• Marvin L. Sears Professor and Chairman, Department of Ophthalmology and Visual Sciences, Yale University School of Medicine
• Chief of Ophthalmology, Yale New Haven Hospital, New Haven, Connecticut
• Past President of the American Glaucoma Society, 1995 to 1996
• Former Chairman of the National Glaucoma Committee, National Society to Prevent Blindness, 1985 to 1991
• Author of Textbook of Glaucoma and Coeditor of The Glaucomas
• Recipient of the AAO's Senior Honor Award, 1995
As a surgeon, do you have any heroes or role models?
I have been fortunate to have many role models in ophthalmology. In fact, one of the joys of our profession is the wonderful people that we are lucky enough to call our colleagues and friends. If I were to try to list all my heroes, I would undoubtedly run the risk of leaving someone out. I will therefore limit my answer to the person who has been a role model for so many of us in glaucoma: W. Morton Grant, MD.
Dr. Grant was the type of physician whom we all should aspire to emulate. He was at the top of his profession with regard to knowledge and scholarly contributions, and yet one of his most striking characteristics was his humility. He never tried to promote himself but was instead only concerned about scientific truth, the welfare of his patients, and the education and success of his students. Those of us who studied under him know that we were truly in the presence of one of the giants of our profession and that we are blessed to have had such a privilege.
What prompted you to author the Textbook of Glaucoma, and what effect do you feel the book has had?
The book began as a series of outlines for lectures I delivered to the residents at Duke University in Durham, North Carolina, just after I returned from my fellowship with Dr. Grant at the Massachusetts Eye and Ear Infirmary in Boston. After the series was complete, I bound the lectures for the residents, who kindly suggested that they might be worth publishing. The first edition was intended as an outline to help other ophthalmology residents and was entitled Study Guide for Glaucoma. No one was more surprised than I when the book was accepted so warmly. The subsequent editions have been called Textbook of Glaucoma and more closely adhere to the format of a textbook.
I will always be grateful to those early residents and to the many thoughtful people whose kind words about the book encouraged me to see it through to a fourth edition. Some of my colleagues and former fellows are currently preparing the fifth edition.
I am unsure what effect the book has had on its readers. For me, it has been an unexpected and highly rewarding part of my professional career. I can only hope that the book has helped others in their learning and practice of glaucoma and that it has ultimately assisted them in preventing the blindness caused by glaucoma.
What led you to choose glaucoma as a subspecialty?
As a resident, glaucoma always interested me, but the truth is that I planned to specialize in the retina. The chairman of our department at Duke, Joseph Wadsworth, MD, knew of my interest in academics and asked if I would like to remain on the faculty with him. The only problem was that they had a retinal surgeon and needed someone in either pediatric ophthalmology or glaucoma. The former did not seem right for me, but I thought the latter would be interesting. As a result, Dr Wadsworth arranged my fellowship with Dr Grant. I have always considered that turn of events to be one of the luckiest things that ever happened to me, and it has made me a firm believer in the power of providence.
How have your numerous visiting professorships broadened your view of the field of glaucoma?
Of the various types of speaking engagements in which we in academic medicine are privileged to participate, I believe that the visiting professorship format is my favorite, because it gives me the opportunity to work with and learn from a department's residents and their mentors.
These experiences have not only taught me about glaucoma (I always seem to learn more than I teach), but they have broadened my circle of friends with each new visit. Most of all, however, these professorships have shown me what an incredibly bright and dedicated group of people we have in the field of glaucoma, and they have assured me that the future of our profession (as evidenced by the younger generation assuming the responsibility of our subspecialty) has great promise.
What is the current focus of your own research, and what do you believe are the most promising developments in the field of glaucoma?
After assuming the responsibility of chair at Yale University in New Haven, Connecticut, I had to curtail my own research efforts. What little I do now continues to focus on the many puzzling clinical questions in glaucoma. I have had the joy of seeking these answers with some wonderful Yale medical students as part of their thesis requirements, as well as with our residents, our fellows, and my colleagues on the Yale faculty. Together, we are looking at new screening approaches for glaucoma, glaucoma drug interactions, the improvement in visual fields after IOP reduction by filtering surgery, and both modified and new approaches to glaucoma surgery.
The main advances that I have seen during my career are the application of laser technology in numerous surgical procedures and the use of computer technology in our diagnostic procedures. Additionally, improvements in glaucoma pharmacology during the last third of the 20th Century have given us far better options for the medical management of our patients than existed when I started out.
Also important is our better understanding of the complex process of glaucomatous optic neuropathy and its principal role in the glaucomas. The possibility that we may soon be able to add pressure-independent neuroprotective agents to our medical armamentarium is exciting. I personally believe, however, that medically and surgically controlling the IOP will remain the mainstays of glaucoma treatment. For that reason, I believe we need to continue looking for better pressure-lowering drugs and, especially, superior surgical approaches for treating glaucoma.
Ultimately (probably far into the 21st Century), our knowledge of the molecular genetic and biological basis of the glaucomas will totally revolutionize our understanding of the glaucomas and the way in which we prevent the blindness resulting from this large group of disorders.
