News and Announcements

Last year, Dr. Amani Fawzi’s group published an innovative study to examine a phenomenon that they were the first to recognize – they observed an unusual, multi-layered pattern of abnormal neovascularization in some patients with wet age-related macular degeneration (AMD). Their goal was to understand whether the unusual and complex phenotype of these membranes had any implications with respect to the response to anti-VEGF therapy. They discovered that these complex neovascular lesions were harder to treat than the ones that were simple, and single-layered. Dr. Fawzi believes this finding provides a framework for the development of a method to prognosticate the outcomes of anti-VEGF treatment. Based on these findings, eyes that harbor these complex three-dimensional vascular lesions are likely to require more frequent anti-VEGF injections compared to eyes that have simpler monolayer neovascular membranes. This provides important guidance to clinicians and patients and may allow us to simplify the treatment algorithm for patients that have more responsive (less complex) neovascular lesions.

To do this study, a talented MD/PhD student, Brian Soetikno, adapted a recently described algorithm to remove the vascular artifacts from the OCT angiography images. This algorithm allowed the removal of all extraneous signals that do not originate within the neovascular lesions, including the normal overlying retinal vasculature that would otherwise appear to artifactually be within these neovascular lesions. Once Dr. Fawzi’s group was able to obtain an unadulterated image of the neovascular lesions without the extraneous artifacts, they were able to analyze their thickness as well as the number of vascular layers within them.

The investigators divided their patient population into those that required monthly anti-VEGF injections for optimal control of their neovascularization and those that were able to remain quiescent with extension of their treatment intervals beyond 6 weeks. Using this approach, they found that eyes needing frequent anti-VEGF therapy were more likely to have the complex multilayered neovascular lesions. As shown in this video, these lesions are quite intricate and definitely more complex than those with a single layer of vasculature, suggesting these complex vessels were more aggressively proliferating and therefore more leaky. Dr. Fawzi believes that sticky and stiff proteins leak and accumulate around this vasculature forming the necessary “scaffolds” for these vascular layers to extend.

This research is now publically available, as open access, as

Nesper, Soetikno, Treister and Fawzi. Volume-Rendered Projection-Resolved OCT Angiography: 3D Lesion Complexity Is Associated With Therapy Response in Wet Age-Related Macular Degeneration. Investigative Ophthalmology & Visual Science April 2018, Vol.59, 1944-1952. doi:10.1167/iovs.17-23361

The volume-rendered videos are available at this LINK, under supplementary material.

Northwestern Ophthalmology Welcomes its First Class of Integrated Interns

Academic year 2018/2019 welcomed the inaugural integrated internship class at Northwestern University Department of Ophthalmology.  Ophthalmologists traditionally do an internship year either in medicine or in a transitional program.  These experiences are highly variable and not connected to the ophthalmology training program.  A national task force recently authored a white paper endorsing the notion of ophthalmology programs moving towards integrated internships.  The Ophthalmology Residency Review Committee of the ACGME and the AUPO are also considering the merits of integrated internships.  This is the case for all other surgical specialties.  It gives the hosting institution the opportunity to provide both general medical training as well as relevant experiences for interns as they progress towards their PGY-2 years and begin formal ophthalmology training.  In an integrated internship there is a chance to ensure early exposure to ophthalmology patients supervised by ophthalmic educators and integration into the Ophthalmology Department’s activities and conferences.

Northwestern has been one of the early adopters of this strategy and this year welcomed our first class of integrated interns who have successfully completed months of training.  Our new residents, Drs. Bowman, Janetos, Rojas and Thakar have come from our nation’s top medical schools and have embraced the integrated training.

The training is rigorous and includes general surgery, surgical electives, internal medicine, emergency medicine and ophthalmology.  Interns are both integrated into the primary service they are working on and have clear connections to our Ophthalmology Department.  This includes participation in a specific curriculum designed for ophthalmology interns, regular attendance and presentation at our conferences and Grand Rounds, and “buddy call” with more senior residents during their months on the ophthalmology service.  Our interns have reported that their time spent in the medial center has so far been an enormously positive experience.  This has given them the opportunity to learn from some of the best internists, surgeons and emergency room physicians in the region, while at the same time maintaining a close connection to the Department and our activities.  Our curriculum is designed to provide interns with a wide variety of worthwhile and relevant experiences as they build their foundation as physicians and ophthalmologists and eventually transition to independence as physicians.

The program is directed by Assistant Professor of Ophthalmology and glaucoma specialist, Anupama R. Anchala, MD, who is an experienced ophthalmic educator.  She works closely with leadership in other Departments to ensure the best experience for our trainees.  Interns are immersed into a tailor-made experience that borrows from the best of both worlds.  Specifically, their general medical, emergency room and surgical rotations highlight the transition to independence and the necessary skills to be a physician.  They are given the opportunity to make key medical and surgical decisions while working independently as ophthalmology interns during their ophthalmology rotations.  This includes caring for patients in clinic, assisting in the operating room, presenting at conferences, and holding many of the same responsibilities as their PGY-2 colleagues.  Ultimately the goal is to make our residents better prepared for the three years of ophthalmology training, with a much more developed skill set and facility with the ophthalmic examination.  We hope this will provide an experience in which the resident can feel that all four years of the training were dedicated to becoming superior ophthalmologists and ophthalmic surgeons. 

The internship year for Northwestern residents will no longer be a simple year of unrelated, highly variable medical and surgical experiences, but in fact will become an integral part of their training to be an ophthalmologist.  Applicants, residents and faculty involved are enthusiastic about the early success of this new program.