Research has benefited me both as a scientist and as a clinician. Most researchers love learning, and research is a focused method of acquiring vertically integrated knowledge of a clinically important subject. This information helps me to under- stand the details of a particular recommendation for a medical problem and how best to treat my patient. It also enables me to understand that this recommenda- tion has no basis in scientific evidence, only on “emi- nence.” Finally, my exposure to research gives me the opportunity to mentor others and to be mentored.

MY FOCUS

Much research relates to a small facet of ocular dis- ease that is unlikely to translate into clinical care. In contrast, a clinician-scientist has the opportunity to direct his or her research toward improving care for groups of patients or individual patients. My research group focuses its efforts on health behavior as it relates to eye disease; advanced biostatistics to improve the evaluation and interpretation of ophthalmological data; clinical trials as a means of predicting individual and group responses to interventions; and the comparative effectiveness of interventions on individuals, communi- ties, and health systems.

We developed the first risk calculator for determining the probability of ocular hypertension's converting to glaucoma. These tools have helped clinicians identify those patients most likely to benefit from treatment and avoid treatment for those unlikely to develop glaucoma.1 Our work with the American Indians in the Northwest has identified the high prevalence of low-tension glauco- ma in this population,2 and it has documented a general- ly large improvement in vision-related quality of life with eyeglasses.3

In the future, we hope to develop more efficient meth- ods of performing prevalence studies. We are also interest- ed in health behavior, which is a relatively untapped topic in eye research. In other fields of medicine, health behavior research and promotion have decreased the prevalence and impact of medical disease, and they should have simi- lar results for ocular disease. We hope to investigate this potential with screening, public service announcements, and patients' adherence to glaucoma therapy.

DOWNSIDE

The role of clinician-scientist has drawbacks. Only through the support of my administration and colleagues can I dedicate a portion of my time to research. Someone else must shoulder my clinical responsibilities when I am focused on scientific investigations. I therefore must be as efficient as possible with my research time and have had to learn to say “no” to subordinate activi- ties. In addition, months of work collecting data and preparing a research proposal do not guarantee fruits from that labor.

ADVICE

My advice to those interested in a career in research is to seek out mentors. Without a doubt, mine have supported, inspired, and fostered my research and clini- cal career. I hope that my mentoring of others, now and in the future, will inspire them to include research in their careers.

Section Editor Tony Realini, MD, MPH, is an associate professor of ophthalmology at West Virginia University Eye Institute in Morgantown. Dr. Realini may be reached at (304) 598-6884; realinia@wvuh.com.

Steven L. Mansberger, MD, MPH, is an associ- ate scientist and the director of glaucoma servic- es at Devers Eye Institute in Portland, Oregon. Dr. Mansberger may be reached at (503) 413- 8202; smansberger@deverseye.org.

  1. Mansberger SL. A risk calculator to determine the probability of glaucoma. J Glaucoma. 2004;13:345-347.
  2. Mansberger SL, Romero FC, Smith NH, et al. Causes of visual impairment and common eye problems in northwest American Indians and Alaska natives. Am J Public Health. 2005;95:881-886.
  3. McClure TM, Choi D, Wooten K, et al. The impact of eyeglasses on vision-related quality of life in American Indian/Alaska natives [published online ahead of print October 16, 2010]. Am J Ophthalmol. 2011;151(1):175-182.e2.