This marks the first time in the history of the survey that there has been a tie.

The survey also found that the high-achieving programs from the 2019 survey maintained their levels of excellence and stayed within the ranks of the Top 12 programs in the country, although the evaluation of the Clinical Care Program segment of the survey saw 3 newcomers to the Best of the Best and 1 new addition to the list of Best Residency Programs.

The health care professionals involved in these exceptional programs are to be congratulated for their continuing successes. The results were determined based on a survey sent by 

 to the chairpersons and residency directors of programs across the US.



Bascom Palmer Eye Institute: an eye to the future


“The Bascom Palmer Eye Institute is incredibly honored to be named the Best Overall Program and the Best Residency Program once again in the 

® survey,” said Eduardo Alfonso, MD, Kathleen and Stanley J. Glaser Chair in Ophthalmology, and director, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine. “Since its founding, Bascom Palmer has been making life-changing discoveries in every field of ophthalmology.”

Alfonso said he credits the institute’s focus on the future for its success.

“We focus on the future to expand knowledge about eye disease at a rapid rate,” he said. “We are advancing interdisciplinary translational research in gene therapy, prosthetics for the cornea, retina, optic nerve and orbit, advanced diagnosis and treatment of cancer, and stem cell therapy.”

International collaborations at Bascom Palmer are an important focus.

“Looking forward, we are determined to continue to work closely with our colleagues around the world in advancing our understanding of vision problems and finding new treatments for our patients,” Alfonso said.

Artificial intelligence (AI) is moving to the forefront in diagnosing, treating, and managing ocular disease using international collaborations to harness efficiency and discovery.

Alfonso said Bascom Palmer’s Artificial Intelligence and Computer Augmented Vision Laboratory is developing personalized and customized digital glasses to augment vision of patients who have lost their vision from various conditions including glaucoma, age-related macular degeneration (AMD), retinitis pigmentosa, or strokes.

“Our teams of scientists and clinicians are also developing AI algorithms to analyze vast databases of digital images to diagnose eye diseases, a step that could revolutionize eye care in underserved communities around the world,” he explained.

Alfonso noted that as the ophthalmic community around the globe was preparing to celebrate vision beyond 20/20, everyone has been faced with the challenge of delivering care during the coronavirus disease 2019 (COVID-19) pandemic, which required dramatic and immediate adjustments in operations and development of new procedures and protocols throughout the entire organization.

“Our team turned the COVID-19 challenge into new opportunities to deliver clinical care more effectively, while advancing our research collaborations and medical education programs worldwide,” he said.

Examples include quickly transitioning to telehealth, incorporating hybrid visits when on-site imaging or testing was needed, and using other innovations in ophthalmic technology. Bascom Palmer also moved its extensive medical education program entirely online.

“Our Global Center for Ophthalmic Education converted all of our lectures, grand rounds, and journal clubs to an online video platform,” Alfonso said. “We then opened it up to other residents, fellows, and ophthalmologists worldwide. Each week we host 12 to 15 programs with professionals, and to date professions from more than 125 countries have logged in.”

Alfonso added that Bascom Palmer launched 

, a new online portal that will provide an ever-increasing collection of our educational programs.


Wilmer Eye Institute focus: clinical care and research


In recognition of the achievement, Peter J. McDonnell, MD, director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, pointed out that 2020 has proved to be a special year in the history of the Wilmer Institute and American medicine.

“I have never been more appreciative of the efforts of the more than 200 faculty and over 1,000 employees who move Wilmer forward,” he said. “Our physicians, nurses, residents, fellows, and staff members have been tireless and courageous in responding to the needs of our patients, and our scientists have furthered their research programs.”

McDonnell said the recognition from peer ophthalmologists around the country this year will be particularly meaningful to his colleagues at Wilmer and Johns Hopkins.

“I wish to offer my congratulations to the members of all the other departments noted in the survey,” he added.

A big accomplishment this year, according to McDonnell, was the report by the institute researchers of the finding of a high density of the ACE2 receptor, to which the novel coronavirus attaches, on the ocular surface. Trainees continue to master the enormous amount of information they are being taught while also serving on the front lines of the pandemic.

 program gained a spot in the 2020 survey by moving into the Number 3 position. The 

at Stanford University rounded out the Top 5. Both programs joined the list of the Top 12 Overall Programs this year.



The 3 top spots in 2020 were occupied, in respective order, by the Wilmer Eye Institute, Massachusetts Eye and Ear, and the 

. Wilmer kept its hold on the first slot, Mass Eye and Ear moved up a slot, and W.K. Kellogg vaulted up 4 spots for its impressive showing.

Laura Ensign, PhD, the Marcella E. Woll Professor, Vice Chair for Research, Wilmer Eye Institute Center for Nanomedicine, said it was an honor for the program to be recognized by its peers.

“It is truly an honor to be awarded Number 1 Research Program in the United States by the 

Ensign pointed out that the research program at Wilmer is steeped in tradition.

“When Dr. William Holland Wilmer planned the Wilmer Eye Institute, it was his vision to put patients, ophthalmologists, scientists, students, operating rooms and laboratories all under a single roof,” she said. “In short, he knew that research would make us better doctors, and better able to serve our patients.”

Ensign said that Wilmer’s vision continues to live on through the program’s integrated teams of clinicians and researchers who work together to solve the most challenging ophthalmic problems of today.

“We believe this integration is the catalyst for true advancement, and that the research we are doing today will transform the medical outcomes in ophthalmology tomorrow,” she said.

Ensign also pointed out that Wilmer’s research program is consistently recognized by the larger scientific community, including the National Eye Institute, which has provided more funding to Wilmer than any other university system.

“In 2019, Wilmer faculty members were awarded more than $40 million in grant funding,” she said. “This supports a wide breadth of research programs, including fundamental studies of development and mechanics, genetics, disease pathogenesis, clinical trials, epidemiology, translational research, and more.”

Moreover, Ensign noted that Wilmer is one of the top departments at Johns Hopkins University in terms of reports of inventions submitted annually, and Wilmer faculty established 12 new startup companies to translate laboratory findings into new therapies.

“As vice chair for research at Wilmer, I am both proud of my colleagues and proud to be part of this incredible institution,” she concluded. “I know I speak for all of us when I say we are grateful for this recognition by our esteemed peers and 

Massachusetts Eye and Ear: Shaping the future of ophthalmology


Joan Miller, MD, the David Glendenning Cogan Professor of Ophthalmology, chief of ophthalmology, Massachusetts Eye and Ear, Massachusetts General Hospital, and Brigham and Women’s Hospital, Chair, Department of Ophthalmology at the Harvard Medical School in Boston, noted that the program is honored to be recognized in the 

“We are constantly striving for excellence across our mission areas in clinical care, research, and education. We strive to be an institution where the future of ophthalmology is made,” she said. “The strength of our department is founded in our large and growing faculty, all of who have diverse skills and interests.”

Miller also pointed out that the program at Massachusetts Eye and Ear has more women faculty in leadership positions than any other department in the country.

“As a tertiary care center with the only 24/7 ophthalmic emergency department in the region, we serve a wide range of patients with diverse pathologies and we offer the most advanced treatment options to all of them,” she said. “We do not have resident-only clinics and believe in one class of care for all our patients.”

Miller pointed out that during the past 6 months, the department has dramatically expanded its offerings in tele-ophthalmology, offering telemedicine screenings and hybrid testing options to patient for safe and convenient care.

Moreover, Miller noted that Massachusetts Eye and Ear is focused on eliminating blinding diseases and disorders of the eye and visual system.

“Tackling these conditions with a multifaceted, multidisciplinary approach has been the mainstay of our past success in translational medicine,” she said.

According to Miller, this approach has led to several groundbreaking advancements in clinical care, such as proton beam irradiation, photodynamic therapy, anti-vascular endothelial group factor therapies, and the Boston Keratoprosthesis (KPro), which have saved sight or improved vision for millions of people worldwide.

“Most of these efforts are organized around Harvard Ophthalmology’s 9 multidisciplinary centers of excellence and institutes, which provide platforms to advance important breakthroughs across the research spectrum, while emphasizing clinical care and training,” she said.

Miller added that Massachusetts Eye and Ear is also “one of the four academic centers nationally awarded access to work with the American Academy of Ophthalmology’s Intelligent Research in Sight (IRIS) database, as a center with expertise in big data.”

Bascom Palmer repeated this year in the Number 1 spot, and the Wilmer Eye Institute and the Wills Eye Hospital took the Number 2 and Number 3 slots, respectively.


Alfonso pointed out that the recognition of the clinical care program at Bascom Palmer is “a great tribute to the entire team, the superb physicians and extraordinary staff who deliver care to patients of all ages, educate medical students and professionals, and propel research by making exciting discoveries that ophthalmologists worldwide incorporate in their practices.”

“We are proud to be a driving force in today’s quickly evolving healthcare environment,” he explained.

Wilmer Eye Institute’s McDonnell credited all members of the health care staff and their expertise with the outstanding response to the patients’ needs during this particular trying pandemic with their ability to snag the Number 2 spot in Clinical Care, which required an immediate pivot to handle the tremendous burden of care.

The University of Iowa moved up 3 places, and The Wills Eye Hospital moved up 1 spot. The Emory Eye Care Center, the Casey Eye Institute, and the Cole Eye Institute joined the list of the Best Clinical Care Programs this year.


This year’s standings in the assessment of the residency programs resulted in Bascom Palmer securing first place for the second year in a row. Massachusetts Eye and Ear took the second spot, and the Wilmer Eye Institute took the third position.


Steven J. Gedde, MD, the John G. Clarkson Chair in Ophthalmology, vice chair of Education and residency program director at Bascom Palmer, said recruitment has been a big part of the program’s continuing success.

“We are able to recruit the best and brightest medical students into our residency program,” Gedde pointed out. “They are all superstars well before arriving in Miami, and we create a learning environment that allows them to realize their immense potential.”

Gedde also pointed out that the residents themselves play a major role in making the training program great, and this allows the program to continue to recruit outstanding residents in a self-perpetuating cycle.

“We have a depth of faculty in every subspecialty of area, many of whom are leaders in the field,” he said. “All of our faculty are deeply committed to teaching the next generation of ophthalmologists.”

Gedde also noted that Bascom Palmer’s emergency room is considered a major asset for its training program.

“Our residents are actively involved in research, and their scholarly activities generally result in publications in the peer-reviewed literature and presentations at national meetings,” he said. “We support our residents during all stages of their careers.”


Massachusetts Eye and Ear: supportive, caring teaching culture


This year’s results saw Massachusetts Eye and Ear move up to second place, up 2 spots from its Number 4 position in 2019.

The residency training program benefits enormously from the breadth of clinical and surgical pathology that presents to the institution as well as the diversity of its faculty expertise and interests, according to Alice Lorch, MD, MPH, assistant professor of ophthalmology and program director of the Harvard Ophthalmology Training Program at Harvard Medical School, associate chief for quality for the Department of Ophthalmology at Massachusetts Eye and Ear.

“Residents learn the foundations of ophthalmology and develop independence in the Emergency Department but also work side by side with world-class leaders and experts in their fields in the clinic and operating room,” she said.

In addition, Lorch said the program offers the opportunity to learn ophthalmology in diverse settings, which include two Veterans Administration hospitals, Boston Children’s Hospital, and Aravind Eye Hospital in India.

“Surgical training is step-wise and deliberate, with foundations in one-on-one and group sessions in our state-of-the-art Surgical Training Lab,” she said.

Lorch added that the program remains focused on training leaders in the field of medicine, with a goal of giving them the resources they need to succeed.

“Residents are supported financially and with protected time to do research and travel to conferences. We also support residents clinically,” she said. “For example, we developed a novel Ophthalmic Hospitalist Service—which now includes 4 faculty members—for the purpose of resident teaching in the Emergency Department and performing inpatient consults.”

The leadership team for the Harvard Ophthalmology Residency Training Program aims to be flexible and creative, listening to feedback and making changes.

“We aim for a supportive and caring teaching culture that also holds our trainees to the highest standards,” Lorch concluded. “We also focus on wellness, with initiatives like group mindfulness sessions and community-building activities. Our program is well-rounded, but also provides depth of experience in any area of interest for residents.”


Wilmer Eye Institute: striving for excellence


Fasika Woreta, MD, MPH, an assistant professor of ophthalmology, residency program director; and director, Eye Trauma Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, lauded all of the programs noted in this year’s survey.

“This has been an unprecedented year in terms of challenges we never dreamed of facing and Wilmer and Hopkins have been at the forefront of clinical care, research, and education during the pandemic,” she said. “As residency program director, I am constantly reminded about what makes our program so special: the top residents in the country, incredible resources within Wilmer and the larger Hopkins community, national and international collaborations, and world-renowned faculty who are also dedicated mentors to our residents. Our culture of always striving for excellence in the tripartite mission inspires me every day.”

Other residency programs that moved up in the standings from last year were the University of Iowa, Duke University Eye Center, and the Casey Eye Institute. A newcomer to be congratulated for its appearance on the Top 12 list of residency programs this year is the Rocky Mountains Lions Eye Institute at the University of Colorado.

extends congratulations to the teams of health-care professionals involved in all these programs. 

Articles

The year 2020 dished up a November surprise with a tie between Bascom Palmer Eye Institute and the Wilmer Eye Institute at the top of the rankings for Best Overall Program in the Ophthalmology Times® Best Program Survey.

2020 surprise: Bascom Palmer, Wilmer Eye tie for top spot


Topical cyclosporine A (CsA) has long been a mainstay of treatment for dry eye disease. In fact, for many years, CsA 0.05% (Restasis, Allergan) was the only treatment available to our patients, other than steroids or palliative artificial lubricants.

More recently, we have seen the introduction of lifitegrast 5% (Xiidra, Novartis), multiple treatments for underlying meibomian gland dysfunction, and higher-concentration CsA formulations (Cequa, Sun Pharmaceutical Industries; and Klarity-C, ImprimisRx) for a more robust armamentarium of treatment options for 

Boosting short-term dry eye management in patients

CsA is an immunosuppressant that inhibits T-cell–mediated inflammation and cytokines, stimulates tear production, and increases goblet cell density.

 

Despite its success in the marketplace and in many of our practices, there are still challenges with its use, including the high cost of the prescription solution for patients and burning or stinging on instillation, which can discourage patients from continuing the drops long enough to see an effect. 

Additionally, it is challenging to formulate a topical CsA preparation because this molecule is not very water soluble.

I have been involved in a study to evaluate efficacy in a real-world clinical practice setting of a higher-dose (0.1%) cyclosporine (Klarity-C) in a unique chondroitin sulfate formulation.3 

Chondroitin sulfate, a compound developed decades ago by Richard Lindstrom, MD, Herbert Kaufman, MD, and others, is the key ingredient in OptiSol-GS (Bausch + Lomb) and is used in several viscoelastic products. It has some unique properties of its own, including lubricating, anti-inflammatory, cell membrane stabilizing, and corneal edema reducing.

As cyclosporine options grow, focus remains on the vehicle


Klarity-C, the drug used in our study, is a preservative-free drop compounded in a 503B FDA-regulated outsourcing facility. 503B pharmacies have to follow stringent quality and manufacturing requirements and are subject to the same FDA inspection and oversight as large pharmaceutical companies. 

However, compounded medications are typically more affordable than other branded drugs.


This was a retrospective, multicenter study conducted by me, Jennifer Loh, MD, and William Trattler, MD. 

Adult patients with a

diagnosis who were treated with Klarity-C twice daily were included. We reviewed patients’ charts to determine the change from baseline in Ocular Surface Disease Index (OSDI) scores and corneal staining after 3 months of treatment.

 (102 eyes) were enrolled. Patients ranged in age from 27 to 80 years, with a mean age of 62 years, and 76% were women.

symptoms, including visual symptoms and ocular discomfort. Patients are asked to select if they experienced any of the 12 symptoms all, most, half, some, or none of the time during the previous week, and the answers are scored from 0 to 100, with a lower score being ideal. 

At 3 months, our patients’ mean OSDI score improved from 37.57 to 23.83 (

 < .001). Pretreatment, 61% of the patients had OSDI scores in the “severe” range (33-100). 





By 3 months, patients scoring in the severe range declined to 20%, and more than one-third of patients reported improvements in symptoms that put them in the normal (0-12) range.

Fluorescein staining of the entire cornea was evaluated for each eye (N = 102). The mean staining grade improved from 3.57 pretreatment to 2.17 (

 < .001) at 3 months. 

I find corneal staining with vital dyes to be an excellent diagnostic tool. In the PHACO study, Trattler et al showed that staining is extremely common in older patients, with 77% of those presenting for 

 demonstrating some corneal staining (central or peripheral), including 50% with central staining.

One patient I treated in this study was a 71-year-old man who complained of blur, light sensitivity, and irritation, which he described as a “sandy, gritty feeling.”

 He thought he needed stronger glasses because he had a hard time focusing to read. He was not on any ocular medications, including artificial tears. His medical history was significant for hypertension, controlled on lisinopril 10 mg and metoprolol 25 mg. He went through a full 

 evaluation.

Tear osmolarity (TearLab) was normal (300 oculus sinister and 301 oculus dexter), but an MMP9 test (InflammaDry, Quidel) was positive for the inflammatory marker in the tear film.He had 1+ central and inferior staining in both eyes, and his OSDI score was 22.7, putting him in the mild-to-moderate category.


Evaluating and treating tear film patients with success

I also like to look at topography images in evaluating dry eye. Pretreatment, the axial maps on the OPD-Scan III (Nidek Inc) revealed that this patient had tear film instability. We could also see missing and warped squares on the Cassini ocular surface qualifier, supporting the finding of an unstable tear film.

After 3 months of treatment with Klarity-C, this patient’s tear film was still not perfect, but the topography images were better; his OSDI score had improved from 22.7 to 6.25—well into the normal category—and he now had only trace inferior staining, with no staining centrally. 

His symptoms improved, including the visual fluctuations that made him feel like something was wrong with his vision. He had no problems tolerating the drops.

CsA is a time-tested, effective treatment for inflammation in dry eye. Twice daily instillation of Klarity-C results in statistically significant improvement in OSDI scores and improvement in corneal staining while offering patients a favorable tolerability and cost profile. 



Matossian is the founder and medical director of Matossian Eye Associates, an integrated ophthalmology and optometry group practice with 3 offices in Pennsylvania and New Jersey.Matossian Eye is an affiliate of Prism Vision Group. She also serves as a clinical instructor in the Department of Ophthalmology at Temple University Lewis Katz School of Medicine. Matossian is a consultant to Allergan, Bausch + Lomb, ImprimisRx, Shire/Novartis, and Sun Pharmaceuticals.

1. Sall K, Stevenson OD, Mundorf TK, Reis BL. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. CsA Phase 3 Study Group. 

. 2000;107(4):631-639. doi:10.1016/s0161-6420(99)00176-1

2. Kunert KS, Tisdale AS, Gipson IK. Goblet cell numbers and epithelial proliferation in the conjunctiva of patients with dry eye syndrome treated with cyclosporine. 

. 2002;120(3):330-337. doi:10.1001/archopht.120.3.330

3. Matossian C, Loh J, Trattler WB. Efficacy of topical 0.1% cyclosporine in chondroitin sulfate ophthalmic emulsion in patients with dry eye. Paper presented at: 2020 American Society of Cataract and Refractive Surgery Virtual Annual Meeting; May 16-17, 2020.

4. Lindstrom RL, Kaufman HE, Skelnik DL, et al. Optisol corneal storage medium. 

 1992;114(3):345-356. doi:10.1016/s0002-9394(14)71803-3

5. Trattler WB, Majmudar PA, Donnenfeld ED, McDonald MB, Stonecipher KG, Goldberg DF. The prospective health assessment of cataract patients’ ocular surface (PHACO) study: the effect of dry eye.

 2017:11;1423-1430. doi:10.2147/OPTH.S120159

Study shows improvements in signs, symptoms after 3 months of treatment


Ophthalmology Times: November 1, 2020

2020 surprise: Bascom Palmer, Wilmer Eye tie for top spot

Novel vehicle contributes to cyclosporine efficacy