1947 to Present

Eye Bank of Canada

The University of Toronto Eye Bank Laboratory and Research Program

The concept of an eye bank in Toronto arose during a conversation between Elliot and Baker in May of 1950. [i] The Eye Bank of Canada was established in 1950 in an agreement between the Canadian Ophthalmology Society (COS) and the Canadian National Institute for the Blind, under the directorship of Baker. [ii] The CNIB donated $500 to the Department of Ophthalmology at the University of Toronto, and in exchange the first eye bank was established at the Banting Institute with Elliot as Chair of the department. Hugh L. Ormsby, the ophthalmologist who would perform the first cornea transplant in Toronto, was appointed the eye bank's first medical director in 1955. He lobbied the government and received a National Health Grant "for the organization of an eye bank and to support a program of research on the problems of corneal grafting." [iii] The department performed research on graft survival in different storage mediums and temperatures. Ormsby also did corneal xenotransplantation research with Prasanta Kumar Basu, an ophthalmologist from India who served as Research Director of the Eye Bank of Canada from 1955 until 1991, on rabbits and several other animal models. They published their investigations into the use of animal or avian tissues for corneal grafting in humans in the American Journal of Ophthalmology in 1957 [iv].

In November 1955, John Piper, a general physician and coroner for the Stratford General Hospital, recovered the first post-mortem donated eyes. Ormsby used the donated corneas to perform penetrating keratoplasty surgeries on two veterans blinded by chemical warfare in WWI [v]. This was not the first cornea transplant in Canada, as Jean Audet-LaPointe performed the procedure in Quebec in 1945 [vi]. LaPointe recognized the need for cornea donors and had unsuccessfully lobbied the Canadian Ophthalmology Society in 1951 to establish a Canadian eye bank.

The human penetrating keratoplasty surgeries took place at the Toronto General Hospital. In 1957 Ormsby and Basu reported the initial clinical outcomes with cornea transplantation in Toronto [vii]. Ormsby had performed 35 penetrating keratoplasties over one year, all surgically successful. Eight patients with "conical corneae" had full-thickness grafts with visual acuities ranging from 20/20 to 20/40. One patient with keratoconus had a graft rejection six week postoperatively; two patients with interstitial keratitis developed delayed graft rejection. Ten patients with "metaherpetic keratitis" had lamellar grafts resulting in improved visual acuities without recurrence of herpetic infections.

Ormsby recognized the need to educate the public on the importance of eye donation for the success of the Eye Bank program. Appeals were made to the public and to Canadian general practitioners. Medical journal advertisements explained the need for donor cards and provided surgical instructions on how a general practitioner could remove a post-mortem eye. [viii]

George Thompson, ophthalmologist, succeeded Ormsby as medical director of the Eye Bank of Canada until 1978 when William Dixon, cornea specialist, was invited to become medical director, a position he later shared for many years with David Rootman, cornea specialist.

Dixon completed his medical school training at the University of Toronto in 1964 and his ophthalmology residency training at the University of Toronto under JC McCulloch. Dixon completed a cornea fellowship at Moorfields Eye Hospital in London in 1971, under Barrie R Jones, MBCHB, and then returned to Toronto to practice at Sunnybrook Health Sciences Centre and the Wellesley Hospital. In 1987, Dixon was appointed Ophthalmologist-in-Chief at Sunnybrook Health Sciences Centre, a position he held until 2010.

Rootman completed his medical school training at the University of Toronto in 1982 and his ophthalmology residency training at the University of Toronto in 1986. He then moved to New Orleans to complete a cornea fellowship at the Louisiana State University under Herbert E. Kaufman, whose name is given to several corneal storage media. Rootman returned to Toronto in 1988 and became the scientific director of the Eye Bank of Canada in 1993, with Dixon as medical director. In 1996 both Dixon and Rootman were named medical co-directors of the eye bank until 2003. In 2003, Dixon became medical director, a position he still holds today, and Charlotte Wedge, cornea specialist, was named assistant medical director.

Dixon and Rootman oversaw many of the recent changes at the Eye Bank of Canada, including the move from One Spadina Crescent to the CNIB in the late 1990s, and the modernization of graft testing and storage. The change from McCarey-Kaufman storage medium to Optisol was significant for cornea transplantation in Toronto as it allowed donor corneas to be stored for 10 days. This permitted flexibility in the use of allograft material and penetrating keratoplasty became an elective rather than an emergent procedure.

Under the Dixon and Rootman leadership, the Eye Bank of Canada bought an endothelial camera to establish cell counts and started routine blood testing to reduce the risk of transmitting infectious diseases in allografts. Much of the funding for these changes was attributed to a grant for $1.2 million secured by Rootman from the Ministry of Health and Long term Care.

In 2004, the Eye Bank of Canada received approval from the Eye Bank Association of America for meeting stringent guidelines. In 2007, they became a Health Canada approved facility.

With the retirement of Wolfe in 1992, Marilyn Schneider became manager. Schneider obtained a grant for $50,000 from the University of Toronto during her tenure. This funding was used to install a clean room, and allow for secured access into the Eye Bank. Schneider was followed in 1996 by Fides Coloma. In 2003, Linda Sharpen was appointed manager of the Eye Bank, a position she continues to hold today.

In 2005, the Eye Bank of Canada (Ontario Division) celebrated its 50th anniversary. Since its inception it had received 69,000 eyes from 35,000 donors[1].

 

 

Prasanta Kumar Basu (1922 to present)

Prasanta Kumar Basu served as research director of the Eye Bank of Canada from its inception in 1955 until 1991. Basu was born in the Bengali region of Mymesingh in the 1920s and trained and practiced in India. Basu was awarded a Colombo Plan Fellowship by the Indian Government. The six-month fellowship term allowed Basu to travel to Toronto in June 1955, where Basu established his research on corneal graft immunology and corneal preservation. [i] In 1955, Elliot and Ormsby were in the process of establishing the first Eye Bank in Canada and recruited Basu's help and experience. Basu presented the initial Eye Bank program to the Canadian Ophthalmological Society in 1956. [ii]

Basu was invited to stay in Canada in 1959 and appointed the Stapells Director of Ophthalmic Research at the University of Toronto, after being released from his obligations to the Indian government. [iii]

Basu was the first director of ophthalmic research in Canada. He also was the first Career Investigator in Ophthalmology of the Medical Research Council of Canada, and the first ophthalmologist to become and honorary member of the Royal College of Physicians and Surgeons of Canada.

During his tenure, Basu started a course on "Third World Ophthalmology" for Toronto medical students. He dedicated his time primarily to research and has over 300 published scientific communications. [iv]

Basu retired from the department in 1991 and currently lives in Victoria, British Columbia. He was awarded the Order of Ontario in 2004 [v].

Anne Marchant Wolfe (1927 to 2015)

Much of the initial success of the Eye Bank is attributed to its first administrator, Anne Marchant Wolf. In the first years of the Eye Bank, Wolf would go to the Toronto General Hospital and look at the list of critically ill patients. She would then approach their nurses and physicians, reminding them to ask the next-of-kin about eye donation when the patient died. Wolf was met with much resistance from medical personnel; cornea transplantation in Toronto preceded kidney transplantation by several years and approaching patients for organ donation had not yet been done. Wolf traveled across the province speaking to the general public on the importance of eye donation and the Eye Bank. The Lions Club became supporters of the Eye Bank and would arrange for transportation of enucleated post-mortem eyes from rural parts of Ontario. [i]

From 1955 until 1992, Wolf coordinated the donation and the allocation of donated tissues to surgeons for the Eye Bank of Canada. She was nominated as a member of the Order of Canada in 1995 for her "early belief in, and commitment to, the first human parts donation program in Canada." She was given a Golden Jubilee Medal by the Governor General of Canada, honouring "Canadians who made a significant contribution to their fellow citizens, their community or to Canada." [ii]

One Spadina Crescent

One Spadina Crescent was an academic building of the University of Toronto. The facility became an academic building in 1972 and was home for the Eye Bank of Canada (Ontario Division); the AE MacDonald Library; the Ophthalmic Pathology Laboratory; research laboratories; departmental administrative offices and classrooms for resident lectures.

The Eye Bank has since moved to the CNIB, and the Ophthalmic Pathology Laboratory moved to Saint Michael's Hospital in 2003. The AE MacDonald Library, administrative offices and resident classrooms for the department are now located at the Toronto Western Hospital. The department officially moved out of One Spadina Crescent in 2010.

 

Ophthalmic Pathology

William S Hunter (1930-2004)

In 1964, the Ophthalmic Pathology laboratory was taken over by William S Hunter (1930-2004) who had recently completed fellowship training in ophthalmic pathology.

After working as a bush plane general practitioner in Northern Ontario, Hunter went to London, England to work with renowned ophthalmic pathologist Norman Henry Ashton (1913-2000). Hunter then returned to Toronto and completed a residency in ophthalmology. Hunter pursued further training in ophthalmic pathology in Washington and San Francisco.[i]

Upon returning to Toronto, Hunter was appointed director of the Ophthalmic Pathology Laboratory at the University of Toronto and established the techniques he had learned during his fellowship training. He formally trained ophthalmology residents in ophthalmic pathology and trained a dedicated ophthalmic pathology medical laboratory technologist, Eileen Girard.[ii]

During Hunter's tenure, the Ophthalmic Pathology laboratory moved from the Banting Institute to Spadina Crescent. Hunter retired from the department in 1998 and Yeni H Yucel, an MD PhD pathologist, was appointed director, a position he continues to hold today. In 2003 the laboratory was relocated to Saint Michael's Hospital.

Hunter was a founding member and chairman of the Canadian Ophthalmic Pathology Society. He was a delegate of the World Health Organization Prevention of Blindness Program, and served as director of Operation Eyesight Universal.

Hunter remained dedicated to rural Ontario and lobbied the CNIB; the Ontario Medical Association Section of Ophthalmology; the Physicians' Services Incorporated Foundation; and the Government of Ontario to help establish the Ontario Medical Mobile Eye Care Unit.[iii] The program consists of a fully equipped mobile ophthalmic facility staffed by nurses and ophthalmologists that travel to remote Ontario locations and serve 5000 residents each year. This program, known as the CNIB Eye Van, continues today[iv].

Hunter died in 2004 at the age of 74.

Eye Research Institute of Ontario

Eye Research Institute of Ontario: a Precursor to the Vision Science Research
Program[1]

In 1984, Mortimer met with two ophthalmologists, William Callahan and Lionel Chisholm, to plan the Eye Research Institute of Ontario (ERIO). Callahan secured financial support from the provincial government and ERIO was established as a private charitable organization, functioning independently from the University of Toronto, but was located on the sixth floor of the Toronto Western Hospital.

The Founding Chair of the Board of ERIC was Callahan, a position he held until ____ when Dr. Robert Mitchell took over. Mitchell stepped down in ____ and was replaced by the last Chair, Mr. Donald K. Johnson. Johnson became a major benefactor to the Toronto Western Hospital Department of Ophthalmology, which was named for him in 2010.

The founding Scientific Director of ERIC was John Stevens, Ph. D., a biophysicist and neuroscientist. Stevens started a company, Visible Genetics, which developed a desktop DNA sequencer.

Martin J Steinbach, a Ph.D. professor of psychology at York, was hired as a scientific consultant. In 1991 the organization changed their name to the Eye Research Institute of Canada (ERIC), in an attempt to improve fundraising, officially opening in 1993.[2]

The ERIC collaborated with the University of Toronto Department of Ophthalmology with the Chair of Ophthalmology holding a position on the ERIC board. In 1992 Steinbach was appointed the Director of Research at the University of Toronto and also served as Associate Director of ERIC. Under the direction of Graham Trope, the Department of Ophthalmology and the Toronto Western Hospital Ophthalmology Practice Plan.allocated funds to support scientists working at ERIC, Stevens left ERIC in 1997, leaving shares of Visible Genetics in exchange for taking the intellectual property developed while he was director. The remuneration from these shares was eventually donated to the University of Toronto.

In 1997, Steinbach was appointed Director of ERIC. In 1999, the ERIC board was unable to raise funds to maintain the private organization. Through negotiations with the University of Toronto and the Toronto Hospital, the Vision Science Research Program was formed, with the remaining assets of ERIC donated to the University of Toronto. The ERIC donation was matched by the University and the Ontario Government leading to a $17.25M endowment fund: the Ontario Student Opportunity Trust Fund. This fund continues to support graduate students pursuing vision-related research. By 2010, the fund had supported 114 students. The Vision Science Research Program has moved the department towards a multidisciplinary research model.[3]

 

Ocular Oncology Group

The Ocular Oncology Group in Toronto was started by George Thompson in the early 1970s. Upon returning from fellowship training in New York in 1976, Brenda Gallie joined Thompson and in 1985 Ernest Rand Simpson, ophthalmologist, took over from Gallie. Simpson and has remained the director of the Ocular Oncology Group in Toronto for the last 25 years. Based at the Princess Margaret Hospital, the program has become one of the top five in North America.[i] The Ocular Oncology Group services 6,000 elective outpatient visits and 1,000 in-house consultations per year.[ii]

Simpson completed his fellowship training in Boston at the Massachusetts Eye and Ear Infirmary, where he witnessed the benefits of a multidisciplinary approach to eye care, a philosophy he incorporated into the Ocular Oncology Group from the beginning.

The unique multidisciplinary team consists of ophthalmic surgical oncologists, radiation oncologists, medical oncologists and radiation physicists, along with multiple support staff. Simpson estimates that 85% of ocular oncology in Canada is managed through the departments' Ocular Oncology Group.[iii]

The Ocular Oncology Clinic is a principal site of the 43 North Americal centres participating in the Collaborative Ocular Melanoma Study, the largest multidisciplinary trail to evaluate the role of therapies in the management of primary malignant intraocular melanoma. Results from this study group have established an international standard of care for the treatment of choroidal melanomas.[iv]

 

Ultrasound Biomicroscopy

Charles J Pavlin (1944 - 2014)

Charles J Pavlin completed his medical school training at the University of Manitoba and pursued residency training at the University of Toronto, completing a fellowship in 1975. He practiced general ophthalmology at Wellesley hospital. He joined the staff of Princess Margaret hospital in the ocular oncology division. After training in New York with Jackson Coleman at Cornell University Medical Center in 1981, he took over responsibility for ultrasonic imaging in this department. A meeting with F. Stuart Foster of the department of medical biophysics led to the conception and development of a new form of ocular imaging which he named ultrasound biomicroscopy. This was the first method that allowed subsurface imaging of intraocular structures at microscopic resolution.[i]

Pavlin and Foster worked with Humphrey Instruments to develop the first commercially available instrument. Later several other companies developed instruments based on the original concepts. These instruments are being used worldwide in departments of ophthalmology and have resulted in numerous breakthroughs in understanding mechanisms of ocular disease particularly in the fields of glaucoma, trauma and intraocular lens complications. Ultrasound biomicroscopy has become an indispensible tool in the clinical management of anterior ocular tumors. Pavlin has numerous publications on ultrasound imaging of the eye and its clinical application. Current concepts of plateau iris syndrome, pigmentary glaucoma, and malignant glaucoma are based on these publications. International publications based on this technology number in the thousands. In 1994, Pavlin coauthored a book with Stuart Foster entitled "Ultrasound Biomicroscopy of the Eye."[ii] He has received the Honor Award of The American Academy of Ophthalmology and the Macdonald Prevention of Blindness Award. Pavlin is an active member of the department based at the Mount Sinai Hospital and the Princess Margaret Hospital.

 

Retinoblastoma

Brenda Gallie (1944 to present)

Brenda Gallie (1944 – present) was accepted into the University of Toronto ophthalmology residency program after a meeting with McCulloch as Chair of the Department. She completed her resident research in choroidal melanoma under the mentorship of Toronto Haematologist Michael Allen Baker (1943 – present). As a resident, Gallie admitted a patient through the Hospital for Sick Children with bilateral advanced retinoblastoma. Gallie presented the case at the departmental rounds in 1971. This life-altering experience motivated Gallie to dedicate the rest of her life to retinoblastoma management and research.[i]

Gallie went to New York to pursue immunology research in retinoblastoma at the Sloan-Kettering Cancer Centre where she successfully grew retinoblastoma cells in both tissue culture, and in an animal model via heterotransplantation into an athymic immune deficient "nude" mouse.[ii]

Gallie returned to Toronto in the 1970s with her animal and tissue models and set up her research laboratory with an EA Baker grant from the CNIB. She also worked at the Wellesley Hospital on staff as a general ophthalmologist with a focus in adult and pediatric ocular oncology. In 1979 Gallie joined the active staff in the Department of Ophthalmology at the Hospital for Sick Children and in 1985 moved her lab to SickKids to dedicate her time exclusively to retinoblastoma.[iii]

Gallie began her retinoblastoma research at a time when the field of cancer genetics was in its infancy. She focused her research on the genetics of retinoblastoma in the 1970s and 1980s. In 1971, Alfred Knudsen, a paediatrician in Houston, first described the principle of tumor suppressor genes in retinoblastoma. Children with retinoblastoma in both eyes carry a defective RB gene. Tumors form when the normal gene becomes defective in a retinal cell, resulting in tumor growth[iv]. It was known in the 1960s that the retinoblastoma gene was located on chromosome 13q. Gallie grew the tumors in tissue cultures and mice[v] and studied immune recognition of the tumors, but found none. In collaboration with Robert Phillips at Princess Margaret Hospital, Gallie showed that multiple chromosomes were altered in the tumors.[vi]

Gallie's group discovered a normal cytogenetic polymorphic difference in chromosome 13 depending on which chromosome was inherited.[vii] The polymorphic differences proved that the tumors had two defective copies of a gene on chromosome 13[viii], and further studies clarified mechanisms.[ix, x]

Gallie showed retinoblastomas rarely "spontaneously regress" in response to host mechanisms, but rather proposed that the loss of the tumor suppressor gene initiated a benign tumor (retinoma) inducing progressive changes in other genes that actually cause retinoblastomas.[xi] Years later her team proved this theory.[xii]

The retinoblastoma gene -- the first confirmed tumor suppressor gene -- was cloned in Boston in 1986.[xiii] Gallie began mutation identification in patients,[xiv] developing sensitive molecular techniques to find the novel mutation in each family. To apply this knowledge to care of families with retinoblastoma, Gallie started a not-for-profit, charity to deliver testing at cost. Gallie's lab currently does molecular testing for retinoblastoma patients and families from all over the world.[xv, xvi]

Gallie worked with oncologist Helen Chan at the Hospital for Sick Children to develop chemotherapy treatments in retinoblastoma[xvii, xviii] recognizing the risk of developing drug resistance due to the overproduction of a multi-drug resistant protein by retinoblastoma cells.[xix] During the 1980s, external beam radiation was the standard treatment for medium and large intraocular retinoblastomas, a therapy now known to promote the development of second lethal primary malignancies. In a search for alternate treatments, Gallie and Chan studied the use of chemotherapy drugs in animal models. They developed a protocol to use chemotherapy with cyclosporine, and focal treatment with laser and cryotherapy.[xx] This "Toronto Protocol" is now being evaluated in the first-ever international multicenter retinoblastoma clinical trial.

Gallie's lab continues to study retinoblastoma and the series of cancer genes that are modified as the tumor progress.[xxi] The genes discovered in retinoblastoma are proving to be important in many other cancers.[xxii, xxiii, xxiv]

Gallie has dedicated her most recent years to the creation of a unified international approach to retinoblastoma diagnosis and management[xxv]. She works with ophthalmologists and many others around the world, to achieve equal opportunities for children everywhere to evidence-based care. The multicenter network and database called One Retinoblastoma World that "seeks for every one of the 8000 children a year newly diagnosed [with retinoblastoma] to have the same level of care."[xxvi] Gallie hopes the network will not only standardize the diagnosis and care patients receive, but also help to create a framework for clinical trials in retinoblastoma.

 

Eye Injury Prevention

Thomas Joseph Pashby (1915-2005): Eye Injury Prevention 

Thomas Joseph Pashby was born in 1915 in Toronto, Ontario. He completed his medical education at the University of Toronto in the 1940s. After working as a general practitioner, Pashby underwent his ophthalmology training at the Toronto Western Hospital under the supervision of McCulloch. He worked as a comprehensive ophthalmologist performing surgeries for strabismus, nasolacrimal duct disease, cataracts and glaucoma. He worked out of the Hospital for Sick Children (HSC) in Toronto from 1948 until 1978.

Pashby dedicated much of his career to the awareness and prevention of eye injuries in sports. His initial interest arose after witnessing the blinding hockey injury Toronto Maple Leafs' star George Parsons received in 1939 that would end his NHL career. George Parsons was not wearing any eye protection. Pashby's dedication to the prevention of injuries in hockey was strengthened after his son suffered a severe concussion in 1959 while playing the sport without a helmet[i].

Pashby became chair of the Canadian Standards Association (CSA) working with the Canadian Amateur Hockey Association (CHA) to perform impact studies, test face protectors and design a protective mask. In 1965 the CAHA made the use of helmets mandatory in amateur hockey. In 1975 the CHS ruled that minor league players were mandated to wear CSA-certified helmets as a national standard. In 1979 the CSA set standards for face protection and in 1980 the CAHA mandated the use of CSA-approved face protectors[ii].

Pashby started a committee through the Canadian Ophthalmological Society in 1974 to study the incidence, types and causes of sports-related eye injuries across Canada. He canvassed ophthalmologists across the country to contribute to the data. He promoted awareness and published his updated data in many journals, including the Canadian Medical Association Journal and the Canadian Journal of Ophthalmology, over the course of the 1970s to the 2000s[iii, iv]. After the introduction of mandatory eye protection, Pashby demonstrated in his data a significant decrease in the number of hockey-related eye injuries[v]. In 1972, 287 hockey-related eye injuries were reported to occur in Canada. By 1999 this number had dropped to 13[vi].

Pashby supported the principle that professional players who learned their skills while wearing protective helmets and masks continued to wear them as adults. The use of protective helmets and eye masks is now an international standard in amateur hockey associations.

After his success in hockey safety, Pashby dedicated his life to promoting safety in all sports through the International Ergoophthalmological Society Sports Safety Committee. The Dr Tom Pashby Sports Safety Fund was established to promote the prevention of catastrophic injuries in sports and recreational activities. This fund continues to support public education, research and the development of prevention programs that promote safety in sport[vii].

Pashby received the Order of Canada for his contribution to eye injury prevention in June of 1981[viii].

Pashby retired from HSC in 1978 but continued on as the Head of Ophthalmology at the Centenary Hospital in Toronto. He retired from ophthalmology practice in 2000 at the age of 85. Throughout his career he continued to treat professional athletes in Toronto who had sustained eye injuries. He was inducted into the Canadian Sports Hall of Fame in 2000[ix]. Pashby died in 2005 in Toronto, Ontario[x].

Women in Ophthalmology

Lois Lloyd (1924-2006): Pioneering Female Ophthalmologist 

Lois Lloyd was born in Toronto in 1924 and graduated from the University of Toronto in medicine in 1949. She spent the last year of her medical school training at Johns Hopkins Hospital in Baltimore. She completed a year of neurology residency at the Toronto General Hospital and then completed her ophthalmology residency training in Toronto[i].

Lloyd completed a fellowship in neuroophthalmology in Baltimore in 1954 with Frank B Walsh (1895-1978), where she assisted him in the preparation of his monumental textbook of clinical neuroophthalmology[ii]. Lloyd then completed a RS McLaughlin Travelling Fellowship and studied neuroophthalmology with SP Meadows in London, England[iii].

Lloyd was a pioneer in Canadian and North American Ophthalmology and was the first female to receive the FRCS(C) in ophthalmology. She pioneered the inclusion of formal neuro-ophthalmology training in residency programs in Canada. She died in 2006 after a battle with Parkinson Disease[iv].

Kensington Eye Institute

The closure of three main cataract surgery sites in Toronto in the 1990s – the Wellesley Hospital, the Doctors' Hospital and Central Hospital – coupled with the downsizing of cataract surgery at the teaching hospitals, prompted a movement to create an independent academic cataract centre.

Discussions began between the University of Toronto's Department of Ophthalmology, the Toronto Academic Health Sciences Network, and Kensington Health Centre. Along with the Ontario Ministry of Health, an agreement was reached. The Kensington Foundation supplied the capital investment to establish an independent cataract centre and the Ministry agreed to fund the operating budget for a certain number of cases per year. (The Kensington Foundation was formed from the Doctors' Hospital Foundation after the closure of that hospital.)

In 2006, the Kensington Eye Institute opened with Dr. Shaun Singer as Medical Director, Dr. Jeffrey Hurwitz as Academic Director, and Kensington's Brian MacFarlane as Chief Executive Officer. The collaboration also involves the city's various teaching hospitals. It is the first off-site academic cataract surgical centre in Toronto. The Institute has helped reduce the cataract waitlist in Toronto and provides a world-class cataract surgical training facility.

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