Reflections on 80 Years of Eye Care at the University of Iowa

by Thomas A. Weingeist, Ph.D, M.D., April 21, 2005

It only seems like yesterday we celebrated our 75^th anniversary.  This year we celebrate our 80^th anniversary and it again gives us cause for reflection and reason for pride, a time to take stock and a time to look ahead.

Before 1925, the Department of Ophthalmology was part of General Surgery and was located west of the Pentacrest and Old Capitol on the east side of the Iowa River.

Dr. Cecil Starling O'Brien, recruited from private practice in Indiana in 1925, studied briefly in Vienna, Austria, before taking over clinical and teaching responsibilities with two other colleagues. O'Brien, or "Obie" as he was affectionately called, was a strict disciplinarian. He was revered by his "boys," the residents of those days, but, as was customary for residents studying under such giants, he was also feared.

Dr. O'Brien's wife, Lillian O'Brien still resides in her home in Tucson, Arizona.  I talk with her periodically and she is just as bright and astute as when I first met her nearly 20 years ago.  She has had age-related macular degeneration for decades and is legally blind, but she is otherwise in remarkably good health for being 101 years old. She still thinks fondly of their days living in the house just beyond where the Butler Bridge crossed the river on North Dubuque Street.

O'Brien's reign ended abruptly in 1947, when he left for Arizona because he was discontent with the new leadership and the practice plan of the College of Medicine. After more than a year with interim chair Glen Walker and two internal candidates, P.J. Leinfelder and Jimmy Allen, the dean hired Alson E. Braley, a native of Iowa, who was then chief of Ophthalmology at Harkness Eye Institute in New York City. Ironically, Braley met Fred Blodi in the Harkness Eye Institute surgery dressing room between cases because their lockers were assigned alphabetically. More than 13 years later, I started graduate studies for a PhD in the same institution working with George Smelser, who had a joint appointment in Anatomy and Ophthalmology. By further coincidence, Smelser had graduated from the same small liberal arts school, Earlham College, I had attended in Richmond, Indiana, and was known to Braley and Blodi.

P.J. Leinfelder, one of the first neuro-ophthalmologists and an expert in the hazards of radiation, remained on the faculty. Jimmy Allen became chief at Tulane. Incidentally, there is also a C. S. O'Brien Library with many of his own books in the ophthalmology department at Tulane.

Braley was a back-slapping, highly enthusiastic and energetic man. His energy and enthusiasm sometimes got the better of him. Long before the days of the resident match, he chose several more residents than the program had room for. He solved the problem by sending some to do research and others to work on the "glaucoma bus" supported by the Iowa Lions to screen people throughout Iowa for glaucoma. He started the Iowa Lions Eye Bank and did the first corneal transplant in Iowa. The graft has remained clear for more than 50 years. He recruited subspecialists like Mansour Armaly for glaucoma, Herman Burian for strabismus and electrophysiology, Edward Ferguson and Robert Watzke for retina and Blodi from New York to serve as chief of the VA Eye Clinic and Ophthalmic Pathology. Dr. Braley left the University of Iowa to go into private practice in Iowa City in 1967.

Fred Blodi took over as head the same year. Fred and his wife Otty had known each other since kindergarten. She rescued Fred from a prisoner of war camp by joining the military as a nurse and bringing him back under the "War Brides Act." It was one of many examples of their love for each other and their strong determination. Otty had lived in Vienna and New York and confesses that initially she did not like Iowa City, but after two years she could not be dragged away even though Fred was offered opportunities in Vienna and major metropolitan cities in the States. Their children, Chris and Barbara, both became vitreoretinal specialists.  Otty celebrated her 86^th birthday in November 2004.

Under Blodi's leadership, the department became internationally known. The faculty traveled extensively and accepted a large number of fellows who gained prominence in their own countries. Fred said, "the faculty is like the Strategic Air Command, half of us are in the air at all times." A number of graduates returned to the department after subspecialty training: Chuck Phelps trained in glaucoma with Bernard Becker; Bill Scott and Jay Krachmer studied with Marshall Parks, Art Jampolsky and Peter Laibson, respectively; Rick Anderson studied with Orkan Stasior in Albany, and Crowell Beard and Marvin Quickert in San Francisco; Stan Thompson studied with Otto Lowenstein and Irene Loewenfeld at Columbia; Gunter von Noorden and Bruce Spivey were residents, and Bruce remained as a faculty member. Later, he accepted a position as chair at the Pacific Medical Center and executive vice president of the American Academy of Ophthalmology. Sohan Hayreh joined the faculty in 1967. I was offered a faculty position prior to completing fellowship training in 1976 with Robert Watzke, Tom Burton, and Jim Diamond.

When Fred Blodi resigned in 1983, and became medical director of the King Khaled Eye Specialist Hospital (KKESH) in Saudi Arabia, a national search was begun. Charles Phelps, who had gained a national reputation as a glaucoma specialist and clinical researcher, was named head in April 1984. A few days prior to starting, a biopsy of his mouth revealed a squamous cell carcinoma. A tremendous tragedy befell the family and department; in about 18 months, Chuck passed away. He had appointed Bob Folberg and Ron Keech to the faculty. Joerg Kolder served as interim chair while another search began. I was named department head in September 1986.

In the ensuing decade under the auspices of The University of Iowa Foundation, three major endowments were created through the generosity of alumni, friends, and philanthropic organizations. The Frederick C. Blodi Professorship which became a chair, exceeds two million dollars and has supported the Blodi Eye Pathology Laboratory, formerly directed by Bob Folberg, for more than a decade. The Robert C. Watzke Vitreoretinal Research Fund has surpassed one million dollars and will be used to support clinical and basic research in retina. The Carver Molecular Ophthalmology Laboratory Fund, created with two million dollars from the Roy J. Carver Charitable Trust and one million dollars from the department, supports the Molecular Ophthalmology Laboratory. Our objective is to create other endowments to support scholarship and research throughout the department.

The foresight of John Colloton, former CEO of the UIHC, and Marvin Pomerantz and his family led to the building of the Pomerantz Family Pavilion. In February 1996, the department moved to the Pomerantz Family Pavilion. With the addition of several other primary care centers, the Pomerantz Family Pavilion will eventually be the largest ambulatory clinic area within University of Iowa Health Care.

More than 500 million dollars of capital development has taken place since 1969, without any funding from the state, in sharp contrast to similar programs in Michigan and Ohio where state funding has accounted for 30 to 50 percent of capital development.

Due to the continuing success of our department, we have expanded our reception area, renovated and added space to the Contact Lens Clinic, and administrative service functions of the Department, and moved the Iowa Lions Eye Bank.

New faculty were recruited for Comprehensive Ophthalmology, Contact Lens, and the VA Medical Center, and other research and clinical faculty positions have been created. Our expanding research needs have been met in part by increasing space in the Oakdale Research Facility, completion of phase one construction of the Medical Education Research Facility, and renovation of the Blodi Eye Pathology Laboratory. 

The Iowa Lions Eye Bank moved to a new location on Mormon Trek Road in December 2001, and the second Executive Director, Pat Mason retired in July 2004.  She has been succeeded by Cindy Reed, RN who has begun an ambitious program to recognize donors and recipients which we hope will be located in the front garden area of the UIHC.  The project is just getting underway and has the enthusiastic support of the Iowa Lions and UIHC.

This year we celebrate the 50^th anniversary of the Iowa Lions Eye Bank founded by Dr. Alson E. Braley and the Iowa Lions and will recognize Pat Mason for her distinguished leadership.  Ruth Fisher, the first director of the Iowa Lions Eye Bank, will also be recognized.  She was one of the first if not the first person to undergo a penetrating keratoplasty in Iowa.  The graft, now more than 50 years old, is still clear.  The ILEB has gone from  a "ham radio operated" information system under Dr. Braley to a contemporary Internet data system to alert surgeons of donor tissue in addition to all of the innovations that have led to maintaining corneas for longer while recipients are prepared for surgery.  Acquisition of tissues has also become far more complex for corneal transplantation as well as for eye research.  Clinical and laboratory screening are required to assure the highest safety of tissue.

The establishment of The University of Iowa Center for Macular Degeneration has resulted in major expansion of research personnel and space primarily through the efforts of Ed Stone, director of the Molecular Ophthalmology Laboratories, and Greg Hageman, director of Morphology and Cell Biology in the Oakdale Research Facility. The center is expected to receive more than 20 million dollars in grants and awards from the National Institutes of Health, Foundation Fighting Blindness, Research to Prevent Blindness, and other philanthropic groups and individuals in the next five years. With completion of the first phase of the Medical Education Research Facility (MERF) in 2001, the Center for Macular Degeneration research program moved into the new facility.

Capital and programmatic expansion cannot be achieved without dedicated and outstanding faculty and support staff. Over the past 18 years, a number of senior faculty retired and others left for other institutions or private practice. Attractive offers come to all the faculty, but most remain and have flourishing careers. A new cadre of young, talented, and ambitious faculty have joined the department and gained national and international recognition. This is a natural evolution, but one that does not occur without support from the institution and teamwork. My job, as Fred Blodi said, is comparable to that of a conductor of a fine symphony orchestra. Each orchestra member is an accomplished artist. All musicians enjoy opportunities to perform solos. The members of our orchestra are no different, and each is recognized for their individual skills; but without a coordinated effort, there would be more cacophony than music. I am often reminded of Fred's analogy and am grateful even in the hardest of times to have been able to serve as Department Head.

Faculty Growth and New Expertise

In spite of the financial challenges from reduced reimbursement and the conversion of the UIHC/Carver COM electronic financial system the Department continues to flourish. Near the completion of my tenure as Department Head we have 31 faculty members, nearly twice the number when I started. We have full-time researchers with state of the art research facilities in our Oakdale Research Facility and in the Medical Education and Research Facility where most of the basic research from the Center for Macular Degeneration takes place. We have a number of joint appointments in the College of Engineering with the Computer and Electrical Engineering (CEE) Departments, the Biomedical Engineering Department in addition to otolaryngology, neurology and neurosurgery.

Edwin M. Stone, MD, PhD, is the first and, to this date, the only Howard Hughes Medical Institute investigator in ophthalmology.  His colleague, Val Sheffield, MD, PhD, is a senior member of the Center for Macular Degeneration, a professor of pediatrics and also an HHMI investigator.  Tom Casavant, PhD, another senior member of the Center, is a professor in the Department of CEE and Director of the Center for Bioinformatics for the University of Iowa.  Michael Abramoff, MD, PhD will lead the Department as Director of Ophthalmic Imaging and will also take a leadership role in the Department’s efforts to establish a program in telediagnosis of ophthalmic diseases. 

The Digital Age

A major change has taken place throughout the Department in the past year.  We have nearly completed the transition from film-based to digital imaging.  Within a few months we anticipate that all color fundus photographs and fluorescein angiograms will be available in digital format throughout the clinic.  In addition all other digital images will become accessible: echography, perimetry, topography, external photography for oculoplastics and pediatrics, etc.  This will be followed by integration of an electronic medical record that will allow HIPAA compliant information acquired in ophthalmology to be readily available throughout the UIHC medical center and to referring physicians via the Internet.  We can proudly say we have in less than a year made a miraculous transformation and arguably have the largest and most complex digital ophthalmic system in the country.

The digital age of ophthalmic imaging is expanding logarithmically.  Within a short period of time we anticipate being able to provide telediagnosis of retinal diseases in rural Iowa family medical centers.  Rural sites will be tied electronically via the internet to the Department.  Color fundus photographs will be evaluated in the Department and physicians and patients in rural areas will be provided with information that will enable them to seek help locally or to come to the University.  This will ultimately be a great savings to patients who will avoid travel for unnecessary consultations and has added value to family medical centers who see a great many patients with diabetic retinopathy that would otherwise depend on consultants.  Ophthalmic consultants will benefit in turn by seeing the patients who can most benefit from their care.

Endowments: Our efforts over the past two decades to create sufficient endowments in the University of Iowa Foundation to support at least one professorship or chair in each clinical unit have nearly been realized.

In all there are over 60 accounts in the UI Foundation used to help carry out the mission of each unit within the Department.  We are very grateful for the continuing support of our alumni, friends, patients, philanthropic organizations and corporate sponsors.  Without their support it would not be possible to achieve the high degree of excellence the Department has become known for nor could we provide the kind of care expected by our patients. 

About Giving to Iowa Ophthalmology

While our ophthalmic family has grown we pride ourselves in continuing to attract the best young physicians to the Department while maintaining a friendly and supportive environment to learn, do research, and treat patients.

Our referral base continues to grow and we strive to satisfy the needs of our patients and all those who send us patients.

Thomas A. Weingeist

April 21, 2005

See also 75 Wonderful Years, photographs from 75 years of ophthalmology at the University of Iowa.