Fall 2010 - University of Alabama at Birmingham

Volume 12, Number 3
Fall 2010
the newsletter of the uab department of ophthalmology
Caring for Infants with
Congenital Cataracts
Pediatric ophthalmologists at UAB are making a difference in children’s lives. Here’s one of their stories.
A
According to Candi Andrews, the condition has existed in her family
for as many as six generations, and she had undergone surgery for congenital cataracts as an infant herself. She thought of this when she was
considering becoming a mother, realizing there was a 50-percent chance
of her child being born with the same condition. As a nurse working in the
neonatal intensive care unit at Huntsville Hospital in northern Alabama,
she approached James B. Byrne, M.D.—a retina specialist who makes
rounds on the ward—to ask his opinion.
“He basically said ‘you were born with cataracts, and you turned out
all right,’” she recalls. “That’s when I realized that you don’t have to have
perfect vision in order to have a good life, or to make an important contribution. So my husband and I decided to go ahead and start our family,
and Nathanael was born on August 13, 2009. His name means ‘gift from
God,’ and that’s definitely what he means to us.”
After successful surgeries to remove congenital cataracts,
Nathanael Andrews wears aphakic contact lenses, which can
be seen in the above photograph.
in this issue
4
5
6
7
8
9
10
11
12
Creative Collaborations:
R. Jeffrey Crain, M.D.
Volker Research Labs Dedicated
Ophthalmic Insights:
Robert H. Osher, M.D.
CDC Grant for Cynthia Owsley, Ph.D.
• Lecture by David W. Parke II, M.D./AAO
Physician Profile:
Sanders benkwith, M.D.
Donor Listing
CEFH Staff Spotlight:
Myra Aultman, R.N., M.N.A.
Hospital News:
• Carol Craig, CRNA, Named CRNA
Supervisor
• Marie Garner on Patient Family
Centered Care
Resident Listing
Decisive Action
Nathanael—known by all as “Nathan”—was also born with congenital
cataracts, which was confirmed after an examination was conducted before the family had even left the hospital. “The whole family was there, as
you can imagine, and when Dr. Byrne dilated him he found that Nathan
had cataracts in both eyes,” Andrews says. “It was a painful moment, of
course, but one we were prepared for since we’d known what the chances were from the beginning. We also knew how important it was to act
quickly in cases like these, so Dr. Byrne was on the phone to Dr. Cogen in
Birmingham that night.”
Martin Cogen, M.D., is a pediatric ophthalmologist in the UAB Department of Ophthalmology. As a tertiary care center, difficult cases are referred to UAB from across the state and southeastern United States, and
Cogen estimates that he’s treated as many as 100 cases of congenital
cataracts over the past decade. He says the causes for infantile cataracts
are quite varied, with about 40 percent having genetic origins, around 10
percent having to do with a systemic disease such as Down syndrome,
approximately 25 percent due to trauma, and the remainder caused by
unknown factors such as an isolated abnormality in the formation of the
lens. Of the cases that are genetic in nature, which are also referred to as
“autosomal dominant familial type cataracts,” symptoms usually present
very early, allowing for quick intervention. Still, there are things parents
should keep in mind.
“A baby will normally gaze directly into its mother’s face in the first
few weeks of life, and if that ‘fixation’ isn’t occurring it’s clearly abnormal. The problem is that by the time such behavior is detected there is
already a pretty significant problem in establishing the visual pathways to
the brain,” he says. “Another challenge involves infants with a cataract
(continued on page 2)
(continued from cover)
in one eye, because the better-seeing eye
will take over for the weak one and there’s
no discernable behavior to watch for. Most
pediatricians do a good job of checking an
infant’s visual condition during ‘well-baby’
exams, looking for a healthy ‘red-eye’ reflex
with no trace of the milky opacity that signals the presence of a cataract, but if there
is a history of cataracts in the family it’s a
good idea to see a pediatric ophthalmologist as quickly as possible.”
Such was the case with the Andrews,
who met with Cogen exactly one week after
Nathan’s birth. In discussing the options,
he explained the critical role timing plays
in performing cataract-removal surgery on
birth—with the operation on the second
eye taking place two weeks later, once the
first eye had been allowed to stabilize and
no complications had been detected. Both
procedures went well, according to Cogen,
leaving the method of rehabilitation to be
determined. “With children who’ve had
cataracts removed you have three options
for correcting their vision, which includes
intraocular lens implants, spectacles, or
aphakic contact lenses,” he says, adding
that “aphakia” refers to the absence of the
lens in the eye. “All the evidence we’ve
amassed indicates that intraocular lens
implants don’t work well with children under six months of age, and keeping a pair
Martin Cogen, left, meets with Candi Andrews and her son Nathan, at center, along with Carol Rosenstiel,
at right. Cogen performed cataract surgery on his young patient at four and six weeks, and Rosenstiel fitted
him with aphakic contact lenses.
such young patients. “Years ago we operated when babies were one or two weeks old
because we thought the sooner the better,”
he says, “but in the past few years we’ve
found that if you operate too early you actually increase the risk of the baby developing glaucoma. But you can’t wait too long
because the baby’s fixation reflex in the
brain isn’t going to be formed properly, and
that typically begins during the first three
months of life. So we have this brief window
of opportunity, with some very important
concerns to take into consideration.”
Balancing these issues, the decision
was made to schedule the first surgery in
three weeks—four weeks after Nathan’s
page 2
of glasses with thick lenses on a child that
young is virtually impossible, especially if
you have a monocular cataract where one
of the lenses would have to be stronger
than the other, and therefore heavier. So
contact lenses really are the best approach
in cases such as these, and they’ve worked
particularly well in Nathan’s case.”
Positive Prognosis
Although every contact lens candidate
must be custom fitted, doing so is especially challenging with infants according to
Carol Rosenstiel, O.D., associate professor
and director of the department’s contact
lens service. “I first saw Nathan in Octo-
ber of 2009, when he was just eight weeks
old,” she says, “and we had to try a number
of different lenses until we had a good fit.
The challenges involve the fact that these
lenses are so small, and they’re also thicker
than usual because they have to be more
powerful for infants, especially those with
aphakia. Plus you’re chasing a moving target, because they’re always growing. That’s
why I always make sure the lenses we dispense come with a warranty, so that there’s
no charge to return them if they don’t fit.”
Once the proper fit has been made the
parents are trained in how to perform the
daily upkeep that will be required, including inserting the lenses and administering
eye drops. Candi Andrews was especially
sensitive to making this ritual as positive as
possible, as well as other circumstances
that Nathan will encounter as he grows
older.
“I wore contacts for about two years after my surgery, but they’re very expensive,
and my mother even found me chewing on
one of them once,” she says, “so the decision was made to put me in spectacles,
which brought on the usual ridicule you see
among children on the playground. The
result is that my memories of that period
aren’t very good ones, and I don’t want Nathan to have to go through that. So my husband Richard and I do everything we can to
make the time we spend with him inserting
the lens and applying the drops a special
activity, where we’re doing something together as a team. Nathan doesn’t know this
isn’t normal, after all, and when he looks
up and gives us that big smile of his I know
he’s not having a bad experience.”
Better, perhaps, than that of parents
having to pay for aphakic contact lenses,
which can cost as much as $500 a pair
and are not often covered under a standard insurance policy. And even if they are,
benefits do not traditionally extend beyond
one pair per year, which isn’t realistic when
considering the patient’s age. “These are
infants and little children, after all,” says
Rosenstiel, “and you really can’t expect a
single pair of contact lenses to last them for
an entire year.”
Even though it’s sometimes been a struggle, the Andrews have found ways to pay
for the lenses that Nathan requires—10
pairs in 12 months, so far—but the experience has led them to wonder how others
who are less fortunate from a financial
standpoint would manage. That’s why, in
cause for confidence
now that nathan’s cataract surgeries are behind
him, and he’s adapted well to the lens insertions
and daily eye-drop applications, what does the
future hold for him? “fewer visits to see us,”
cogen says, including his colleague in the department and fellow pediatric ophthalmologist
anne marie arciniegas-bernal, m.d. “we saw
him pretty often right after the surgery, but then
we started spacing the visits out so that we’ll be
seeing him every three to six months over the
next few years. we want to make sure there are
no complications, and we’ll need to keep adjusting the prescription of the lenses as he grows.
we’ll also need to check for strabismus, which
is a crossing of the eyes that requires patching
the dominant eye so that it won’t take over for
the other one, and for amblyopia, or ‘lazy eye.’
about a third of these babies require eye-muscle
surgery later in life, so that’s something we have
to watch for. nathan has the potential for good
vision, though, so we’re going to do everything
we can to help make that happen.”
even though a recent examination indicated
that nathan has developed aphakic glaucoma,
the department is part of a network of specialists who are equipped to provide whatever treatment he will require throughout his life—a fact of
which the andrews are well aware.
“as hard as this has been for us, dr. cogen
has been awesome. he spent more than an
hour just talking with us the first time we met,
and it was clear that he’s on top of all the latest
research being done on congenital cataracts,”
andrews says. “and when someone is confident
in their skills and knowledge it causes you to
have confidence in them, too.”
to contribute to nathanael’s
fund contact lindsay KnoX, director of development, at (205)
325-8526 or [email protected].
the delivery of health care is a complex
undertaking involving highly trained individuals,
sophisticated instrumentation, and state-of-the-art
diagnostic studies, all taking place in carefully designed
clinics and hospitals. So it might be easy to lose sight
of what truly drives the entire clinical enterprise, but
it is really pretty simple—the patient!
In this issue of vision you will read of the daunting
challenge in treating pediatric patients with cataracts. It
is one requiring some urgency in management, as the
visual system of the newborn child is in a critical period
of development. It is essential that each eye see clearly
to allow the visual brain to achieve optimal binocular vision. Drs. Martin
Cogen and Ann Marie Arciniegas-Bernal are superbly trained pediatric
ophthalmologists who are well equipped to deal with this clinical problem.
But treatment of pediatric patients with cataracts is made much easier
when partnering with a family like the Andrews, who clearly understand
the importance of following a treatment regimen. But the Andrews went
even further by creating a philanthropic fund to assist families who do
not have the resources to purchase contact lenses for their children
following cataract surgery. The Andrews family is truly “giving back” in a
very meaningful way. The department is grateful for their leadership and
compassion in helping treat other patients like their son Nathanael.
Another example of putting the patient first will be found when reading
about the Multidisciplinary Comprehensive Diabetes Clinic here at UAB.
As part of this clinic Jeffrey Crain, M.D., is working hard to identify and
treat diabetic eye disease in its earliest stages. The hope is that diabetic
patients will receive more coordinated and comprehensive care resulting
in improved clinical outcomes.
Just as the Andrews family is giving back, so too is Sanders Benkwith,
M. D., who is a strong supporter of the UAB Department of Ophthalmology.
When I began my consultative practice in neuro-ophthalmology Dr.
Benkwith’s father, Karl Benkwith, M.D., referred many patients to me. His
referral letters were clearly written, precise in the details of the particular
eye problem, and always expressing gratitude for helping his patients.
Sanders has continued strongly supporting the department and building
on the legacy established by his father.
2010 began the second decade of the 21st century. The UAB Department
of Ophthalmology is poised for even greater success in the years to come.
The faculty is keenly aware that much is expected, and we pledge to our
patients that they will always come first!
from the department chair
conjunction with the uab department of ophthalmology, they have established “nathanael’s
fund” to help parents of children born with
cataracts in alabama afford aphakic contact
lenses to correct their children’s eyesight. “without the proper contacts these babies don’t have
a chance of developing good vision,” andrews
says, “and if you don’t get them fitted quickly
enough their visual systems will basically shut
down. this isn’t for nathan, because we’ll find
a way to take care of him, but many others are
not so fortunate, so we wanted to do something
to help other people who find themselves in this
situation.”
Lanning B. Kline, M.D.
eyesight foundation of alabama chair
professor and chairman
UAB Department of Ophthalmology
The Department of Ophthalmology
University of Alabama School of Medicine
Is Pleased
to Welcome
Virginia Lolley, M.D.
Assistant Professor of Ophthalmology
Cataract Surgery/Lasik
Appointments: (205) 325-8620
page 3
Creative Collaborations
R. Jeffrey Crain, M.D.
UAB has often been referred to as a “university without walls”
due to its philosophy of fostering relationships between disciplines.
Such was the case when the university’s Division of Endocrinology,
Diabetes, and Metabolism launched its Multidisciplinary Comprehensive
Diabetes Clinic (MCDC) two years ago, which was designed to serve
as a clinical arm for the UAB Comprehensive Diabetes Center and to
complement the Diabetes Research and Training Center. Housed in
The Kirklin Clinic, it was also structured to provide an opportunity for
clinicians from multiple specialties to focus their time and resources
on diabetes patients, offering a one-day series of evaluations along
with lifestyle education.
UAB diabetes specialist Fernando Ovalle, M.D., was joined at the
clinic by other endocrinologists along with an orthopedic surgeon, a
nephrologist, a registered dietitian, and a social worker. R. Jeffrey
Crain, M.D.—an associate professor in the UAB Department of
Ophthalmology and director of Birmingham’s VA Medical Center
Ophthalmology Service—joined the team as well, eager to pursue his
desire of diagnosing diabetic retinopathy early so that vision loss is
Jeffrey Crain, at right, with his colleague and diabetes specialist Fernando Ovalle collaborate on cases at the UAB Multidisciplinary Comprehensive Diabetes Clinic.
minimized. “I’d often spoken with my colleague and retina specialist
Dr. Doug Witherspoon about what we both agree is an issue that really
isn’t being addressed properly,” Crain says, “and that involves the
fact that an estimated two thirds of all diabetics in this country don’t
receive eye care on a regular basis. By the time patients are referred
to specialists like Dr. Witherspoon, many of them have already lost a
significant amount of their vision.”
As is the case in making any diagnosis, early detection and
intervention is key, and the focus on diabetes provided by the
multidisciplinary collaboration at the MDCD has resulted in the
development of a plan toward achieving that goal. Seeking ways
to offer screenings for diabetic retinopathy more easily—and by a
wider range of primary care physicians and technicians—Crain,
Witherspoon, Ovalle, and endocrinology division director Stuart J.
page 4
Frank, M.D., met recently to discuss their options. Since
Crain already had a patient base that he was seeing on
a regular basis at the MDCD that could be used as a
control group, Witherspoon suggested photographing
their retinas using his equipment at the Callahan Eye
Foundation Hospital. These images would then be used
for Crain to make comparisons with the patients’ retinas
during his physical examinations in order to determine
if advance screenings for diabetic retinopathy could
be conducted using relatively standard photographic
equipment.
“Although we’re only in the early stages of testing this
approach, we’re very optimistic, especially since this
would allow screenings to be held in so many places
beyond the clinical setting,” Crain says. “They could
be done in elementary schools and at universities,
or during health fairs at local malls, so that we’d be
taking the equipment to where numbers of people are
already gathered instead of requiring them to make an
appointment and come downtown to UAB. The images
could be taken by trained technicians and then examined
by physicians. This would expand the screening field to
diabetics who do not see an eye doctor regularly, and
perhaps to members of the public who don’t even know
they have the disease.”
Technological advancements in recent years have
resulted in improvements to the cameras so that dilating
drops are not required, simplifying the screening
process. “We can train a wide variety of health-care
providers to take the photos, which would really help
with early detection,” Crain says. “I think that all of us
who are involved in treating diabetes realize the numbers
are only rising, so that patients experiencing diabetic
retinopathy are increasing as well, especially among
older individuals.”
With this collaboration still in its early stages, Crain says
that it’s just one example of how healthy relationships
and communication between disciplines benefit everyone
involved, especially patients. “While we’re prepared to
address diabetes from a number of different perspectives
at the Multidisciplinary Comprehensive Diabetes Clinic,
there are so many people out there who don’t even realize
they have a problem yet that we quickly realized how
important it was that effective outreach be addressed. By
sharing our experiences and learning from each other,
I believe that we’ve been able to come together and
develop a completely new approach to diagnosing this
disease.
“I think it’s important for any ophthalmologist, no
matter their area of specialization, to get an occasional
reminder of how our work connects with those practicing
in other areas,” he explains. “There really is a ‘wholebody’ connection between different disease processes,
and by working together we can address them more
quickly and effectively.”
New Facilities for Ophthalmology Research
The paint has dried, the cabinets are installed,
the floors are gleaming white, and 15 researchers have
occupied the newly renovated EyeSight Foundation of
Alabama Vision Research Laboratories in Volker Hall.
Investigators from the UAB Department of Ophthalmology and the UAB School of Optometry’s Department of
Vision Sciences expect this partnership will one day
bring the scientific world closer to understanding the
diseases that cause blindness.
“The space is wonderful,” says Judith Kapp, Ph.D.,
professor of ophthalmology and vice chair for basic research. “For many of us this is a more central location
within the university, and it’s a much richer environment for research. To walk into a modern, state of the
art space as well done as this is exhilarating.”
The facility was created through a $1.2 million grant
from the EyeSight Foundation of Alabama, plus additional funds from the provost’s office and the Schools
of Medicine and Optometry. The open-lab design
concept will enable several faculty members to share
large, conjoined lab spaces and create more opportunities for collaboration.
“We have a strong group of vision scientists on campus, but some are in the School of Medicine and some
are in the School of Optometry,” says Lanning Kline,
M.D., chair of the UAB Department of Ophthalmology.
“These researchers have made great strides on their
own, but in many cases they’re working several blocks
apart. The EyeSight Foundation of Alabama recognized
the value of bringing these two groups together to create a synergy that will enable us to generate new ideas
and accelerate the research through collaboration.”
Paul Gamlin, Ph.D., professor and chair of Vision
Sciences, agrees that proximity will help overcome
challenges and make it easier to actively collaborate
on projects and attract more grant funding and novel
research. “We now have ongoing collaborations between faculty in different buildings, but the logistics
are complicated,” he says. “Several new collaborations already are being planned. People will have more
coffeepot conversations about projects they’re working
on, which will facilitate ideas.”
The goal of these laboratories will be to address the
underlying pathology of vision loss associated with
glaucoma, diabetic retinopathy, genetic diseases, and
age-related macular degeneration, determining the
best treatments for these blinding diseases and, ultimately, curing them.
The prevalence of partial vision loss and blindness
from these diseases is disproportionately high in the
Southeast, particularly in Alabama. The hope is that
the new research space will provide the infrastructure
that will help prevent vision loss throughout the state,
region and nation. “Most of the focus is on basic research, but there is an increased emphasis on transla-
Judith Kapp, vice chair for basic research in the UAB Department of Ophthalmology, and Paul
Gamlin, chair of Vision Sciences in the UAB School of Optometry, will use the new space to collaborate on research into a wide range of eye diseases.
tional research and moving into clinical treatments,” Gamlin says. “That
represents the push at the National Institutes of Health.”
“Hopefully this translational emphasis will generate new clinical trials
that also will take advantage of the other strengths we have, such as
the Clinical Vision Research Unit directed by Dr. Cynthia Owsley,” Kapp
adds. “The CVRU provides core research infrastructure to increase the
clinical research capability at UAB in eye disease and vision impairment
so that our investigators can develop high-quality research programs
and enhance existing ones. The CVRU provides core resources and consultation to investigators in the areas of study design and implementation, project coordination, database design and management, biostatistical analysis, grantsmanship and grants management. They have a great
base of knowledge.”
Faculty from the UAB Department of Ophthalmology who have relocated to the new laboratory space include Kapp, Christine Curcio,
Ph.D., Christopher Girkin, M.D., Clyde Guidry, Ph.D., Russell Read,
M.D., Ph.D., Shu-Zhen Wang, Ph.D., and Yuhua Zhang, Ph.D. Vision
researchers are excited about the opportunity to generate more clinical
studies from within UAB. Kapp believes this is an important stimulus for
basic scientists.
“When you’re focused on your own area, which goes all the way down
to the molecular level, it’s easy to wonder if what you’re doing is going to
translate into a treatment for disease in patients in your lifetime, or ever,”
Kapp says. “This will be an excellent environment where researchers
can work together and imagine how their work is going to translate, and
it will keep them focused.”
UAB Reporter
page 5
ophthalmic
Headline please
Insights
During the Annual Clinical and Research Symposium held last spring—and moderated by Jeffrey Crain,
M.D., associate professor in the UAB Department of Ophthalmology and director of the Birmingham VA
Medical Center Ophthalmology Service—Robert H. Osher, M.D., spoke on cataracts and his phacoemulsification technique. Osher is professor of ophthalmology at the University of Cincinnati College of Medicine and medical director emeritus at the Cincinnati Eye Institute. His response to the following question
is presented here: Please summarize your current phacoemulsification technique, including the mode of
anesthesia, incision size and location, nuclear disassembly method—e.g. horizontal vs. vertical chop,
primary chop vs. stop and chop, and why you prefer your current method—and cortical cleanup (coaxial
vs. bimanual).
osher: my routine cataract procedure is performed through a
three-plane, near-clear, temporal incision. the incision is constructed as an internal flare with an outer diameter of 2.2 mm
and an inner diameter of 2.4 mm. healon 5 is then injected to fill
the anterior chamber for a capsulorhexis approximately 5 mm in
diameter which is made with a bent 22-gauge needle. the lens
contents are cleaved using gentle hydrodelineation and hydrodissection. a 1 mm incision is made with a diamond blade 2 clock
hours to the left of the main incision. i prefer a .9 mm phaco tip,
which i designed with alcon that has a reverse 30° bevel on a
12° curved shaft. the bimanual emulsification with torsional ultrasound is performed with the infiniti system and the new ip
software. using an aspiration rate of 25 cc a minute and a vacuum
of 250 mm of mmhg, the bevel-down approach creates a central
divot for fluid exchange and leaves the overlying ovd undisturbed.
next, the tip is rotated until bevel-up and a groove is sculpted
with a low vacuum of 40 mm of mercury since occlusion does
not occur. this vacuum prevents inadvertent penetration of the
lens and is too low to evacuate the ovd from the anterior chamber. either a double-finger chopper or a mature chopper separates
the nucleus into hemispheres and the nucleus is rotated 90° to
facilitate the chopping of the distal hemisphere into quadrants.
the vacuum is increased to 200 mmhg of mercury and using
100-percent torsional energy, the two quadrants are removed very
efficiently without repulsion. the remaining hemisphere is rotated
180° and chopped into quadrants which are then removed. the
nuclear quadrants are emulsified in the central portion of the bag
adjacent to the next nuclear bank, which mechanically separates
the posterior capsule from the phaco tip. when the final quadrant
is removed, the chopper is placed behind the nucleus to prevent
the capsule from “trampolining,” which is very rare at these low
parameters.
i strongly prefer the silicone i&a tip and always remove the subincisional cortex first. this allows the remaining cortex to keep the
capsular bag open like a shoe tree which simplifies the removal
of the most difficult cortex. after all cortex has been removed,
the silicone tip is extremely safe for vacuuming the posterior capsule using an aspiration rate of 5 cc per minute and a vacuum of
12 mm of mercury. when the posterior capsule is crystal clear,
healon 5 is injected to expand the bag. my three aspheric lenses
of choice, an acrysof sn60wf, a toric iol, or a restor +3 add
Headline please
page 6
can each be injected into the capsular bag without enlarging
the incision. i prefer a one-handed insertion technique using counter-traction in the second incision. a blunt y-hook is
used to gently rotate the lens into a vertical position or to the
intended axis if a toric lens has been injected. the incision
is hydrated before removing the ovd from behind and in
front of the iol with a silicone tip. i like to constrict the pupil
with miochol in order to obtain optimal centration (especially
with restor) and the water-tightness of the incision is always confirmed. my goal is to perform a safe, reproducible
operation that allows the patient to enjoy excellent uncorrected vision on the day following surgery.
owsley Receives
CdC grant
UAB Department
UAB
of department
Ophthalmology
of ophthalmology
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Assistant
Professor
zzrilis euguero
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enit
at. reresearch initiative.
principal
investigator
for thenit,
$1.5
million,
five-year
Elsas, M.D.
Clinical
Associate Professor
Asscociate
Professor
Gerald McGwin Jr.,Frederick
Ph.D
Andrew Everett, M.D.
Assistant Professor
“previous
research
has suggested
that sequat
african-american
adults are
mod doloree
tumsandre
min vendion
lorClinical
Associate Professor
Asscociate
Professor
Gerald McGwin Jr.,Richard
Ph.DFeist, M.D.
less
likely
to
receive
routine,
comprehensive
eye
care
when
newly
Christopher
Girkin,
M.D.
Professor
periure ming etum nos nim quis nostionum aliquAsscociate
Professor
Gerald McGwin Jr.,Clyde
Ph.D
Guidry, Ph.D.
Associate
Professor
emerging
eyevolortie
conditions
could
be detected
timely
isit etuerilit,
magna
conse
vel dignaand
facitreated in aGerald
Hein, M.D.
Clinical
Instructor
Asscociate
Professor
McGwin Jr.,Eric
Ph.D
Wade Joiner, M.D.
Clinical Associate Professor
fashion.”
el ilissi.nsecte loreril ercillam zzrit, sublamconse
Asscociate
Professor
Gerald McGwin Jr.,Judith
Ph.D
Kapp, Ph.D.
Professor
and Vice Chair
barriers
to
care
include
cost,
lack
of
health
insurance,
communiKimble, M.D.
Clinical
Associate Professor
Asscociate
Professor
velisis ero dip ea acil erostin heniatin utet am nos
Gerald McGwin Jr.,James
Ph.D
Lanning Kline, M.D.
Professor and Chair
cation, and trust, she explains. the shortage of eye care providers
Assistant
Professor
Professor
Gerald McGwin Jr.,Virginia
Ph.DLolley, M.D. Asscociate
ea feuipisi.dit inisi.
who work in geographic areas with high-risk populations, as well as a
John Long, M.D.
Clinical Associate Professor
Asscociate
Professor
Gerald McGwin Jr.,John
Ph.D
eniam
eummodiam,
suquisl
et,
vel
in
ut
alisMason, M.D.
Clinical
Associate Professor
shortage of clinics that accept patients who are uninsured contribute
Clinical
Associate Professor
Asscociate
Professor
Gerald McGwin Jr.,Andrew
Ph.DMays, M.D.
modolore
tie faccu
Gerald McGwin, Ph.D.
Associate Professor
to the problem.
Asscociate
Professor
Gerald McGwin Jr.,Marc
Ph.D
Michelson, M.D.
Clinical
Associate Professor
owsley says the new research center will look for ways to improve
Morris, M.D.
Clinical
Associate Professor
Asscociate
Professor
Gerald McGwin Jr.,Robert
Ph.D
Cynthia Owsley, Ph.D.
Professor and Vice Chair
access to care and search for strategies to improve the overall qualParker, M.D.
Clinical
Assistant Professor
Asscociate
Professor
Gerald McGwin Jr.,John
Ph.D
ity of eye care available for underserved, older african americans.
Robert Phillips, M.D.
Clinical Associate Professor
Professor
Gerald McGwin Jr.,Russell
Ph.DRead, M.D., Ph.D.Asscociate
Associate
Professor
studies will focus on primary open angle glaucoma, diabetic eye care
Rosenstiel, O.D. Asscociate
Associate
Professor
Professor
Gerald McGwin Jr.,Carol
Ph.D
Jennifer Scruggs, M.D.
Assistant Professor
and visually impaired persons in need of rehabilitation services. the
Professor
Gerald McGwin Jr.,Harold
Ph.DSkalka, M.D. Asscociate
Professor
center will also participate in collaborative network-wide studies with
Swanner, M.D.
Associate
Professor
Asscociate
Professor
Gerald McGwin Jr.,Jason
Ph.D
Michael S. Vaphiades, D.O.
Professor
the cdc and the other trc sites at Johns hopkins university, the
Clinical
Assistant Professor
Professor
Gerald McGwin Jr.,Matthew
Ph.D Vicinanzo, M.D. Asscociate
university
of miami,
and willsmodolore
eye health
system
Shu-Zhen Wang, Ph.D.
Associate Professor
dolore magnit
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feugue
ex in philadelphia.
Asscociate
Professor
Gerald McGwin Jr.,Douglas
Ph.DWitherspoon, M.D.
Professor
the
trc will involve
faculty
the uab
of ophthalent auguero
consequisl
ut from
ea facipit
pratdepartments
lorem
Jeff Yee, M.D.
Associate Professor
Yuhua Zhang, Ph.D.
Assistant Professor
mology
and
surgery
in
the
school
of
medicine,
the
departments
of
quis dolorpe rcidunt ercipis nis
epidemiology and health care policy and organization in the Clinical
school
Faculty
of public health, and the school of optometry, as well as physicians
Clinical Faculty
Gerald McGwin Jr., Ph.D
Assistant Asscociate Professor
and researchers from cooper green mercy hospital.
Michael A. Albert, Jr., M.D.
Clinical Instructor
Asscociate
Professor
Gerald McGwin Jr.,
Ph.D
James
Byrne, M.D.
Clinical
Instructor
Britton
Carter,
M.D.
Clinical
Instructor
Asscociate Professor
Gerald McGwin Jr., Ph.D
William Cox
Clinical Adjunct Assistant Professor
Asscociate
Professor
Gerald McGwin Jr.,
Ph.D
Susan
Eiland, M.D.
Clinical
Assistant Professor
Thomas
Finley, M.D.
Instructor/Fellow
The UAB Department of Ophthalmology
Asscociate
Professor
Gerald McGwin Jr.,
Ph.D
Assistant
Andrew Hsia, M.D.
Instructor/Fellow
Asscociate
Christopher
InstructorProfessor
Gerald McGwin Jr.,
Ph.D Kelly, M.D. AssistantClinical
i n vites you to at tend the
Price Kloess, M.D.
Clinical Assistant Professor
Asscociate
Gerald McGwin Jr.,
Ph.D
AssistantClinical
Ferenc
Kuhn, M.D.
Associate Professor
Professor
Elmar
Lawaczeck,
M.D.
Professor Professor
Asscociate
Gerald McGwin Jr., Ph.D
AssistantClinical
Wright Lauten, M.D.
Instructor/Fellow
Professor
Gerald McGwin Jr.,
Ph.DMassey, M.D. Asscociate
Michael
Clinical
Assistant Professor
Nancy
Medeiros, M.D.
Clinical
Assistant Professor
Asscociate
Professor
Gerald McGwin Jr.,
Ph.D
Thomas H. Metz, M.D.
Clinical Assistant Professor
Asscociate
Professor
John
Morgan, M.D.
Clinical
Assistant Professor
Gerald McGwin Jr.,
Ph.D
Cameron Nabavi, M.D.
Instructor/Fellow
Asscociate
Professor
David w. parke ii, m.D.
Gerald McGwin Jr.,
Ph.D
Troy
Newman, M.D.
Instructor/Fellow
Matthew
Instructor/Fellow
Professor
executive vp and
Ceo McGwin Jr.,
Gerald
Ph.DOltmanns, M.D. Asscociate
John Owen, M.D.
Clinical Instructor
Asscociate
Professor
American Academy of Ophthalmology
Gerald McGwin Jr.,
Ph.DPfister, M.D.
Roswell
Clinical
Professor
Dustin
L. Pomerleau, M.D.Asscociate
Instructor/Fellow
Professor
Ph.D
“HOW WILL OPHTHALMOLOGY Gerald
FARE McGwin Jr.,
James Powell, M.D.
Clinical Associate Professor
Asscociate
Professor
Elise
Cox Pratt
Adjunct
Instructor
Gerald McGwin Jr.,
Ph.D
WITH HEALTH-CARE REFORM?”
Matthew Sapp, M.D.
Clinical Assistant Professor
Asscociate
Professor
Gerald McGwin Jr.,
Ph.D
graNd rouNdS: Friday
Wayne
Taylor, M.D.
Clinical
Instructor
Martin
Thomley, M.D.
Clinical
Associate Professor
Asscociate
Professor
Ph.D
nov. 12, 2010—7:00Gerald
a.m. McGwin Jr.,
Andrew Velazquez, M.D.
Clinical Assistant Professor
Caption HereCaption HereCaption HereCaption HereCapAsscociate Professor
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Charles Burnham M.D. Lecture
page 7
Physician Profile
Sanders M. Benkwith, M.D.
Sanders Benkwith, who is carrying on his father’s legacy by
building on the practice he established in 1945, is a strong
supporter of the UAB Department of Ophthalmology.
When Sanders Benkwith, M.D., graduated from the
University of Alabama School of Medicine at UAB in 1973,
he had plenty of reasons to continue his studies in state.
His father Karl Benkwith, M.D., had established the first
ophthalmology practice in the city of Montgomery in 1945,
and he was also a good friend of Alston Callahan, M.D.—
the first chair of the UAB Department of Ophthalmology
and founder of the Callahan Eye Foundation Hospital.
That’s before he’d heard what could be described as
“The Call of the West.”
“I took a summer job at Yellowstone National Park, and
I simply fell in love with the area,” he says. “I knew that
I would probably end up returning to Alabama at some
point, but I wanted to do what I could to extend my stay
in that part of the country, so I completed my internship
in internal medicine and ophthalmology residency at the
University of Utah Medical Center. I performed research
into the physiology of the retina with Dr. Thomas Ogden
while I was there, and then I joined my father’s practice
in Montgomery in 1977.”
That’s when his relationship with the UAB Department
of Ophthalmology began to deepen. He’d rotated through
page 8
when he was a medical student, getting to know Callahan personally,
and had found himself impressed with the quality of the residency
training program. When it was time for his practice, Montgomery
Eye Physicians, to bring another ophthalmologist onboard in 1985
he selected James Glassner, M.D., who had graduated from the
residency program at UAB. Two years later they selected another
program graduate, Tom Lyle Mitchell, Jr., M.D. While Glassner, a
triathlete, died in a tragic bicycling accident in 2001, Mitchell remains
with the practice, where his main focus is cataract and eyelid surgery.
Benkwith specializes in comprehensive ophthalmology, and the group
now has two additional ophthalmologists and three optometrists.
In the years since Benkwith and what he refers to as his “likeminded”
colleagues have soldiered on, continuing to build on his late father’s
vision of an ophthalmic practice that delivers high quality, state
of the art medical and surgical eye care with both courtesy and
professionalism. Montgomery Eye Physicians now has three locations
in the greater Montgomery area. One office, The Benkwith Eye Center,
is adjacent to the area’s only dedicated eye surgery facility, which is
known as the Montgomery Eye Surgery Center. The Sturbridge office
in East Montgomery houses the practice’s Laser Vision Center, which
offers both a femtosecond and an excimer laser, making Benkwith’s
practice the first in Alabama to bring bladeless LASIK technology to
area patients. The third center, Montgomery Eye Physicians-Prattville,
offers the fast-growing Autauga County area a wide range of routineto-specialty services.
As his career progressed, Benkwith found himself continuing to take
advantage of the many professional offerings provided by the UAB
Department of Ophthalmology, including attending Grand Rounds
lectures and utilizing continuing medical education programs. When
Lanning Kline, M.D., became department chair, Benkwith watched as
it began to take even greater strides forward.
“I was impressed with how Dr. Kline managed to grow the department,
continuing to recruit cutting-edge researchers just as Dr. Callahan had
done,” he says. “That made me comfortable about referring my patients
there for second opinions or specialized treatment. The department’s
experts are also very accessible—I always get timely callbacks from
their physicians and staff when I reach out for information, so they’re
a great resource.”
As past-president of the Montgomery County Medical Society,
Benkwith is dedicated to community service, which is a trait he shares
with the department’s faculty and staff. “I’ve seen the department
grow so much over the years in terms of the excellence of the training
it provides as well as its involvement in the surrounding community.
When I think about the good work the department is doing, especially
teamed with the Callahan Eye Foundation Hospital and the EyeSight
Foundation of Alabama, I feel that everyone in this state and region
has very good reason to be thankful.”
According to Benkwith, he has many reasons to be thankful. Now a
senior partner in the practice his father established, he and his wife
Linda—along with their two adult children and two grandchildren—
gather at their Colorado vacation home to hike and ski as often as
they can.
“I love spending time with my family in the mountains, and then
returning to see my family of patients in Montgomery,” he says. “It’s
the best of both worlds.”
Development update
2008—2009
DONORS
Uab Department of ophthalmology
honoreD patrons
($1,000,000)
The EyeSight Foundation
of Alabama
visionaries
($50,000-$1,000,000)
Brasfield & Gorrie
The Gorrie Family
Carl G. and Pauline B. Buck Trust
The Community Foundation of
Greater Birmingham
Eliza Odell Kennamer Estate
Lions Clubs of Alabama &
Lions International
sUpporters
($10,000-$50,000)
ACIPCO Charity Group
Alabama Eye Bank
The Peter W. and Peggy H.
Field Foundation
North Alabama Fabricating Co.
Springhill Medical Center
Thompson Tractor Foundation
Mr. & Mrs. Deakins Rushton
Mr. & Mrs. Herman D. Bolden
C. Phillip McWane
frienDs & alUmni
($1,000 to $10,000)
The Able Trust
The Nabers Charitable Foundation
M.A. Rikard Charitable Trust
Alfreda J. Schueler Trust
Henry G. Sims & Henry U. Sims
Memorial Foundation
Cooper T. Smith
Stevedoring Co., Inc.
Aric Aldridge, M.D.
Thomas M. Allison, M.D.
Rita J. Armitage, M.D.
John Armstrong, M.D.
Walter W. Bates
Sanders M. Benkwith, M.D.
Stephen M. Breaud, M.D.
Ray Cain, M.D.
Bry Coburn, M.D.
Martin Cogen, M.D.
C. Barry Dabbs, M.D.
Dawn K. DeCarlo, O.D.
James Dooner, M.D.
Joseph M. Farley*
Richard M. Feist, M.D.
Clarence Floyd
Christoher A. Girkin, M.D.
Bryan Grissett, M.D.
James H. Guildford, M.D.
Roy Hager, M.D.
William M. Hammonds, M.D.
Marnix Heersink, M.D.
Sarah Jablecki Hays, M.D.
E. Van Johnson, M.D.
Lanning B. Kline, M.D.
Benny M. LaRussa
Elmar Lawaczeck, M.D.
Scott W. LeCroy, M.D.
Charles R. Leone, M.D.
Ralph Z. Levene, M.D.*
John O. Mason, M.D.
Tom Lyle Mitchell, M.D.
Ernst Nicolitz, M.D.
John Owen, M.D.
James Powell, M.D.
William W. Pyron, M.D.
Jennifer Scruggs, M.D.
Todd Sleep, M.D.
Jason C. Swanner, M.D.
James Veal, M.D.
Charles H. Williamson, M.D.
*Deceased
To learn more contact Lindsay Knox, director of development, at [email protected] or (205) 325-8526.
page 9
Hospital News
Staff Spotlight: Myra Aultman, R.N., M.N.A.
As assistant vice president for patient care at the Callahan Eye Foundation
Hospital (CEFH), Myra Aultman is fostering communication among the
staff and efficient patient flow.
In 2007, after spending 25 years working at UAB
in various capacities, Myra Aultman decided it was time
for a change. She retired from the university, sold her
home, and was thinking of relocating when she heard
the position of chief nurse anesthetist/CRNA supervisor
would soon be opening at the Callahan Eye Foundation
Hospital. “I had worked directly with critically ill patients
for many years,” she recalls, “and I was drawn by the
thought of tackling administrative challenges instead, so
I applied for the position and was very happy when they
invited me to join them.”
Aultman began her nursing career in 1978 after earning her bachelor’s degree from UAB. She spent two years
working in the operating and emergency departments at
Longview General Hospital in Graysville, Alabama, before
joining UAB’s cardiovascular operating room staff. She
held that position in the practice of John W. Kirklin, M.D.,
for the next 12 years, also serving in the neurosurgical in-
page 10
tensive care, surgical intensive care, and post-anesthesia care units.
She returned to the classroom in 1993, earning her master of nurse
anesthesia degree from the UAB School of Nursing. She also worked
weekends at the Shelby County Medical Center in Alabaster, coordinating the efforts of certified registered nurse anesthetist (CRNA) students. For another 12 years she worked as a CRNA in UAB’s Anesthesia Services Division, honing her administrative and leadership skills
by seeking additional assignments with the liver transplant anesthesia
team, supply and equipment committee, and leadership committee.
On non-surgical days she supplemented that experience as a locum
tenens—Latin for “to hold the place of”—employee at UAB Medical
West, as well as the Callahan Eye Foundation Hospital.
When she rejoined the hospital in 2007 she had a number of goals,
such as getting the department’s finances in order and ramping up
anesthesia education. Setting goals and reviewing her methodology
were traits she’d developed while working with critically ill patients.
“At the end of every day I would think back over my work and ask
myself what I could’ve done better,” she says of her time working with
the cardiology and liver transplant teams. “We were always looking for
ways to improve outcomes, always trying to tweak the system in order
to make it better.”
That experience taught her to prioritize, to stay calm in hectic environments, and to always remember that “the least things are still
vitally important.” When mistakes persist, she says, it’s time to stop,
reconsider, and reassess, and she vowed to bring those critical-care
lessons to nursing administration.
In the same way that she’d learned to constantly evaluate the system she was operating within, Aultman paid close attention to her
own skills as well. While she felt that her clinical skills were solid, she
realized that some of her administrative skills—financial, legal, and in
human resources, for instance—could be strengthened. To address
these areas she enrolled in the online Master of Health Administration Program offered by the University of St. Francis in Joliet, Illinois.
That training proved invaluable when she was recently named to the
position of assistant vice president for patient care services at the Callahan Eye Foundation Hospital.
“My goal is to improve the efficiency of our patient flow,” she says,
adding that she is also focusing on effective communication by holding weekly meetings with the hospital’s staff to discuss how to streamline procedures. “Not only do we want to provide the best patient care
that we possibly can, we also want to create an environment where
the physicians know that patients will be prepped for surgery in a
timely manner. By paying attention to the details, the entire system
is improved.”
Plans for the future include improving efficiency by revising surgery block time, and she is currently reviewing plans for more preoperative and recovery beds. She says that she feels she made the
right decision in coming out of retirement to work at the hospital, and
that she’s honored to have the opportunity to contribute to its stellar
reputation. “I’ve worked in so many different areas of the health-care
system, and I’ve enjoyed them all,” she says. “But I’m particularly
drawn to ophthalmology because there are so many subspecialties to
learn about. It really is a fascinating field.”
UAB Department
of
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Asscociate Professor
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but that’s not the case anymore,” says Garner, pictured at right. “So we’re asking
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Asscociate Professor
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Asscociate
Professor
Gerald McGwin Jr., Ph.D Information
won’t unintentionally cross any boundaries.”
gathered
during the patient
Asscociate
Professor
Gerald
McGwin
Jr.,
Ph.D
As an example, in some cultures it is not allowed for women to discuss matters advocacy meetings will
be used to formulate
Professor
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Jr., that
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involving hygiene or personal care with a man, so when a Gerald
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Asscociate
Professor
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McGwin
Jr.,
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region is discharged from the CEFH information on how they should care for care at the CEFH, and
certain patients will
Professor
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Jr.,how
Ph.D be invited Asscociate
themselves must be conveyed by an appropriate family member.
Learning
to remain part
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Asscociate
Professor
Gerald
McGwin
Jr.,
Ph.D
such situations should be handled can make all the difference between a positive communication sessions.
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Gerald
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Asscociate
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Clinical Faculty
could be made. Other things we’ll discuss could be as simple as where patients park mystery out of the medical environment.”
Gerald McGwin Jr., Ph.D
Assistant Asscociate Professor
Asscociate Professor
Gerald McGwin Jr., Ph.D
Asscociate Professor
Gerald McGwin Jr., Ph.D
Asscociate Professor
Gerald McGwin Jr., Ph.D
Craig Appointed CRNA Supervisor
Gerald McGwin Jr., Ph.D
Assistant Asscociate Professor
Asscociate Professor
Brian Spraberry, president and registered nurse
anesthetists
for the Ophthalmic
AnesGerald
McGwin Jr.,and
Ph.D newsletterAssistant
Asscociate
Professor
Gerald McGwin
Ph.D thesia Society.
Assistant
chief executive of the Callahan Eye anesthesia technicians.
Prior Jr.,
to her
Craig
served as
presGerald McGwin Jr., Ph.D
Assistant Asscociate Professor
Foundation Hospital, announces tenure at CEFH, Craig served as a ident of the Association of VA Nurse
Asscociate Professor
Gerald McGwin Jr., Ph.D
that Carol Craig, CRNA, has ac- medical/surgical,
surgical
intensive
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page 11
Incoming Residents
Graduated Residents
Christopher Compton, M.D.
University of Alabama School of Medicine
Undergraduate: Tulane University
Kristin Carroll Bains, M.D
Cornea fellowship at Baylor University
Houston, Texas
Gavin Davis, M.D.
Medical University of South Carolina
Undergraduate: University of Georgia
Luke Wahl Deitz, M.D.
Pediatric/adult strabismus fellowship at Jules Stein Eye
Institute, UCLA: Los Angeles, California
Mark Hill, M.D.
University of Alabama School of Medicine
Undergraduate: Harvard University
Shelly Rani Gupta, M.D.
Glaucoma fellowship at Wills Eye Institute
Philadelphia, Pennsylvania
Thomas “Peter” Lindquist, M.D.
Rush Medical College
Undergraduate: Wheaton College
Kristen Hawthorne, M.D.
Cornea fellowship at Massachusetts Eye & Ear Infirmary
Boston, Massachusetts
Sara Mullins, M.D.
Louisiana State University School of Medicine
Undergraduate: Louisiana State University
Taylor Mosley, M.D.
Private practice in comprehensive ophthalmology
Jasper, Alabama
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