Wake Forest University Eye Center
Clinical, Academic and Research Excellence
Proven state-of-the-art, evidence-based patient care. Graduate and post graduate medical education. Clinical scientific research. Achieving excellence in any one of these objectives would challenge most academic medical centers; excelling at all three makes the Wake Forest University Eye Center an even more remarkable institution. The center has achieved national clinical acclaim. The Eye Center was recently named one of the top 10 eye centers in the US for clinical care by ophthalmology chairmen and program directors in the country. This ranking was published in Ophthalmology Times.
The only full-service university based eye care facility in west-central and western North Carolina, the center serves as the Department of Ophthalmology for Wake Forest University School of Medicine and is located in the Richard Janeway Clinical Sciences Tower of the medical center complex. The faculty treats a full range of ophthalmic conditions and diseases specializing in the medical and surgical treatment of complicated ophthalmic problems, as well as common problems like cataracts, glaucoma, and diabetic eye disease.
“The reason we have achieved such distinction in the clinical and patient care arenas is our outstanding faculty,” says Craig M. Greven, MD, professor, chairman and director of the Eye Center. “They are all dedicated, caring, compassionate physicians who are recognized nationally for their outstanding patient care. This outstanding care translates into excellent resident training, as the residents are intimately involved in observing the attending faculty’s management of complicated diseases.”
“People, not numbers”
“Our objective is to take care of patients the way we would want our family members to be taken care of,” adds Dr. Greven. “When patients come here, they want to continue getting their care here. We treat our patients like they are individuals, not numbers.
“We also have a talented, caring staff composed of excellent secretaries, ophthalmic technicians, nurses and photographers. Our staff is great at treating patients in a respectful, courteous manner.”
Former chair M. Madison Slusher, MD explains: “Our clinical ratings result from a group effort. The majority of our staff members have been here more than 10 years, some more than 20 years. Most of our patients have a high acuity of eye disease. They have a fear of blindness, so the staff works extra hard to reassure and encourage patients…to make them comfortable with complicated diseases. This is good medicine.
“The vast majority of our patient care is outpatient. We have more than 75,000 patient visits a year. Additionally, Eye Center physicians perform more than 2,800 surgeries annually.”
Retinal Diseases
“Tremendous advances have occurred in the management of vitreoretinal diseases over the past ten years,” says Dr. Greven. “We are now able to treat diseases we couldn’t treat before, and we are more successful in managing these diseases. Macular degeneration and diabetic retinopathy are two of the leading causes of loss of vision in this country.
“We not only provide excellent state-of-the-art treatment in the management of these conditions, but, as an academic medical center, we also conduct many studies testing some of the newer medications and treatment modalities in the management of these diseases. This is clearly a benefit to our patients; when they come here they know that they will be getting the most advanced, up-to-date treatments for their problems.”
In addition to managing diabetic eye disease and macular degeneration, Dr. Slusher and Dr. Greven treat complicated retinal detachments, ocular trauma patients and more rare retinal diseases.
Opthalmic Detective
Timothy J. Martin, MD could be called an “ophthalmic detective.” His Neuroophthalmology specialty bridges a gap between neurology, neurosurgery and ophthalmology. Although some patients are sent to Dr. Martin with a known or suspected diagnosis, most of his consultations are ophthalmic mysteries--patients with unexplained vision loss. In many cases, the cause is a neurologic problem such as optic neuritis from multiple sclerosis, but other subtle eye diseases are also often discovered.
"The most important step in solving these ophthalmic mysteries is to take a careful history, and to consider all the possibilities, says Dr. Martin. “It is also very helpful having specialized tools, such as Ocular Coherence Tomography (OCT) and Electroretinography (ERG) immediately available at the Eye Center. Having a full complement of fellow subspecialty ophthalmologists for additional consultation if necessary is also key. Obviously, our colleges in neurology, neurosurgery, and neuroradiology are important resources for a neuro-ophthalmologist, and we have the best right here at the Medical Center."
Dr. Martin's other duties at the Eye Center include doing cataract surgery in a subset of patients who have retinal problems, such as patients who have had a previous vitrectomy or retinal detachment repair.
In addition to a heavy clinical schedule, Dr. Martin is Program Director of Residency Training for the Department of Ophthalmology. “We accept two new resident physicians each July for a three-year training program in ophthalmology. Our residents have gone on to become superb ophthalmologists in their communities, with many doing additional subspecialty fellowships at other prestigious programs," he notes.
Glaucoma
J. Brent Bond, MD, specialist in glaucoma care, received fellowship training in glaucoma at Wills Eye Hospital in Philadelphia, one of the most renowned glaucoma departments in the world. His practice is limited to evaluation and treatment of glaucoma. He sees patients in consultation from other ophthalmologists, from optometrists, or from primary care physicians. He confirms the presence or absence of glaucoma, or recommends treatment in patients already known to have the disease.
“Glaucoma is the third leading cause of blindness in the U.S., with about three million people older than 40 suffering from glaucoma,” says Dr. Bond. “About half these people are unaware they have the disease until late in its course. This is a major public health issue,” he cautions.
In October, 2004, the Congressional Glaucoma Caucus Foundation awarded Dr. Bond and WFU School of Medicine a grant to perform glaucoma screenings. The objective: identify some of these patients who are undiagnosed and untreated. The Eye Center also conducts clinical research in the best methods of glaucoma treatment, and was previously chosen by the National Institutes of Health as one of 14 clinical centers nationwide, and the only center in the Carolinas, to take part in a seven-year study evaluating the success of medicinal or surgical treatment for glaucoma.
Ongoing laboratory research projects include a study looking for genetic enzyme defects in pigmentary glaucoma (with Dr. Vijay Setaluri in Dermatology), and in vitro experiments on modifications of glaucoma tube shunt drainage devices.
At a recent meeting of the American Academy of Ophthalmology, Dr. Bond and Dr. Greven jointly taught a course on neovascular glaucoma to ophthalmologists from around the country. Last year at this meeting, this course was rated one of the top ten courses in glaucoma.
Pediatric ophthalmology
Hundreds of children owe their vision to the dedication and skill of R. Grey Weaver, Jr., MD. Within the complex specialty of ophthalmology, Dr. Weaver decided 21 years ago to enter pediatric ophthalmology, a job, he says, “most people don’t want to do.”
It certainly has its own unique challenges. “You can’t talk to young children and they won’t talk to you,” he explains. “You have to be a good observer and listen to what the parents tell you.” Weaver sees patients ranging in age from birth to 16 years with the gamut of ocular problems from crossed eyes to cataracts to glaucoma to eye cancer. “Anything that can happen to an adult can happen to a child so you need at least a reasonable knowledge of all areas of ophthalmology,” Dr. Weaver explains.
Dr. Weaver has collaborated with every member of the Department of Pediatrics and Pediatric Surgery during his tenure at WFU School of Medicine, and his vast knowledge has been described as encyclopedic.
His work with premature infants stands out. He pioneered the use of cryotherapy to treat infants with retinopathy of prematurity and is highly adept and experienced with the use of laser therapy to treat the same condition, halting the growth of abnormal blood vessels, bleeding and scarring inside the eye.
LASIK surgery
Keith A. Walter, MD, a corneal and refractive sub-specialist, has achieved national recognition for a recent study involving LASIK surgery. Dr. Walter suggests that humidity in the OR, and even outdoors, may affect the outcome of LASIK surgery.
His study was published in the April 2004 issue of the Journal of Cataract and Refractive Surgery, and was cited in medical columns nationwide.
“We are always in a quest to improve the outcomes of LASIK, he says.
This study was the first of its kind to suggest that the patient’s environment prior to the procedure may affect the procedure’s outcome. An estimated 10 percent of LASIK patients must undergo enhancement procedures, and Dr. Walter may have found a reason for some of the less-than-perfect results. He noticed he was performing more enhancements in November and December on patients who had undergone LASIK during the previous summer. His suspicion was that humidity, which can reach 90 percent in Winston-Salem, might play a part in the number of enhancement surgeries required. He reviewed data that he had kept on LASIK procedures performed on 368 eyes in 2000. Then he looked at a dozen possible factors including the patient’s age, sex, corneal curvature and environmental factors such as indoor and outdoor humidity and temperature. Dr. Walter discovered that the results tended to be over-corrected in the drier months, leaving some patients a bit farsighted. In humid months peaking in September, results tended to be under-corrected, leaving some patients still nearsighted.
According to Dr. Walter, “When the air is more humid, the corneal tissue takes on more moisture and absorbs less laser energy so less tissue is removed. As a result, we adjust for the procedure by adding more laser pulses to remove more tissue. In dry months, less moisture is absorbed and fewer pulses are needed.
“Since making adjustments for humidity, my reoperation rates have decreased from 15 percent to three or four percent,” he says.
His findings suggest that physicians need to adjust the depth of the corneal cutting with the laser, relative to indoor and outdoor humidity at the time of the procedure.
Comprehensive Ophthalmology and Cataract Surgery
Paul J. Dickinson, MD, a comprehensive ophthalmologist and cataract surgery specialist at the Eye Center, conducted a key research study of the rate of posterior capsular opacification…when the capsule around the lens implant becomes cloudy from scar tissue. The study found an increased rate of clouding of the capsule with a certain lens implant, which resulted in an increased need for laser treatment after cataract surgery. Also found was an increased risk of retinal swelling associated with that scarring. The recommendation based on the study was to consider other lens implants for use during cataract surgery.
Dr. Dickinson also serves as director of the comprehensive eye service and the resident clinic. “We offer a full range of service,” he explains. “Our residents see patients and follow patients longitudinally during their career here. All patients are seen in conjunction with a faculty member, so the patients actually get checked by at least two ophthalmologists at each visit. We provide excellent continuity of care and the center is recognized nationally for the quality of eye care provided and for its well-trained residents.”
Dr. Dickinson is also currently the chief of ophthalmology for the cataract cousult service at the Veteran’s Affairs Medical Center in Salisbury. The involvement of the eye center in the V.A. is expanding, he says. “We expect to hire a faculty ophthalmologist to work at the V.A. soon, and expand the Comprehensive Eye Service to improve care for our veterans,” he says. He also notes that the V.A. will also soon offer subspecialty glaucoma and retina care, and hopefully, other specialties in the future.
Ophthalmic Plastic Surgery
When not working to eradicate a growth on the eye, Patrick Yeatts, MD, Vice Chair of the department, often works around the eye repairing facial fractures or removing orbital tumors. “Arguably, oculoplastic surgery has the most varied procedures in ophthalmic surgery,” says Dr. Yeatts. As examples, he can address the cosmetic concerns of a patient seeking facial plastic surgery or perform orbit reconstruction following craniofacial resection by one of his otolaryngology or neurosurgical colleagues. He often performs an eyelid lift or addresses a facial defect created by excision of a skin cancer.
Dr. Yeatts’ research interests are as varied as his practice. He was one of the first investigators to describe topical chemotherapy to manage ocular surface malignancy. This promising work can help save vision in eyes that, prior to 1995, required surgery to remove the growth, or resulted in eye removal. “By using topical chemotherapy we can control or eliminate ocular surface cancers,” he says. “We now have the ability to use medications instead of surgical procedures for many of these tumors. This has already changed the way we treat cancer or precancerous conditions of the eye surface.”
Dr. Yeatts recently concluded a study of the quality of life in patients suffering from Graves’ ophthalmopathy. This study permits assessment of changes in quality of life associated with interventions in this disease. In addition, his recent article in Ophthalmology investigated the feasibility of small incision evisceration with the use of an injectable ocular implant that preserves globe size. “We concluded that small incision evisceration is possible with ocular volume replacement with an injectable orbital implant,” says Dr. Yeatts. “Injectable hydroxyapatite paste shows promise as an option for implantation after eye evisceration. Further studies, however, are needed.”
“We have a truly symbiotic relationship of academic excellence and clinical excellence,” concludes Dr. Slusher. “The depth of subspecialty abilities lends skills and abilities to trainees and reaches into clinical care.”