We aspire to be the leading eye center in the country–second to none. We aspire to apply the latest in science to the treatment of blinding eyedisease, while continuing to provide true excellence in patient care andtraining the next generation of leaders in scientific and clinicalophthalmology. In all of our missions, we aspire to be second to none.

With your support, the Duke University Eye Center will realize oursoaring aspirations – to cure, to heal, to serve – and ultimately, to winthe battle against blinding eye disease.

Planning and Development OfficeBox 3802, Erwin Road, Durham, NC 27710919.684.3182 • www.dukeeye.org

D U K E U N I V E R S I T Y E Y E C E N T E R

“Soaring aspirations

to cure, to heal,

to serve.”

©Duke University Eye Center 2003

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At the Duke University Eye Center,that end is to win the battle againstblinding eye disease.For more than thirty years, the Duke University Eye Center has led theway in applying the latest science to advance the understanding of eyedisease and to develop promising new treatments and cures.

Our ambition is to be second to none. Our basic science researchers andclinician-scientists collaborate daily to fulfill our three-fold mission: topursue the most advanced research; to provide our patients with the verybest care; and to train the next generation of scientific and clinical leadersin ophthalmology.

Together with our generous philanthropic partners, supporters, andambassadors, we look forward with great anticipation to the opening ofthe Albert Eye Research Institute, and ultimately, to the opening of a newclinical pavilion. Inside these state-of-the-art facilities, researchers andclinicians will work together, translating scientific innovations into newtreatments that will preserve and restore sight for generations to come.

At the Duke University Eye Center, we have soaring aspirations to cure,to heal, to serve. With your help, we are confident that we will achieveour ultimate goal: to win the battle against blinding eye disease.

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Ralph Snyderman, MD

For generations, the Duke Eye Center has helped preserve the gift ofsight for children and adults throughout North Carolina and theSoutheast. Renowned for innovations in microscopic and laser surgery,superb clinical care, and excellent training for tomorrow’s ophthalmolo-gists, the Duke Eye Center today is poised to fully realize its potential asan international center for groundbreaking eye research.

As medical science enters a new era of discovery spawned by advances inmolecular biology and genomics, the promise of new cures for devastatingeye diseases is brighter than ever. I am proud to support the Eye Center’svision for the future, beginning with construction of the Ruth and HermanAlbert Eye Research Institute. This state-of-the-art facility will provideadvanced laboratory equipment and space to accommodate additionalfaculty. But more importantly, it will facilitate the collaboration andsynergy that occurs when clinicians and researchers work closely together.

In the following pages, you will learn about the extraordinary research nowunderway at the Duke Eye Center and the tremendous impact newtreatments have had on our patients. You will also hear about the criticalrole our friends and donors play in supporting this important work. Iencourage you to become involved, and I pledge our institution’s continuedsupport for the Duke Eye Center.

Sincerely,

Ralph Snyderman, MDChancellor for Health Affairs

President and CEO, Duke University Health System

Our mission: provide you the best in care

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Researchers’ collaboration results in superior patient careR. Sanders Williams, MD

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By its very nature, ophthalmology has always been about looking deep—usingmagnification to explore the tiny and delicate structures within the eye that

transform light into images, the miracle of sight.

With the advent of genetics and molecular science, ophthalmology researchers—like other medical scientists—are now able to see and manipulate theinnermost workings of the cell. This new understanding holds great promisefor predicting and preventing the diseases that continue to rob children andadults of precious eyesight.

As you will read, Duke Eye Center researchers are advancing against eyedisease on all fronts. They are learning to manipulate genes to treat glaucoma,corneal disease, and diseases of the retina. After years of studying cellularprocesses within the structures of the eye, they are developing new surgicalprocedures to restore sight, such as corneal transplantation and maculartranslocation surgery.

Many projects now in the early stages at the Eye Center could scarcely havebeen imagined a decade ago: cell therapy to restore sight in retinitispigmentosa, a gene “gun” to track cell movement in the corneal healingprocess, and gene therapy to correct the fluid buildup that causes glaucoma.Other projects, such as the development of a new corneal glue and arevolutionary drug delivery system to treat severe inflammation, illustrate thepower of collaboration with departments throughout Duke University andbeyond.

I hope that you will enjoy learning about the Duke Eye Center and that youwill be as excited as I am about the future of eye research at Duke.

Sincerely,

R. Sanders Williams, MDDean, Duke University School of Medicine

Vice Chancellor for Academic Affairs

“Our friends andsupporters,through theirphilanthropy andadvocacy, havejoined us in thisquest to help usall realize oursoaringaspirations forthe future.”

Applying basic science to our understanding of eye diseaseDavid L. Epstein, MD

Over the past three decades the Duke University Eye Center hasestablished itself as one of the leading eye institutions in the world.This reputation has been earned through the relentless pursuit ofgroundbreaking scientific research, the extraordinary collaboration ofour world-renowned researchers and clinicians, an outstandingeducation program that draws students and trainees from the worldover, and a commitment to providing the best and most innovativepatient care available.

While we celebrate our achievements, we are mindful that, if we are toachieve our goals to eliminate eye disease and preserve vision, ouraspirations require us to continue to expand our program. We mustadd transforming researchers and the latest scientific technology toachieve continuing innovation towards the cure for devastating eyediseases. We must continue to grow and expand our educationalendeavors and our ability to share knowledge. And, always, we mustprovide the excellence in patient care that our patients expect anddeserve.

Many of the world’s finest researchers and clinicians have joined theDuke Eye Center in our quest to understand and treat the diseases thatsteal sight. I hope that the stories that follow will also inspire you toshare our aspirations and to work with others to preserve and restoreone of the most precious gifts of all – the gift of sight.

Sincerely,

David L. Epstein, MDChairmanDuke University Eye Center

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”As Research Director,I will implement the goals articulated by our academicleadership: toenhance ourresearch facilitiesbased on cutting-edge technology, to facilitate teamscrossing traditionalboundaries to worktogether on adisease focus, and to accelerate thepace of translatinglaboratory knowledge to clinical applications.“

Fulton Wong, PhD

Former University President Terry Sanford once eloquentlycharacterized Duke as an institution with “outrageous ambitions.”

Today, that ambitious spirit continues to thrive in the daily endeavorsof the Duke University Eye Center. With the vision of a dreamer, theinstinct of a scientist, and the compassion of a clinician, David L.Epstein, MD came to Duke University to lead the Department ofOphthalmology in 1992, and proceeded to build one of the finestdisease-focused eye research programs in the world. The success ofthis program over the last decade now fuels the next stage ofdevelopment of the Eye Center. The Albert Eye Research Institute isthe fulfillment of this dream.

A key component of the Duke Eye Center’s success is our teamapproach: this commitment to clinicians and basic scientists workingclosely together is a hallmark of research at the Eye Center. Asadvances in the basic and clinical sciences take shape by leaps andbounds, the team approach provides the ideal vehicle for translationalresearch—taking knowledge from the laboratory bench to the clinicto serve patients. The Albert Eye Research Institute will provide newopportunities for recruitment to enhance our existing research teams.

Our objectives cannot be achieved without the inspiring vision of ourmany loyal supporters. As their generosity and commitment arecelebrated in these pages, it is clear that they are an integral part of the“outrageous ambitions” that inspire us to want to soar—to cure, toheal, and to serve.

Sincerely,

Fulton Wong, PhDResearch DirectorDuke University Eye Center

Science is the key that unlocks the future

PerspectiveCharlie Gaddy: My father went legally blind from glaucoma inthe 1950s when I was just a young boy. This really made animpression on me and caused me to watch closely over the pressurein my own eyes. Later in life when I was diagnosed with primaryopen-angle glaucoma, I crossed paths with the Duke Eye Centerthrough a work project. I was so impressed with the Eye Center andits faculty and staff. It is comforting to me to know that some of themost cutting-edge research in glaucoma is going on right here atDuke—by some of the most skilled researchers in the world. It’s alsonice to know that I can be treated by these same skilled doctors whomay find a cure.

Mr. Gaddy and his wife, Nancy, have joined Duke in the quest to finda cure for glaucoma by serving on the Duke Eye Center’s AdvisoryBoard for many years.

“When you give someone their sight,you are giving them life.”

Early detection and treatment of glaucoma can protect against vision loss

Glaucoma is not asingle disease, but agroup of more than50 distinct disordersthat, together, are themost common causeof irreversible visionloss in the world.Glaucoma affectsmore than threemillion people in theU.S. and more than60 million worldwide.

Most cases ofglaucoma result fromincreased pressure inthe eye. In general,there are few if anysymptoms. Visionloss occurs slowly,usually over manyyears. As a result,nearly half of thoseaffected by glaucomaare unaware that theyeven have it. At itsworst, glaucoma canlead to severe or totalloss of vision.Unfortunately, thedamage cannot berepaired. With earlydetection andtreatment, however,serious vision lossmay be preventedand vision preserved.

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Charlie Gaddy, Retired WRAL-TV News Anchor and Glaucoma Patient

Future Drug Treatments for Glaucoma Duke Eye Center Chairman Dr. David L. Epstein has studiedextensively the trabecular meshwork and worked towardsachieving novel treatments for glaucoma that could be curative.His investigations have led to the development of severalpromising drug treatments that act by altering cell shape in thetrabecular meshwork to allow more fluid to flow through. Dr.Epstein’s contribution to understanding the trabecularmeshwork in both healthy and glaucomatous eyes has enabledfellow researchers to make great strides in the treatment ofpatients with primary open-angle glaucoma (POAG), the mostcommon form of glaucoma, for which there is currently nospecific treatment.

Gene TherapyNow in its early stages at the Eye Center, gene therapy researchcould ultimately help restore normal function to the trabecularmeshwork when the drain is not working properly. Drs. PedroGonzalez and Montserrat Caballero and their research team areworking to identify the genes involved in the outflow of fluidthrough the trabecular meshwork under normal conditions andwhen glaucoma is present. They have already found that, under

the stress of increased eye pressure, several genes inthe meshwork are activated. Together with

Dr. Epstein, these Duke researchers arecollaborating on several genetic

research projects to understandwhat causes the aqueous humorfluid to be unable to leave the eyenormally, and to find and delivernew genes to the trabecularmeshwork to restore the normaloutflow process. These discoveriescan lead to new treatments to

prevent the increase in eye pressurethat leads to glaucoma and its

consequential damaging effects tovision.

The Science ofGlaucoma The optic nerve is a bundleof more than a millionnerve fibers connecting theretina—the light-sensitivelayer of tissue at the backof the eye—to the visioncenters in the brain.Normally, a clear fluidcalled the aqueous humorforms within the eye andcirculates and nourishes theeye continuously. The fluidexits the eye through adelicate, spongy draincalled the trabecularmeshwork. When ablockage to the drainoccurs and fluid is trapped,eye pressure becomeselevated and can causedamage to the optic nervefibers responsible forcarrying vision messages tothe brain. This damage canresult in a slow loss ofvision.

Glaucoma research

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Dr. Leon Herndon screens a patient for glaucoma. The test is painless, and everyone should beroutinely screened for glaucoma. Patients of African-American descent have a four to six timesgreater risk of developing glaucoma. If detected early, the progress of the disease can be slowedwith medication or surgery.

Gene delivery to thetrabecular meshworkin vitro.

Glaucoma research14 15

New Diagnostic Tool for Early PreventionAlthough glaucoma cannot yet becured, it can often be controlledwith proper treatment. That’swhy early diagnosis is crucial toprotect sight. Dr. Sanjay Asranihas developed a unique approachto early detection: a pioneeringimaging technology called theRetinal Thickness Analyzer. Bydetecting glaucoma at its earlieststages in the retina, Dr. Asranibelieves that this novel approachcan someday help save theeyesight of thousands of peoplewho currently lose their sighteach year.

Drs. RandAllingham andMike Hauserdiscuss newmethods to findthe genes thatcause glaucoma.Dr. Allingham andcollaboratorsreported findingthe locations fortwo majorglaucoma genesat the AmericanSociety of HumanGenetics meetingheld in Baltimorein 2002.

Below: Dr. PratapChalla operates ona glaucoma patientin Ghana.

Childhood GlaucomaAlthough primary open-angle glaucoma is the most commonform of glaucoma worldwide, forms such as low-tension andnormal-tension glaucoma, closed-angle glaucoma, andglaucoma related to trauma or inflammation also steal sight.While most people affected by this group of eye diseases areolder, several rare types of glaucoma afflict infants andchildren. Dr. Sharon Freedman is an expert in childhoodglaucoma. Her research focuses on developing and evaluatingoptimal strategies for treating childhood glaucomas,including new medicines and modifications to surgicalprocedures used to treat adult glaucoma patients. Throughher research, Dr. Freedman hopes to increase awareness andearly diagnosis of this potentially blinding disease in children,and to preserve sight through appropriate medical andsurgical therapy for our youngest patients. With the openingof the Albert Eye Research Institute, Dr. Freedman and hercolleagues will work and serve in an advanced clinical carefacility more conducive to the well-being of patients and theirfamilies. This new facility will provide spacious patient waitingand play areas and house delicate equipment for its optimaluse in the quest for new and better ways to protect and reclaimlost vision in our youngest patients.

disease. To understand this genetic link, Dr. Allingham and Drs.Leon Herndon and Pratap Challa have enrolled many Ghanianfamilies with glaucoma into Duke’s POAG Genetic LinkageStudy. In addition to collecting data, the Duke Eye Centerteam strives to teach these families and their local physiciansto better manage glaucoma. Identificaton of the genes thatcause the disease, along with an understanding of who is athighest risk of developing glaucoma, can lead to earlydiagnosis. The process of how glaucoma starts can also bediscovered, creating the opportunity to develop entirely newtreatments. Early detection is important because, whileglaucoma cannot yet be cured, it can be controlled throughmedical and surgical treatment.

Genetic Research Around the WorldIdentifying individuals who are genetically predisposed todevelop glaucoma is another important avenue toward earlydetection and treatment of this disease. Duke Eye CenterGlaucoma Service Chief Dr. Rand Allingham collaborates withresearchers around the world to identify the genes responsiblefor glaucoma. His innovative research is being conductedthroughout the U.S. and in India, Africa, Iceland, and otherregions. He is currently leading a major project in Ghana,West Africa, to help identify susceptibility genes for primaryopen-angle glaucoma, the leading cause of blindness inAfrican-Americans. While POAG affects between two and sixpercent of the adult population, individuals of African-American descent are four to six times as likely to develop the

Challenged to detect glaucomain its earliest stages, Dr. SanjayAsrani pioneered the RetinalThickness Analyzer, an imagingtechnology that reveals retinaltissue lost due to glaucoma.

Adult Stem Cell Research for NeurodegenerativeDiseases of the Retina and Optic Nerve May Restore Sight One of the greatest remaining challenges in eye research is to find a wayto restore the vision of patients who have already lost their sight todiseases like glaucoma, macular degeneration, and retinitis pigmentosa.Today, most treatments can only delay or slow the progress of thesediseases. Recent research advances in cell-based therapies have fueledexcitement and brought us closer than ever to the possibility ofsomeday finding restorative treatments for these devastating diseases.

Researcher and Developmental Neurobiologist Dr. Dennis Rickman isleading cell transplant research at the Duke University Eye Center. Hisresearch team is transplanting adult stem cells derived from the brain,bone marrow, and retina of adult animals into the diseased retinas ofrats and mice. There are currently no therapies for successfullyreplacing retinal cells lost to degeneration. Dr. Rickman hopes hisresearch may ultimately lead to a similar strategy for cell transplantationin diseased retinas of humans to restore sight that would otherwise beforever lost.

Dr. Rickman has also been working collaboratively with Dr. Epstein toinitiate a program to restore sight to those with glaucoma byregenerating damaged tissue in the optic nerve.

Left: Adult stem cells (appearinghere in green) from an adult ratbrain have been injected into thediseased retina of a rat. Researchshows that these transplantedcells have successfully engraftedand matured.

Right: Dr. Dennis Rickmandiscusses his vision of cell-basedtherapies and transplantation torestore retinal nerve cells lost todegeneration.

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Glaucoma research

PerspectiveCarolyn Wayne: I make my living as a seamstress and have worn eyeglasses since I was12 years old. In my early forties, an eye doctor discovered that I had Fuchs’ Dystrophy. For thenext 20 years or so, I lived with the deteriorating effects of this disease. When I asked my doctorwhat could be done to halt these effects, he told me there were currently no promisingtreatments available. I faced the real possibility that I might lose my vision. I was without hope.

Still, I sought help and turned to a family friend, who urged me to visit the Duke Eye Centeras soon as possible. I came under the care of Dr. Terry Kim, who told me that my visioncould be restored through the revolutionary process of corneal transplant surgery. One day,while struggling with the decision to go forward with the surgery, I sat next to a man at theEye Center who was in an extra cheerful mood. I said, “You sure seem to be seeing it as ahappy day today.” He replied, “Yes, I sure do, because I’m seeing it through the eyes ofsomeone else!” Struck by a moment of revelation, I knew that this was my sign to moveforward with the surgery. I told Dr. Kim, “Let’s go with it.” I recall the day the bandageswere removed from my right eye: it was autumn and the leaves were changing. I don’tremember ever seeing the colors of the leaves so bright as I did on that day.

Carolyn Wayne now serves as an ambassador for the Duke Eye Center, sharingher story of hope with everyone she encounters.

Seeing the world differently after corneal transplant

“Dr. Kim is a wise and kind doctor, and I could never ask for a better one.” Carolyn Wayne, Cornea Patient

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After restorative surgery Dr. Terry Kim monitors Carolyn Wayne’s vision.

Cornea researchThe Science ofCorneal DiseaseMore than 4.3 millioncases of cornealdisease occur annually,resulting in discomfort,pain, or vision loss.The second mostcommon blinding eyedisease, cornealdisease is generallycaused by infection,injury, or dystrophy, adisorder that causesclouding of the eye.

The cornea is thetransparent, dome-shaped window thatcovers the front of theeye. Because there areno blood vessels in thecornea, it is normallyclear, functioning muchlike the outer lens of acamera. When lightstrikes the cornea, thislens bends—orrefracts—the incominglight onto the paper-thinretinal tissue at theback of the eye. Whenthe cornea is clear, aclear picture emerges.If the cornea is cloudedby injury, infection, ordystrophy, the imagewill be faint andblurred, and vision lossmay result.

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Progress inCornealTransplantsCorneal lacerations andperforations arecommon injuries thatresult from trauma,infection, inflammation,or other conditions.Corneal wounds areusually consideredophthalmic emergencies,and repairing them canbe difficult. Thesewounds can causeclouding of the eye thatprevents light frompenetrating andreaching the light-sensitive retina, resultingin low vision or evenvision loss. For seriouscases, a cornealtransplant may benecessary to replace thescarred or diseasedcornea and restorevision. Approximately45,000 cornealtransplants are per-formed each year in theU.S. alone. At the DukeEye Center, nearly 250corneal transplantsoccur annually. Incorneal transplantsurgery, the surgeonremoves the centralportion of the cloudedcornea and replaces itwith a clear cornea,usually donated throughan eye bank. The newcornea is sewn into theeye using fine threadthat remains for monthsor years. Eyedrops helpthe healing process.

The Cornea Group, part of the Klintworth Legacy, will continue hispioneering work. Left to right: Cornea Service Chief Dr. Alan Carlson,and Drs. Natalie Afshari and Terry Kim.

Dr. Gordon Klintworth shares his expertise with medical students.

The Klintworth LegacyUnder the leadership of Dr. Gordon Klintworth, the Duke Eye Center hasbuilt one of the finest corneal research programs in the world. Dr.Klintworth, a leading authority in ophthalmic pathology, has dedicatedmore than 40 years to research and teaching at Duke: a span that includesthe entire life of the Eye Center. He has mentored several of Duke CorneaService’s current leaders, who continue his pioneering research. An expertin genetics and inherited eye disease, Dr. Klintworth has collaboratedwith investigators around the world in his quest to bring newunderstanding to the molecular genetics of inherited diseases of thecornea and conjunctiva such as macular corneal dystrophy and hereditarybenign intraepithelial dyskeratosis. Because inborn genetic errors can robpatients of their vision, Dr. Klintworth has sought to understand the basicnature of these diseases so that new treatments can be developed torestore vision. With the aid of emerging technology and the enthusiasm ofa new generation of researchers, Dr. Klintworth believes that bettermethods of diagnosis and treatment for corneal diseases are just aroundthe corner.

Cornea research

Cataract ResearchCataracts—clouding of the normally clearlens inside the eye—are another leadingcause of vision loss throughout the world.Currently, surgery is the only treatment forcataracts. Although surgical techniques haveimproved tremendously, surgery is stillexpensive and side effects are unavoidable.Dr. Vasanth Rao, a basic scientist at the EyeCenter, is working to identify the cellsignaling pathways involved in maintainingeye lens transparency and to understandtheir role in cataract formation. Usinghuman lenses and animal model systems, Dr.Rao is employing a variety of researchtechniques to learn how lens cellscommunicate with one another and respondto external signals. He hopes his research willhelp identify cellular proteins and genes thatcan be targeted by new medical treatmentsfor certain types of cataracts.

Corneal GlueCorneal transplant surgery and other eye surgeries canrequire delicate surgical skills and long spans in theoperating room. To reduce instances of unevenhealing, inadequate closure, infections, and scarringthat can occur during these surgeries, the Eye Center’sDr. Terry Kim and Dr. Mark Grinstaff are investigatingthe use of novel adhesives called biodendrimers for thetreatment of corneal wounds. Biodendrimers areunique molecules that have the ability to form verystrong bonds and to become activated by laser light.While Dr. Grinstaff synthesizes these molecules in hislaboratory, Dr. Kim tests their ability to close variouscorneal wounds in human donor eye bank and animaleyes. Preliminary results show that these newadhesives seal wounds more quickly and efficientlythan conventional sutures. Dr. Kim and his colleaguesbelieve that these biodendrimers can be used to seal cataract and corneal transplant incisions as wellas laser vision correction flaps. If these new adhesives continue to demonstrate successful results, theymay change the way eye surgery is performed and offer patients a safer, faster recovery time followingcataract, corneal, and refractive surgery.

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Corneal glue developed by Dukeresearchers may improve healing ofcorneal wounds.

Dr. Vasanth Rao explores how cells signal eachother within the eye.

GeneTherapy Because thecornea is locatedat the front of theeye, easy accessmakes it an idealplace to targetgene therapy. Dr.Natalie Afshari isexploring newapplications forgene therapy thatcouldrevolutionizetreatment forcorneal diseases.Today, the genesassociated withmany cornealdiseases are notyet known, so Dr.Afshari and Dr.GordonKlintworth lead ateam of Duke EyeCenter scientistsin a search toidentify theseimportant genes.

New Weapon: The Gene GunDrs. Fulton Wong and Natalie Afshari are investigating a new technique forgene delivery to the cornea using an innovative “gene gun.” By using the gunto mark corneal epithelial cells with a fluorescent protein “shot” into thecornea, the research team can track and study these cells as they move in thecornea. This technique may help the investigators identify the underlyingmechanisms of corneal wound healing and, with continued success, couldsomeday be used to facilitate gene therapy for treatinghuman corneal diseases.

The green fluorescent glow from a protein“shot” into the cornea using a “gene gun”helps researchers track the movement ofcorneal epithelial cells during woundhealing.

PerspectiveMary Szabady: I’ve always enjoyed wonderful vision until one day, a few years ago, when I wasteaching preschool: I leaned over and my eyesight flooded with floaters. It was so severe, I thought Iwas having a brain hemorrhage. I was rushed to the nearest doctor, who explained that floaters werenot uncommon and that my vision appeared fine. Uncomfortable with this diagnosis, I continued to

seek help; eventually, a local ophthalmologist determined that I had a severe eyedisease known as pars planitis, a disease of the uveitis family. Because much of theresearch on this disease was limited and often contradictory, I desired to be underthe care of not only a great clinician, but a great researcher: someone who soughtto understand my disease and discover ways to slow or even halt it.

My quest led me to Dr. Glenn Jaffe at the Duke Eye Center, where I’ve been apatient ever since. By coming to Duke, I have complete confidence that I amreceiving the best care available and that I always have access to the latestbreakthroughs in treatment. Coming to the Duke Eye Center is the bestdecision I’ve ever made. Dr. Jaffe is treating my disease with steroids knownas kenelog injections. Fortunately, I have not experienced any side effects andmy eyesight is responding to the treatment. Dr. Jaffe instills a lot of trust andconfidence in his patients, which is important since a positive outlook andlow anxiety level are conducive to a successful treatment regimen.

Mary Szabady believes in giving back. Using her experience and passionfor teaching preschool children, she teamed with family, friends, and theDuke Eye Center to create a CD-ROM with fun and colorful art activitiesfor kids. Half of the purchase price for each CD benefits the Duke EyeCenter’s Building Fund.

Peace-of-mind in finding the best care

“By coming to the Duke University Eye Center, I am assured that I always have access to the latestbreakthroughs in treatment.”Mary Szabady, Retina Patient

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Retina researchThe Science of VitreoretinalDisease The retina—the light-sensitivetissue that lines the inside of the eye—iswhere the eye’s miraculous ability totransform light into vision begins. It is alsothe site of some of the most serious eyediseases, including those that can result invision loss. The retina consists of two typesof light-sensitive photoreceptor cells: conesand rods. Rods are found near the edgesof the retina and are used to see in dimlight or to see items to the side of our lineof vision. Cones are concentrated near thecenter of the retina—the macula—and areresponsible for seeing color and detail ingood light conditions. At the center of themacula is the fovea, which is responsiblefor the eye’s fine detailed vision.

Age-Related MacularDegeneration (AMD) is the leadingcause of vision loss in people over 50. Itaffects more than 12 million Americans, anumber expected to double by 2020 asbaby boomers age. The degeneration ofthe macula eventually robs individuals oftheir ability to see color, sharpness, andclarity. AMD exists in dry and wet forms.With the dry form, yellow deposits calleddrusen accumulate under the macula andcan thin the retinal layers, leading tovision loss. In the wet form, abnormalblood vessels grow behind the retina andleak blood and fluid, resulting in severevision loss over weeks or months as thecone cells that mediate fine vision are lost.Although the dry form is more common,the wet form of AMD leads to the mostirreversible vision loss.

Retinitis Pigmentosa (RP) is agroup of hereditary eye disorders forwhich there are limited treatments and nocures. RP is usually detected when ateenager loses the ability to see well atnight. This vision loss is caused by thedeath of the eye’s rod cells. Although RPpatients lose the function of their rod cellsearly in life, their cone cells remainfunctional for many years, allowing themto keep their daytime vision for muchlonger. Over the course of a few decades,the cone cells gradually begin todeteriorate as well, leaving patients withsevere vision loss.

Uveitis Drug DeliveryUveitis—severe inflammation ofthe eye—can cause tremendouspain, light sensitivity, decreasedvision, and sometimes blindness.Dissatisfied with current treatmentregimens that may be ineffective orhave intolerable side effects, Dr.Glenn Jaffe is leading the effortto understand and treat chronicuveitis. Dr. Jaffe is studying newexperimental devices that can beimplanted in the eye to deliverdrugs directly to the area thatneeds treatment. Once surgicallyimplanted into the patient’s eye,the tiny device can releasemedication over a period of weeks,months, or even years. In time,related new technologies may helptreat not only uveitis, but also otherdiseases that can cause vision loss.

Dr. Glenn Jaffe performs laser treatment on a patient.

Ectopic synapses(arrow, yellow)between conephotoreceptorterminals (red) and rodbipolar cell dendrites(green) may provide amechanism linking rod-specific mutations toprotracted degenerationof cones in retinitispigmentosa and otherretinal degenerations.Photo Credit:Nature Neuroscience(Vol.3, p.1121-1127, 2000)©2000 Nature America, Inc.,New York, New York.

Revealing the Disease Mechanisms ofRetinitis PigmentosaAt least 30 genetic mutations and genomic sites havealready been linked to different forms of retinitispigmentosa, evidence of the complexity of the blindingeye disease. Many important questions about theunderlying disease mechanisms are still unanswered.Dr. Fulton Wong’s pioneering research focuses onanswering the most critical questions by identifying thenon-genetic, cellular mechanisms common to theprogression of this disease. Dr. Wong believes that thesemechanisms would be ideal therapeutic targets, becauseintervention at these sites may prove to be effective forlarge groups of patients. A collaboration between Dr.Wong and his colleagues from North Carolina StateUniversity has resulted in the creation of a geneticallyengineered pig model for RP. As with human RP retinas,these pigs’ cone photoreceptors survive much longerthan their rod photoreceptors, allowing Dr. Wong andDr. You-Wei Peng to discover synaptic abnormalities inthese degenerating retinas. This discovery has far-reaching implications for the disease mechanisms of RPand for designing therapeutic strategies.

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PerspectiveVigilance of patient and doctor pays off”AMD took the everyday things in my life away from me;Dr. Toth and this surgery have given them back again.“Alice Haynes, Age-Related Macular Degeneration Patient

Alice Haynes: Several years ago I noticed a change in the vision in my left eye.After seeing an ophthalmologist, I learned that I had the wet form of age-related maculardegeneration and that little could be done. Not satisfied, my husband and I sought helpfrom some of the leading eye institutions in the world.

A friend told me about a retina specialist who lived in our neighborhood and worked atDuke. By the time I met Dr. Cynthia Toth, my eyesight had deteriorated rapidly. She per-formed some limited surgery to preserve my vision, and stressed the importance of mon-itoring the eyesight in my right eye daily. A few years later, I noticed a change. Dr. Tothsaw me that same day and immediately performed laser surgery on my right eye. Shemonitored my vision every two weeks. Within a month and a half, I noticed once againa sudden loss of vision in my right eye. I could no longer read the newspaper or drive acar. When Dr. Toth saw my condition, she recommended macular translocation 360surgery to preserve my sight. My recovery was difficult: I had to keep my head loweredon a table or couch for countless hours a day. Because my retina had been rotated, I sawat a 45-degree angle. During a follow-up procedure six weeks later, Dr. SharonFreedman relocated the muscles, enabling me to see without a noticeable tilt, and Dr.Toth placed a new lens in my eye. It was a miracle—I could see again!

Sharing the story of her miraculous experience has helped make Alice Haynes a special ambassador for the Duke Eye Center.

The Battle Cry:Save the ConesThe success of future age-relatedmacular degeneration therapies lies intheir ability to preserve, protect andeventually even restore cone photore-ceptors and their function, since it isultimately the loss of these cells andthe sharp color vision they mediatethat results in devastating vision loss inAMD. Dr. Catherine Bowes Rickman isleading a team of Duke Eye Centerresearchers that has made great stridesin identifying the genes expressed incone cells and is determining the rolethese genes play in degenerative retinaldiseases such as AMD. Dr. BowesRickman hopes that this research willcontribute to our basic understandingof cone photoreceptor biology and thechanges that take place through degen-erative disease processes. These find-ings may lay the groundwork todevelop therapies that prolong pho-toreceptor survival in macular degener-ation and, ultimately, prolong sight.

Dr. Catherine Bowes Rickman is searching for the genes associated with age-related macular degeneration.

“There is a need for new scienceto cure macular degeneration.“David L. Epstein, MD

Retina research

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The Duke Center for Macular Degeneration (AMD)Believing that the needs of macular degeneration patients and their families gobeyond simply medical concerns, the Eye Center has established The Duke Center forMacular Degeneration to develop and provide new forms of education, research, andpatient care for those facing this sight-stealing disease. The AMD Center, directed byDr. Michael Cooney, takes a multidisciplinary team approach to its goal to improvecare and quality of life for AMD patients and their families.

The Duke Center for Macular Degeneration strives to enhance and integrate existingAMD programs and services such as vision rehabilitation, clinical care, maculartranslocation surgery, and AMD research with entirely new programs such as patientand family support and the Duke Macular Degeneration Learning Institute. The firstprogram of its kind, the Learning Institute provides comprehensive, ongoing educa-tion programs for patients, community members, physicians, and staff.

The AMD Center also provides a framework for basic science and clinical researchersto work together to develop new therapies and preventive strategies for maculardegeneration. By providing a unique environment that cultivates teamwork and con-tinuous learning, The Duke Center for Macular Degeneration aims to make life betterfor the millions currently afflicted with AMD, even as we lay the groundwork for theday when macular degeneration will be cured.

These vitreoretinal specialists are on the front lines in the battle against macular degen-eration and other diseases of the retina. Left to right: Drs. Glenn Jaffe, Michael Cooney,Sharon Fekrat, Retina Service Chief Brooks McCuen, Cynthia Toth, and Eric Postel.

Macular Translocation SurgeryA Duke vitreoretinal surgeon has worked to perfect a noveltreatment for AMD called Macular Translocation 360 Surgery.The achievement by Dr. Cynthia Toth is based on the pioneer-ing research of former Duke Eye Center Chairman Dr. RobertMachemer. The goal of this surgery, for patients who are losingthe last of their central vision to AMD, is to lift the macula awayfrom underlying abnormal blood vessels and move it to a new,healthier location to restore central vision. This procedure hasalready helped many AMD patients who had little or no hope ofseeing again, to be able to resume many daily activities.

A multidisciplinary Duke Eye Center team is working to fine-tune this complex technique, which can now be performed onan outpatient basis, to reduce recovery time and improve out-comes for patients with severe AMD. Drs. Sharon Freedmanand Laura Enyedi are performing follow-up surgery to correctthe tilted vision that is a common side effect of maculartranslocation surgery. Duke doctors are also training vitreoreti-nal surgeons around the world to perform this pioneeringsurgery.

Clinical Trialsfor WetMacularDegenerationPatientsDr. Sharon Fekrat isthe lead investigatorat the Duke EyeCenter for two excit-ing multicenter,national clinical trialsfor patients with wetmacular degeneration.TranspupillaryThermotherapy(TTT), uses a warmlaser to heat theabnormal bloodvessels that grow inwet macular degener-ation. TTT may ulti-mately lead to visualstabilization, and insome cases, improve-ment of sight. Otherstudies involve theadministration ofinvestigative medica-tions into the eye thatmay halt or slowdown the abnormalgrowth of bloodvessels under themacula. Dr. Fekratbelieves both newresearch approachesoffer hope to thosewho suffer from thedevastating effects ofwet macular degener-ation. A broad arrayof clinical trials formacular degenerationare being planned atthe Duke Eye Center.

Dr. Cynthia Toth instructing during Duke Eye Center’s first coursein macular translocation surgery.

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Pediatric Eye CareBecause a child’s visualsystem develops untilabout age eight, earlyproblems with vision, ifuntreated, can lead toa lifetime of poorvision. For this reason,regular eye exams andearly diagnosis andtreatment of eyeproblems are of theutmost importance.

The Duke Eye Center’sLions Pediatric EyeClinic sees 12,000children each year forroutine exams andspecialty care,including many kidswho have received caresince birth.

“Dr. Buckley will always hold a special place in myheart. If it wasn’t for him, I probably wouldn’t beable to see how I see now.”Mindy Brooks, Pediatric Ophthalmology Patient

Pediatric careOptimizing Sight, Right From The StartThe pediatric division of the Duke Eye Center handles a broad spectrumof eye problems in young patients, from the relatively simple butimportant problems of fitting eye glasses on babies and treating ‘lazy eye,’to the complex issues involved in treating children with glaucoma,cataracts, retinopathy of prematurity, and retinoblastoma. When the newAlbert Eye Research Institute opens its doors, the second floor of theInstitute will be home to the new Pediatric Eye Service, a much-neededexpansion of the existing facility. With plenty of space and windows, thenew pediatric area will feature a lighter and brighter atmospherespecifically designed for the comfort and care of children and their families.Expanding the growing clinical research program in this facility, while alsoincorporating pediatric low vision services, family counseling, play therapy,and other critical areas of treatment will help improve the quality ofpediatric eye care and foster the development of treatments to restore sightin our youngest patients.

Above: Mindy Brooks(right) and her twinsiblings, Meghan andMitch, are just onefamily that benefitsfrom the Eye Center’spledge to preserveand optimize sight inchildren.

Left: Dr. Ed Buckleyhas cared for Mindysince she was aninfant.

Collaborating on thelatest in pediatric eyecare are Drs. LauraEnyedi, SharonFreedman, and PediatricOphthalmology Service Chief Dr. EdBuckley.

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Top Left: Motivated by theirdesire to help others facingeye disease, Ruth and herlate husband HermanAlbert, donated $8 millionto the Duke University EyeCenter to help create theAlbert Eye ResearchInstitute.

Top Right: Groundbreakingceremony for the AlbertEye Research Institute, Fallof 2002. Chairman Dr.David L. Epstein, Leonardand Rose Herring, RuthAlbert, and Dr. AlanCarlson.

Bottom Left: Evelyn Hunter-Longdon honored her latehusband, Stanley Longdon,with a building fund gift of $1 million.

Bottom Right: The AlbertEye Research Institute,scheduled to open 2004-2005, will provide much-needed space andresources for the EyeCenter’s growing research,patient care, andeducation endeavors.

“When it came time to make the gift of a lifetimefor medical research, we had no doubt aboutwhere to place our trust as well as our resources.’’ Herman Albert 1922-2002

The Duke University Eye Center aspires to be the leading eye center inthe country – second to none – for scientific innovations that willtransform the treatment of eye disease. To make our soaring aspirationsa reality, the Eye Center relies on the generosity of friends who supportour programs directed at blinding eye diseases. These benevolentindividuals have each built a relationship with the Duke Eye Center oftenthrough their own or a loved one's experience facing vision loss from eyedisease. As a result of their experiences, they have stepped forward tohelp us achieve our vision for the future.

Duke Eye Center supporters contribute in many ways: as benefactors,ambassadors, and advocates. Ruth Albert, a grateful patient of Dr. AlanCarlson, and her husband, the late Herman Albert, initially presented Dr.David Epstein with an endowment fund for eye research with a goal that“through research others might not suffer from eye disease.”Subsequently, the Alberts made history with the magnitude of their $8million gift to help us begin to build an Eye Research Institute at Duke.

We need you. The Albert Eye Research Institute, and, ultimately, a new clinical pavilionare essential to the Eye Center's ability to achieve the innovative researchand goals described on these pages. Your gift will allow us to provide ourresearchers with state-of-the-art laboratories, support, and equipmentneeded to understand the causes of eye disease, discover more effectivetreatments, and preserve vision for generations to come.

Asoaring aspiration to serve others

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People from all walks of life experience potentially blinding eyeconditions. While some families are blessed with plentifulresources from which to give, others give as they can to advancethe treatment of eye disease. Gifts to the Duke Eye Center at alllevels make a difference in our quest to create a future free of eyedisease.

The Eye Center welcomes gifts in many forms, from checks andcredit card donations, to gifts of stock, to namings of the Centerin wills and trusts. Our staff can guide you as you decide how bestto give to meet your current income needs and minimize taxliability.

The Eye Center also encourages donations of time, whether as avolunteer, a clinical trial participant, or by simply serving as anambassador for the Eye Center in your daily life.

With your help, we will realize our soaring aspirations to cure, toheal, to serve. Together, we can win the battle against blindingeye disease.

Driven to helpothers living witheye disease, theWannamakerfamily generouslymade a $2.5 milliongift to the Duke EyeCenter.

Right: HarrietWannamakerMoorhead reviewsresearch performedat the DukeUniversity EyeCenter with Dr.Fulton Wong,Director ofResearch. Herbrother, the late Mr. William HaneWannamaker, Jr.,established theIsabel StringfellowWannamaker andWilliam HaneWannamaker, Sr.,Endowment in2001 to honor theirparents.

The senior Mr.Wannamaker wasthe first Dean ofDuke University andserved theUniversity for over50 years.

“I know of the challenges one faces whenblind, since I saw my brother struggle on adaily basis with retinitis pigmentosa. It iswonderful that he planned his estate to helpfuture generations.”Harriet Wannamaker Moorhead, sister of William Wannamaker, Jr.

Gifts make a difference

We aspire to be the leading eye center in the country–second to none. We aspire to apply the latest in science to the treatment of blinding eyedisease, while continuing to provide true excellence in patient care andtraining the next generation of leaders in scientific and clinicalophthalmology. In all of our missions, we aspire to be second to none.

With your support, the Duke University Eye Center will realize oursoaring aspirations – to cure, to heal, to serve – and ultimately, to winthe battle against blinding eye disease.

Planning and Development OfficeBox 3802, Erwin Road, Durham, NC 27710919.684.3182 • www.dukeeye.org

D U K E U N I V E R S I T Y E Y E C E N T E R

“Soaring aspirations

to cure, to heal,

to serve.”

©Duke University Eye Center 2003