David S Rootman

Toronto Western Hospital, Toronto, Ontario, Canada

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Publications (162)325.27 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to assess the efficacy of accelerated crosslinking (irradiance of 9 mW/cm; 10 minutes) in keratoconus-affected eyes through topographical, visual, and refractive end points.
    Cornea 06/2014; · 1.75 Impact Factor
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    ABSTRACT: To compare two lenticule insertion methods currently in use for Descemet stripping automated endothelial keratoplasty (DSAEK).
    American journal of ophthalmology. 05/2014;
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    ABSTRACT: To compare posterior corneal curvature in the fellow eye of the same patients after Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK). This retrospective, case series comparative study included consecutive patients who underwent DSAEK in one eye and DMEK in the fellow eye. Each eye underwent corneal evaluation with Pentacam HR (Oculus, Wetzlar, Germany). Postoperative corneal curvature, corneal thickness, and visual acuity were assessed. Twenty eyes of 10 patients (5 women and 5 men) aged 72.5 ± 13.5 (range, 42-87) years were included. No significant differences were observed between front flat K's (43.01 ± 1.6 vs. 43.5 ± 0.9, P = 0.27) and front steep K's (44.17 ± 1.5 vs. 44.52 ± 0.7, P = 0.39) in DMEK vs. DSAEK eyes, accordingly. Posterior curvature was statistically significantly flatter in DMEK compared with DSAEK eyes; back flat K's (-6.30 ± 0.2 vs. -6.84 ± 0.6, P = 0.012), back steep K's (-6.64 ± 0.1 vs. -7.2 ± 0.3, P = 0.03), and back Km (-6.45 ± 0.1 vs. -6.99 ± 0.4, P = 0.005), accordingly. Corneas in DMEK eyes were significantly thinner than in DSAEK eyes (541.0 ± 61 vs. 627.9 ± 70 μm, P = 0.007). Eyes that underwent DSAEK surgery have thicker corneas with steeper posterior corneal curvature than fellow eyes that underwent DMEK. This difference may explain the hyperopic shift commonly observed after DSAEK and should be considered when choosing an intraocular lens for cataract surgery.
    Cornea 04/2014; · 1.75 Impact Factor
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    ABSTRACT: To evaluate the clinical features and outcomes of patients with recurrent corneal erosion syndrome who underwent anterior stromal puncture. Retrospective, nonrandomized, consecutive case series. Database search of patients from 2003-2013 who underwent anterior stromal puncture was conducted at a tertiary care hospital cornea clinic. Charts of 30 patients (35 eyes) were reviewed. Outcome measures included demographics, laterality, history of corneal trauma, prior ocular history, frequency and duration of symptoms, failed treatments, signs on examination, degree of symptom resolution, additional treatments needed, and complications. Mean patient age at presentation was 37 (± 11.5 SD) years, 60% were male. A total of 83.3% of patients had unilateral and 16.7% had bilateral involvement. In all, 62.9% of eyes had prior history of corneal trauma and 2.9% had prior laser-assisted in situ keratomileusis. Ninety-seven percent of eyes had symptoms of pain upon awakening refractory to conservative treatment. In 97% of eyes, there were findings of microcysts, fingerprint lines, loose epithelium, and/or faint scars. Mean follow-up was 14 months (range: 3-120 months). At final follow-up, 62.9% of eyes were symptom free and 37.1% experienced milder episodes. Seventeen percent required additional treatment: 16.6% superficial keratectomy, 66% repeat anterior stromal puncture, and 16.7% phototherapeutic keratectomy. No complications were observed. Anterior stromal puncture using a short (5/8 inch) 25 gauge bent needle is a simple, safe, and cost-effective procedure for symptomatic relief in patients with recurrent corneal erosion syndrome refractive to conservative measures. Repeat treatment may be performed prior to additional surgical intervention.
    American journal of ophthalmology 02/2014; 157(2):273-279.e1. · 3.83 Impact Factor
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    ABSTRACT: Purpose To compare two lenticule insertion methods currently in use for Descemet stripping automated endothelial keratoplasty (DSAEK). Design Prospective randomized single masked study Patients and methods Twenty patients with Fuchs endothelial dystrophy and pseudophakic bullous keratopathy undergoing DSAEK surgery were included and randomized to the use of either Endoglide (AngioTech, North Yorkshire, UK) or EndoSerter (OSI , NC, USA) as a delivery method for the donor lenticule. Post-surgery, patients were monitored for up to one year. Evaluation included corrected distance visual acuity (CDVA) and refraction. Specular microscopy images were obtained at the 6 and 12-month visits. Complications, including rebubbling rate, graft dislocation and graft failure were recorded. Results Twenty eyes were randomized to receive the Tan Endoglide or the Endoserter injector for lenticule insertion. Mean patient age was 65.9 ± 8.4 years and 70.3 ± 9.8 years in the Tan Endoglide and EndoSerter groups, respectively (p=0.3). Two eyes in each group needed rebubbling. The mean endothelial cell loss, including the rebubbled eyes, at the 12 month visit was 1093 ± 629 cells/mm2 (range: 239 to 2109 cells/mm2, mean percentage cell loss 41.2%) and 877 ± 566 cells/mm2 (range: 116 to 1851 cells/mm2, mean percentage cell loss 31.4%) in the Tan Endoglide and EndoSerter groups, respectively (p=0.45). Mean CDVA did not show a statistically significant difference between the two groups at the 6 or 12 month visit. Conclusion The EndoSerter shows comparable results to the Tan Endoglide. However, further investigation is warranted in order to validate these findings.
    American Journal of Ophthalmology. 01/2014;
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    ABSTRACT: The aim of this study was to report the outcomes of corneal collagen crosslinking (CXL) after previous radial keratotomy (RK) in patients with decreasing visual acuity and/or diurnal visual fluctuations. The charts of all patients who had undergone CXL because of a worsening corrected distance visual acuity (CDVA) and/or diurnal visual fluctuations after RK were reviewed retrospectively. Uncorrected distance visual acuity, CDVA, manifest refraction, and corneal topography were recorded preoperatively and at 1, 3, 6, and 12 months after the procedure. Nine eyes of 6 patients that had undergone an RK 15 to 23 years before the CXL were included in the study. In 5 patients (8 out of 9 eyes), discontinuation of diurnal visual fluctuation was reported between 6 and 12 months after the CXL. The mean uncorrected distance visual acuities pre and 12 months after the CXL were 0.7 logarithm of the minimum angle of resolution (logMAR) and 0.6 logMAR, respectively (P = 0.3). The mean CDVAs pre and 12 months after the CXL were 0.2 logMAR and 0.1 logMAR (P = 0.5), respectively. The mean average keratometry pre and 12 months after the CXL were 40.1 and 39.1 diopters (P = 0.06), respectively. The mean corneal astigmatism values pre and 12 months after the CXL were 2.3 and 1.9 diopters (P = 0.06), respectively. The mean manifest refraction spherical equivalents (MRSEs) before and 12 months after the CXL were +1.4 and +2.5 (P = 0.1), respectively. CXL is a safe and effective method to restore corneal stability in eyes with a history of RK. However, some of the effect that was achieved at the 6-month visit was blunted at the 12-month visit. Therefore, a longer follow-up is necessary to validate these findings.
    Cornea 12/2013; · 1.75 Impact Factor
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    ABSTRACT: To compare outcomes and complications of femtosecond laser (FSL) mushroom configuration and manual trephine (MT) straight-edge configuration deep anterior lamellar keratoplasty (DALK). A cohort of 19 consecutive eyes that underwent FSL DALK was compared with 19 consecutive eyes that underwent MT DALK. Surgery was performed for eyes with keratoconus, corneal ectasia and scarring. Patient demographics, best-corrected visual acuities (BCVAs), refraction and complications were compared. Groups were comparable for age, gender and preoperative BCVA. Rates of intraoperative and postoperative complications were low and comparable between the groups. These included intraoperative Descemet's membrane (DM) perforation which did not require conversion to penetrating keratoplasty; stromal rejection successfully treated with topical steroids; postoperative DM detachment; delayed epithelial healing and increased intraocular pressure which resolved with topical anti-glaucoma drops. At 3 months, the mean BCVA was significantly better in the FSL group compared with the MT group (p=0.00002). At 6 months and 1 year, there was no significant difference between mean BCVA between the two groups. Mean spherical equivalent, cylindrical astigmatism and keratometric cylinder preoperatively and at 3, 6 and 12 months postoperatively were similar between the two groups. FSL or trephine DALK are viable options for keratoconus, ectasia and corneal scars. Earlier visual recovery occurs with FSL mushroom configuration compared with MT straight-edge DALK.
    The British journal of ophthalmology 10/2013; · 2.92 Impact Factor
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    ABSTRACT: To compare the outcomes with IntraLase-enabled keratoplasty using (IEK) Top Hat (TH) versus Zig Zag (ZZ) configuration. Retrospective comparative series of 24 eyes that underwent TH and 10 eyes that underwent ZZ IEK. There were no significant differences in LogMar Best-spectacle corrected visual acuity (TH- IEK=0.3; ZZ-IEK=0.18, p=0.18), spherical equivalent (TH-IEK=-3.55±3.7 dioptres (D); ZZ-IEK=-2.69±4.85 D, p=0.60), manifest cylinder (TH- IEK=3.79±2.43 D; ZZ- IEK=4.61±3.29 D, p=0.45), topographic astigmatism (TH-IEK=3.67±2.34 D; ZZ-IEK=4.26±1.1 D, p=0.63), total higher-order aberrations (TH- IEK=8.26±3.53; ZZ-IEK=8.1±4.71, P=0.92), endothelial cell density change from baseline (TH- IEK= -41.55%±15.86; ZZ-IEK=-25.45%±30.66, p=0.22) or time to suture removal in months (TH- IEK=7.48±4.07; ZZ- IEK=6.93±2.71, p=0.75). There was no difference in requirements for astigmatic keratectomy (TH-IEK=54.2%±13; ZZ-IEK=50%±5, OR=1.18) or complications (TH-IEK=25%±6; ZZ-IEK=30%±3, OR=0.78). TH-IEK and ZZ-IEK have comparable visual and refractive outcomes, wound healing and endothelial cell counts at 1-year.
    The British journal of ophthalmology 09/2013; · 2.92 Impact Factor
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    ABSTRACT: To describe a surgical technique to repair Boston type 1 keratoprosthesis (KPro)-related corneal melts. Technique description and review of 3 representative cases. After harvesting the buccal mucosa from the patient's inner lower lip, the exposed area of the KPro back plate is prepared for repair by adequate exposure and removal of necrotic tissue. The area is then covered with a lamellar patch of cornea secured in place with interrupted 10-0 nylon sutures, followed by a thin layer of buccal mucosa secured in place with interrupted 8-0 vicryl sutures. This technique provides surgeons with a method to repair KPro-related corneal melts when there is a conjunctival deficiency.
    Cornea 09/2013; · 1.75 Impact Factor
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    ABSTRACT: To report the outcome and the reversibility of refractive outcomes after intrastromal corneal ring segment (ICRS) explantation in patients with keratoconus treated with ICRS implantation and same-day collagen crosslinking (CXL). This is a retrospective review of ICRS explantation in 3 eyes of 3 patients with keratoconus that had undergone femtosecond laser-enabled placement of paired ICRS (Intacs) with same-day CXL by a single surgeon between 2008 and 2011. The main outcome measures included baseline/preexplantation/postexplantation visual acuity, refractive error, keratometry, and higher order aberrations. None of the patients lost best-corrected distance visual acuity lines. ICRS can be safely and easily explanted from keratoconic eyes with previous CXL. Some of the topographic benefits gained from ICRS implantation may persist after explantation. Despite the reversal of refractive outcomes, the preservation of topographic changes may occur in some cases after the explantation of 1 or both the segments in patients with keratoconus treated with ICRS implantation with same-day CXL.
    Cornea 09/2013; · 1.75 Impact Factor
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    ABSTRACT: To analyze the outcomes of cataract surgery with high-power toric intraocular lens (IOL) implantation in patients with high corneal astigmatism. Retrospective case series. Twelve eyes of 9 patients. Patients with idiopathic, pathologic, or postsurgical corneal astigmatism and a visually significant cataract were included in the study. Cataract extraction with implantation of a custom-made high-power toric IOL was performed on all patients. Outcomes included uncorrected and best corrected distance visual acuity (UDVA and BCDVA), manifest refraction, and mean and steepest keratometry. Analysis of astigmatic vectors was also performed. The mean follow-up time was 3.75 months. At the last follow-up visit, there was a significant improvement of UDVA (1 ± 0.64 vs 0.39 ± 0.21 logMAR; p < 0.05), cylindrical refraction (-4.72 ± 1.13 vs -1.81 ± 1.10 D; p < 0.01), and refractive spherical equivalent (-4.56 ± 5.58 vs -0.36 ± 1.19 D; p < 0.05). The BCDVA improvement did not reach statistical significance. Astigmatism on the target axis was reduced by an average of 5 D (p < 0.01). Cataract surgery with implantation of a high-power toric IOL was safe and effective in correcting high values of corneal astigmatism.
    Canadian Journal of Ophthalmology 08/2013; 48(4):246-50. · 1.15 Impact Factor
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    ABSTRACT: To evaluate the efficacy of single or paired intrastromal corneal ring segments (ICRS) combined with ultraviolet-A and riboflavin collagen crosslinking (CXL) in patients with keratoconus. Cornea Unit, Toronto Western Hospital, Toronto, Ontario, Canada. Retrospective comparative case series. Consecutive patients with keratoconus had femtosecond laser-assisted ICRS implantation combined with same-day CXL between 2008 and 2011. The main outcome measures included improvement in visual acuity, subjective refractive error, keratometry values, and total higher-order aberration (HOA). Eighty-five eyes of 74 patients with keratoconus (paired ICRS: 47 eyes of 40 patients; single ICRS: 38 eyes of 34 patients) were included in the study. The uncorrected distance visual acuity was significantly improved after single ICRS (3.4 lines; P=.04) and paired ICRS (2.7 lines; P=.01) implantation combined with CXL, while corrected distance visual acuity (CDVA) remained stable. The single and paired ICRS groups had a significant reduction in mean cylinder at 1 year (single ICRS: -3.84 diopters [D] ± 1.72 [SD] versus -2.19 ± 1.54 D, P=.02; paired ICRS: -3.91 ± 1.45 D versus -2.96 ± 1.92 D) (P=.02). There was no significant difference in total HOAs. Single ICRS implantation and paired ICRS implantation with CXL were equivalent in all refractive parameters. No patient lost lines of CDVA. As determined by corneal topography, implantation of single or paired ICRS combined with same-day CXL was safe and effective in patients with keratoconus. No author has a financial or proprietary interest in any material or method mentioned.
    Journal of Cataract and Refractive Surgery 06/2013; · 2.75 Impact Factor
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    ABSTRACT: To compare combined intrastromal corneal ring segment implantation with same-day ultraviolet-A/riboflavin corneal collagen cross-linking (ICRS-CXL) versus ICRS implantation alone in patients with corneal ectasia. Retrospective comparative study. Sixty-six eyes from 54 patients with corneal ectasia were included in the study. The groups were composed of 32 eyes from 27 patients and 34 eyes from 27 patients for the ICRS-CXL and ICRS groups, respectively. We reviewed the charts of all patients who underwent these procedures from November 2008 to February 2011 for preoperative and for up to 1 year postoperative uncorrected (UDVA) and best corrected distance visual acuity (BDVA), refraction, topographical analysis (mean and steepest keratometry [K]), as well as root mean-square (RMS) of higher-order aberrations (HOAs). Overall, a significant improvement was seen in both groups for UDVA, BDVA, sphere, cylinder, mean refractive spherical equivalent (MRSE), mean and steepest K, coma, spherical and total HOA at 12 months. Trefoil did not improve, and higher-order astigmatism worsened in the ICRS group (p = 0.0466). There was no statistically significant difference between the 2 groups for visual acuity, sphere, cylinder, coma, trefoil, and spherical HOA. Outcomes were significantly more improved in the ICRS group for MRSE (p = 0.0082), mean K (p = 0.0021), steepest K (p = 0.0152), and total HOAs (p = 0.0208). No complications were observed. ICRS-CXL and ICRS alone were both safe and effective in treating corneal ectasia. The ICRS alone group demonstrated better outcomes of MRSE, mean and steepest K, as well as total HOA.
    Canadian Journal of Ophthalmology 06/2013; 48(3):173-8. · 1.15 Impact Factor
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    ABSTRACT: PURPOSE: To evaluate the efficacy of phototherapeutic keratectomy (PTK) combined with implantation of a single inferior intrastromal corneal ring segment (ICRS) and riboflavin with ultraviolet-A collagen crosslinking (CXL) performed sequentially on the same day in the management of keratoconus. SETTING: Cornea Unit, Toronto Western Hospital, Toronto, Ontario, Canada. DESIGN: Case series. METHODS: This retrospective review comprised consecutive patients with progressive keratoconus having transepithelial PTK followed by femtosecond laser-enabled placement of a single inferior ICRS and CXL on the same day by the same surgeon between December 2010 and August 2011. The main outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), mean refraction spherical equivalent, keratometry (K), and total higher-order aberrations. RESULTS: Sixteen eyes of 13 patients were included in the study. Six months after same-day PTK combined with implantation of a single inferior ICRS and CXL, there was a significant improvement in UDVA, CDVA, and the mean and steep K values. No patient lost CDVA lines. CONCLUSION: Phototherapeutic keratectomy combined with implantation of a single inferior ICRS and CXL on the same day was a safe, effective treatment for improving visual acuity in select patients with progressive keratoconus. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
    Journal of Cataract and Refractive Surgery 05/2013; · 2.75 Impact Factor
  • Ophthalmology 03/2013; 120(3):647-648. · 5.56 Impact Factor
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    ABSTRACT: To evaluate the safety and efficacy of corneal ultraviolet A/riboflavin collagen cross-linking (CXL) in patients with mild-to-moderate keratoconus. Retrospective cohort study. Thirty-nine eyes from 30 patients who underwent CXL for progressive mild and moderate keratoconus were included. Clinical charts for keratoconus patients who had undergone CXL alone from November 2008 to February 2011 were reviewed for preoperative and postoperative uncorrected and best corrected distance visual acuity (UDVA and BDVA, respectively), manifest refraction, topographical and Scheimpflug imaging, as well as ultrasound pachymetry and haze. Mean and steepest keratometry, central corneal thickness, and root mean-square from corneal aberrations were extracted from the topography. Central and thinnest corneal thicknesses were extracted from the Scheimpflug imaging A significant improvement in UDVA was seen at 3, 6 and 24 months with an average change in logMAR of 0.39 (p = 0.003) at 24 months compared with baseline. Change in BDVA failed to reach significance, but subgroup analysis showed that a baseline BDVA worse than 0.1 logMAR was associated with better improvement. Stability of refraction, keratometry, and aberrations was demonstrated. Presence of haze was statistically significant up to 12 months (p≤0.001), being maximal at 3 months, then insignificant by 24 months. No complications were observed during the follow-up period. CXL is a safe and effective stabilizing strategy for progressive mild-to-moderate keratoconus with significant improvement of the UDVA. There was a trend toward improvement of BDVA in patients with lower preoperative BDVA value.
    Canadian Journal of Ophthalmology 02/2013; 48(1):63-8. · 1.15 Impact Factor
  • Ruti Sella, David Rootman, Irit Bahar
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    ABSTRACT: Descemet's stripping automated endothelial keratoplasty (DSAEK) has recently become the preferred treatment for corneal endothelial dystrophies in adults. We describe the case of an 8-month-old boy with congenital corneal epithelial edema due to posterior polymorphous corneal dystrophy who was treated successfully with bilateral DSAEK. This case shows that DSAEK is a treatment option for endothelial dysfunction secondary to posterior polymorphous corneal dystrophy even in very young patients.
    Journal of AAPOS: the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus 01/2013; · 1.07 Impact Factor
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    ABSTRACT: Corneal ectasia is a serious complication of laser in situ keratomileusis (LASIK). We report the case of a 29-year-old man who underwent LASIK in both eyes and in whom corneal ectasia developed in the left eye 3 years after surgery. He was treated sequentially with intraocular pressure-lowering medication, intrastromal corneal ring segment (ICRS) implants, and collagen cross-linking. Vision improved and the ectasia stabilized following treatment. Combined ICRS implantation and collagen cross-linking should be considered early in the management of post-LASIK ectasia.
    Digital journal of ophthalmology : DJO / sponsored by Massachusetts Eye and Ear Infirmary. 01/2013; 19(1):1-8.
  • Canadian Journal of Ophthalmology 12/2012; 47(6):e46-7. · 1.15 Impact Factor
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    ABSTRACT: To evaluate the predisposing factors, indications and coincident procedures in patients requiring a secondary intraocular lens (IOL)-related intervention. We reviewed data on 183 consecutive secondary IOL-related procedures. Information collected included demographics, predisposing factors, IOL status, indication for surgery, coincident procedures, and final IOL location and fixation method. Of the 183 procedures performed, 73 were secondary IOL implantations, 68 were IOL exchanges and 42 were IOL repositionings. Predisposing factors were found in 88.6 % of the cases, the most common being complicated cataract surgery (39.8 %) followed by trauma (20.2 %). The most common indications for surgery in the anterior chamber IOL and posterior chamber IOL groups were pseudophakic bullous keratopathy ± failed graft (77.2 %) and subluxated IOL (57.53 %), respectively. A malpositioned or subluxated lens was found in 47.86 % of all pseudophakic eyes. A simultaneous procedure was performed in 67 % of cases, anterior vitrectomy being the most common (43.7 %), followed by keratoplasty (35 %). Secondary IOL-related interventions were associated with predisposing factors, complicated cataract surgery being the most common. Patients implanted with anterior chamber IOLs seemed to have a more complicated course requiring more complex secondary surgeries and associated procedures.
    International Ophthalmology 09/2012;

Publication Stats

1k Citations
325.27 Total Impact Points

Institutions

  • 1993–2014
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 1988–2014
    • University of Toronto
      • • Department of Ophthalmology and Vision Sciences
      • • Department of Laboratory Medicine and Pathobiology
      • • Faculty of Medicine
      • • Department of Medicine
      Toronto, Ontario, Canada
  • 2013
    • McMaster University
      Hamilton, Ontario, Canada
    • Bnai Zion Medical Center, Haifa
      H̱efa, Haifa District, Israel
  • 2004–2013
    • University Health Network
      • Department of Ophthalmology
      Toronto, Ontario, Canada
  • 2009
    • Barzilai Medical Center Ashkelon
      Majdal, Southern District, Israel
  • 2008
    • Université de Montréal
      • Department of Ophthalmology
      Montréal, Quebec, Canada
  • 2002
    • SickKids
      Toronto, Ontario, Canada
    • Great Ormond Street Hospital for Children NHS Foundation Trust
      Londinium, England, United Kingdom