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Hindsight shows department’s founders had vision: USC ophthalmology celebrates its 25th anniversary

Shown above in a photo from the mid-1970s, Stephen J. Ryan (right), the first faculty member of the USC Department of Ophthalmology, and a medical resident examine a patient.

USC’s Department of Ophthalmology was born into modest circumstances, staffed by three physicians who, for a variety of reasons, decided to go into debt to finance their fledgling dream.

Now, as it celebrates its 25th anniversary, the department is recognized as one of the finest in the country, carving new paths in eye disease and injuries, optic nerve disorders and corneal surgery.

But Ronald E. Smith, the depart-ment’s chair and one of its founding members, spends little time dwelling on past successes and growth.

“I think we’ve accomplished a lot, but the most exciting time for me is the future,” said Smith, sitting behind a desk awash in papers in his office on the fifth floor of the Doheny Eye Institute.

Stephen J. Ryan, now dean of the School of Medicine, was the ophthalmology department’s first full-time faculty member, arriving from Johns Hopkins in 1974 with the goal of establishing a world-class eye institute. A year later he recruited Smith and Mike Allen, who now practices in San Francisco.

When Ryan arrived, USC ophthalmology services were provided exclusively at LAC+USC Medical Center.

Ryan said he was amazed that LAC+USC eye clinic physicians had only two slit lamps – the most important and standard instrument for evaluating most eye problems and diseases. This was less than 10 percent of what was required, and neither slit lamp worked reliably, Ryan said.

Sol Bernstein, then chief of staff at the LAC+USC Medical Center, worked tirelessly with the county to correct the problems and provide the necessary ophthalmology equipment in the outpatient department, Ryan recalled.

The public care at LAC+USC Medical Center was only part of the equation.

Ryan, Smith and Allen needed money to buy equipment and malpractice insurance to set up the first private practice on the USC Health Sciences Campus. But no money was available from the university, medical school or eye institute for two main reasons: Conventional wisdom held that academic medicine such as an ophthalmology private practice could not survive in East Los Angeles. And in 1975 soaring malpractice insurance costs had spawned a crisis atmosphere throughout Southern California. Many L.A. physicians wondered if a future existed for private practice.

The only choice for the three physicians was to leave USC and pursue their dreams at another university – or to go deeply into personal debt.

So the three doctors and their wives put up their homes as collateral and secured a $250,000 loan from a commercial bank. Without any institutional support, the personal financial risk undertaken by the three physicians was critical to the success of the university’s first private practice.

The department’s original home, the current Doheny Vision Research Center, was built with $6 million from the Carrie Estelle Doheny Foundation and opened in 1975.

Today, surveys regularly rank the ophthalmology department among the country’s top 10. Its annual research budget alone, which comes from private and federal grants, is about $6 million.

Clinical work and surgeries are done at the Doheny Eye Institute, which also houses the department’s administrative offices and the editorial offices of the Journal of Ophthalmology, the field’s preeminent peer-review publication. The journal’s editor-in-chief is Don Minckler, professor of ophthalmology.

Scientists are developing new medicines, therapies and treatments in the department’s research laboratories in the Doheny Vision Research Center. Satellite clinics in Arcadia, Riverside, Palms Springs, Orange and Westlake Village make it easier for people in outlying areas to benefit from the department’s physicians and technology.

The work of its 23 full-time doctors is complemented by 65 volunteer faculty, eight post-resident fellows, 28 international research fellows and 15 residents.

Residency positions are highly coveted, with roughly 300 medical students applying for five positions each year, Smith said. Smith attributes the department’s spectacular growth to a unique collaboration among the Doheny Eye Institute, School of Medicine and LAC+USC.

Patients referred by private doctors benefit from the university’s vast resources while at the same time helping to support the research mission of the university and eye institute. The realms of patient care, research and education are interwoven so that each supports and enhances the other.

“That’s what it’s really all about – it’s a discovery and the new knowledge comes back rapidly to the patient,” Smith said. “It’s what distinguishes an academic private practice from a non-academic private practice.”

Although the Department of Ophthalmology has international recognition and leadership in all of the major sub-specialties, physicians and scientists are focusing on:

o Finding causes of and treatments for retinal disorders, especially macular degeneration, which is the most common eye disease in older Americans.

o Optic nerve regeneration and protecting the optic nerve from the effects of injuries and disorders caused by glaucoma, stroke and multiple sclerosis.

o Developing new laser treatments and medications for better cornea surgery results.

o Treating eye injuries, including complex procedures to repair wounds caused by such traumas as auto accidents, knifings and gunshots.

Department faculty members have made a number of important advances in recent years.

Alfredo Sadun figured out the cause of an optic nerve disease that was blinding tens of thousands of Cubans. Henry Fong, Narsing Rao and Jeannie Chen identified molecules and proteins involved in retinal development and degeneration, which could be important in understanding the causes of macular degeneration. George Baerveldt, a former faculty member, invented, and Minckler and Rohit Varma helped develop, a tiny plastic shunt that is inserted into a glaucoma patient’s eye to drain fluid and lower the vision-inhibiting pressure.

Last year, Varma won the biggest grant in the department’s history – $6 million in federal money to study eye disease in Latinos.

Ryan achieved his goal of establishing a world-class ophthalmology program. Now he wants it to be the best in the country.

That, he said, will happen if Smith continues to recruit top people to replace faculty who leave Doheny to head other ophthalmology departments throughout the country.

“We have a great faculty, we take great pride in our ophthalmologists and scientists,” Ryan said. “When good people like our faculty leave to advance their careers and the national effort in vision research, we must recruit the best to replace them.”

Hindsight shows department’s founders had vision: USC ophthalmology celebrates its 25th anniversary

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