Hopkins Voices

Morton Goldberg, M.D., Director, Wilmer Eye Institute.

Why did you decide to become an ophthalmologist?

Dr. Goldberg:  It's the only place where you can look inside the body, through the crystal clear tissues and the pristine structures of the eye, and see what's happening inside the body without inserting an instrument. Also, you can provide great benefits. Remove a cataract, or open up a cloudy membrane in the pupil with a laser, and within minutes the patient is rehabilitated. And you're helping people who cannot function or work, who are unhappy, who can't recognize their spouses or grandchildren. So, emotionally, it's enormously gratifying.

How would you characterize this period in ophthalmology?

Dr. Goldberg:  It's a golden age, for sure. When I was in training here in the mid-1960s, the laser had not yet been invented, the operating microscope and scans like CT and MRI didn't exist, nor did the enormous array of antibiotics that we use today. The knowledge related to the treatment of eye diseases has expanded astronomically, such that there has been a revolution in patient care.

On what kinds of eye diseases does the department focus its research?

Dr. Goldberg:  On the most-common blinding diseases, like cataract, diabetic retinopathy, glaucoma, strabismus, macular degeneration. But we also focus on diseases that are not so prevalent, because what we learn about their mechanisms may give us insights into more prevalent disorders. For example, we studied sickle cell anemia and its effects on the retina for many years, which has helped us understand diabetic retinopathy and other vascular diseases of the retina.

Does Wilmer do research outside the United States?

Dr. Goldberg:  Of course. We have a public health division in ophthalmology, involving about 20 full-time faculty from numerous divisions in the department, and more than 25 research protocols worldwide. We have major cataract, glaucoma, infectious disease and nutritional programs in South America, Africa, Asia, Hong Kong, India, Indonesia, the People's Republic of China, Singapore, Tanzania and Uganda.

Any recent surprises out of this work?

Dr. Goldberg:  As it turns out, the incidence of blindness is very high in the Hispanic population, due to a variety of diseases like cataract, diabetic retinopathy and macular degeneration, in addition to glaucoma.

What would you say is the department's top priority?

Dr. Goldberg:  Macular degeneration is certainly one. We have a multi-faceted approach, including fundamental cell and molecular biology research, prevention studies, and surgical and laser therapies. We now know from Susan Bressler's work that we can reduce the risk of a major form of the disease through a combination of antioxidant vitamins and zinc. Also, her husband, Neil Bressler, showed us for the first time that you can preserve vision in a substantial portion of these patients with photodynamic therapy (see story p. tk). Another researcher, Peter Campochiaro has been helping us understand why the blood vessels that cause the disease grow and bleed.

Has this research led to new drug therapies?

Dr. Goldberg:  In the past all we could do was blast these vessels with a laser beam. Now we've got new drugs that-at least in the laboratory and in animal models-appear to be very favorable in suppressing new blood-vessel formation. Soon, we hope they will be approved for human use.

How about eye trauma?

Dr. Goldberg:  Trauma to the eye is certainly not going away; people are hit in the eye, both purposely and accidentally, splashed in the eye, punctured by bushes and thorns each day. So, we have a very busy trauma service, open 24 hours a day, seven days a week. We now know how to take care of lye burns quicker and better, using more effective microsurgical techniques and antibiotics to minimize vision loss. 

Are we working on new treatments for detached retinas?

Dr. Goldberg:  Yes. The latest technique involves the use of heavier than water liquids that push the detached retina back against the wall of the eye. (see story p. tk) We're also studying two experimental therapies for retinal vein thrombosis. For example, Dan Finkelstein uses a  laser to create a spark, which makes a micro-controlled explosion to allow the blood to flow outside the eye to an alternative channel. Peter Campochiaro can also surgically decompress some blocked veins.

Are Hopkins ophthalmologists involved in developing new technologies?

Dr. Goldberg:  Yes. Ran Zeimer, a medical physicist, has invented several devices to measure non-invasively what's going on inside the eye. His latest invention is the Digiscope, used in physicians offices around the country to obtain a digital image of the patient's retina. That image is then sent here, on the Web, for us to evaluate. This device saves the sight of a lot of patients who didn't know they were sitting on a time bomb.

Is part of your mission to teach others about such advances?

Dr. Goldberg:  Absolutely. We're in the business of both developing and disseminating new knowledge. We're also in the business of training people.

What kind of qualities do you look for when recruiting clinical staff?

Dr. Goldberg:  Let's start with impeccable character and ethics, and include insatiable curiosity, self-starting initiative, enormous physical and emotional energy, great intellect and technical skills, farsightedness and collaborative spirit.
 
How do you maintain and nurture that?

Dr. Goldberg:  By providing staff with everything they need, patting them on the back, telling them what the important issues are if they haven't figured it out already. Fortunately, we are at the pinnacle of a buyer's market in that the best people in the world want to come here.

So, how would you distinguish Wilmer?

Dr. Goldberg:  It's sometimes said that you can't be all things to all people, but this is one of the few places in the world that tries to do that. We have outstanding medical students, residents and fellows; continuing medical education, international symposia, and both fundamental and applied research. We disseminate that research through publications, books, journals, and Internet Webcasts, and we provide superlative care for patients.

What does the future hold?

Dr. Goldberg:  We're in a golden age, and it's getting even brighter. The technology, like Wavefront for LASIK is getting more exciting, and the knowledge base, including knowledge of the genome, is expanding, which means previously untreatable diseases may someday be treated. That's really exciting.

Final question: What do you mean when you say you want to make vision care user-friendly?

Dr. Goldberg:  When I meet with new employees, I tell them that if they find themselves in an elevator with a patient, their job is to alleviate that patient's worry. A lot of patients don't know what's wrong with them. If they need expertise for one or more problems, they can get it here. No matter what's wrong with you, you've got the world's experts right here.