Visionary Medicine - October 2014

Expanding Clinical Expertise

Neeti B. Parikh, MD
Attending Physician, Ophthalmology & Visual Sciences
Assistant Professor, Ophthalmology & Visual Sciences

Dr. Parikh received her medical degree from Albany Medical College. After completing her ophthalmology residency at the Henry Ford Hospital in Detroit, Michigan, she completed a fellowship in cornea and refractive surgery at the New York Eye and Ear Infirmary.

During her training, she received first place in the cataract division for her poster presentations at the 2008 American Society of Cataract and Refractive Surgery Annual Meeting in Chicago, Illinois and second place for her resident research project at the Michigan Society of Eye Physicians and Surgeons 38th annual conference in 2006.

In addition, Dr. Parikh is certified in laser surgery using the VISX system. Dr. Parikh is fluent in English, Gujarati and Spanish.

David M. Rubaltelli, MD
Attending Physician, Ophthalmology & Visual Sciences
Assistant Professor, Ophthalmology & Visual Sciences

Dr. Rubaltelli received his medical degree from Jefferson Medical College. He also has an MBA from Harvard Business School.

After completing his residency in ophthalmology at New York Medical College, where he was appointed chief resident, Dr. Rubaltelli completed a clinical fellowship in vitreoretinal surgery at the Massachusetts Eye and Ear Infirmary of Harvard Medical School. Prior to arriving at Montefiore, Dr. Rubaltelli was an attending physician in ophthalmology at NYU Langone Medical Center and the Veterans Administration New York Harbor Health System in Brooklyn.

Dr. Rubaltelli is board certified by the American Board of Ophthalmology and a member of the American Academy of Ophthalmology, the American Medical Association and the Westchester Ophthalmologic Society. Dr. Rubaltelli is fluent in Italian and Spanish and speaks French as well.

Erin K. Walsh, MD
Attending Physician, Ophthalmology & Visual Sciences
Assistant Professor, Ophthalmology & Visual Sciences and Pediatrics

Dr. Walsh received her medical degree from New York Medical College. She completed her residency in ophthalmology at the Medical College of Georgia and was the first person to complete her fellowship in pediatric ophthalmology at Montefiore.

As a medical student, Dr. Walsh completed a summer research internship at the National Eye Institute, National Institutes of Health, in Bethesda, Maryland. She was also a lab technician and medical assistant at New York Medical College and the Doris Stein Eye Research Center at the University of California, Los Angeles (UCLA). While attending UCLA, she was a NCAA Division 1 swimmer. Dr. Walsh has published widely on pediatric ophthalmology and is currently conducting research on the "Patterns of All Pediatric Ocular Trauma in an Urban Population" and "The Morbidity and Mortality of Retinopathy of Prematurity Ophthalmic Exams."

Dr. Walsh is a member of the American Association of Pediatric Ophthalmology, the American Academy of Ophthalmology and the Association for Research and Vision and Ophthalmology. She is also a member of the Surgical Subspecialty Lecture Series, Ophthalmology and Visual Sciences, Einstein.

Research Reflecting Our Patient Population

In addition to offering patients leading-edge clinical care, the Department of Ophthalmology and Visual Sciences places great importance on research as a means to advance clinical care. We also strongly encourage our clinicians' participation in academic and scientific activities. Faculty, including attending physicians, residents, fellows and nurses, design and conduct research studies that aim to optimize clinical care delivery and patient outcomes; evaluate the efficacy of drugs, devices, procedures or diagnostic tests; and assess various approaches to improving quality and cost efficiency of care.

Umar K. Mian, MD, Director, Retina, Ophthalmology and Visual Sciences, Montefiore and Associate Professor, Ophthalmology and Visual Sciences, Einstein, notes that diabetes brings a host of eye complications. "The Bronx has higher rates of diabetes than most of the country, including New York City," he says. "It is also a major risk factor for heart disease and eye complications, which have a direct impact on our patients, as it affects their ability to work and drive. For the community that we serve, the treatment of diabetes is one of our foremost priorities."

Because diabetic eye disease is a leading cause of vision loss in patients between the ages of 20 and 74 years, the Department of Ophthalmology is focusing its research efforts on diabetic patients. Current studies within the Department are focused on proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME).

Macular edema is common in diabetes sufferers. The lifetime risk for diabetics for DME is roughly 10 percent. "The macula is the central portion of the retina with the best acuity. Macular edema is defined as retinal thickening within 2 disc diameters of the center of the macula, and is due to diabetic damage to the retinal blood vessels, causing leakage into the surrounding retina. This can lead to the severe decrease of vision and blindness," says Dr. Mian.

Researchers have determined that a normal protein called vascular endothelial growth factor (VEGF) is produced in excessive amounts by damaged retina and makes blood vessels leak and spurs the growth of abnormal blood vessels, which can lead to hemorrhaging, scarring and retinal detachment and blindness. The standard of care treatment has been based on laser photocoagulaiton of the retina to decrease the risk of all complications. Anti-VEGF medicines block the effects of VEGF.
Blocking this protein slows the growth of the abnormal blood vessels and lessens the leakage of the blood vessels, decreasing the probability of vision loss due to DME, as well as age-related macular degeneration.

Studies being held at Montefiore in collaboration with the Diabetic Retinopathy Clinical Research Network, a collaborative network funded by the National Eye Institute, part of the National Institutes of Health, include:

  • Protocol T (A Comparative Effectiveness Study of Intravitreal Aflibercept, Bevacizumab, and Ranibizumab for Diabetic Macular Edema) comparing the efficacy and safety of three different intravitreal drugs used to treat DME in eyes with visual acuity of 20/32 to 20/320 (a range of vision). Study participants have only one eye included in the study and are randomized to one of the study drugs.
  • Protocol S (Prompt Panretinal Photocoagulation Versus Intravitreal Ranibizumab with Deferred Panretinal Photocoagulation for Proliferative Diabetic Retinopathy) studying treatment of proliferative diabetic retinopathy (PDR). It is currently treated with scatter or panretinal photocoagulation (PRP), which destroys areas of retina, but preserves central vision. Studies have indicated that VEGF is a major causative factor in PDR, indicating the possibility of using anti-VEGF agents in treatment.
  • Protocol V (Treatment for Central-Involved Diabetic Macularm Edema in Eyes with Very Good Visual Acuity) examining the use of anti-VEGF therapy to treat DME in eyes with good visual acuity. Previously, research focused on eyes with poor visual acuity. Because of this focus, we do not know whether eyes with central-involved DME and good visual acuity will improve with anti-VEGF therapy initially; focal/grid laser treatment, or observation initially followed by anti-VEGF therapy only if vision worsens.

In addition, our research efforts focus on advancing the treatment of pediatric eye conditions. Norman B. Medow, MD, FACS, Director, Pediatric Ophthalmology, Ophthalmology and Visual Sciences, Montefiore and Professor, Ophthalmology and Visual Sciences and Pediatrics, Einstein, who has more than 35 years of experience as a pediatric ophthalmologist, is completing a study supported by Bausch and Lomb. This study compares a known anti-inflammatory agent with a product in development by the company to check for its safety and efficacy in cataract surgery in children 7–11 years old.

Training the Next Generation

The Department of Ophthalmology and Visual Sciences has announced the construction of a new 'wet lab' that will greatly enhance the Department's stature and resident training capabilities.

The Department of Ophthalmology and Visual Sciences has announced the construction of a new 'wet lab' that will greatly enhance the Department's stature and resident training capabilities. The establishment of the Ronald M. Burde, MD, Surgical Training Center is crucial to the program's continued success, allowing residents to receive advanced, hands-on practice for many ophthalmological procedures in a controlled and supervised environment. The lab, named after the Department's first chairman, will occupy an expansive space on the fifth floor of the Moses Research Tower including six teaching stations with interactive didactic surgical modules, video operating microscopes, and individual Kitaro® cataract surgery simulators. In addition, the Center will be equipped with a complete surgical unit, providing residents with comprehensive practical experience. "Ron Burde and his predecessors were passionate about training residents," says Department Chair Roy S. Chuck, MD, PhD, "and this new lab and the fund in Ron's honor will continue that dedication to excellence for generations to come."

The Center is the first project of the Ronald M. Burde, MD, Resident Education Fund, initiated by alumni to honor the chairman who led the Department to become nationally renowned. Dedication of the new laboratory will take place this fall.