Once a private home in the early 1900s, the historic

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1 OPHTHALMOLOGY Once a private home in the early 1900s, the historic building situated in Toronto s prestigious downtown on Prince Arthur features an elegant, renovated facade. But it s what is inside that is truly eye-catching; amid the opulent furnishings and tasteful decor is a high-tech laser and surgical centre housing the most advanced vision-correction equipment. Toronto s Maxwell K. Bochner Eye Institute pays tribute to its namesake, one of Canada s most revered pioneer ophthalmologists, by promoting clinical excellence and providing convenient outpatient surgery and optimal levels of patient care. At the entrance of the Eye Institute s gracious old building you are greeted by a picture of Dr. Bochner. The high ceilings, stained glass windows, and oak staircases of the past remain, and modern furnishings and selected Impressionist reproductions have been added to the facility. The Legend - Dr. M.K. Bochner The Bochner Eye Institute was established and founded in 1929 by Dr. Maxwell Bochner. While Dr. Bochner was one of the earliest surgeons to specialize in diseases of the eye, he was also one of the nation s leading ophthalmologists until his death in When performing cataract surgery and diagnosing eye disorders, he was able to recognize symptoms of other serious disorders of the body by examining only the eyes. This capacity was truly revolutionary more than 50 years ago. In 1929 Dr. Maxwell K. Bochner became the first trained ophthalmologist in Canada after graduating from the University of Pennsylvania s famed Will s Eye Hospital. In the past, the specialty included eyes, ear, nose, and throat, but Dr. Bochner devoted his entire career to ophthalmology alone. In 1936 he became the first Chief of Staff at the Mount Sinai Hospital - a position he held for 40 years. At the same time, he also became the founder of the Scarborough General Hospital under the Sisters of Misercorde; he was also its Chief of Staff. He was the first physician in Canada to hold the Chief of Staff position at 2 major hospitals at the same time. His innovative thinking coupled with diligent yet gentle patient care is a legacy Dr. Bochner has passed on to the Institute s practitioners and patients. His acumen, which has been repeatedly demonstrated by pioneering techniques in vision correction and a continual investment in state of the art laser technology, is also why other physicians regularly come to the Bochner Eye Institute. In fact, they come not only to learn about new techniques and technologies, but sometimes to seek treatment for themselves. The Bochner Eye Institute: Past, Present, and Future Dr. Bochner s humility and humanity were hallmarks of a great man. He was an outstanding physician and ophthalmologist but, most of all, he was an unusual human being whose first concern was for people. Currently, two tangible expressions of the devotion and respect of his hospital colleagues are the Maxwell Kurt Bochner shelf in the Ophthalmology section of the Mount Sinai Hospital s Medical Library, and a portrait of Dr. Bochner that hangs in a place of honour in the lobbies of both the Mount Sinai Hospital and the Scarborough General Hospital. Today, the Bochner Eye Institute houses numerous programs for preventative medicine, active treatment, and research and education. In order to maintain clinical excellence in light of today s continuing technological advances, the medical directors of the institute - Dr. Harold Stein, Dr. Albert Cheskes, and Dr. Raymond Stein - offer the latest in vision enhancement, including the newly introduced state-of-the-art Allegretto 400 KHz blue line and VISX S4 with iris registration lasers, which are used to correct nearsightedness, farsightedness, and astigmatism. Dr. Harold Stein joins Dr. Bochner at the Bochner Eye Institute Dr. Harold Stein is a graduate of the University of Toronto Medical School. After completing an internship at Mount Sinai Hospital in Toronto, he received a fellowship to study ophthalmology and ophthalmic surgery at the prestigious Mayo Clinic in Rochester, Minnesota. Dr. Stein also received a Master of Science degree from the University of Minnesota, and a fellowship in the Royal College of Surgeons. Later he became qualified as a plastic surgeon after studying with worldrenowned plastic surgeon Professor Pomfret Kilner in Oxford, England. In Toronto, he began practicing with Dr. Maxwell K. Bochner, working side by side with the Bochner Eye Institute s founder for over ten years. Dr. Stein was soon recognized by the medical community for expertise in cataract surgery, corneal transplants, contact lenses, and later, refractive surgery. Over the years, he has been a major international force in contact lenses, having been one of the first to initiate and pioneer the soft aphakic contact lens in the days of intracapsular surgery. He was one of the first to introduce intraocular lenses in Canada, and they became state of the art in cataract surgery. Initially, he imported lenses from Russia and Holland until America took its lead role in implant manufacturing. Dr. Stein has served as the Chief of Ophthalmology for over 35 years at Scarborough General Hospital, Scarborough Ontario. 12 AOE Academy of Ophthalmic Education

2 Dr. Stein is credited with developing the professional role and educational format of the Ophthalmic Assistant in Canada and the United States. Recognizing a need for ancillary personnel in ophthalmology, he developed an office ophthalmic assistant s role in the early 1960s. Later, working with Centennial College in Toronto, he began the world s first Ophthalmic Assistant s education program. He also co-wrote (as senior author) the first ophthalmic assistant s textbook, now in its eighth edition. This expanded the role of the ophthalmologist in the delivery of eye care and provided a new field of endeavor for young professionals in the eye care field. Over the years, Dr. Harold Stein has been invited to speak about cataract, contact lenses, and laser eye surgery at medical meetings and conferences around the world. As a tribute to his professional status, The Harold Stein Lecture was created by three separate eye organizations in Canada and the United States. Dr. Stein s commitments extend to developing countries where he has volunteered to perform delicate eye surgery in areas where blindness is rampant. In addition, he has donated his time to teach doctors and other medical professionals in several countries about improved treatments, techniques, and technology. The Bochner Eye Institute and the role of some of its leading ophthalmologists will be explored in two subsequent publications of Eye Care Review. OPHTHALMOLOGY Corresponding author: alikhanro@rogers.com AOE Academy of Ophthalmic Education 13

3 Dr. Albert Cheskes Joins the Practice Dr. Albert Cheskes joined the Bochner Eye Institute with Dr. Harold Stein and Dr. Maxwell Bochner in While growing up in Toronto, Dr. Albert Cheskes and his family were patients of Dr. Maxwell Bochner, the founder of the Bochner practice. In fact, Dr. Bochner is credited with saving the life of Dr. Cheskes s mother when he detected a kidney problem while examining her eyes in the 1920s. Dr. Cheskes graduated from the University of Toronto, Faculty of Medicine in From 1963 to 1966 he trained as a resident in ophthalmology at the Mayo Clinic. He also received a Master of Science degree from the University of Minnesota, doing corneal research. Dr. Cheskes is a highly respected expert in cataract implant surgery, consultative ophthalmology, ophthalmic surgery, and laser refractive surgery. Throughout his career, Dr. Cheskes has been a pioneer in the field of ophthalmic surgery. He witnessed the first experiments with keratomileusis (an early form of corneal refractive surgery) in the early 1960s, and along with Drs. Harold and Raymond Stein, was one of the first surgeons in Canada to perform laser vision correction procedures. Since then he has performed many thousands of excimer laser refractive procedures. Dr. Cheskes is an assistant professor of ophthalmology at the University of Toronto and is an active staff member at St. Michael s Hospital in Toronto. He is also on the ophthalmology staff at Sunnybrook Hospital and Scarborough General Hospital. Dr. Cheskes was previously the Chief of Ophthalmology at Centenary Health Center, as well as the Chair of the Eye Safety Committee of the Canadian Ophthalmology Association for many years, acting as an advocate for public safety in ophthalmology. Dr. Cheskes, his wife, and their three children are all longtime Toronto residents and are very much involved in their communities. Dr. Raymond Stein Joins the Practice Dr. Raymond Stein began practicing at the Bochner Eye Institute in 1986, alongside Dr. Harold Stein and Dr. Albert Cheskes. Since graduating from the University of Toronto s Faculty of Medicine in 1982, Dr. Stein has distinguished himself in the highest manner both academically and professionally. Upon completing his residency in ophthalmology in 1986 at the Mayo Clinic in Rochester, Minnesota, he was chosen for a one-year fellowship in cornea & external The Bochner Eye Institute: Part II diseases at the renowned Wills Eye Hospital in Philadelphia, Pennsylvania. In 1987, he became a Fellow of the Royal College of Surgeons, Canada, and a diplomat at the American Board of Ophthalmology. Dr. Stein currently serves as Medical Director for the Bochner Eye Institute. He is also Chief of Ophthalmology at Scarborough Hospital in Toronto; Cornea Consultant at Mount Sinai Hospital in Toronto; Assistant Professor of Ophthalmology at the University of Toronto; and Past President of the Canadian Society of Cataract & Refractive Surgery. He is the editor of the scientific journal Clinical and Surgical Ophthalmology. Dr. Stein is licensed to practice ophthalmology in Ontario, New York, Arizona, and Minnesota. Dr. Stein brings his international reputation to the Bochner Eye Institute, for his pioneering work in excimer laser surgery, implant surgery, and keratoconus treatments. Dr. Stein has performed thousands of cataract & laser surgery procedures, lectured extensively to professional colleagues around the world, and has published numerous books, scientific papers, magazine articles, and book chapters on the latest techniques of vision correction. He has received awards from various international organizations including the American Academy of Ophthalmology, the International Intraocular Implant Club, and the Contact Lens Association of Ophthalmologists. He was selected by three international organizations to deliver the Harold Stein Lecture in Montreal, New Orleans, and Las Vegas. He was recently chosen as the eye surgeon for the television show, Style by Jury. Throughout his career, Dr. Stein has demonstrated a commitment to excellence in clinical research, education, and patient care. Dr. Jordan Cheskes joins the practice Dr. Jordan Cheskes, son of Dr. Albert Cheskes, joined the fold in 2001 after completing a 4-year residency at the Mayo Clinic in Rochester, Minnesota, and a retinal fellowship at the University of Toronto. Dr. Jordan Cheskes specializes in medical and surgical retina, to round out the practice. He has been active in offering the newest treatment modalities for retinal diseases. As the newest member of the team, Dr. Jordan Cheskes serves as Chief of the Retinal Division for both the Scarborough Eye Associates and the Bochner Eye Institute. He also practices at St. Michaels s Hospital and is the Chief of Ophthalmology at Centenary Hospital. Dr. Cheskes is a lecturer for the Department of Ophthalmology at the University of Toronto and is often asked to speak at professional meetings. OPHTHALMOLOGY AOE Academy of Ophthalmic Education 17

4 OPHTHALMOLOGY From left to right: Dr. Harold Stein, Dr.Albert Cheskes and Dr. Raymond Stein. Vision for the Future Dr. Harold Stein, Dr. Albert Cheskes, Dr. Raymond Stein, and Dr. Jordan Cheskes all attended medical school in Toronto and continued on at the Mayo Clinic, from which they all graduated. All four men now hold faculty positions at the University of Toronto. Combined, they have over 100 years of experience practicing ophthalmology. All four physicians of the Bochner Eye Institute are involved in writing and research, and give lectures on ophthalmic conditions worldwide. They have authored and co-authored over 35 textbooks in ophthalmology. The physicians have also presided over a number of professional ophthalmological organizations throughout their careers and are regularly called on to give seminars at clinics and conferences around the globe. They have made extensive academic contributions to leading medical journals and have contributed to or written textbooks that are used worldwide in several languages. Active hospital appointments among the group include Mount Sinai Hospital, Scarborough Hospital, Centenary Hospital, and Sunnybrook Hospital. Patients of the Bochner Eye Institute come from a wide geographic area, and span all ages, ethnicities, and economic backgrounds. The Institute is unique in that it also features a licensed surgical facility funded by the Government of Ontario. It has sterile operating rooms and a viewing area for visiting physicians, ophthalmologists, students, patients, relatives, and prospective patients, where they may watch procedures such as cataracts and laser surgery. This was the first licensed surgi-centre in Ontario. Visiting foreign doctors, medical students, optometry students, and high school students are welcomed on a daily basis as observers. Since 1991, The Bochner Eye Institute has been on the cutting edge of excimer laser correction for myopia and astigmatism. Its physicians were trained by Dr. Stephen Trokel - the inventor of the excimer laser - in 1991, and the laser s use remains one of the pioneering central activities of the Bochner Eye Institute. (The laser was only approved in 1991 in Canada and in late 1995 in the United States.) In addition to mastering the newest laser procedures available, the Institute s ophthalmologists are eagerly developing vision correction techniques for the future. New instrumentation is constantly being added to cataract surgery, plastic surgery, and laser surgery; research is ongoing. At the time of this writing, the Bochner Eye Institute was the first and only centre in Canada to offer a new treatment called corneal collagen cross-linking with riboflavin (C3R) to prevent disease progression of keratoconus. The treatment involves the use of riboflavin drops and ultraviolet light to enhance the strength of the cornea. This innovative treatment can also be offered to radial keratotomy patients to reduce fluctuation in their vision as well as the hyperopic shift over time. Other treatment modalities for keratoconus are offered at the Institute, including intracorneal rings, phakic implants, and topographically-linked laser ablations. The goal of these new advances is to improve upon the Institute s already stellar record of patient success. The Bochner Eye Institute has become one of the most modern, sophisticated, and patient-oriented eye care centres in the eye care world. Corresponding author: alikhanro@rogers.com 18 AOE Academy of Ophthalmic Education

5 Dr. Harold Stein During their ophthalmology training at the prestigious Mayo Clinic and the University of Toronto, 4 doctors (H. Stein, A. Cheskes, R. Stein, J. Cheskes) learned the importance of valuing teamwork, respecting their patients, and the beneficial role of continuing medical education. The Bochner Eye Institute in Toronto is based on these ideals, which were an integral part of Dr. Bochner s vision for the institute. The fact that two father and son teams work there together, make its legacy unique; all four still teach at the University of Toronto. The doctors agree that their greatest commendation comes from other doctors all over the world, who refer their family members and patients to the Institute, and who come to study and observe the team s surgical techniques. The doctors are all active and contributing members in their own communities and in communities around the world. They have each traveled to developing countries to provide clinical and surgical skills to impoverished people, performing procedures that improve lives Dr. Albert Cheskes dramatically. Phacoemulsification machines and hand-pieces have also been donated to surgeons in Nicaragua, Greneda, and Nigeria in the name of the institute. The Bochner Eye Institute is a patient-friendly venue. Through the work of its ophthalmologists and staff, the institute has helped people pursue careers in policing, firefighting, the military, and countless other professions that are sight-dependent. To date, over 300 eye-doctors and over 100,000 patients have chosen The Bochner Eye Institute for their laser surgery. In fact, patients from over 40 countries have traveled to the institute for surgery. Despite their busy practices, the surgeons continue to write scientific papers and lecture to the international ophthalmic community. Each has also provided professional leadership as the president or chair of numerous societies and committees in Canada and internationally. What makes the Bochner Eye Dr. Raymond Stein Institute so noteworthy? Quite simply, its incredible surgeons and its staff, who all have a tremendous commitment to the Bochner tradition of group medical practice. Their ORIGINAL PAPER The Bochner Eye Institute: Part III relentless pursuit of an effective treatment plan for every patient makes Bochner one of the most trusted medical and surgical centres in Canada. Below is a timeline of the Bochner Eye Institute: 1929 Dr. Maxwell Bochner became the first trained ophthalmologist in Canada after graduating from the University of Pennsylvania. At that time, the specialty included eyes, ears, nose, and throat Dr. Bochner became Chief of Staff at Mount Sinai Hospital, a position he retained for 40 years Dr. Bochner became the founder of Scarborough General Hospital and its Chief of Staff. He was the first and only physician in Canada to act as Chief of Staff at two major hospitals Dr. Harold Stein graduated from the prestigious Mayo Clinic with a Master s degree and completed a fellowship in Oxford, England Dr. Albert Cheskes graduated from the Mayo Clinic with a Master s degree in clinical research Dr. Bochner was honored by the Mayor of Toronto for his academic, humanitarian, and community achievements The first Ophthalmic Assistants textbook was published. Eight further editions would be written and distributed worldwide Dr. Raymond Stein, the grandson of Dr. Bochner, graduated from the Mayo Clinic and then completed a cornea fellowship at the Will s Eye Hospital in Philadelphia Dr. Harold Stein became the President of the Canadian Society of Ophthalmologists Dr. Albert Cheskes became Chairman of the Eye Safety Committee of the Canadian Society of Ophthalmologists. The Society recognized his efforts in the prevention of sports-related injuries The Government of Ontario and the College of Physicians and Surgeons designated the Bochner Eye Institute the first and only approved Cataract Surgical Centre outside a hospital in Ontario One of the first Laser Vision Correction Centre s in North America was opened - the Bochner Eye Institute - and its doctors were trained by Dr. Steven Trokel, the inventor of the excimer laser. OPHTHALMOLOGY AOE Academy of Ophthalmic Education 7

6 OPHTHALMOLOGY 1993 Institute surgeons wrote the first clinical textbook on Laser Vision Correction for training ophthalmologists. The book was sold in North America and internationally; a second edition was subsequently written. Courses were held at the Bochner Eye Institute for the next 13 years, teaching visiting surgeons the latest innovative and proven techniques Institute surgeons wrote Laser Vision Correction: A New Age, which was launched at Indigo in Toronto The first phakic implant procedure in Ontario was performed at the institute, for extreme glass prescriptions that are not correctable with laser vision correction The institute became the first centre in Canada to insert intra-corneal rings to flatten the cornea and correct nearsightedness. Dr. Raymond Stein was interviewed on national television programs including, Canada AM, to discuss this innovative procedure The institute was the winner of the Consumer Choice Award for the Top Laser Centre in Toronto (9 consecutive years). The institute was designated the Official Laser Centre for the Toronto Maple Leafs and Raptors, a position the Bochner Institute retains to this date Dr. Jordan Cheskes joined the practice after completing a residency at the Mayo Clinic and then a retinal and vitreous fellowship The institute acquired the VISX S4 Excimer laser from California for custom ablations The institute then acquired the Allegretto Wave excimer laser from Germany for wavefront and topography-linked laser ablations Dr. Raymond Stein became the President of the Canadian Society of Cataract & Refractive Surgery. Canada s first Restor multifocal implant following cataract surgery was inserted at the institute; it provided both distance and near vision The Bochner Eye Institute was designated the official laser and eye centre for the Toronto Blue Jays A new surgical technique was pioneered by Bochner surgeons- the Epi-LASIK without an epithelial flap. Earlier techniques developed at the institute include epithelial removal techniques, bitoric ablations for mixed astigmatism, and the Stein implant. ORIGINAL PAPER 2006 The institute made news with the first 60 KHz Intralase in Canada for the creation of bladeless LASIK flaps A medical mission to Nicaragua was conducted to train local ophthalmologists and donate surgical equipment. It was the latest mission in a series of expeditions by Bochner surgeons over 30 years. Peru, Haiti, Malta, Cyprus, Pakistan, as well as several African countries have also benefited from medical expeditions by the Bochner Institute The 4th edition of the textbook, Ocular Emergencies was published. It was the 35th book written by Bochner Institute surgeons, the largest number of academic books written by a private institute in North America The Bochner Eye Institute became the Official Laser Centre for the Toronto FC Soccer Team. To date, over 300 eye doctors and 100,000 patients have chosen the Bochner Eye Institute for their laser surgery. Patients have traveled from over 40 countries to undergo surgery at the institute. The institute was the first in Canada to implant the Tetraflex accommodative implant which provides both distance and near vision. The institute acquired the Allegretto 400 KHz blue-line laser, one of the fastest and most accurate lasers in the world The institute was the first in Canada to introduce Corneal Collagen Cross-Linking to arrest the progression of Keratoconus. The institute published a book on Laser Vision Correction (2nd Edition) to educate consumers. The Bochner Eye Institute celebrated its 80 th anniversary. We hope you enjoyed this brief series on the history of the Bochner Eye Institute, and we welcome your feedback, including personal accounts of your experience with the institute, or its ophthalmologists. Corresponding author: alikhanro@rogers.com 8 AOE Academy of Ophthalmic Education