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Department of Neurology

Neuro-Ophthalmology Program at Penn

Program History

The Neuro-Ophthalmology Program at the University of Pennsylvania bridges the fields of ophthalmology and neurology through diagnosis and management of patients with neurological disorders that affect vision and eye movements. With six full-time faculty members and active clinical and research components, it is one of the largest neuro-ophthalmology groups in the country.   The program is part of Penn's Neurological Institute and the Scheie Eye Institute.

Since 1994, the Neuro-Ophthalmology Program has trained 13 fellows, most of whom have current positions at academic medical centers. These individuals represent many of the field’s young leaders in clinical neuro-ophthalmology and in clinical and basic science research.  They have been involved in producing some of the most important findings in the field of Neuro-Ophthalmology during the past decade.

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Research at Penn

  • Researchers at Penn are leading international efforts to validate new measures of visual function to be used in multiple sclerosis (MS) clinical trials, including low-contrast letter acuity.  These studies have established the visual profile of MS as including sub-clinical dysfunction not detectable by conventional high-contrast (black on white) visual acuity testing. 
  • Penn is also leading and collaborating on efforts to establish a role for optical coherence tomography (OCT), a non-invasive imaging technique used to quantify retinal nerve fiber layer axon loss, in clinical trials of neuroprotective and other novel therapies for optic neuritis, multiple sclerosis, and other forms of optic nerve disease.
  • Paradigms used to develop new visual and OCT outcomes are being applied at Penn toward the study of other neurodegenerative disorders, including Parkinson’s disease and Friedreich ataxia.  In the case of Freidreich ataxia, current clinical trials of antioxidant therapies as well as trials in the design phase have already incorporated low-contrast letter acuity and OCT as clinical outcomes.
  • Novel therapies for acute optic neuritis, such as those that target receptors responsible for excitotoxicity and cellular stress responses, are being investigated in experimental autoimmune encephalomyelitis, a mouse model of MS.  Current investigations have helped identify basic mechanisms of axonal damage and neuronal cell death in optic neuritis and MS.
  • Novel therapies for acute optic neuritis, such as those that target receptors responsible for excitotoxicity, are being investigated in experimental autoimmune encephalomyelitis, a mouse model of MS.
  • Researchers, including current fellows, are establishing longitudinal data collections that will lead epidemiologic investigation in neuromyelitis optica (NMO), a potential variant of MS that affects predominantly the optic nerves and spinal cord.
  • Penn Neuro-Ophthalmology Faculty have been key participants in the development of the Neuro-Ophthalmology Research Disease Investigation Consortium (NORDIC), a network of researchers at centers across the U.S. that will facilitate multi-center collaborative research in neuro-ophthalmology.  This network will likely receive funding from the National Eye Institute (NIH), and will provide support for Penn researchers to direct larger collaborative research efforts.
  • Penn Neuro-Ophthalmology Fellows have participated in and published a variety of clinical studies during their fellowships, including recent studies on pediatric optic neuritis, automated kinetic perimetry, functional visual loss, and subacute angle-closure as a source of headaches.
  • Penn Neuro-Ophthalmology Faculty have been leading the way in a national effort to improve compentency in residency and fellowship training.  This has included development of novel hands-on training in surgical approaches to ophthalmologic and neuro-ophthalmologic diseases.

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Program and Faculty

 

Grant T. Liu, MD
Professor

Dr. Liu, a Professor of Neurology and Ophthalmology, received his medical degree from Columbia University. He completed a residency at the Harvard-Longwood Neurology Program and a fellowship at the Bascom-Palmer Eye Institute. Although he sees both adult and children with neuro-ophthalmic problems, his special interests are in pediatric neuro-ophthalmology and adults with headache.

Nicholas J. Volpe, MD
Adele Niessen Professor

Dr. Volpe, the Adele Niessen Professor of Ophthalmology and Neurology, was awarded his medical degree from State University of New York, Brooklyn. He performed a residency in ophthalmology and a fellowship in neuro-ophthalmology at Massachusetts Eye and Ear Infirmary, Harvard Medical School. He is the residency director for the Department of Ophthalmology at the University of Pennsylvania. Dr. Volpe is board certified in ophthalmology and has special interests in optic nerve disease and surgery, eye trauma, skull base tumors, and eye muscle surgery for double vision.

Dina A. Jacobs, MD
Assistant Professor

Dr. Jacobs joined the PENN Medicine Neuro-Ophthalmology and Multiple Sclerosis Divisions as a faculty member in 2002.  With dual training in both Neuro-Ophthalmology and MS, Dr. Jacobs has distinguished herself within PENN Medicine, and throughout the Delaware Valley region as an expert, thoughtful, and compassionate clinician for MS patient care.  As local Principal Investigator for clinical trials, she is currently enrolling patients in clinical trials to investigate the potential roles of neutralizing antibodies on clinical course in MS.  Women’s health and the potential effects of MS on family planning represent another important research and clinical interest.  Dr. Jacobs serves as a mentor for a Penn medical student projects, including one entitled Experiences and Concerns Regarding Pregnancy and Family-Building in Patients with MS.  Results of this ongoing survey will be particularly important for assessing patient expectations with regard to MS therapy and disease.

Kenneth S. Shindler, MD, PhD
Assistant Professor

Dr. Shindler, who joined the faculty in July 2004 as an IAssistant Professor of Ophthalmology, received his medical degree from Washington University, St. Louis, MO. He completed residency in ophthalmology and fellowship in neuro-ophthalmology at the Scheie Eye Institute, University of Pennsylvania. Dr. Shindler has a PhD in neuroscience from Washington University. His research interests include studying mechanisms of nerve cell damage in optic neuritis and other diseases of the optic nerve. In addition to treating patients at Scheie, Dr. Shindler directs the Neuro-Ophthalmology service at the Philadelphia VA Medical Center.

Dr. Shindler’s laboratory studies experimental optic neuritis in a mouse model of multiple sclerosis.   Mice immunized with myelin proteins develop a relapsing/remitting course of CNS inflammation and demyelination similar to MS patients.  Two-thirds of eyes in this model develop inflammatory cell infiltration consistent with optic neuritis.  Dr. Shindler has demonstrated that significant axonal damage and loss of retinal ganglion cells (whose axons comprise the optic nerve) occurs after inflammation begins.  These results have shown that axonal damage occurs secondary to inflammation, and have provided a quantitative model for assessing potential neuroprotective therapies.  Ongoing studies are evaluating neuroprotective effects of novel drugs that have a potential to lead to clinical trials for treatment of optic neuritis and other optic neuropathies.

 

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Honors and Awards

Faculty Awards
Dr Galetta was named the American Neurologic Association and the American Association of Medical Colleges distinguished teacher of the year in 2004. He has won the Lindback, and Dripps teaching awards at the Perelman School of Medicine. In 1998, he won the Louis Duhring award as the outstanding clinical specialist at the Perelman School of Medicine.

Dr Liu has won the following teaching awards :Excellence in Teaching Award, class of 1999, University of Pennsylvania School of Medicine, 1995-96 school year.  “Penn Pearls” Teaching Award, May 2002,  University of Pennsylvania School of Medicine.  Resident’s Award for Excellence in Teaching, Department of Neurology, University of Pennsylvania School of Medicine, June 2002.

Dr Volpe won the 2004 Straatsma Award for Excellence in Residency Education  awarded by American Academy of Ophthalmology and Association of University professors of Ophthalmology "recognizing commitment to residency training in ophthalmology and for excellence and innovation as a Residency Training Program Director"  At the University of Pennsylania he has won the  2006 Robert Dunning Dripps Memorial Award for Excellence in Graduate Medical Education in recognition of  excellence and committment in graduate medical education and the Golden Apple and Silver Apple (surgical) Teaching awards from Scheie Residents.

NANOS Awards
Penn fellows and other trainees mentored by Neuro-Ophthalmologists have received awards for papers presented at the North American Neuro-Ophthalmology Society (NANOS) Annual Meetings.  The following is a list of papers selected for these awards:

Wu G.F., Nano-Schiavi M.L., Baier M.L., Galetta S.L., Cohen J.A., Jacobs D.A., Markowitz C.E., Pfohl D.C., Maguire M.G., Cutter G.R., Balcer L.J.:  Visual function and disease phenotype in multiple sclerosis.  (Presented at the North American Neuro-Ophthalmology Society [NANOS] Annual Meeting, Orlando, Florida, 2004). 
NANOS Award for Best Paper Presented by a Resident.

Bonhomme G.R., Liu G.T., Balcer L.J., Volpe N.J., Shindler K.S., Jacobs D.A., Galetta S.L.:  Isolated pediatric optic neuritis:  Brain MRI abnormalities and risk of multiple sclerosis. (Presented at the North American Neuro-Ophthalmology Society Annual Meeting, Copper Mountain, Colorado, 2005).
NANOS Award for Best Paper Presented by a Fellow.

Wu G.F., Schwartz E.D., Jacobs D.A., Markowitz C.E., Galettta S.L., Nano-Schiavi M.L., Baier M.L., Maguire M.G., Souza A., Misra S., Udupa J.K., Lei T., Desiderio L.M., Cutter G.R., Balcer L.J.:  Regional MRI abnormalities and visual dysfunction in patients with multiple sclerosis.  (Presented at the North American Neuro- Ophthalmology Society [NANOS] Annual Meeting, Tucson, Arizona, 2006, abstract available at www.nanosweb.org). 
NANOS Award for Best Paper Presented by a Fellow.

Burkholder B.M., Frohman T.C., Chang S.C., Nano-Schiavi M.L., Pulicken M. Markowitz C.E., Jacobs D.A., Galetta S.L., Calabresi P.A., Frohman E.M., Balcer L.J.:  Low-contrast acuity loss over time in multiple sclerosis correlates with reductions in retinal nerve fiber layer thickness and macular volume by OCT. (Presented at the North American Neuro-Ophthalmology Society [NANOS] Annual Meeting, Snowbird, Utah, 2007, abstract available at www.nanosweb.org; and at the American Academy of Neurology Annual Meeting, Boston, Massachusetts, 2007). 
NANOS Award for Best Paper Presented by a Medical Student.

Ko M.W., Raphael B.A., Nano-Schiavi M.L., Valotta J., Bank W., Colcher A, Duda J., Horn S., Hurtig H., Siderowf A., Stern M, Balcer L.J.:  Visual outcomes in Parkinson’s disease.  (Presented at the North American Neuro-Ophthalmology Society [NANOS] Annual Meeting, Snowbird, Utah, 2007, abstract available at www.nanosweb.org; and at the American Academy of Neurology Annual Meeting, Boston, Massachusetts, 2007). 
NANOS Award for Best Paper Presented by a Resident.

Glisson C., Frohman E., Balcer L., Jacobs D., Markowitz C., Galetta S.:  Clinical characteristics associated with neuromyelitis optica (NMO) antibody seropositivity.  (Presented at the North American Neuro-Ophthalmology Society [NANOS] Annual Meeting, Snowbird, Utah, 2007, abstract available at www.nanosweb.org).
NANOS Award for Best Paper Presented by a Fellow.

For more information about The Neuro-Ophthalmology Program at the University of Pennsylvania Health System, visit http://www.upno.org/.

 

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