When Judy Goldstein, M.D. looks out at the world, she sees a rapidly graying population in desperate need of low-vision services to improve their quality of life. And yet, for reasons that are not immediately clear, it can be difficult to encourage young eye specialists into careers in the field.
Goldstein, who is chief of the Lions Vision Research and Rehabilitation Center (Wilmer’s Low Vision division), says that part of the challenge is that the caregiver must be equal parts physician, therapist, counselor and educator. To maximize a patient’s quality of life, low vision faculty and staff members spend a great deal of time and attention to coordinate the best combination of treatment strategies.
Treatments can range from prescribing specialized lenses that allow patients to drive a car to counseling them that they must discontinue driving and put alternative transportation options in place. Dedicating one’s career to rehabilitation medicine takes a unique commitment to caring for the entire person and the recognition that the success of treatment often depends on engaging and motivating the patient to understand and participate in the process.
Often, the appointments take a lot longer than in other specialties and involve extensive education and counseling. And in medicine, as in almost any profession, time means money. Many young ophthalmologists and optometrists, often burdened by school debt, opt for higher-paying careers in other specialties.
“Low vision is not a high-volume field,” Goldstein says. “And there are too few who do this kind of work.”
Rectifying this problem has become one of Goldstein’s missions, and she has enlisted an old friend—the Lions Clubs—to help her do it. For the last 30-plus years, the Lions have contributed millions of dollars to the Lions Low-Vision Research Fund at Wilmer. And in the last decade or so, the civic organization has extended its commitment to the Lions Low Vision Fellowship, $100,000 annually that underwrites a full year of clinical and research training for low vision specialists at Wilmer. The fellow’s time is split 80 percent in the clinic and 20 percent doing research.
The goal of the fellowship is to seed Wilmer’s particular brand of care as widely as possible. One recent fellow, a glaucoma specialist, hailed from Thailand and has returned to his native country to help lead the low vision program at King Chulalongkorn Memorial Hospital.
The fellowship is open to ophthalmologists and optometrists who have completed their residencies. In return, they get a full year of intensive training at Wilmer. Bob Massof, Ph.D., is the research director of the Lions Low Vision Fellowship. He says that in the fellows’ research component, they learn key data gathering, analysis and writing skills that are needed to establish their research careers. Most complete their year at Wilmer with a published paper to show for it.
“We’re now starting to see the proteges of former fellows returning to Wilmer as fellows themselves,” Massof says. “It’s great to see this echo effect.”
The emphasis on research sets the Lions program apart. The fellows not only study existing rehabilitation techniques, therapies and technologies but conduct investigations that expand the body of knowledge about low vision care.
Patients in the mid-Atlantic are blessed to have a low vision program like Wilmer, says Lion Larry Burton, chair of the Lions Vision Research Foundation. “But it’s not the norm across the country or even internationally,” he says, “and we want to spread the wealth as far as we can.”
Recently, the Lions have taken things a dramatic step forward, leading an effort to permanently endow the fellowship—a gesture requiring at least $2.3 million in funding to yield an annual fellowship of $100,000.
The Lions—often known as “the Knights of the Blind”—have been committed to Wilmer’s low vision care since Arnall Patz was Wilmer director in the 1980s. “The clinical fellowship was a natural extension of that work,” says John Shwed, who heads the Lions’ development committee and is the one charged with raising the endowment. Shwed points to the approximately 5 million people in the U.S. with low vision and says: “We wanted to make a statement that those people matter.”
Ashley Deemer, O.D., is a recent Lions fellow who stayed on as a faculty member after her training. For her, the work in low vision, and the fellowship, are personal.
“I have a grandma with glaucoma,” Deemer says. “Her caregivers treated her medical conditions, but no one was addressing her quality of life, and that’s where the low vision program really pays off.”
Deemer used her fellowship to get involved with a project looking at the frequent connection between macular degeneration and depression, assessing two therapeutic options. For someone who had no prior research experience, the chance to learn at Wilmer was invaluable. “It was just too good an opportunity to pass up,” she says. Goldstein says the fellowship has one additional intent that is not always apparent. “The Lions fellowship is just a year of training in one’s life, but fellows truly connect to the mission and grow in their love for the work,” she says. “Then, it becomes a career.”