Team Colorado Retina Associates had a blast Saturday, October 8 at Foundation Fighting Blindess’s VisionWalk. Team CRA raised over $10,400.00 helping with the walks total of over $120k was raised this year!! Such a wonderful event!!
Dr. David Johnson and Dr. Stephen Petty recently completed week-long return trips to Hospital Elias Santana, home of the ophthalmology residency and fellowship training programs run by Juan Batlle, MD, in Santo Domingo, Dominican Republic. The hospital has seen an increase in patient visits and surgeries. The increased demand for services has led the Retina Department to expand with additional fellows and equipment, including a second microscope and a second Constellation vitrectomy machine.
During his recent visit in March 2016, Dr. Johnson focused on surgical training with the retina fellows and he also gave daily lectures to the residents. Cases ran the gamut from macular pucker and macular holes to complex diabetic traction detachment and trauma. In April 2016, Dr. Petty gave lectures, mentored surgery, and spent time with the residents and fellows teaching exam techniques, including scleral depression and retina drawing.
Visits to this special place continue to encourage international bonds. Graduating fellow, Gevorg Ghahramanyan, MD, visited with us in Denver after the AAO Annual Meeting in November 2015, before returning to Armenia. Current senior fellow, Eva Dewi, MD, plans to visit Denver in July 2016, before returning to Indonesia. Upcoming fellows Jimmy Borda, MD (Bolivia) and Audrey Juan, MD (Dominican Republic) are progressing nicely and round out the international contingent.
After a week of hard but rewarding work, Dr. Johnson was taken on a tour of Los Tres Ojos (The Three Eyes) national park, by Drs. Dewi and Borda. The three underground limestone caves and small lakes are unique and beautiful. Taino Indians were the first inhabitants and used the area for religious ceremonies.
CRA strives to deliver the best care in Denver and the Front Range. But, CRA physicians also have impact on every continent — teaching, presenting at meetings, and growing out the American Academy of Ophthalmology’s Global Leadership Development Program. Places visited in 2015: Kenya, Ghana, Colombia, France, Austria, Hungary, New Zealand, and the Dominican Republic.
State Leaders Broaden Horizons
Two graduates of the Academy’s Leadership Development Program (LDP) had the opportunity to share the organizational skills and training they acquired with their colleagues in Africa. Immediate Past President of the Texas Ophthalmological Association Sidney K. Gicheru, MD and Councilor for the Colorado Society of Eye Physicians and Surgeons Alan E. Kimura, MD, MPH, recently collaborated with the African Ophthalmology Council (AOC) President Kunle O. Hassan, MBBS and the International Council of Ophthalmology to launch the AOC LDP on August 21-22 in Naivasha, Kenya. Dr. Gicheru noted, “we had 16 total confirmed AOC LDP participants. They will be part of a two-year program with two face to face encounters, two remote learning sessions and a final graduation with project presentations in 2017. We need to give the AOC LDP all the support we can. I think we will make such a big difference. Kunle is a great and able leader and is very well respected. He is a giant in Africa”.
AOC LDP participants in Naivasha, Kenya
I recently completed my fifth trip to Elias Santana Hospital in Los Alcarrizos, on the outskirts of Santo Domingo, DR. The retina department is growing and there are additional new attendings. The current surgical fellow, Gevorg Ghahramanyan, MD (Armenia), and upcoming surgical fellow Eva Rosita Dewi, MD (Indonesia) are both developing nicely with increasing skills and good clinical judgment. Two first year fellows, Audrey Juan, MD (DR) and Jimmy Borda, MD (Bolivia) are showing great promise, with mainly clinic responsibility now.
After morning rounds and lecture, surgical fellows perform 4-5 cases daily and see consults in the clinic throughout the day. Cases run the gamut from macular holes and ERM, to complex PVR and PDR detachment cases. Due to financial and travel constraints, most patients with complex problems require CE/IOL, vitrectomy, scleral buckle and silicone oil. On this trip, I taught my technique for scleral belt loops for 240 band placement.
Alex Willoughby, a third- year medical student at Duke University, was our special guest. He showed good proficiency with the techniques of indirect ophthalmoscopy and slit lamp examination, and he learned a lot about ocular anatomy and retinal surgery techniques. He connected well with the residents and fellows and made some new life-long friends.
I hope to continue yearly trips to this special place. I like teaching and making connections with budding retinal surgeons who will take their skills into the far corners of the world. It is my hope that CRA can host Gevorg this fall for an observational trip to Denver.
Colorado Retina Associates team is committed to raising funds for research.
We have been participating in VisionWalk, FFB’s signature fundraising event for 9 years. In that time we have raised over $53k with donation circles in our offices, fundraising dinners, and raffles.
Since its inception in the Spring of 2006, VisionWalk has raised over $22 million to fund sight-saving research. As promising treatments move into critical human studies, the need for research funding is greater than ever.
VisionWalk is a signature fundraising event of the Foundation Fighting Blindness, a 501(c)(3) tax-exempt organization. Over 10 million Americans are affected by blinding retinal diseases including macular degeneration, retinitis pigmentosa and Usher syndrome. The Foundation Fighting Blindness is working to find treatments and cures for these devastating diseases, by funding leading edge research in area such as genetics, gene therapy, transplantation, artificial retinal implants and pharmaceutical and nutritional therapies. The Foundation Fighting Blindness is making a difference today to make the world a brighter place for those suffering with retinal degenerative diseases.
I recently made my first visit to the Dominican Republic, and I am sure it will not be my last. I had known about the ophthalmology residency program at the Elias Santana Hospital, through my introduction to the director, Dr. Juan Batlle, by my mentor, Dr. Kenneth Hovland, many years ago. I was also aware of Dr. Stephen Petty’s past involvement in teaching these residents and fellows. When the need arose for more retinal teaching this year, I decided to pitch in and help out for a week. It proved to be a rewarding and productive experience that I would recommend to anyone.
The residency program was established in 1985, with a mission to bring modern ophthalmology to the neediest patients of the Dominican Republic, while training doctors from all over the world. The program now trains eight residents each year in a three year program equivalent in scope and quality to U.S. residency training. There are also fellows in all sub-specialty areas, staffed by graduates of the program who practice locally. The senior residents and fellows perform over 5000 major surgeries each year. I met residents and fellows from Honduras, El Salvador, Brazil, Bolivia, Peru, Columbia, Armenia, Indonesia and Ethiopia, as well as from the Dominican Republic.
As an introduction to a “medical mission” trip, I found this experience to be highly organized and basically stress-free. I gave lectures for an hour each morning and scrubbed in with the fellows for most of the day, seeing postops and some consults between and after surgical cases. There was even some time to teach indirect ophthalmoscopy and scleral depression to the first year residents. The week flew by and it was a welcome break from the usual business of medical practice in the U.S. The delivery of health care in a teaching environment to under-served patients puts it all in perspective.
Dr Joondeph spent several years working in Auckland, New Zealand as a Consultant Ophthalmologist before moving to Denver. He returns there once or twice a year for a week of clinical work and teaching in the public health system, teaching the residents and fellows, and working in the retina clinics. Not only is it a “working holiday” for him, but it also provides a close look at a health care delivery system different from that in the US, namely a single payer, government run health system. He enjoys catching up with friends and colleagues while in Auckland, sharing a bit of American medicine, and learning Kiwi approaches to retinal treatment.
We doctors in CRA understand that there are many countries in the world that have few or no retina specialists to care for their people. It is estimated that 2/3s of the countries of the world do not have a single retina specialist. There are over twenty in the Denver area alone. The need for what we do is magnified by the predication that there will be twice as many diabetics in the world in the next 20-30 years. Many diabetics throughout the world are needlessly going blind, not to mention those with retinal detachments and other retinal diseases.
To help solve this problem a number of us have become involved in international teaching. We go for one to several weeks at a time to teach doctors how to do retina surgery in other countries. By passing on our skills we hope to play a small part in eliminating blindness in the world.
Since a few of us are doing this type of work, we have set aside a little space for each of us to describe our experiences and vision for this type of educational experience.
Stephen T. Petty, MD
My first trip was as a senior medical student to the Dominican Republic. Our team worked for 2 weeks and saw 20,000 patients and did 500 surgeries. The patients actually camped and cooked in the line they were in for several days, and the line was over a quarter of a mile long. It was the first time I actually experienced, firsthand, the overwhelming need for eye care in the world. I remember a little lady, blind from cataracts, come back the day after surgery and actually see her granddaughter for the first time when her eye patch was taken off. There was not a dry eye in the house. Below is a photo of the line of patients on that trip.
I have been on over 100 trips since that time, and have worked on international boards of directors, mission hospital boards, and have done several other projects like my first one described above. In the end I found that my true calling is to teach, since a new skill can be taught and then be used by that doctor for the rest of their career, to the benefit of thousands of patients.
My vision is to teach someone how to do surgery, and then to see those same skills taught by my student to other students, until every country has enough retina specialists.
Probably wildly optimistic, but it is nice to keep a little optimism after being in medicine for so many years.
I have been to several countries over the years including Azerbaijan, Dominican Republic, Mexico, Honduras, China, Ecuador, Honduras, Peru and Nigeria. My wife Nancy and I have taken graduate courses at the University of Colorado on Non-profit development, and have written a paper on a model for successful short term teaching of surgical techniques in the practice of retina.
The first and best model for training retina specialists is to attend an organized fellowship program, and a lot of my time spent teaching is in such programs. Another model however, that I would like to see developed more, is to identify physicians that are already doing other types of eye surgery, in areas of the world with no retina surgeons, and train them how to do retina surgery. I have found that if I go back to see them again and again, that after about ten trips they are able to pick up the necessary surgical skills to perform retina surgery. I have heard this concept called a “reverse fellowship” because the teacher goes to the student rather than the other way around.
Many good eye surgeons, for a myriad of reasons, are unable to leave their communities to attend a formal fellowship program, and so why not send the professor to them. This is a very different way of delivering training to people than is traditional, but it could train many more retina surgeons than are presently being trained in traditional fellowship programs. I have seen this method work in my own experience, and so I know firsthand that this method could produce more retina surgeons. The problem with the traditional programs is that there are not nearly enough of them to produce the numbers of retina surgeons that are required to meet the needs of the world.
It is time to look at other ways to achieve this.
My most recent trip has been to the Santana Hospital in the Dominican Republic with Dr. Curtis Hagedorn, of our practice. Below is a photo of the three fellows presently training there. To the left is Sadin who is from Ethiopia. Center is Jeanette from the Dominican Republic. To the right is Luis from Colombia.