice), the European Society of Ophthalmology (Prix Jules Francois),
the Chicago Ophthalmological Society (best teacher), Ophthalmological Society of Scotland (Mackenzie
Medal), Australian Society of Ophthalmology (Gregg Medal), Irish Ophthalmological Society (Mooney
Medal), and the New York Academy of Sciences (Lewis Rudin Prize). He is a Gold Fellow of ARVO, a
recipient of the Secretariat Award of the American Academy of Ophthalmology. He has given 35 named
lectures, including the 66th Edward Jackson Lecture (American Academy of Ophthalmology).
Dr. Quigley has trained 55 glaucoma clinician--scientists who practice in the U.S. and worldwide. His
research has improved the early diagnosis of glaucoma and has developed instruments and techniques to
identify glaucoma damage better including a suturing technique for trabeculectomy that has been widely
adopted. His investigations demonstrated the degree of glaucoma damage that precedes present
detection methods. He was the first to report on long-term success with laser iridotomy.
He has participated in pioneering studies of the epidemiology, morbidity and progression rate of
glaucoma and other eye disease in American, African, Asian, and Hispanic populations, serving as a
consultant to the World Health Organization. He conceptualized new roles for iris and choroidal volume
change as risk factors in angle closure glaucoma. In the laboratory, he has demonstrated successful gene
therapy to protect retinal ganglion cells from experimental glaucoma, and developed glaucoma models
in monkeys, rats and mice.
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Selected Publications from last two years:
Quigley HA, Cassard SD, Gower EW, Ramulu PY, Jampel HD, b. The Cost of Glaucoma Care Provided to
Medicare Beneficiaries from 2002-2009. Ophthalmology. 2013; 120(11):2249-57.
Jampel HD, Cassard SD, Ramulu PY, Friedman DS, Shekhawat NS, Whiteside-de Vos J, Quigley HA,
Gower EW. Trends Over Time and Regional Variations in the Rate of Laser
Seager FE, Jefferys JL, Quigley HA. Comparison of dynamic changes in anterior ocular structures
examined with anterior segment optical coherence tomography in a cohort of various origins. Invest
Ophthalmol Vis Sci. 2014 Mar 19;55(3):1672-83. doi: 10.1167/iovs.13-13641. PubMed PMID:
24557354.
Bourne RR, Stevens GA, White RA, Smith JL, Flaxman SR, Price H, Jonas JB, Keeffe J, Leasher J, Naidoo K,
Pesudovs K, Resnikoff S, Taylor HR; Vision Loss Expert Group. Causes of vision loss worldwide, 19902010: a systematic analysis. Lancet Glob Health. 2013 Dec;1(6):e339-49. doi: 10.1016/S2214109X(13)70113-X. Epub 2013 Nov 11. PubMed PMID: 25104599.
Pradeep Y. Ramulu, MD, MHS, PhD
Associate Professor
Dr. Ramulu received his Bachelor’s degree from Stanford University with Highest Honors, and his MD,
MHS, and PhD degrees through the Johns Hopkins School of Medicine and Bloomberg School of Public
Health. He joined the Dana Center faculty in 2007 after completing his glaucoma fellowship at the
Bascom Palmer Eye Institute. He is also an Associate Member of the Johns Hopkins Center on Aging and
Health.
Dr. Ramulu has received the Achievement and Secretariat Awards from the American Academy of
Ophthalmology, and has obtained grant funding from several agencies including the National Eye
Institute, Research to Prevent Blindness, the American Geriatric Society, and the American Glaucoma
Society. Since joining the Wilmer faculty he has had continuous funding from the NIH, as well as numerous
other funding organizations. He has authored 8 book chapters on a wide variety of topics and has
published over 50 peer-reviewed articles. He serves on the editorial board of BMC Ophthalmology, and
has peer-reviewed over 50 articles for a variety of journals over the last 2 years. He is a standing
member of the American Academy of Ophthalmology’s Publish Health and Research and Regulatory
Committees and serves as an Associate Advisory Board Member for the World Glaucoma
Association. He has given several international invited lectures, including lectures at the Aravind Eye
Institute, the LV Prasad Eye Institute, and the Chilean Congress of Ophthalmology. Based on his
understanding of the functional consequences of poor vision, he has served as a consultant to the Federal
Bureau of Investigation (FBI) to help set vision standards for FBI employees including special agents.
Dr. Ramulu’s primary focus is to understand the functional consequences of vision loss. He currently leads
the NEI-funded Falls in Glaucoma Study (FIGS), which will longitudinally assess risk factors for falls, and
identify specific falls risk factors in this group which could be improved as part of an intervention. Dr.
Ramulu also has ongoing work to understand the anatomic and genetic basis of angle closure glaucoma in
South Indian populations. He is also a practicing glaucoma specialist and has pioneered and implemented
several creative changes to the way Ophthalmology residents are taught at Wilmer. Dr. Ramulu continues
to care for glaucoma patients and leads resident education activities in glaucoma at the Wilmer Eye
Institute.
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Selected Publications from last two years:
Brown JC, Goldstein JE, Chan TL, Massof R, Ramulu P, and the Low Vision Research Network Study
Group. Description of Functional Complaints in Patients Seeking Outpatient Low Vision Services in the
United States. Ophthalmology. 2014;121(8):1655-62.
Kavitha S, Zebardast N, Palaniswamy K, Wojciechowski R, Chan ES, Friedman DS, Venkatesh R, Ramulu
PY. Family history is a strong risk factor for prevalent angle closure in a South Indian population.
Ophthalmology. 2014;121(11):2091-7.
Loprinzi PD, Brodowicz GR, Sengupta S, Solomon SD, Ramulu PY. Accelerometer-assessed physical
activity and diabetic retinopathy in the United States. JAMA Ophthalmology. 2014;132(8):1017-9.
Sherrod CE, Vitale SE, Frick KD, Ramulu PY. The association of vision loss with work status in the United
States. JAMA Ophthalmology. 2014;132(10):1239-42.
Nguyen AM, van Landingham SW, Massof RW, Rubin GS, Ramulu PY. Reading ability and reading
engagement in older adults with glaucoma. Investigative Ophthalmology and Visual Science.
2104;55(8):5284-90.
Shannath Merbs, MD, PhD
Associate Professor of Ophthalmology
Shannath L. Merbs, M.D., Ph.D., FACS is an Associate Professor of Ophthalmology at the Wilmer Eye
Institute and an Associate Professor of Oncology in The Johns Hopkins University School of Medicine. She
is the current Executive the Secretary of the American Society of Ophthalmic Plastic and Reconstructive
Surgery and is the director of the ASOPRS fellowship program for the Wilmer Eye Institute. Dr. Merbs
recently completed the Leadership Development Program through the American Academy of
Ophthalmology. In addition to her NIH-funded basic science research on the role that epigenetics and
DNA methylation play in retinal development and disease, Dr. Merbs is also actively involved in research
to improve the outcome of surgery for trachomatous trichiasis, the leading infectious cause of blindness
worldwide. With colleague Dr. Emily Gower, Dr. Merbs developed a new surgical instrument called the
TT clamp to aid non-physician surgical technicians who perform the surgery. She was a co-investigator in
a clinical trial in Tanzania to test the outcome of surgery using the TT clamp vs the standard
instrumentation that was funded by the Bill and Melinda Gates Foundation. Dr. Merbs is also the lead
author of the new edition of the World Health Organization manual for trichiasis surgery. Dr. Merbs was
invited by the Colombian Ministry of Health and the Pan American Health Organization to lead a
national training program for trachomatous trichiasis surgery in Mitu, Colombia, a small town located in
Southeastern Colombia in the Amazon Basin only accessible by river or plane. Trachoma has recently
been identified in the local population that lives in the rainforest there. She taught surgeons from Bogota
how to do trachoma surgery and as a group they operated on about 30 patients with severe disease. In
June, she went back to Mitu assess the individuals who had received surgery the year before and taught
a new set of surgeons. A manuscript on the potential importance of incision height in the surgery was
recently accepted and might eventually lead to changing the way the surgery is done throughout the
world.
Selected Publications from last two years:
Gower EW, West SK, Cassard SD, Harding JC, Munoz BE, Othman MS, Merbs SL. Results of a
Randomized Clinical Trial to Compare the TT Clamp to Standard Bilamellar Tarsal Rotation
Instrumentation for Trichiasis Surgery, JAMA Ophthalmol. 2013 Mar;131(3):294-301. PMID: 23494035
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Koo JJ, Wang J, Thompson CB, Merbs SL, Grant MP. Impact of Hospital Volume and Specialization on the
Cost of Orbital Trauma Care. Ophthalmology. 2013 Dec;120(12):2741-6. PMID: 24120326
Merbs SL, Resnikoff, S., Kello, A., Mariotti, S.P., Greene, G., West, S. Trichiasis surgery for trachoma.
France: World Health Organization, 2013.
Merbs SL, Oktavec KC, Munoz BE, Perlini EF, West SK, Othman MS, Gower EW. Lower Post-operative Scar
Height is Associated with Increased Post-operative Trichiasis One Year After Bilamellar Tarsal Rotation
Surgery. Ophthalmic Epidemiology, 2014. In Press.
Oliver D. Schein, MD, MPH, MBA
Grossman Professor of Ophthalmology
Oliver D. Schein, M.D., M.P.H., M.B.A. is the Burton E. Grossman Professor of Ophthalmology and Vice
Chair for Quality and Safety at the Wilmer Eye Institute at the Johns Hopkins University School of
Medicine with a joint appointment in the Department of Epidemiology at the Bloomberg School of Public
Health at Johns Hopkins University. Dr. Schein received his M.D. from Johns Hopkins University in 1981, his
M.P.H. in 1984, and his M.B.A. in 2005. He completed a residency in internal medicine and a fellowship
in preventive ophthalmology at Hopkins followed by a residency in ophthalmology and a fellowship in
cornea and external disease at the Massachusetts Eye and Ear Infirmary where he joined the faculty at
Harvard Medical School before returning to Hopkins. He joined Wilmer's Dana Center for Preventive
Ophthalmology and its Cornea and Anterior Segment Service in 1990. Dr. Schein's clinical expertise is in
the medical and surgical management of conditions involving cataract, the cornea, and anterior segment.
His principal research interests and accomplishments involve the epidemiology of major ocular diseases
and technology and outcomes assessment in ophthalmology.
Selected Publications from last two years:
Chae JJ, Mulreany DG, Guo Q, Lu Q, Choi JS, Strehin I, Espinoza FA, Schein O, Trexler MM, Bower KS,
Elisseeff JH. Application of a collagen-based membrane and chondroitin sulfate-based hydrogel
adhesive for the potential repair of severe ocular surface injuries. Mil Med. 2014 Jun;179(6):686-94.
doi:10.7205/MILMED-D-13-00360. PubMed PMID: 24902138.
Schein OD, Banta JT, Chen TC, Pritzker S, Schachat AP. Lessons learned: wrong intraocular lens.
Ophthalmology. 2012 Oct;119(10):2059-64. doi: 10.1016/j.ophtha.2012.04.011. Epub 2012 Jun 14.
PubMed PMID: 22704833.
Keay L, Gower EW, Cassard SD, Tielsch JM, Schein OD. Postcataract surgery endophthalmitis in the
United States: analysis of the complete 2003 to 2004 Medicare database of cataract surgeries.
Ophthalmology. 2012 May;119(5):914-22. doi: 10.1016/j.ophtha.2011.11.023. Epub 2012 Jan 31.
PubMed PMID: 22297029; PubMed Central PMCID: PMC3343208.
Megan Collins, MD
Assistant Professor of Ophthalmology
Megan Collins is an Assistant Professor of Ophthalmology at the Wilmer Eye Institute. Dr. Collins received
her BA in Philosophy and History and her BS in Biology from University of Notre Dame and her MD from
The University of Chicago. She completed her ophthalmology residency training at The University of
Chicago, as well as an ethics fellowship at the MacLean Center for Clinical Medical Ethics.
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Dana Center for Preventive Ophthalmology Annual Report
Dr. Collins pursued fellowship training in pediatric ophthalmology and adult strabismus at University of
Toronto’s Hospital for Sick Children. From 2011-2014, she was on the faculty at University of Wisconsin
Madison. Dr. Collins joined the Wilmer faculty in July 2014. Her clinical interests include retinopathy of
prematurity, orbital tumors and venolymphatic malformations and adult strabismus.
Dr. Collins is an investigator in the Baltimore Reading and Eye Disease Study, a project examining the
prevalence of eye disease in school-age children and the impact of eyeglasses on reading skills. She is
also an investigator with the Pediatric Eye Disease Investigator Group and participates in clinical trials
related to pediatric cataracts and strabismus. Dr. Collins has a background in bioethics and is
collaborating with faculty from the Johns Hopkins Berman Institute for Bioethics to develop an ethics and
professionalism curriculum for ophthalmology residents.
Collins ME, Petronic-Rosic V, Sweiss NJ, Marcet MM. Full-thickness eyelid lesions in sarcoidosis. Case
Reports in Ophthalmological Medicine, vol. 2013, Article ID 579121, 3 pages, 2013.
doi:10.1155/2013/579121
Marcet MM, Setabutr P, Lemke BN, Collins ME, Wesley RE, Fleming JC, Putterman AM. Surgical
Microanatomy of the Müller’s Muscle-Conjunctival Resection Ptosis Procedure. Ophthalmic Plastic and
Reconstructive Surgery 2010; 26(5): 360-364.
Collins ME, Hariprasad SM. Free-floating iris cyst. New England Journal of Medicine 2010; 362:1720.
Collins ME, Sheth V, Raichand S, Saidel M, Hariprasad SM. Microincisional sutureless vitrectomy for a
dislocated IOL. Retina Today 2009; 4(8):32-35.
Halperin H, Paradis N, Mosesso V, Nichol G, Sayre M, Ornato JP, Gerardi M, Nadkarni VM, Berg R,
Becker L, Siegler M, Collins M, Cairns CB, Biros MH, Vanden Hoek T, Peberdy M. Recommendations for
Implementation of Community Consultation and Public Disclosure Under the Food and Drug
Administration’s "Exception From Informed Consent Requirements for Emergency Research. Circulation
2007;116: 1855-1863.
Bonnielin Swenor, MPH, PhD
Assistant Professor of Ophthalmology
Bonnielin Swenor is an Assistant Professor at the Wilmer Eye Institute at Johns Hopkins University. She
received an MPH concentrating in Epidemiology and Biostatistics and a PhD in Epidemiology from the
Johns Hopkins Bloomberg School of Public Health. As a graduate student, Dr. Swenor was awarded the
Dana Center for Preventive Ophthalmology Student Award, recognizing researchers committed to a
career in public health ophthalmology. She completed a Postdoctoral Fellow at the National Institute on
Aging in the Translational Gerontology Branch prior to returning to Wilmer in August of 2014.
Dr. Swenor’s research is at the intersection of aging and ophthalmology. Her primary research focus is to
determine how visual impairment and eye disease effect functioning and quality of life trajectories in
older adults. She maintains her association with the NIA oversees the ophthalmic data collection in the
Baltimore Longitudinal Study of Aging (BLSA). Dr. Swenor has epidemiologic expertise in longitudinal
study design and analysis. Her current research includes examining neurocognitive, mobility, and reading
outcomes in older adults with vision loss.
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Selected Publications from last two years:
Christ SL, Zheng DD, Swenor BK, Lam BL, West SK, Tannenbaum SL, Muñoz BE, Lee J. Longitudinal
Relationships Among Visual Acuity, Daily Functional Status, and Mortality: The Salisbury Eye Evaluation
Study. JAMA Ophthalmol. 2014 Aug 21.
Swenor BK, Bandeen-Roche K, Muñoz B, West SK. Does walking speed mediate the association between
visual impairment and self-report of mobility disability? The Salisbury Eye Evaluation Study. J Am Geriatr
Soc. 2014 Aug;62(8):1540-5.
Swenor BK, Muñoz B, West SK. A longitudinal study of the association between visual impairment and
mobility performance in older adults: The Salisbury Eye Evaluation Study. Am J Epidemiol. 2014 Feb
1;179(3):313-22.
Swenor BK, Ramulu PY, Willis JR, Friedman D, Lin FR. The prevalence of concurrent hearing and vision
impairment in the United States. JAMA Intern Med. 2013 Feb 25;173(4):312-3.
Ramulu PY, Swenor BK, Jefferys JL, Friedman DS, Rubin GS. Difficulty with out-loud and silent reading in
glaucoma. Invest Ophthalmol Vis Sci. 2013 Jan 23;54(1):666-72.
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Adjunct Faculty
Ann M. Ervin, MPH, PhD
Assistant Scientist, Johns Hopkins University School of Public
Dr. Ervin’s research interests focus on the comparative effectiveness of interventions to treat and prevent
ocular disease and visual impairment. She is currently the Principal investigator of a project funded by
the Johns Hopkins Evidence-Based Practice Center and the Agency for Healthcare Research and Quality
to prepare a comparative effectiveness review of screening methods and medical and surgical treatment
for chronic open-angle glaucoma. Dr. Ervin also collaborates with ophthalmologists and optometrists on
systematic reviews that examine treatments for uveitis, cataract, dry eye syndrome and other visual
disorders. She plays an active role in training vision researchers to perform and interpret systematic
reviews, critically appraise ophthalmology and optometry literature, and utilize systematic review
findings in clinical practice during courses offered by the US Cochrane Center.
Dr. Ervin has a long term interest in the design and conduct of randomized clinical trials and has worked
on numerous studies of the causes, prevention, diagnosis or treatment of disorders of the eye and visual
system including age-related macular degeneration, refractive error, low vision, and diabetic retinopathy.
Other research interests include the impact of US federal regulations for institutional review boards (IRBs)
on ethical review of multicenter clinical trials and the advantages and disadvantages of alternate IRB
review models for streamlining the review process in the multicenter setting.
Selected Publications from last two years:
Scherer RW, Sieving PC, Ervin AM, Dickersin K. Can we depend on investigators to identify and register
randomized controlled trials? PLoS One. 2012;7(9):e44183. doi: 10.1371/journal.pone.0044183. Epub
2012 Sep 11.PMID: 22984474
Mathew MC, Ervin AM, Tao J, Davis RM. Antioxidant vitamin supplementation for preventing and slowing
the progression of age-related cataract. Cochrane Database Syst Rev. 2012 Jun 13;6:CD004567.
Review. PMID: 22696344
Boland MV, Ervin AM, Friedman D, Jampel H, Hawkins B, Volenweider D, Chelladurai Y, Ward D, SuarezCuervo C, Robinson KA. Treatment for Glaucoma: Comparative Effectiveness [Internet]. Rockville (MD):
Agency for Healthcare Research and Quality (US); 2012 Apr. PMID: 22649800
Ervin AM, Boland MV, Myrowitz EH, Prince J, Hawkins B, Vollenweider D, Ward D, Suarez-Cuervo C,
Robinson KA. Screening for Glaucoma: Comparative Effectiveness [Internet]. Rockville (MD): Agency for
Healthcare Research and Quality (US); 2012 Apr. PMID: 22649799
Emily W. Gower, PhD
Associate Professor, Wake Forest University School of Medicine
Dr. Gower is a tenured Associate Professor in the Department of Epidemiology and Prevention, at Wake
Forest School of Medicine, with a joint appointment in the Department of Ophthalmology. She held a
primary appointment within the Wilmer Eye Institute from 2002-2010. Her primary research focuses on
improving surgical outcomes for ocular diseases. Much of her research is on improving trichiasis surgery
outcomes. Within the last year, her team has developed the first commercially available surgical
simulator for trichiasis surgery. It is now being used as part of routine training for all new surgeons being
trained in 9 countries. She remains integrally involved with research at the Dana Center. She is currently
the PI on an NEI-funded grant that is analyzing data from four trichiasis-surgery trials in the hopes of
identifying ways to improve surgical outcomes. Dana Center faculty Beatriz Munoz and Shannath Merbs
are key players in that grant.
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Dana Center for Preventive Ophthalmology Annual Report
Dr. Gower also conducts analyses of Medicare data to evaluate issues related to access to care and
geographic variation in diagnoses of and treatments for ocular disorders. She works closely with Dr.
Friedman on this project.
Selected Publications from last two years:
Gower EW, West SK, Harding JC, Cassard SD, Munoz BE, Othman MS, Kello AB, Merbs SL. TT Clamp
versus Standard Bilamellar Tarsal Rotation Instrumentation for Trichiasis Surgery: Results of a Randomized
Clinical Trial. JAMA Ophthalmol. 2013; 131(3):294-301.
Lee BS, Munoz BE, West SK, Gower EW. Functional Improvement after 1- and 2-Eyed Cataract Surgery
in the Salisbury Eye Evaluation. Ophthalmol. 2013; May;120(5):949-55.
Friedman DS, Cassard SD, Williams SK, Baldonado K, White RA, Gower EW. Outcomes of a Vision
Screening Program for Underserved Populations in the United States. Ophthal Epidemiol. 2013; Aug;
20(4):201-211.
Gower EW, Silverman E, Cassard SD, Williams SK, Baldonado K, Friedman DS. Barriers to Attending an
Eye Examination after Vision Screening Referral within a Vulnerable Population. J Health Care Poor
Underserved. 2013; 24(3):1042-52.
Quigley HA, Cassard SD, Gower EW, Ramulu PY, Jampel HD, Friedman DS. The Cost of Glaucoma Care
Provided to Medicare Beneficiaries from 2002-2009. Ophthalmology. 2013; 120(11):2249-57.
Jampel HD, Cassard SD, Ramulu PY, Friedman DS, Shekhawat NS, Whiteside-de Vos J, Quigley HA,
Gower EW. Trends Over Time and Regional Variations in the Rate of Laser Trabeculoplasty in the
Medicare Population. JAMA Ophthalmol. 2014 Jun; 132(6):685-90.
Do DV, Bressler SB, Cassard SD, Gower EW, Tabandeh H, Jefferys JL, Bressler NM. Ranibizumab for
Macular Telangiectasia Type 2 in the Absence of Subretinal Neovascularization. Retina. 2014
Oct;34(10):2063-71.
Oktavec KC, Cassard SD, Harding JC, Othman MS, Merbs SL, West SK, Gower EW. Patients’ Perceptions
of Trichiasis Surgery: Results from the Partnership for Rapid Elimination of Trachoma Surgery Clinical Trial.
Ophthal Epidemiol. In press.
Owsley C, McGwin G, Lee DK, Lam BL, Friedman DS, Gower EW, Haller JA, Hark LA, Saaddine J.
Diabetes Eye Screening in Urban Settings Serving Minority Populations: Detection of Diabetic Retinopathy
and Other Ocular Findings Using Telemedicine. JAMA Ophthalmol. In press.
Eliseo Guallar, MD, DrPH
Professor, Epidemiology
Dr. Guallar obtained his MD at the University of Zaragoza (Spain), and trained in Epidemiology at the
University of Minnesota (Minneapolis) and the Harvard School of Public Health (Boston), where he
obtained a Doctor of Public Health degree. He joined the Dana Center faculty in 2014 and holds
appointments as Professor of Epidemiology and Medicine at the Johns Hopkins University Bloomberg of
School of Public Health and Johns Hopkins School of Medicine in Baltimore, Maryland. He is also a core
faculty member of the Welch Center for Prevention, Epidemiology, and Clinical Research at Johns Hopkins
University. At the Department of Epidemiology, Dr. Guallar is the Director of the Environmental and
Occupational Area of Concentration.
Dr. Guallar is interested in the impact of cardiovascular and environmental risk factors on the
development and progression of eye disease and in the evaluation of the natural history of glaucoma.
Together with Dr. David Friedman, he has evaluated the role of cardiovascular risk factors on the
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Dana Center for Preventive Ophthalmology Annual Report
trajectories of intraocular pressure in the Kangbuk Samsung Health Study, a large cohort of 400,000
Korean men and women with repeated health screening and ophthalmologic exams over 10 years of
follow-up. Dr. Guallar also collaborates with Dr. Friedman in a major award from the Centers of Disease
Control and Prevention to develop an effective algorithm for glaucoma screening in high-risk populations
and in the re-analysis of national prevalence data for glaucoma using fundus photographs in the
National Health and Nutrition Examination Survey.
Dr. Guallar is a Fellow of the American Heart Association and he has obtained grant funding from
several agencies including the National Heart and Lung Institute, the National Institute of Environmental
Health Sciences, the Centers for Disease Control and Prevention, and the American Heart Association and
he has maintained continuous funding from the NIH, as well as numerous other funding organizations. He
has published over 240 peer-reviewed papers and serves on the editorial boards of the Annals of
Internal Medicine and of Environmental Health Perspective. Dr. Guallar is also a member of the American
Heart Association / American College of Cardiology.
Selected Publications from last two years:
Kim MH, Zhao D, Kim W, Lim D-H, Song Y-M, Guallar E, Cho J, Sung J, Chung E-S, Chung T-Y. Heritability
of myopia and ocular biometrics in Koreans: The Healthy Twin Study. Invest Ophthalmol Vis Sci
2013;54:3644-9. Epub 2013 Apr 25.
Zhao D, Cho J, Kim MH, Guallar E. The association of blood pressure and primary open-angle glaucoma:
A meta-analysis. Am J Ophthalmol 2014;158:615-27. Epub 2014 May 28.
Zhao D, Cho J, Kim MH, Friedman DS, Guallar E. Diabetes, fasting glucose, and the risk of glaucoma: A
meta-analysis. Ophthalmology 2014. Epub 2014 Oct 2 (Epub ahead of print).
Zhao D, Kim MH, Pastor-Barriuso R, Chang Y, Ryu S, Zhang Y, Rampal S, Shin H, Kim JM, Friedman DS,
Guallar E, Cho J. A longitudinal study of age-related changes in intraocular pressure: the Kangbuk
Samsung Health Study. Invest Ophthalmol Vis Sci 2014; 55(10):6244-50. Epub 2014 Sep 2.
Kim MH, Zhao D, Cho J, Guallar E. Cadmium exposure and age-related macular degeneration. J Expo Sci
Environ Epidemiol 2014. Epub 2014 Nov 12 (Epub ahead of print).
Zhao D, Cho J, Kim MH, Friedman DS, Guallar E. Diabetes, glucose metabolism, and glaucoma: The 2005
– 2008 National Health and Nutrition Examination Survey. PLoS ONE 2014;9:e112460.
Susan Vitale, MHS, PhD
Research Epidemiologist, Division of Epidemiology and Clinical Applications, National
Institutes of Health/National Eye Institute
Dr. Vitale is currently a member of the external working group of the NIH Blueprint for Neuroscience
Research and an adjunct Associate Professor of Ophthalmology at the Johns Hopkins University School of
Medicine in Baltimore, MD. She also serves as a member of the NIH Combined Neurosciences Institutional
Review Board and the NEI Intramural Clinical Research Review Committee and is an inaugural Silver
Fellow of the Association for Research in Vision and Ophthalmology (ARVO). Her current work includes
continued research on factors associated with myopia and visual impairment in Americans; further
collaboration on the use of dynamic light scattering to measure early cataract; and collaboration on
large epidemiologic studies of uveitis.
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Dana Center for Preventive Ophthalmology Annual Report
David Green, MPH
David Green has worked with many organizations to make medical technology and health care services
sustainable, affordable and accessible to all. David is a MacArthur Fellow, Ashoka Fellow and is
recognized by Schwab Foundation as a leading social entrepreneur. David directed the establishment of
Aurolab (India), to produce affordable intraocular lenses (now has 10% of the global market share)
suture and pharmaceuticals. He has developed high-volume, quality eye care programs that are
affordable to the poor and self-sustaining from user fees, including Aravind Eye Hospital in India - which
performs over 370,000 surgeries per year - 50 percent of the care is provided free of charge or below
- cost, yet the hospital is able to generate substantial surplus revenue. He has played a role in
developing major eye care programs in China, India, Nepal, Egypt, Tanzania, Bangladesh and
Guatemala. Within this paradigm of ‘empathetic capitalism’, he now works to create social investing
funds to support sustainable social enterprises (The Eye Fund with Deutsche Bank for $15M). He cofounded Sound World Solutions, a social enterprise to make affordable hearing devices with a novel
fitting; and Brien Holden Vision Diagnostics, to design unique and affordable ways to detect eye disease,
diabetes and neurological disorders. He leads efforts for LegWorks, a Canadian social enterprise which
makes high quality prosthetic legs affordable. He works with Pacific Vision Foundation to establish an
eye institute serving all in N. California. David is also Vice President at Ashoka, the leading
organizations promoting social entrepreneurship. He graduated from the University of Michigan with a
Bachelor in General Studies (1978) and a Masters degree in Public Health (1982). He is on the faculty
of Johns Hopkins Wilmer Eye Institute. He is the recipient of the 2009 “Spirit of Helen Keller” award for
humanitarian efforts in blindness prevention; is the recipient of the 2009 University of Michigan
Humanitarian Service Award; and was selected by University of Michigan Engineering students as a
leading social entrepreneur alumnus. He is on the boards of the University of Michigan School of Business
Social Venture Fund; the Stanford Biomedical Fellowship for India; and is on the advisory board of the
Seva Foundation.
David Green works with Dana Center faculty to plan new activities and to advise and collaborate. These
include work in China and Africa. David also teaches students and fellows at the Dana Center during his
trips to the area.
Advisor to the Dana Center
Alfred Sommer, MD, MHS
Professor and Dean Emeritus, Johns Hopkins University School of Public Health
Dr. Sommer is a Gilman Scholar and University Distinguished Service Professor at Johns Hopkins
University; Johns Hopkins Professor of Epidemiology, Ophthalmology, and International Health; and Dean
Emeritus of the Johns Hopkins Bloomberg School of Public Health. He received his MD from Harvard
Medical School (1967) and his Master of Health Science in Epidemiology from the Johns Hopkins School
of Public Health (1973). He has published 5 books and over 300 scientific articles; has received numerous
awards including the Albert Lasker Award for Clinical Research, the Warren Alpert Foundation Prize, and
the Duke Elder International Gold Medal for Contributions to Ophthalmology; has delivered over 30
named lectureships, including the Jackson Memorial Lecture (American Academy of Ophthalmology), Duke
Elder Oration (Royal College of Ophthalmologists), De Schweinitz Lecture (College of Physicians,
Philadelphia), Dohlman Lecture (Harvard Medical School), Doyne Lecture (Oxford Ophthalmologic
Congress), and the Kimura Lecture (University of California, San Francisco), among others; and is a
member of both the National Academy of Sciences and its Institute of Medicine. His current research
interests include child survival and blindness prevention strategies, micronutrient interventions, and the
interface between public health and clinical medicine.
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Dana Center for Preventive Ophthalmology Annual Report
TRAINEES AND EDUCATIONAL ACTIVITIES
PhD Students
Dolly S. Chang, MD, MPH
PhD; Department of Epidemiology (completed 2013): The detection of glaucoma using pupillography
Advisor: David S. Friedman
Bonnie Scuerman Swenor, BS, MPH
PhD; Epidemiology (completed 2012): Visual impairment and impacts on quality of life and functioning
Advisors: Pradeep Y. Ramulu, Sheila K. West
MD/MPH Students
Cheryl Sherrod
MD/MPH (In progress)
Preventive Medicine Resident
Research focus:
 Employment outcomes among the blind and visually Impaired
 Patient education
Mentors: David S. Friedman and Pradeep Ramulu
Gregory Greene, B.S.
MSPH (In progress)
MSPH Capstone: Reducing the backlog of trichiasis through a novel screening and surgical program
Capstone Advisor: Sheila K. West
Nakul Shekhawat, BA
In progress: MD, Vanderbilt University; MPH, Johns Hopkins University
Research projects:
 Cohort- and age-specific effects of annual mass drug administration on prevalence of trachoma
in rural Tanzania (Sheila K. West, Capstone advisor)
 Regional and physician variations in utilization of laser peripheral iridotomy and laser
trabeculoplasty among Medicare beneficiaries (David S. Friedman, Advisor)
Angeline M. Nguyen, BS, BA
In progress: MD, Johns Hopkins University School of Medicine
Pre-doctoral research program for medical students
Research projects:
 Exploring fear of falling as a potential mediator for physical activity restriction in age-related
eye disease
 Assessing real-world mobility in age-related macular degeneration using accelerometers
 Measuring difficulty with and restriction of specific reading tasks in glaucoma
 Characterizing the association between severity of visual field loss and fall risk in glaucoma
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Dana Center for Preventive Ophthalmology Annual Report
Chun-Hao Lee, MD
In progress: MPH, Johns Hopkins University
MPH Capstone: The Surgical Outcome of Modified Bleb Needling
Capstone and Academic Advisor: David S. Friedman
Priya Matthews, BS, BA
M.D., M.P.H. (In progress)
Research Projects: Glaucoma-Related Disability
Samuel Choudhury
M.B.B.S. (Singapore), M.P.H.(JHU)
Capstone: Retinal Detachments in eyes with choroidal melanoma following I-125 brachytherapy in the
COMS (Collaborative Ocular Melanoma Study)
Capstone Advisor-Dr Barbara Hawkins
Academic Advisor-Dr David Friedman
Other Students
Nazlee Zebardast, BASc, MSc
In progress: MD, Yale University
Summer Research Scholar
 The impact of visual field loss from glaucoma and hearing loss on social function
 Comparing the Impact of refractive and non-refractive vision loss on disability: The Salisbury Eye
Evaluation
 Indian family angle closure evaluation part 2 (In collaboration with the Aravind Eye Institute)
Advisors: Pradeep Y. Ramulu and David S Friedman
Aleksandra Mihailovic, ScM Epidemiology
Research projects:
 Impact of visual field loss on quality of life in glaucoma patients
 Falls in Glaucoma Study
Advisor: Pradeep Ramulu
Postgraduate Research Fellows
Srinivas Marmamula, MSc, PhD
Research Area: Refractive errors and presbyopia
Fellowship Preceptor: Dr. David Friedman
Sponsoring Organization: L V Prasad Eye Institute, India
Elham Hatef, MD, MPH
General Preventive Medicine Residency Program, PGY2
Diabetic Retinopathy Screening in the Pharmacies in Baltimore
Preventive Medicine Rotation: Dana Center
Rotation Preceptor: David S. Friedman
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Dana Center for Preventive Ophthalmology Annual Report
Educational Activities
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Mentoring for MPH Capstone thesis projects and teaching courses at the School of Public Health
Developing a public health ophthalmology concentration in the School of Public Health
Advising medical students in their research
PhD thesis advising
Online lectures developed for the AAO on global ophthalmology
Frequent lectures at universities and meetings around the world on blindness prevention
ADVOCACY
World Health Organization
Collaborating Centre for Research in trachoma and age-related macular degeneration
Participation in meetings to discuss the next five-year plan (David Friedman) for blindness prevention
activities and discussions about trachoma control (Sheila West and Beatriz Munoz)
International Agency for the Prevention of Blindness
Organizational Member
Diabetic Retinopathy Summit in Bangkok (2013) and Brighton (2014) David S. Friedman co-leader of the
programs at these meetings and member of the committee dedicated to diabetic retinopathy blindness
prevention
International Trachoma Initiative
Trachoma Expert Committee (Sheila West)
World Ophthalmology Congress
Annual Meeting, April, 2014 (Tokyo, Japan)
Dana Center Representative: David S. Friedman
Association for Research in Vision and Ophthalmology (ARVO)
Annual Meeting, May 2014 (Ft. Lauderdale, FL)
Dana Center Representatives: Beatriz E. Munoz, Harry A. Quigley, Pradeep Y. Ramulu, Sheila K. West
(past-president of ARVO)
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