OLSHF

Letters sent to our Research Lab from surgeons who have come to the Lions Vision Research Lab to practice the DLEK procedure and then to watch Dr. Terry perform the surgery in patients:

I found my experience observing Dr. Mark Terry performing DLEK surgery to be very beneficial. Dr. Terry is a gifted surgeon and great teacher. It was invaluable to not only be present in the operating room but also to see the patients the next day at various stages of follow-up. The time spent in the research lab with Paula Ousley was another highlight. I learned a lot in the short time I spent with Dr. Terry and Ms. Ousley, certainly a considerable amount more than I would have from just lectures and videos. The information I acquired has enabled me to start doing the DLEK procedure at Wills Eye Hospital in Philadelphia. I have my first patient scheduled for sometime in the next few weeks. I can only hope to someday be able to do as good a job as Dr. Terry. His exemplary commitment to providing excellent patient care as well as to sharing his knowledge and experience with others is most admirable and most appreciated.

Dear Research Lab,
Thank you very much for the privilege of learning DLEK at the hands of the pioneer surgeon in this country, Dr. Mark Terry. This unique concept in Corneal Transplantation will change the efficiency and quality of visual rehabilitation in patients in need of this surgery. Although this procedure is in its infancy, all corneal surgeons recognize the profound change that this represents and the improvement this offers our patients.
It is essential that this technique be available to corneal surgeons so we may learn and expand its potential. You and Dr. Terry are providing a very valuable service to surgeons and patients alike. You provide this teaching essentially free of charge, and yet you have spent hours and hours of time working out the details of the procedure. You are to be commended for the community service you provide, and the effort at greater good given to us and especially our patients.
My father was a Lion, and a District Governor, and I know from his work the value and importance of community participation. This concept of sharing information and surgical knowledge is in the true spirit of giving back to the "community"--that is the community of corneal surgeons, and especially our patients. This is truly the "Lions" spirit.
Thank you very much for your time and efforts.
You may use my name, and any of the above information especially if it helps further teaching and patient care.

Ivan Schwab, MD
University of California – Davis

It is obvious to many physicians including me that the DLEK program in Portland serves as the central launching point for corneal surgeons who are interested in this exciting new technique. Without the laboratory experience at the Lions Vision Research lab or the exposure to Dr. Terry's surgery and patients, there would be no possible way for surgeons to acquire the necessary experience and knowledge to perform this type of surgery.

Lions Friends - I found the visit to Portland helpful for several reasons. Firstly, the DLEK procedure is one that requires demonstration and hands-on trial. It cannot be learned well from a written description. Secondly, seeing DLEK done well in patients assures the new learner that it can actually be done, with good results. Thirdly, the visit transmits the infectious enthusiasm for the procedure which is necessary to encourage the considerable effort necessary to begin a new procedure.

My experience in Portland with Dr. Terry and Paula Ousley to learn DLEK surgery was invaluable. This is a technically demanding surgery which would be almost impossible to perform successfully on a live patient without the opportunity to learn the procedure from experienced individuals. This surgical procedure is very promising as a way to treat certain corneal diseases and well may become the standard of care for these conditions, replacing traditional corneal transplant surgery. Thus, it was important for me as a corneal surgeon to learn this procedure in an effort to remain up to date in the treatments I am offering to my patients.

Albert S. Jun, M.D., Ph.D.
Assistant Chief of Service
The Wilmer Eye Institute
The Johns Hopkins Medical Institutions

It is my pleasure to provide you with feedback regarding my trip to Portland Oregon to observe DLEK surgery.

I think the service you provide is an extremely useful one and the caliber of education I received was outstanding. As you know, during my 3-day visit, I was able to first assist Dr Terry on one DLEK operation and observe 2 other DLEK operations. I was also able to see postoperative patients with Dr Terry, thereby allowing me to obtain first hand information about the results of the surgery. Moreover, I found the wet lab that you conducted at the Lions Vision Research Lab to be extremely well organized and practical.

Overall I would rate my learning experience at your institution to be first class.

It's been quite sometime since we last met in Portland.
I'd like to express my deepest gratitude for your help and support during my short visit to Portland. I gained a lot of confidence by practicing the DLEK procedure in your lab to operate successfully on my patients. Your help and sincere guidance of Dr. Terry on a fairly new surgical approach were extremely useful to master the procedure.

It was very helpful to visit with you and Mark and I am grateful to the
generosity of you and the patients for allowing us to be involved in the process. There are pearls of wisdom and technique that are difficult to acquire without the experience in its current form.

Ayad A. Farjo, M.D.
Department of Ophthalmology
Dean Health Systems
Arcand Park Clinic

I am writing to thank you and Mark for helping me get DLEK off the ground here at Moorfields. The hands on training in the Lions Vision Research Lab wet lab and the opportunity to observe Dr Terry performing DLEK surgery were invaluable. I am more convinced than ever that this technique, championed by Dr Terry and yourself in Portland will become, over the next five years, the surgical technique of choice in treating patients with corneal endothelial failure.

I am very happy to write a letter in support of the major contributions you are making to the cornea world and the care of our patients. The Lions Club and you deserve major thanks for your research involving DLEK, as well as other projects for which you have a well-deserved international reputation.
Without your encouragement and support I would not have been able to learn the DLEK procedure, which I think is one of the most exciting and beneficial developments I have witnessed in my 20 years as a corneal specialist. My two days spent with you in Portland in your lab, clinic, and operating room were critical in my obtaining the skills to perform the DLEK procedure. I think it would be reckless and ill-advised for even the best of surgeons to attempt this procedure without the hands-on instruction and lab experience you provide. You have given me and many of our colleagues your time and shared your wisdom, with no renumeration other than our thanks and respect.
I hope the Lions organization appreciates your work, and continues to support it and be recognized for doing so.
In closing, I should add that the Lions paid my cornea fellowship salary at the U. of Iowa. Both my Dad and grandfather were Lions Club chapter founders and presidents. I would not be where I am without the Lions' support. And my DLEK patients would not be seeing as clearly without your support and those everpresent Lions.

It was a great pleasure to spend time in your lab learning about DLEK and in addition to have the opportunity to observe surgery and to see a range of post-operative patients. I learned a great amount, which I have finally begun to apply to my patients. I did my first case at the end of last month.

Your commitment and energy as well as your expertise will help many patients throughout the country and the world.

Joel Sugar, MD
Professor of Ophthalmology
Director- Cornea Service
University of Illinois at Chicago Eye and Ear Infirmary

I arranged for Dr. Farjo and Goins and myself to attend the DLEK training sessions in Portland to help us in our adoption of this novel technique. Although we are all Cornea surgeons, this is a novel surgery that builds on other techniques. Familiarity with the instruments and the sequence of surgery is essential to get good results from the very first case. In essence, we are learning from Dr. Terry's "mistakes" or "learned efficiencies". The wet lab was very useful to solidify what we observed in surgery and clearly makes it possible for us to use this new technique in Iowa.

John E. Sutphin, MD
Professor
Director of Cornea, External Disease and Refractive Surgery
Department of Ophthalmology and Visual Sciences
The University of Iowa Hospitals and Clinics

Dear Dr. Terry
We feel grateful for the opportunity that you gave us to learn and practice in your lab. To watch DLEK surgery on a video presentation cannot give us all the experience that we need to start performing the procedure.
It´s very important to be able to visit you at the Dever´s Institute. Practicing with bank eyes is essential to obtain the ability to understand the DLEK surgery, to earn experience and security at each step and to handle all the instruments .For that purpose it´s very important to count with an Eyebank as you do.
To watch the surgeries and to see the patients’ follow-up made the technique reliable.
Thank you very much for teaching us and especially for your kindness.
Sincerely yours,

Larisa Fabiani M.D and Oscar Asis,MD
BARCELONA-SPAIN

Gothenburg 2 October 2003
Just a few lines to express my gratitude and appreciation for letting me spend two valuable and important days with you and Dr Terry.
Even though I have been working for many years with cornea surgery, to learn a new technique like the DLEK, it is of great importance to see the procedure done live, and then, while you have it fresh in your memory be able to practice it yourself in a wet lab. I had read papers about the technique and seen the very instructive video, but I don’t think it is advisable to start on your own without having visited Portland.
It was also very good to have the opportunity to see some patients post op, it will help me assess my own patients, knowing what it “should” look like. Both you and Dr Terry were very generous in telling me about the difficulties and problems that I have to be prepared for.
Your well equipped wet lab and the professional and friendly attitude made the long trip from Sweden to Portland very worthwhile. I also very much enjoyed the opportunity to socialise during the nice dinner.

Yours sincerely
Margareta Claesson MD
The Eye Clinic
Sahlgrenska University Hospital

Dear Sirs: I took part in the surgical observation and wetlab program for Deep Lamellar Endothelial Keratoplasty (DLEK) that was conducted at the Devers Eye Institute in Portland Oregon in preparation for my participation in the Endothelial Keratoplasty Group to develop a systematic approach to this new and important procedure. Both the surgical observation and the wet labs were crucial to acquiring the background to do perform this procedure. Dr. Terry's expertise with the procedure and Ms. Ousley's assistance in developing the laboratory practice techniques were central to understanding the important subtleties of the surgery. Moreover, seeing post-operative patients was very significant in providing a sense of the impact of this operation on the patients.

I want to thank you for the support that you have provided concerning the research on the Deep Lamellar Keratoplasty procedure in Portland by Mark Terry , MD and Ms. Paula Ousley. In 2001 I was invited to watch live surgery and then practice doing the deep lamellar keratectomy procedure in the wet lab in Portland. I returned to Santa Rosa, Ca and at the Kaiser hospital and began ordering the instruments necessary to perform the procedure at my own facility. I then felt I needed more training and returned to Portland in 2002 to watch and to again practice in the lab. After this education and after working on a dozen eye bank eyes in Santa Rosa I performed my first case in Dec 2002. My first patient did well. I have done two more of these procedures and now feel very excited that this operation is far superior to standard Penetrating Keratoplasty. All of my cases have been successes. I am now offering to train other surgeons and to perform DLEK procedures on the patients of all California Kaiser ophthalmologists. This is a very technical operation to master and I would never have attempted it without the wonderful training I received in Portland from Mark Terry and Paula Ousley. In addition, Mark Terry has been heroic in his efforts to guide me by telephone when I experienced obstacle to success.

Once again, I cannot thank you enough for supporting this exciting clinical research. We are now able to more quickly rehabilitate pseudophakic patients with corneal edema. Additionally, the increased skills in lamellar dissection learned in order to perform this procedure give surgeons greater confidence to perform anterior lamellar procedures. Anterior lamellar keratoplasty is useful to treat visually-disabling corneal scars or in blind mentally retarded patients where the risks of penetrating keratoplasty are too high.

To Whom It May Concern: I would like to express my deepest gratitude and support for the work being conducted by Dr. Mark Terry and Paula Ousley at the Devers Eye Institute and Lions Vision Research Laboratory.

As a corneal surgeon at the University of Michigan, I found the on-site training course proctored by Dr. Terry and Ms. Ousley to be invaluable in learning and practicing Deep Lamellar Endothelial Keratoplasty (DLEK), a promising new technique for restoring vision. Although watching live surgery and interacting with Dr. Terry was very helpful, the opportunity to practice what had just been demonstrated on a live patient on a cadaver eye in the laboratory was an invaluable experience. Not only did it help cement some of the nuances of the technique, but it provided a basis for self-practice upon my return to Michigan. Having the opportunity to examine actual patients in various stages of having DLEK was also extremely helpful. The course was an exciting experience that allowed for an exchange of ideas and information that also helped me beyond the DLEK procedure itself.

Qais Farjo, MD
Clinical Assistant Professor
Department of Ophthalmology and Visual Sciences
University of Michigan

I wish to take a moment to congratulate Dr Terry and his staff in particular Paula Ousley for the work they have done in DLEK. This new surgical technique continues to revolutionize the corneal transplant world.

This surgery although technical demanding is a great step forward to providing our patients with faster recovery while decreasing complications that traditional transplantation involves.

The most important component of this DLEK at Devers Eye Institute is the personal one-on-one training from Ms Ousley and Dr Terry when I was a student in Portland last month. The pre visit reading material was exceptional and prepared me for the cadaver training in the Lion's Club Laboratory. Paula spent the entire morning answering my questions and guiding my neophyte ands in this new technique.

Later that afternoon I was fortunate enough to observe firsthand the exquisite surgery performed by Dr Terry. The following day Dr Terry was able to bring not one but five postoperative patients to his clinic for me to examine. They were in various stages of the postoperative period which allowed me to observe the spectrum of healing that these DLEK patients undergo.

In summary the trip to across the country to study DLEK, which I personally funded, was without doubt a wise investment on my part. As an academic physician, whose responsibilities include the daily teaching of medical students, residents, and fellows, it was an exceptional visit which I remained honored to participated in. My sincere thanks to Ms Ousley, Dr Terry and the Lion's Club of Oregon for a job well done. I anticipate performing DLEK surgery in the near future here at Yale, as my Portland visit has given me the confidence and skills to begin this exciting surgery.

The new DLEK procedure is a revolution in cornea transplant surgery. It is one of the more original ideas for transforming cornea transplantation so that the procedure can be made safer, with more rapid recovery, and better quality vision. I would anticipate that this procedure may have a wider international application that the traditional penetrating keratoplasty. The wet lab sponsored by the Lions Club in Portland has done a great service for ophthalmologists. It has allowed us to have first hand experience in doing the procedure. It allows the procedure to be done consistently in multiple centers nationally and internationally. It also increases communication between physicians and centers to improve the procedure and cornea transplantation techniques. I applaud Dr. Terry and Ms. Ousley for developing and maintaining this resource for us.

My name is Vernon Parmley, and I am an ophthalmologist and cornea specialist practicing in Wausau, Wisconsin. Three months ago I had the opportunity to come to Portland and watch doctor Mark Terry perform a new technique for cornea transplantation that offers quicker visual rehabilitation and more stable post operative prescriptions than standard cornea transplants. This procedure is called deep lamellar endothelial keratoplasty, or DLEK.

There is a great advantage of coming to Portland and actually seeing the patients post-operatively. This allowed me direct comparison of DLEK patients with standard transplant patients, not only of how they look to me, but also to experience first hand the patient's perspective. After observing the surgery, I was able to perform the procedure myself in the laboratory on eye bank eyes. This was also an invaluable experience as it helps convince me that the procedure is one I can master with the right tools and training.

Dr Terry and Ms. Paula Ousley are to be commended for their tremendous work and personal sacrifices in developing a new surgical technique for cornea surgery that has tremendous potential for decreasing the prolonged visual recovery time after a cornea transplant. They are to be especially applauded for the cautious and ethical way they have decided to "spread the gospel" of this new procedure. I wish to also give thanks to the members of the Lions clubs of Oregon for supporting this important and visionary research.

I am writing to tell you how much the lab time and especially your assistance has benefited me and my patients. As you know, few people have the expertise that you and Dr. Terry possess. Your willingness to share your knowledge, techniques and eye bank laboratory with visiting surgeons has advanced the development of new surgical techniques and contributes greatly to the world wide ophthalmic community.

I was very helpful coming to Portland for a site visit to observe Dr. Terry performing DLEK surgery, seeing two patients in Dr. Terry's office who have had the procedure, and performing the procedure in the Lion's Vision Research Laboratory. I am in an academic institution and am just now getting the instruments needed to perform the procedure so have not yet had the opportunity to practice here at Case and University Hospitals of Cleveland but hope to have got started before the American Academy of Ophthalmology meeting in California. If Portland were not so far, I would request a "refresher". I am a strong believer in DALKP, deep anterior lamellar keratoplasty, for suitable candidates and expect to become a strong proponent of DLEK also.

William J. Reinhart MD,
Associate Professor of Ophthalmology, Case School of Medicine, Cleveland, Ohio