Rees and Acquavella Scholars Appointed Even as he enjoyed a successful career on Wall Street, Homer Rees struggled for years with glaucoma. Mr. Rees, onetime vice president of J. P. Morgan and chair- man of Prudential Capital Corporation, knows firsthand the seriousness of his disease. “I’ve lived with glaucoma for over 20 years,” said Mr. Rees, who established the new Homer McK. Rees Scholar in Glaucoma Research. He has been retired for eight years, and for most of his retirement, glaucoma, a degenerative eye disease, has been slowly impairing his vision. He received early care from Columbia’s Dr.John Espy and was later treated by Dr. Max Forbes at the Harkness Eye Institute. As his condition deteriorated, THE DEPARTMENT OF OPHTHALMOLOGY Columbia University The Edward S. Harkness Eye Institute Summer 2001 VIEWPOINT Miranda Wong Tang,a member of the Department of Ophthalmology’s Board of Advisors, has provided funding to support the creation of a new assistant professorship at Columbia. The Miranda Wong Tang Assistant Professorship will be used to advance the work of a talented, young investigator, interested in corneal disease research and treatment. “I believe that the success of any medical institution depends on its com- mitment to research, teaching and patient care,” says Mrs.Tang, explaining her motivation for creating the assistant professorship. Noting that Department In This I s s u e FROM INSIDE THE LAB TO A TREATMENT NEAR YOU • EATING RIGHT FOR HEALTHY EYES Dr. Stanley Chang with Mr. Homer Rees and Dr. James Tsai cont. p4 cont. p3 Miranda Wong Tang Endows Assistant Professorship in Cornea Research
Transcript
Rees and Acquavella Scholars AppointedEven as he enjoyed a successful career on Wall Street,Homer Rees struggled for years with glaucoma. Mr.Rees, onetime vice president of J. P. Morgan and chair-man of Prudential Capital Corporation, knows firsthandthe seriousness of his disease.
“I’ve lived with glaucoma for over 20 years,” saidMr. Rees, who established the new Homer McK. ReesScholar in Glaucoma Research. He has been retired foreight years, and for most of his retirement, glaucoma, adegenerative eye disease, has been slowly impairing hisvision. He received early care from Columbia’s Dr. JohnEspy and was later treated by Dr. Max Forbes at theHarkness Eye Institute. As his condition deteriorated,
THE DEPARTMENT OF OPHTHALMOLOGY Columbia UniversityThe Edward S. Harkness Eye Institute
Summer2001
VIEWPOINT
Miranda Wong Tang, a member of the Department of Ophthalmology’s Boardof Advisors, has provided funding to support the creation of a new assistantprofessorship at Columbia. The Miranda Wong Tang Assistant Professorship willbe used to advance the work of a talented, young investigator, interested incorneal disease research and treatment.
“I believe that the success of any medical institution depends on its com-mitment to research, teaching and patient care,” says Mrs.Tang, explaining hermotivation for creating the assistant professorship. Noting that Department
In This I s s u e
FROM INSIDE THE LAB TO
A TREATMENT NEAR YOU
•
EATING RIGHT FOR HEALTHY
EYES
Dr. Stanley Chang with Mr. Homer Rees and Dr. James Tsaicont. p4
cont. p3
Miranda Wong Tang Endows Assistant Professorship in Cornea Research
Sincerely,
Stanley Chang, M.D.Edward S. Harkness ProfessorDepartment of Ophthalmology Chairman
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Views from the Chair
Dear Friends:It’s been a productive spring, and I’m delighted to have
this opportunity to share news of our latest developments withyou.
First, we are pleased to welcome Dr. James Tsai and Dr.Melanie Sohocki, who join our faculty on July 1. AppointedHomer McK. Rees Scholar and director of the Glaucoma Ser-vice, Dr.Tsai brings ingenuity and experience to the challenge ofadvancing glaucoma research and care. As William Acquavella Scholar, Dr. Sohocki, atalented and dedicated researcher, will work to further our understanding of thegenetic components of retinal diseases, an important step in finding new avenuesfor treatment of macular degeneration and other retinal disorders.
I’m equally pleased to acknowledge opportunities for growth created by twonew endowed faculty positions. Such endowments are the lifeblood of an academicmedical center and help to sustain high caliber research, teaching and care. Specialthanks to Mrs. Miranda Wong Tang, whose generous support for the Miranda WongTang Assistant Professorship will help to enhance the Department’s work in cornealresearch. We are also grateful to Dr. Laszlo Bito for his help in promoting basicresearch in the Department through the Laszlo Z. Bito Professorship. Finally, ourBoard of Advisors and circle of friends continue to grow. Their commitment andgenerosity help to sustain many of our most promising programs, and we’re deeplygratified by their support.
With special thanks to all our friends and best wishes for a healthy,enjoyable summer.
3THE BOARD OF ADVISORS
Department of Ophthalmology at Columbia University
William AcquavellaRand AraskogWilliam BeutelDr. Endré BalazsRobert L. Burch IIIHoward L. Clark, Jr.Joseph C. ConnorsDorothy EwesonGloria and Louis FlanzerPolly GuthLouis V. Gerstner, Jr.Joel HoffmanT .C. HsuHelen and Martin KimmelDr. Henry KissingerAmbassador John L. Loeb, Jr.John ManiceBarbara MargolisSeymour MilsteinBjorg and Stephen OllendorffHomer McK. ReesJohn RobinsonMiranda Wong TangCandace VanAlen Richard Woolworth
Chairman Stanley Chang has been successful inbringing to Columbia “a fresh breed of doctorswho have the energy and dedication to con-duct groundbreaking research and are commit-ted to their patients,” she adds, “These factorshave worked to raise the quality of care.”
According to Mrs.Tang, her involvementwith the Department of Ophthalmology hasgrown since Dr. Chang, her friend for morethan ten years, became chairman. “His vision-ary leadership coupled with strength broughtto the Department by members of the Advisory Board, are helping to ensure the quality of Columbia’s ophthalmology programs.The new assistant professorship will providefurther assistance by promoting the study ofcorneal disease prevention and treatment,rounding out specialty areas already in place.I believe the position will enhance Columbia’sreputation as a pioneer and leader in all areasof ophthalmology research.”
Rees had to undergo surgery in his right eye.Glaucoma has not slowed Homer Rees
down; he is currently serving as interim direc-tor of the Bruce Museum of Arts and Sciencesin Greenwich, Connecticut. His gift, he said,marks “a combination of the successful out-come of surgery and appreciation of the excel-lent care that I received from Dr. Forbes.” Mr.Rees, a member of the Department of Ophthal-mology’s Board of Advisors, donated $300,000to sponsor a Glaucoma Scholar, in hopes thatresearch at Columbia can put an end to the disease that has damaged his right eye.
DR. JAMES TSAI: An Interest in Tracing Glaucoma’s Causes
Dr. James Tsai, the newly appointedHomer McK. Rees Scholar, has dedicated hiscareer to fighting the enigmatic disease. A graduate of Amherst College and StanfordMedical School, Dr.Tsai completed a residencyin ophthalmology in Los Angeles’s Doheny EyeInstitute. He underwent glaucoma training inMiami and London before becoming a profes-sor at Vanderbilt University in Nashville sixyears ago. At Columbia, Dr. Tsai will be an associate professor of Ophthalmology anddirector of the Glaucoma Service.
“This is an opportunity to really contribute to the development and further theadvances of glaucoma research,” said Dr.Tsai,
whose research has focused on surgical andretinal management of complicated glaucomas.He plans to analyze the wound healing process-es associated with glaucoma surgery, in orderto improve the success rate of the treatment.He is also interested in the many possible factors that can cause glaucoma, like ocularblood flow and genetics. “We’re really just atthe tip of the iceberg, starting to understandthat controlling eye pressure is critical, but it’snot the only risk factor we have to be con-cerned about,” said Dr.Tsai. He predicts thatthe next five or ten years will bring majoradvances in understanding the physiology of thedisease. He looks forward to setting up a glaucoma center at Columbia, with state-of-the-art diagnostic and therapeutic capabilities thatwill be a resource for internists, ophthalmolo-gists and glaucoma specialists.
Supporting Dr.Tsai’s goals seems espe-cially worthwhile to Mr. Rees, who has recentlygotten a taste of the difficulties of nonprofitwork. “I now have a heightened appreciationfor the problems of managing nonprofit organi-zations,” he said. “On Wall Street, the drivingforce was making money. It’s very refreshing towork with people whose principal motivation istied to other sources of satisfaction.”
“There are no guarantees withresearch,” Mr. Rees said. “All you can do is keep trying.”
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Rees and Acquavella Scholars Appointed, cont.
DR. MELANIE SOHOCKI: Drawn toResearch in Eye Disease Genetics
As a high school student, Dr. MelanieSohocki got a first glimpse of what wouldbecome her life’s work. She was helping in theoffice of a retina specialist, and every day shewatched patients deal with severe vision prob-lems. Touched by their struggle and intriguedby the study of genetics, Dr. Sohocki embarkedon a path of study that could someday savethousands of lives. Now, she is about to joinColumbia as the first-ever William AcquavellaScholar in RetinaResearch. The Schol-ar’s position is a giftfrom William Acqua-vella, a New York artgallery owner whoserves on theDepartment of Oph-thalmology’s Board of Advisors. His gift of $500,000 for the newscholar is not his first contribution to Columbia; last year, he installed an exhibition ofCezanne watercolors in his gallery to benefitthe Department.
As an art enthusiast, Bill Acquavella has aunique appreciation for the gift of good vision.Through her research, Dr. Sohocki is trying tomake sure no one is ever robbed of that gift.
Dr. Sohocki got her Ph.D. at the
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graduate school of biomedical sciences at theUniversity of Texas in Houston. There shebegan work on identifying genes linked withinherited retinal disorders. One of the genesshe identified turned out to be associated withLeber’s Congenital Amaurosis, a form of child-hood blindness.
“Because of the human genome project,we’re identifying many new genes associatedwith inherited blindness,” said Dr. Sohocki, whowas promoted to associate professor last yearat the University of Texas. She explained that
there are over 120different genes forinherited retinal disorders recognized,but less than half havebeen found. Locatingeach of them involvesa complicated map-ping strategy.
At Columbia, she hopes to study thefunctions of mapped genes in order to under-stand what might be lacking in patients withcertain eye diseases. “One huge benefit of theOphthalmology Department at Columbia isthat they have a very strong clinical program inaddition to research. It’s going to be a big teameffort,” Dr. Sohocki said. “The people in Ophthalmology have been so wonderful andsupportive.”
“Because of the humangenome project, we’reidentifying many newgenes associated withinherited blindness.”
He is not knownto have sufferedfrom any unusualeye problems, butph i lanthrop i s tEdward S. Hark-ness had a clearinterest in help-ing those whodid. The benefac-tor, who in 1928donated land tobuild Columbia-P r e s b y t e r i a n
Medical Center, saw fit to include a hospitaldevoted to eye care as part of its overallplan. By 1931, Mr. Harkness had made a $5million pledge for construction of an eyeinstitute at the corner of 165th Street andFort Washington Avenue. His gift also provided support for ophthalmologyresearch.
Today, the Department of Ophthal-mology’s commitment to understanding thebasic processes that cause, prevent andtreat diseases of the eye continues. Inrecent years, laboratory research at the Eye
Institute has yielded groundbreakingapproaches that include advances in lasertechnology; improved surgical techniquesfor cataract, corneal and retinal surgery;and the discovery of a new glaucoma treatment.
Biomedical advances could not occurwithout the painstaking work of talentedinvestigators, devoted to the search for newinformation. In Columbia’s Department of Ophthalmology, Drs. Jorge Fischbarg,David Maurice and Abraham Spector areamong the researchers, whose laboratoryexplorations hold new promise for visionpreservation.
Ocular Water Ways It may not seem like all that compelling a
subject, but the question of how water traverses ultra-thin layers of tissue within theeye is a topic of endless fascination to Dr. Jorge Fischbarg. “Eighty-to-ninety percent of the eyeis comprised of water,” he says by way of explanation. “Fluid movement is fundamental toocular function.”
Among Dr. Fischbarg’s important findingsis the determination that water transport doesindeed occur across epithelial tissue within theeye’s lens, a layer of cells in the part of the eye
6
From Inside the Laboratory to A Treatment Near You
Edward S. Harkness
A Commitment to Visionary Research
that directs light rays toward the retina. His labalso co-discovered the presence of fluid move-ment in epithelial cells of the eye’s conjunctiva,or mucous membranes.
More recently, however, the basis of fluidmovement through the corneal endothelium,
the cornea’s innermost layer of cells, has beenabsorbing this Professor of Physiology, CellularBiophysics and Ophthalmology’s attention. “I’vereturned to a first love,” he confesses. “Despiteoccasional diversions, I’ve actually been inter-ested in the endothelium for the past 30 years.”
For several of those years, he and otherresearchers had been investigating whether aprocess called local osmosis explained the
phenomenon of fluid transport across theendothelium. Under the premise, specializedcellular water channels within the endotheliumserved as a conduit for fluids, which were driven from cell to cell by osmotic pressure.The widely held theory seemed to holdwater––so to speak––until, says Dr. Fischbarg,“certain chinks in its armor began to appear.”Apparently, normal water transport activitieswere not curtailed in knockout mice, speciallybred without a water channel-producing gene.Researchers also found that people with certain rare genetic disorders that precludenormal water channel functioning showed norelated illness.
Undaunted, Dr. Fischbarg began toexamine another theory to explain endothelialwater transport. Electroosmosis, the move-ment of charged molecules along a chargedsurface, is hardly a new concept, he says. Theprocess––one that is commonly used in waterand soil treatment––has often drawn the atten-tion of medical researchers, but has never beenfully examined as a basis of cell-to-cell fluidtransport. But now, Dr. Fischbarg’s latestresearch suggests that electroosmosis may bethe force that drives fluids across the minutecrevices between endothelial cells.
Of what import is this finding? Electroosmosis could play an important part inmaintaining many bodily processes, as disparateas lung secretions, intestinal absorption, tearproduction and kidney function. “If our theoryis right,” says Dr. Fischbarg, “it may provide afresh approach to treating the symptoms of
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Dr. Jorge Fischbarg
fluid transport systems gone awry––as theyaffect vision as well as other aspects of health.”
Eyes on Corneal RepairWhy devote a lifetime to studies of the
cornea? For Professor of Ocular PhysiologyDavid Maurice, the attraction to this particularpatch of ocular tissue is a question of simplicity.“Corneas are so nice, so smooth, so completelytransparent,” he lovingly observes and thenadds, “When I started my research, there weremany gaps in our understanding. I guess I wasdrawn to filling them in.” Now, even after morethan half-a-century of laboratory investigation,says Dr. Maurice, his interest in the cornea’sdelicate structure and functioning continues togrow.
Many of Dr. Maurice’s recent studieshave involved the cornea’s response to injury.Interested in learning how individual cornealcells react to even mild disturbances throughthe hours and days following injury, he wasdetermined to do so in a way that’s never beendone before. Researchers, he explains, areoften hampered by the short life span of isolated corneas. But calling himself an experi-mentalist at heart, Dr. Maurice designed andfashioned a unique device to observe and trackmicroscopic changes in the corneal cells of livemice over a period of many days. The studieshave revealed important insights into the healing process, including some surprises.
“Most scientists believed that wheninjury occurred, white blood cells, called leukocytes, made a beeline for the damaged
area. But, unexpectedly, we’ve noticed thatmany of these cells either linger or wanderabout without ever getting to the wound. Wedon’t know whether this curious lag delays orpromotes healing, but understanding questionsabout the speed and direction of leukocytemovement will help us to develop ways of
enhancing injury repair mechanisms.”Another finding by Dr. Maurice and
colleagues Drs. Jin Zhao and Takayuki Nagasakihas raised new questions about the role oftears in corneal wound healing. Factors in tearfluid may be the direct cause of cell death thatoccurs when the cornea is injured. “Surprising-ly,” says Dr. Maurice, “we discovered that celldegeneration did not take place when tissue
8
was protected from tears.” Nevertheless, hecautions, more research is needed to determinewhether tears and ensuing cell death help orhinder corneal healing.
The cornea’s ability to rebound frominjury can affect the success of laser vision correction of refractive errors and other eye
surgeries, as well as recovery from accidentaleye trauma and many corneal diseases. Thestudy of cell migration to an injury, says Dr.Maurice, may yield important information toprevent scarring, unwanted blood vesselgrowth, and other complications that impedequick and complete healing when tissue is dam-aged.The cornea, he adds, is also an excellent
model that should provide insight into woundhealing throughout the body.
Clearing the Cataract Cloud Name the diseases associated with
oxidative stress and you list some of humanity’smost devastating scourges: cancer, Lou Gehrig’sdisease, Parkinson’s, Alzheimer’s and other ravaging afflictions. Oxidative stress occurswhen oxidative agents, such as free radicals orperoxides, are generated by natural, disease orenvironmental processes. Cataracts, the clouding of the eye’s lens that affects about halfof us as we age, have also been linked to oxidative stress.
Malcolm P.Aldrich Professor of Ophthal-mology and Director of Research AbrahamSpector has targeted much of his work tounderstanding the eye’s lens. Trained as a protein chemist, he became interested in ocularresearch after discovering that the eye’s lenshad a particularly high concentration of protein.He has since applied his interest to studies ofcataract development and prevention.
The leading cause of sight loss world-wide, cataracts account for approximately 42percent of all blindness. In developing countries, Dr. Spector explains, there are simplynot enough surgeons to perform cataractremoving procedures. In the United States,where cataract surgery is relatively safe, eachyear about two percent of the two millioncataract patients––some 40,000 people––develop serious, vision-threatening complica-tions from surgery. These include retinal
9
Dr. David Maurice
detachment and severe corneal edema, requir-ing corneal transplantation. As the populationof older people grows, says Dr. Spector, the per-sonal and economic consequences of cataractsas a major disease will also increase.
The escalating problem, both in the United States and other countries, he says, callsfor a medical rather than surgical solution.Toward that end, he is leading efforts to
identify genes that contribute to defending thelens against oxidative stress. “By age 80,” hesays, “half the population has cataracts. But, ofcourse, the flip side is that the other half doesn’t!” His laboratory is trying to learnwhat genetic factors contribute to thecataract-free group’s ability to maintain clear,healthy lenses.
So far, the researchers have examinedone-third of the mouse genome in lens epithe-lial cell lines developed by Dr. Spector to resistoxidative stress. He and his colleagues haveidentified about 100 genes in these resistantcells that may shield against cataracts. Oncethis phase of their search is complete, theinvestigators plan to select genes that play aparticularly significant role in cataract prevention and examine ways of enrichingthem or their gene product.
“Diseases like macular degeneration andcataract are complex and may have more thanone initiating factor,” says Dr. Spector. “But,little by little, we’re chipping away at these andother eye problems of aging.”
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Dr. Abraham Spector
When Joel Hoffman arrived at Columbia twoyears ago with a serious tear in his retina, hewas not sure if his vision could ever be fullyrestored. Today Mr. Hoffman has excellentvision, and he is doing his part to make surechildren of the future are not threatened byblindness or serious eye diseases. The JoelHoffman Scholar in Pediatric Ophthalmology isa promising step forward in curing childhoodeye problems. For Mr. Hoffman, it is a way ofsaying thank you.
“I’m fortunate in many ways,” said Mr.Hoffman, who graduated from Columbia Uni-versity in 1967, earned a New York UniversityM.B.A., and is also a Certified Public Accoun-tant. His thriving real estate business owns sixmillion square feet of commercial real estate.But in November of 1997, Mr. Hoffman wasdiagnosed with a giant retinal tear in his eye. ALong Island specialist, Dr. Paul Svitra, repaired it,but said he was at risk for the same conditionin his other eye. When another retinal detach-ment turned up two years later, Dr. Svitra sug-gested he see Columbia’s Dr. Stanley Chang,under whom the specialist had trained. “If youdon't do the retinal surgery right, you can goblind,” Mr. Hoffman said. Soon after, Dr. Changperformed the much-needed operation with asuccessful outcome.
“Having had some good luck in businessand because of my great appreciation forColumbia, I try to give something back to theschool,” said Mr. Hoffman, whose “something”includes a scholarship at the undergraduateschool, a $100,000 contribution towards retinalresearch, and $500,000 to endow the Joel Hoff-man Scholar. He has a close relationship withColumbia; he remembers fondly his days on theschool's basketball team and has gotten toknow Dr. Chang professionally and personally.“I have tremendous respect for him and whathe's trying to accomplish,” Mr. Hoffman said.“I’m also fortunate to see as well as I do. I'mreally just paying back.”
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Joel Hoffman’s Way of Saying “Thanks”
Joel Hoffman
Xalatan is the most widely prescribed glaucomatreatment in the world. The drug’s existence,not to mention its overwhelming success, can inlarge part be attributed to the persistentefforts of Dr. Laszlo Bito, a retired professor ofOphthalmology at Columbia.
Often called the “sneak thief of sight,”glaucoma, the leading cause of preventableblindness in the United States, has been diag-nosed in more than two million Americans. Suc-cessful glaucoma treatment depends on pre-venting increased pressure from causingirreparable damage to the optic nerve. Xalatanworks by increasing the eye’s natural outflow ofaqueous humor, the fluid that nourishes theeye’s cornea and lens, to reduce intraocularpressure (IOP). Unlike other medications thatrequire multiple applications throughout theday, Xalatan needs just a single daily dose andproduces fewer side effects.
Earlier this year, the Department ofOphthalmology announced the establishmentof a chair in Dr. Bito’s honor. “The Laszlo Z.Bito Professorship in Ophthalmology,” saysDepartment Chairman Stanley Chang, “willserve as a lasting tribute to Dr. Bito and hissight-saving achievement. It will also help toadvance the kind of diligent scientific investiga-tion that led to Xalatan’s development.”
The story of how Xalatan got “discov-ered” begins in Dr. Bito’s Columbia Universitylaboratory nearly three decades ago. A nativeof Budapest, Bito had come to the UnitedStates in 1956, graduated from Bard Collegethree years later, and earned a Columbia Ph.D.in 1963. He soon became interested in eyeresearch––specifically the effects ofprostaglandins, a group of hormone-like substances on the aqueous humor. Althoughprevailing opinion held that administeringprostaglandins to the eye caused an undesirableincrease in IOP, the researcher surmised theopposite to be true. “Prostaglandins,” he nowexplains, “are produced by virtually all body tissues. That told me they couldn’t be all bad.”Years of research proved him right.
The Long Road to SuccessLikening his journey of discovery to a
roller coaster ride, Dr. Bito describes twists andturns that caused years of delay. One of hisearly setbacks occurred when he and fellow scientist, Dr. Carl Camras, first exploredprostaglandins’ effects on rabbits. To their dismay, the investigators found that the druglost potency after being used for just a fewdays. Only later did they realize that rabbiteyes, designed to protect against predators,
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New Professorship Honors ResearcherBy Reinvesting in Research
produced exaggerated reactions that wereinaccurate predictors of prostaglandins’ effectson human eyes. Subsequent research on monkeys and cats showed that prostaglandinsdid indeed supply long-term IOP reduction.
Further obstacles, says the tenacious scientist, “only showed there was more workto be done.” Experimenting on his own eye, hesaw that the drug produced redness and irrita-
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Dr. Laszlo Bito
tion. “For me this was a challenge. I knew wehad to find a way to maintain the drug’s efficacywhile eliminating unacceptable side effects.”
In 1982––nearly 20 years after he beganstudying prostaglandins––Dr. Bito filed for apatent. Soon after, he teamed with the Swedishcompany, Pharmacia, the only manufacturerwilling to work with him to refine and developthe drug. By 1988, the collaboration producedlatanoprost, a prostaglandin derivative that isthe main component of Xalatan. Eight yearslater, after extensive clinical trials, the FDAapproved Xalatan for treatment of glaucoma.
A New ChapterNow living in Budapest, Dr. Bito has
achieved yet another noteworthy success––thistime as the author of best-selling Abrahamand Isaac as well as other novels. “There is lifeafter prostaglandins,” he pronounces, addingthat writing, lecturing, and book tours occupytime once spent inside the lab.
Of the Bito Professorship’s value in pro-moting innovative research, he says, “Seniorinvestigators need to maintain a long-term perspective––an outlook made difficult whenthere is pressure to produce immediate results.Independent funding is the best mechanism toassure good research.”
At the start of Dr. John Espy’s career, cataractsurgery required a week-long hospital stay, andcontact lenses were the latest development ineye care. That was the early 1960’s when theHarkness Eye Institute had 100 beds, most ofwhich were usually filled.Today, only outpatientsurgery is performed at the Institute, and thereis not even one overnight bed. This dramaticchange is typical of the major medical strides witnessed by Dr. Espy,clinical professor ofOphthalmology, duringhis long affiliation withColumbia.
In 1960, hecame to Columbia fora three-year residen-cy––the last traineeappointed by John H.Dunnington. On-call residents were responsi-ble for monitoring over 100 patients, writingthe next day’s orders, and assisting and per-forming surgery. Things got busy after 2 p.m.the start of the surgical schedule. “The operat-ing rooms lay fallow until then,” Dr. Espy said.After his residency, Dr. Espy went into practicewith Dr. Maynard C. Wheeler and shared anoffice with him. In 1968, he opened the Lexing-ton Avenue office where he still practices today.
Dr. Espy’s expertise is in the anteriorsegment of the eye, external disease, cataractsand contact lenses. When contacts debuted inthe 1960’s, he began a contact lens clinic, wherehe taught residents how to fit lenses. The clinicopened in 1963, and Dr. Espy directed it formore than 25 years. During that time, it movedfrom the Vanderbilt Clinic to the lower level ofthe Eye Institute.
According toDr. Espy, the develop-ment of lasers playeda critical role in revolutionizing eyecare. CATs, MRIs,ultrasonography andother screeningtools have also madediagnosis and treat-
ment more reliable and effective. Still, Dr. Espysaid, the health profession as a whole needs toadjust itself to changes in structure. HMOshave led to a rise in hospital-based medicineand a move away from solo practitioners.
“The new system is necessary but difficult for people who’ve been practicing foryears,” Dr. Espy said. He believes that eventual-ly there will be a two-tiered system, with asmaller percentage of patients receiving
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Years of Excellence:John Wilson Espy, M.D.
“There is a great deal ofpromise in discoveriesabout genetically modifieddisorders and correctivegene therapy.”
distinctly private care, while the vastmajority will be under HMO plans.
Looking AheadAs someone who has witnessed
revolutions in eye care, Dr. Espy isoptimistic about what the futureholds. “A major concern for eyehealth over the next few years is age-related macular degeneration (AMD),he said. “AMD is the most commonvision problem as patients live longer.”He predicts that soon it will be possi-ble to help AMD patients throughmacular translocation (moving parts ofa patient’s own macula), retinal trans-plantation, or an electronic device thattransmits visual impulses directly tothe brain. “There is also a great deal ofpromise,” he adds, “in discoveriesabout genetically modified disordersand corrective gene therapy.”
“John Espy’s unique historicalperspective is an invaluable resourcefor the department,” says Dr. StanleyChang, chairman of Ophthalmology.“He is an outstanding clinician andteacher, and we hope he continues tolend his knowledge and expertise toour programs for years to come.”
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Dr. John Espy
The key to healthier eyes may beas close as your refrigerator. Medicalresearch has made great strides in improv-ing vision problems, but sometimes, extrahelp from special foods and vitamins canmake a world of difference. Here are somevision nutrition tips recommended by doctors:
• Scientists have discovered thatfruits and vegetables contain compounds that may prevent maculardegeneration and cataracts. Some greatones to incorporate into your diet arewatercress, spinach, broccoli, corn andpeaches.
• Chemical compounds calledcartenoids are essential to the retina.According to Dr. Jim Dillon, the best way toget them is in cooked tomatoes, green andorange plants, and fruits.
• Vitamins are never as effectiveas nutritious foods. “In general, thehealthier way to get all your vitamins andminerals is in the form that nature providesthem, in the right proportion and rightchemical form,” said Dr. Cynthia MacKay.“We can’t improve on nature.”
• Starches like potatoes andturnips do not improve eye health;stick to green and yellow vegetables.
• High dietary intake ofcartenoids called lutein and zeaxan-thin are associated with higher macular pigment density, which protects againstmacular degeneration. Vitamins are nowbeing supplemented by lutein.
• Be careful when taking vitamins. “Too many vitamins can be toxicto the eye. Vitamins can act as a drug inhigh amounts,” Dr. MacKay said. Vitamins A,D, E, and K are the most potentially harmful;water-soluble vitamins like C, B12, and folicacid are less toxic. Metals like zinc and sele-nium can be toxic to the eye in large doses.
Nutrition for Healthy Vision
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•Smoking is a risk factor formany diseases, including eye diseases.Incidence of macular degeneration is two-and-a-half times greater among patientswho smoke.
• Eat healthy foods all the time,even ones not known to help vision.“The healthy body has a healthy eye,” Dr.MacKay said. Some patients who aren’t vegetable lovers prefer to get theircartenoids from blended juice drinks.
• As with any health regimen, becautious. Dr. Ted Smith had this advice:“The caveat with all these things is, ofcourse, everything in moderation.” Headded that the research on vitamins andcartenoids and their effect on vision indi-cates a correlation between the products’use and better vision; there is no proven“cause and effect” relationship.
See your doctor once a year sothat any problems can be caughtand treated early.
When leading organizations decide whichresearch institutions deserve their support,they make sure to ally themselves with thebest. It is no surprise that some of the mostsuccessful vision organizations in New Yorkhave built strong partnerships with Columbia’sDepartment of Ophthalmology. Through thehelp of groups like Research to Prevent Blind-ness, Foundation Fighting Blindness, and Fightfor Sight, the Depart-ment is making greatstrides in clinical trialsand research and buildingbridges with industry.
“Columbia hasalways been a worldleader in research,” saidDiane Swift, executive director of Research toPrevent Blindness (RPB). The organizationis the largest voluntary non-government agency that supports eye research in the United States.During Columbia’s long relationship with RFB,the school received about $2 million in grantsupport from the agency.
Funding from Foundation FightingBlindness (FFB) has helped Columbia pursueFFB’s goal: finding causes, treatments,preventions and cures for retinal degenerative diseases.
“Columbia presented research proposalsthat passed our peer review analysis and rigorous scrutiny by a 100-member advisorypanel,” said Executive Director Vivian Holmes.Since 1971, the Foundation has raised $150 million for research and is consistently rankedby the National Health Council for the percent-age of dollars it spends on research.
For 55 years, Fight for Sighthas funded 2,600student and post-doctoral fellow-ships and grants-in-aid, with thegoal of using oph-thalmology re-search to help
prevent blindness.Their funding gives a leg upto young researchers and pilot research pro-jects. “We fund selected children’s eye clinicsthat serve disadvantaged children,” said Execu-tive Director Grace Fisher. Columbia is amongthe 165 leading eye centers and universitiesworldwide that receive their support.
Through partnerships with Columbia, allthree organizations guarantee that theirresearch dollars are well spent. “You want tosupport research where there is excellentresearch being done,” RPB’s Swift said. “We’rehappy to be associated with Columbia.”
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Organizations Lend a Hand to Benefit Eyes
“You want to supportresearch where there is excellent research being done.”
Creating a Charitable Gift Annuity for OphthalmologyGiving Well is the Columbia University Health
Sciences planned gifts program that can assist you in
making the type of gift to the Department of
Ophthalmology that will best accomplish your personal
financial and charitable goals. Charitable Gift
Annuities are among the planned giving options avail-
able through the Giving Well program. Here are some
commonly asked questions and their answers about this
popular type of planned gift:
Q: What is a Charitable Gift Annuity?
A: A charitable gift annuity is a simple arrangement
that provides a secure lifetime income for you
and/or someone you choose, while providing a sub-
stantial gift to achieve your philanthropic goals.
Q: What are the advantages of a Charitable
Gift Annuity for me?
A: A charitable gift annuity provides you with a
sizeable income tax charitable deduction, guaran-
teed lifetime annual income, and reduced capital
gains taxes (if you use appreciated securities).
Q: How much income can I expect to
receive from a Charitable Gift Annuity?
A: Income payments are based on age. For exam-
ple, a 60-year-old donor will receive annual lifetime
income, partially tax free, equal to 6.4 percent of
the gift. A donor who is 75 years old when making
the gift will receive partially tax-free annual lifetime
income equal to 7.9 percent of the gift amount.
Income to joint donors is based on both their ages.
Q: Is any portion of my Charitable Gift
Annuity gift tax deductible?
A: Yes, in addition to lifetime income, in the year
you make your gift, you will receive a charitable tax
deduction for a portion of its value. The amount of
your deduction will be based on you age and the
amount of your gift.
Q: How do I purchase a Charitable Gift
Annuity?
A: To establish a gift annuity, you enter into a sim-
