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The Epitome of Excellence

Diary of a Director General
By Prof. Ehud Kokia
Director General, Hadassah Medical Organization

Dear Family and Friends of Hadassah,

There are many ways to measure excellence. Some people judge by reputation or demand, and they are important criteria, but for us at HMO the yardstick for excellence is the level of performance – in the past, in the present and the potential for the future.

Among our many Centers of Excellence, Hadassah's Dr. Leon, Eugenia and Dr. Boris Pines Department of Ophthalmology is more than worthy of that distinction. Its groundbreaking history alone affords it a special place in the annals of Hadassah and of Israel. When Henrietta Szold arrived in Jerusalem over a century ago, she was struck by the poverty of the city's residents and by the eye diseases that afflicted them. Consequently, when Hadassah's first nurses arrived in 1913, they enlisted the help of Dr. Albert Ticho. A year later they reported they had treated 5,000 children for eye disease – 20 percent of them with trachoma.

In the years that followed, Hadassah recruited Dr. Aryeh Feigenbaum who established eye clinics throughout Jerusalem and opened Hadassah's first Department of Ophthalmology in Hadassah's first hospital on Rechov Ha-Nevi'im, the Street of the Prophets. He and Prof. Isaac Michaelson, who succeeded him, pioneered clinical and academic ophthalmology, training generations of specialists who in turn would become leaders in the field. Today, Prof. Jacob Pe'er, a world-renowned ocular oncologist and ophthalmic pathologist, heads Hadassah's Department of Ophthalmology, overseeing a complex of specialized outpatient clinics and a smaller inpatient service, while continuing to perform sophisticated surgery and conduct significant research.

If the demand for services is a decisive measure in the excellence scale, his department more than qualifies. "On a normal day – if there is such a thing as a normal day in the medical world – we see 250 to 300 patients in our outpatient clinics, more than 40,000 patients a year," he says. "Ours is essentially an outpatient department. Even those patients that need to be hospitalized usually stay only a day or two. Yet, our need for more space is essential, space for our clinics, space for our research labs, space for our surgical needs and especially space for our patients."

The pressure on the Department has been growing for some years now as more and more people come from throughout the country – and even from throughout the world – to take advantage of its expertise in every pediatric and adult ophthalmology specialty and sub-specialty. During the past decade there has been a 250 percent increase in the number of patients seen in the outpatient clinics alone – and that number grows about ten percent each year. Pictured right: Dr. Julio Diaz of Mexico, who is studying within the framework of Hadassah's three-year theoretical and practical Diploma Course in Ophthalmology for physicians from abroad.

The increased demand is directly connected to the major clinical and research advances that have taken place in this complex field during the same time period and how Hadassah incorporates them into patient diagnosis and treatment. As in all of Hadassah's Centers of Excellence, the physicians in the Department of Ophthalmology are also research scientists, practicing what has come to be called translational medicine – the "translation" of basic research into real therapies for real patients, linking the laboratory with the patient's bedside. At Hadassah translational medicine has become transformational medicine, literally transforming the lives of thousands of people through the application of major research breakthroughs.

"Everything we do is designed to effectively diagnose and treat the patient," says Dr. Shahar Frenkel, the young specialist in ocular oncology and ophthalmic pathology who is following in Prof. Pe'er's footsteps. Dr. Frenkel, who holds a PhD in biochemistry as well as a medical degree, recently received an Israel Science Foundation grant to pursue his research on possible new treatments to discover metastasis in adults who have suffered eye cancer. "At the moment, we have no way of knowing if or when a cancer will metastasize and at the moment there is no really effective treatment," he says. The passionate pursuit of solutions to these problems impels him to spend as much time as he can in his research lab – precious time that is shared with the one day of the week he spends operating on patients with tumors of the eye and the two days a week he spends in the ocular oncology clinic assisting Prof. Pe'er. Pictured above: Dr. Shahar Frenkel (left) and Prof. Jacob Pe'er (right) examining the image of a child's retina before surgery.

Research triumphs that resulted in treatment advances have made a significant difference for the growing number of older people developing Age-Related Macular Degeneration (AMD). "Until 2005, this disease was completely untreatable. Then came the revolution in biological therapies and with it, the possibility of retarding the progress of the disease and even reversing its effects," says retina specialist Prof. Itay Chowers. "In many ways, we are victims of our success," he explains. "People who receive this treatment need to be treated forever; even now we can't treat all the people who need our help. Since the beginning of 2012, we have increased the number of treatments by 30 percent," he says. "In fact, there is a 30 percent increase every six months.

"Demographics also play a significant role," he adds. As the population ages, so do the number of people over 60 developing AMD. About 30 percent of the people over the age of 75 have some form of AMD. "The problem is that our capacity is limited. We want to save sight and we want to do that by providing an exceptional standard of service but we're having difficulty keeping up with the demand."

Despite his very intense patient schedule, Prof. Chowers is completely immersed in his research, some of which is conducted as part of the International AMD Genetics Consortium established by the National Eye Institute of the American National Institutes of Health. Hadassah is the only hospital in Israel and probably the only hospital in the Middle East that is involved in this group of 18 medical centers that is trying to identify the genetic risk variants for AMD.

For Itay Chowers and his colleagues, the seamless integration of research and patient care is obvious. "What was incurable is now curable. It is fantastic and intensive," says Prof. Eyal Banin, Director of the Hadassah Center for Retinal and Macular Degeneration, referring to the major changes in the treatment of retina diseases. "Our young doctors and researchers are highly motivated and very talented," Prof. Banin says. "All the members of our department provide exceptional patient care and produce very high quality research but the lack of sufficient physical space poses a significant challenge."

Like his colleagues, Prof. Banin (right) juggles his time taking care of patients with his time conducting research – and like his colleagues, he considers these two aspects of his professional life inextricably intertwined. Perhaps the project that will have the most dramatic effect on the greatest number of people is the research Prof. Banin and Prof. Benjamin Reubinoff, Director of the Sidney and Judy Swartz Human Embryonic Stem Cell Research Center, are conducting on transplanting pigment-containing visual cells derived from human embryonic stem cells to treat AMD. They have already proved the effectiveness of their work on laboratory animals and are now conducting safety studies. Prof. Banin envisions beginning Phase I clinical trials for dry AMD in about 1½ years.

Prof. Pe'er is immensely proud of all the talented men and women his Department attracts – of the treatment they provide and the research they conduct. He is equally proud to continue promoting Hadassah's longstanding tradition of bringing eye care to the community through the Michaelson Institute for Rehabilitation of Vision in downtown Jerusalem and through a joint program with St. John Eye Hospital in East Jerusalem to improve patient ophthalmologic care and train Palestinian ophthalmology residents.

The attributes of excellence are difficult to define but clearly apparent to all who consider them. They can be easily seen in Hadassah's Department of Ophthalmology and obviously evident in the outstanding men and women who bring the best of their profession to their patients and their research, changing lives with their dedication and determination. On this eve of Yom Kippur, please accept my heartfelt wishes for a Happy New Year and that you and your loved ones be inscribed in the Book of Life.



Prof. Ehud Kokia, MD, MHA
Director General

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