Patients as Partners

A team approach helped address ‘a perfect storm’ of problems for Howard Freedman, who was inspired to create a new fellowship aimed at embracing complexity in treatment.

Published in Wilmer - Annual Report 2022

In October 2018, Howard Freedman’s vision in his left eye suddenly became very blurry, to the point that he couldn’t see out of it. Freedman and his wife, Randy, were on vacation in Shanghai, China, at the time. After seeing an ophthalmologist there and in Hong Kong, and communicating with Freedman’s ophthalmologist at home in York, Pennsylvania, they learned that Freedman had a dislocated intraocular lens. His artificial lens — a lens that was implanted when he had cataract surgery 15 years prior — had fallen to the back of his eye, causing the fogginess and sudden loss of vision.

After returning home, Freedman’s ophthalmologist recommended he see Yassine Daoud, M.D., chief of ophthalmology at Johns Hopkins Medicine — Howard County General Hospital and an associate professor of ophthalmology at the Wilmer Eye Institute.

At Wilmer, the Freedmans quickly felt at ease with Daoud. “We would talk for an hour about our families and travel, so we developed this camaraderie,” says Freedman, whose career in retail leadership included serving as president of the Pfaltzgraff Retail Division and vice president of merchandising for Ollie’s Bargain Outlet.

“I felt comfortable that he knew who I was and that he understood my eye.” This was important because Freedman has had many issues with his left eye, which, along with cataracts and the dislocated intraocular lens, have included a history of retinal detachment and corneal disease.

“He came in with a perfect storm of many complex problems,” says Daoud, adding that Freedman also had been diagnosed with pseudoexfoliation, a condition in which tiny clumps of protein fibers build up in the eye. This clogs the eye’s drainage system, increases pressure, can potentially lead to glaucoma, and makes it more complex to perform surgery on the eyes.

As part of Freedman’s care, in December 2018, Daoud first addressed the intraocular lens. Daoud explains that the lens sits in a box-like capsule and is connected to the wall of the eye by about 10,000 hanging, stretchy beams called zonules. “If the zonules become weak or damaged, then the lens may move out of place or drop to the back of the eye,” he says. During surgery, Daoud exchanged the lens and created a new support mechanism for it, with haptics, or flexible extensions, to anchor the lens to the sclera, the white part of the eye.

Then nearly a year later, Freedman needed a partial corneal transplant,
a procedure in which the damaged part of the cornea is replaced with healthy corneal tissue from a deceased donor. In a normal eye, the front and the back of the eye are separated by the natural lens, which sits behind the iris, and the zonules. However, in Freedman’s eye, where his artificial lens is anchored to the sclera, the natural lens and zonules are gone, meaning that his eye lacked this separation. This complicated the matter of which type of corneal transplant surgery would be most effective.

Still, Daoud, who has performed thousands of complex cataract and cornea surgeries, felt comfortable moving forward. “Mr. Freedman’s transplant took within the first week or two and then he started seeing better and better,” he says.

Today, Freedman sees two other specialists at Wilmer in addition to Daoud: Akrit Sodhi, M.D., Ph.D., a retina specialist and the Branna and Irving Sisenwein Professor of Ophthalmology, and Pradeep Ramulu, M.D., Ph.D., chief of Wilmer’s Glaucoma Division and the Sheila K. West Professor of Ophthalmology.

After this patient experience, the Freedmans — philanthropists who have supported many causes, including a new children’s playground at The York Jewish Community Center in Pennsylvania where Randy Freedman was executive director for 12 years — wanted to contribute to furthering Daoud’s work. Their gift will be used to establish The Freedman Fellowship, which will support the work of two consecutive fellows with the goal of training them to specialize in the kinds of complex corneal and cataract cases for which Daoud is known.

During this fellowship, which will begin in July 2023, each fellow will serve for a one-year period, and each will be directly involved in Daoud’s research and his clinic and will work on a variety of cases, often within the same day. (On a recent Wednesday, Daoud’s schedule included every form of corneal transplant, three lens replacements and two complex cataract surgeries.)

Establishing a fellowship was appealing to the Freedmans because of its clear impact. “We try to look for opportunities that are measurable as to what the potential outcomes could be,” says Randy Freedman. “This fellowship fit because we knew this would be a specific project that would move Dr. Daoud’s field forward in a very clear way.”

“Our intent would be that the two fellows will improve their skills and techniques through this fellowship, which will then help hundreds or thousands of patients like me,” adds Freedman.

For Daoud, the support of patients like the Freedmans is a necessity in furthering his work and continuing to provide the most advanced care for other patients. “We are very fortunate in that sometimes patients become partners, and, without that support, much of what we do might not be possible,” he says.