A vision for vision

In November 1996, when Bruce Shields arrived as the new chair of the Department of Ophthalmology and Visual Science, he had his work cut out for him. While Yale remained a world leader in vision research and the treatment of glaucoma, the department had significant problems to solve. With the advent of managed health care, reimbursement rates for clinical services were dropping, with no end in sight. At the same time, insurers began moving to redirect all but the most complex eye-care cases back to primary care physicians. Faculty had to increase their patient load to compensate for the reimbursement deficit, and the more difficult caseload had begun to cut sharply into teaching time. “Ophthalmology,” says Dr. Shields, “was hit as hard as any specialty.”

Meanwhile, the future of funding for all biomedical research was under fierce debate in Washington. As academic medicine faced its most serious challenges in decades, the ophthalmology department was without permanent leadership. Two acting chairs forged ahead as Yale searched for a successor to glaucoma pioneer Marvin Sears, who had stepped down as chair in 1993.

Two years after Dr. Shields’ arrival, the department still faces challenges but a plan is in place. Faculty have worked together to define a concise mission for the department, which has launched new programs and recruited promising young faculty to its ranks. One of Dr. Shields’ first decisions was to strengthen Yale’s expertise in retina care and research, with the goal of creating a world-class program as the department has done with glaucoma since the 1960s.

Other new programs are in the works. Cooperation among community ophthalmologists, Yale-New Haven Hospital and the School of Medicine led to the establishment this summer of the Yale-New Haven Eye Laser Center, which specializes in refractive surgery to correct nearsightedness and astigmatism. The department has transformed its residents clinic—a concept that has become outmoded in modern academic medicine—into a comprehensive eye service that has solved part of the primary care-referral problem while eliminating a two-tiered system that had channeled indigent patients to the care of physicians-in-training. Another initiative has been the establishment of a low-vision center to offer practical help to patients whose poor vision cannot be improved. Meanwhile, Dr. Shields is cultivating alumni of the residency program to increase their involvement in departmental activities, enhancing continuing medical education, and devoting time to fund-raising.

An authority in glaucoma like his predecessor, Dr. Shields speaks enthusiastically about maintaining excellence in glaucoma research and specialized care. His own research has been devoted to the development of new laser treatments for advanced forms of the disease. Focusing on retina, too, makes sense not only financially, he says, but also in terms of public service. “When we talked with ophthalmologists in the community, one of their messages was that Yale should strive to offer services that aren’t readily available elsewhere,” he says. “Glaucoma and disorders of the retina are two major disciplines in ophthalmology that account for most of the blinding disorders in this country. They also represent areas of significant technological advances and the promise of better care.” YM