BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY EDMUND G. BROWN JR., GOVERNOR

Continuing Education Course Approval Checklist

Title: Identifying Retinal Findings

Provider Name: Carey Vision Medical Group c/o Dr. Erin Lally, MD

☒Completed Application Tentative course date (Mid Oct – Early Nov) Open to all optometrists? ☒Yes ☐No Maintain record agreement? ☒Yes ☐No

☒Detailed Course Description ☒PowerPoint and/or other presentation materials ☐Advertising (optional) ☒CV for EACH course instructor ☒License Verification for each course instructor

Disciplinary History? ☐Yes ☒No

PAGE 01/01 08/24/2015 14:51 4082934872

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\-~______::___------~----:-lk\\e----:-~-~:---=--\v"\,~{,u-------r BUSINESS, CONSUM~R S5RV1Ces, AND HOUSING AGENCY GOVERNOR EDMUND 0 BROWN JI'{.

___" {{I\\\_______STATE-BOAR.O-O~OP-TOME-TR¥ _ __________ -- . -------__-_-,-+I_J__~----- ~----- -- --- -- -- ---vmoDE[-PASOROA0~-SD1TE-f05,-$ACRAM-ENTO, CA 95834\ ·-. _..· 0 PlTOMETR.y P (916) 575-7170 F (916) 575-729~ www.aotometrv,G11sox

CONTINUING EDUCAilON cou_ .R=S--=E..-:._A:=_P:___P::_::_RO-=-V_:_::_A-=L=-----------4 ----APPtlCA.TION­1 ~-----------------------r---------------,j;

Pursuant to Callfomia Code of Regulation$ (CCR) § 1536, the Board will approve continuing education (CE) courses after I

receiving the applicable fee, the requested information below ahd It has been determined that the course meets criteria I• I,'

I specified In CCR § 1536(g). fl

In addltron to the information requested below, please attach a \~opy of the course schedule, a detailed course outline and I H

i presentatron materials (e.g., PowerPoJnt presentation). AppliGc)~lons must be submitted 45 days prior to the course presentation date. I] ~ ~ Please tiE1e or erint clearll, · I!

J r•"'• Title [I Prosontattoo Dale ~). i-: Tentatively Planned for Mid Oct-Early Nov.

I \u.~h\ \Y\~ ~~"' f\v\o\'n~ - ITI lliJ/uJ liJ/@J [QJ m~ i I __.­Course Provider ContaetJnformation

Provider Name \

I Erin Lally 8. (First) (La~t) {Mlddte)

Provider Malling Address I I IStreat 2110 Forest Ave, Ste B City San Jose 11 State CA Zip 95121

II

Provider Email Addre!lls Jenny@careyvision \I -!1

Will the proposed course be open to all California licensed ~ptometrists? 'V{ES ONO

Ii Do you agree to maintain and furnish to the Board a~d/or a~~nding licensee such records of course cont~nt and attendance as the Board requires, fo'I~ period of at feast three years dvEs ONO from the date of oourse prasentatlon? i\

' Course Instructor )nfonnation

Plea$e provide the lnforrnatlon below and attach the curriculum vitae for~ instructor or lecturer involved in the course If there are more instructors in the course, please provide the rec Ue$ted Information on a separate sheet of caper. Instructor Name '

' Erin Lally B.

(First) (Last) I\ (Middle)

I· MDLicen$& Number A143148 Lie• ;nse Type ! I I

!295-3433Phone Number~ Emr\11 Address

I cJ_ectare under penalty ofperjury under the laws of the ~t~teJ~f California that all the information submitted on t})Js_!!,rm and on any accompanying attachments submitted 'Fi true and correct.

~~~~ ~ \\! ~~~~_..;;;.,,,.'q__ S/gntJ.ture ofCounwP~er : &ts

! Fann CE-01, Rev. 5/16i i

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-- - - -------------- --- ----- - --------

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Cashiering and Board Use Only Receipt# Payor ID . Beneficiary ID Amount

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:/ 77 t/idl:ll Diiti!JrdJi . t'BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY

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PursuanttoCalifornra Coae of Regulations (CCR) § 1536, tne Boara will approve continuing eaucation (CE) courses after receiving the applicable fee, the requested information below and it has been determined that the course meets criteria specified in CCR § 1536(g).

In addition to the information requested below, please attach a copy of the course schedule, a detailed course outline and presentation materials (e.g., PowerPoint presentation). Applications must be submitted 45 days prior to the course presentation date. Please type or print clearly. Course Title Course Presentation Date

Tentatively Planned for Mid Oct-Early Nov.

DD/DD/DODD Course Provider Contact Information

Provider Name

Erin (First)

Provider Mailing Address

Lally (Last)

B. (Middle)

Street 2110 Forest Ave, Ste B City San Jose State CA Zip 95121

Provider Email Address jenny@careyvision

Will the proposed course be open to all California licensed optometrists? ¢,rES ONO

Do you agree to maintain and furnish to the Board and/or attending licensee such records of course content and attendance as the Board requires, for a period of at least three years ES ONO from the date of course presentation?

Course Instructor Information Please provide the information below and attach the curriculum vitae for each instructor or lecturer involved in the course. ..If h t ere are more instructors rn t e course, p ease prov, e t e reques e h I 'd h t d .rnforma ,on on a separa e s eet o f t h f paper. Instructor Name

Erin Lally B.

(First) (Last) (Middle)

MD: License Number A143148 License Type

'Phone Number 295-3433 Email Address 'D\e{;e. (A COYa.l\K \00 · --,

_-1 declare under penalty of perjury under the laws of the State of California that all the information submitted on C: s!!!rm and on any accompanying attachments submitted is true and correct.

. Signature of Course Proer Date&-- KJS"

2

Form CE-01, Rev. 5/16

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------------------------ -- ------------ ------- ------- ---------- ----------- ----- - -- - ----- ------ ----- ------ ---------------------------- --------------------- ---------- --- - - ' - - /

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_na_ _l _-at_n_o_Tog- _ y----;- - -iin__agin_g__pmodalities, treatment options and indications for referral for retinal disease frequently encountered in an outpatient setting. Highlighted topics will include

--+--------b=oth dry and rLeoxasculaLmacular degeneration, diabetic retinopathy amLdiabetic - - - - -----+--- - - - - - --maGular-edema,Fetinal-vei-n-eGGlu-sien-and-d-Fug-a-nd-metabeliG-texfoity. -----------

Outline: •­ Dry AMD

o o o

•­ WetAMD o o o

OCT findings AREDS indications Reticular drusen

FA/ICG findings Treatment options Cases

• Diabetes and diabetic macular edema o Mild/Moderate/Severe o NPDR vs PDR o When to refer o Treatment options o F ocal vs diffuse Diabetic macular edema

• Retinal vein occlusion-o Risk factors o FA findings o Treatment options

• Plaquenil Toxicity o How to screen o Appropriate doses o Cases o Treatment

• Metabolic toxicity o What to look for o What to do

• "Stump the Chump" o Case presentation/series of diagnostic dilemmas and difficult cases

3

vitamins

Early Dry AMD Medium drusen without RPE ?Amsler, Annual

changes no AREDS

vitamins

Intermediate Dry Any of: Amsler, 3-6

AMD Medium drusen + RPE changes AREDS vitamins months

Large drusen

Non-central GA

Advanced AM D Central GA Depends

NVAMD

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!?rin B. Lally, MD 2530 Erwin Road Apartment 415 Durham NC, 27705 (724) 989-2541

- -·- --- _ eblally@gmaihcom_ r

EDUCATION

Fellowship, Durham NC Duke Eye Center

-f - -

Medical Retina

Residency, Philadelphia PA Wills Eye Institute Ophthalmology

Internship, Philadelphia PA Albert Einstein Medical Center Transition Year, Internal Medicine

Jefferson Medical College, Philadelphia, PA Doctor of Medicine

Georgetown University, Washington DC Bachelor of Arts in French, C-0ncentration in Pre-Medicine Minor in Theology

EXAMINATIONS

Board Eligible 2017

USMLE Step l, passed USMLE Step 2 CS, passed USMLE Step 2 CK, passed USMLE S'tep 3, passed

AWARDS AND HONORS

Clinical Years: Highest Honors in OBGYN Highest Honors in Psychiatry Excellent in Internal Medicine Highest Honors in Anesthesiology Highest Honors in Ophthalmology Excellent in Family Medicine Excellent in Pediatrics Highest Honors in Ocular Pathology

.. Highest Honors in Clinical Ophthalmology atTemp_le University

Undergraduate: Magna Cum Laude, Georgetown University Cumulative GPA 3.72. Honors /Dean's List every semester

2015-2016

2012- 2015

2011 - 2012

2007 - 2011

2003 - 2007

June 2009 June 2010 July 2010 April 2012

2009

2009

2009

2010

2010

2010

2010

2010

2010

2003-2007

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RESEARCH EXPERIENCE AND PUBLICATIONS j ' '

Duke University Eye Center, Durham, NC 2016 Poster presentation

- - lh=·ngham M, Mukherjee D, Lally EB. A quantitative a,0Jroach to predict differential effects of anti-VEGF treatmentonc:liffuse anci-focaneakage in parients witndia:b-ettc-macular--eaema--:-Postenession-presented-at:-- -- -

-1- - --'A'-==

The Assoc_iation for Research in Vision and Ophthalmology. 2016 May 1-5. Seattle, WA.

Duke University Eye Center, Durham, NC 2015- 2016 -,ev-;;;,nv-estigato--- - --- - -- - -- - --- ­-j ---- - r - - -- - - -- - - - -- - -­

Spectralaomain-optical coherence tomographyangiography of retinat -diserues--- - ­Working with Principal Investigator Priyatham S. Mettu MD to use a new algorithm on the OptoVue OCT-Angiography device to visualize retinal vascularization and identify vascularization subtypes in Age-Related Macular Degeneration.

Duke University Eye Center, Durham, NC 2015-2016 Co-investigator Pilot study of safety of flucinolone acetonide intravitreal insert (FA-i) for the treatment of uveitis affecting the posterior segment Working with Principal Investigator Glenn K. Jaffe, MD to determine tolerability, safety, and benefirs of the extedned-release flucinolone acetonide intravitreal insert in people who have non-infectious intermediate, pos"tefror, or pan-uveitis.

Wills Eye Institute, Philadelphia, PA 2014 Author Lally EB, Murchinson AP, Moster ML, Bilyk JR. Compressive Optic Neuropathy From Neurosarcoidosis. Ophthal Plast Reconstr Surg. 2014 Nov 25.

Wills Eye Institute, Philadelphia, PA 2014 Author Lally EB, Shields CL. Fundus autofluorescence of congenital hypertrophy of the retinal pigment epithelium. In: Lois N, Forrester J, eds, Fundus Autofluorescence, edition 2. Philadelphia: Lippincott Williams Wilkins, 2015.

Wills Eye Institute, Philadelphia, PA 2014 Author Shields CL, Arepalli S, Lally EB, Lally SE, Shields JA. Iris Stromal Cyst Management With Absolute Alcohol-Induced Sclerosis in 16 Patients. JAMA Ophthalmol. 2014 Jun 1;132(6):703-8.

.. .

Wills Eye Institute, Philadelphia, PA 2010 Research Assistant, Glaucoma Service Working under Dr. George Spaeth to test a new method of determining contrast sensitivity that does not require letter recognition. By eliminating the confounders of literacy and pattern recognition, the study seeks to establish a more valid determination of contrast sensitivity.

Wills Eye Institute, Philadelphia, PA 2010 Author

-:tally-EB, -Kligman-BE;-Shields e:c-. ·eavitary Retinoblastoma: A low-grade variant-of-retinoblastoma with anticipated minimal response to therapy. Submitted to the Journal of American Association for Pediatric Ophthalmology and Strabismus. Project pending publication.

Wills Eye Institute, Philadelphia, PA 2010 Author Lally EB, Shields CL. Conjunctiva! Nevi Clinical Features and Therapeutic Outcomes. Evidence-Based Ophthalmology. 11(3):160-161, July 2010.

Wills Eye Institute, Philadelphia, PA 2010

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Author Shields CL, Lally EB. Discussion of: A 30-month prospective study on the treatment of retinoblastoma in the Gabriel Toure Teaching Hospital, Bamako, Mali. Br J Ophthalmol. 2009:94:467-9. Evidence-Based Ophthalmology 2010; in press.

Wills Eye Institute, Philadelphia, PA 2009-2010 Research Assistant, Wills Emergency Room ·Participated in retrospective study detailing admissions to the Wills Emergency Room over a one-year

-;- - - perio- -charr-analysis-for-over8;800-patients.:;---- - - -- -- - - -- -- -d:-Proje1;rinclmles - - - - -

Wills Eye Institute, Philadelphia, PA 2009-2010 Author Lally SE, Lally EB, Shields CL, Shields JA. Postpartum Conjunctiva! Hemorrhage as the Initial Manifestation of Orbital Lymphangioma. Project pending publication.

Wills Eye Institute, Philadelphia, PA 2008 Research Assistant, Ocular Oncology Service Clinical research project with Dr. Bianciotto and Dr. Carol Shields comparing effectiveness between Ultrasound Biomicroscopy and Anterior Chamber Optical Coherence Tomography in the detection of ocular pathology of the anterior chamber. Project pending publication.

Wills Eye Institute, Philadelphia, PA 2008 Research Assistant, Ocular Oncology Service PresentatioJ;}. at the Grand Rounds Tumor Clinic on the clinical presentations of Optic Nerve Coloboma and Morning Glory Syndrome.

VOLUNTEER AND LEADERSHIP EXPERIENCE

Qbank Co-founder and board member 2013-present Created and developed an on-:line question bank for OKAP study review. Database contains over 2,000 questions written by Wills Eye faculty, alumni and current residents. Online release pending.

Wills Eye Gives Kids Sight Day, Philadelphia, PA 2009- present Volunteer Participated in a citywide event that provided vision screening, eyeglasses and full ophthalmic examinations for children of all ages at no cost.

Jefferson Sports Medicine Society, Philadelphia, PA 2008-2009 co:.President Organized physician-run talks and clinics that focused on topics of Sports Medicine. Participated in community service events to benefit Philadelphia elementary and high school children.

JeftllOPE (Health, Opportunity, Prevention and Education), Philadelphia, PA 2007 - 2011 Volunteer Voiiinteerat astuoent.:.run ·organization that provides medicakareto Philadelphia's homeless population.

Dr., Jacob DaCosta Learning Society, Philadelphia, PA 2007 - 2011 Society Member Participated in community service events and mentored high school students interested in the medical profession.

PERSONAL AND OTHER INTERESTS

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,-' ' - ,,, ·,., Rock and Ice Climbing 1997-present StJmmited Mount Everest, May 2011. Climbed to Camp II on south side of Mount Everest (22,000') in 2007. Climbed eight, 18,000 to 20,000 peaks in the ·Bolivian A ndes over a 10-day period in 2007. Summitted Mount Blanc, The Matterhorn and numerous peaks in the French and==S wiss A l in 2006.ps== = =Ascencleclmoretlian 20 ofColoraclo's 1'4 000' peaks.

Running 1999-present Completed the 2009 Chicago Marathon, 2012 Philadelphia Marathon, 2013 Philadelphia Marathon and

-1- - -1mmerou-s1ralf:ma:ratlrons.

Paragliding 2002-present Piloted over 600 solo flights throughout the-United States, Mexico and Europe.

Other personal interests include skiing, traveling, and cooking.

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