Someone waiting for a routine eye exam in Dr. Randy Epstein’s office would probably be unaware that a clinical drama could be unfolding in the next room. That’s the range of Dr. Epstein’s cornea practice – from everyday eye care to complex cornea surgery, with LASIK surgeries in between.

“Much of what I see and do every day is high drama, in the sense of the television show E.R., believe it or not,” says the Chicago surgeon, researcher and longtime affiliate of the Illinois Eye-Bank. “The challenge I have as a specialist who also provides comprehensive, general eye care, which I still enjoy, is that on any given day, interspersed with people coming in for routine eye exams, could be someone who has a horrendous corneal infection that they acquired from their contact lenses, or someone who got poked in the eye by a tree branch and has fluid leaking out from their eye.” Epstein’s greatest frustration is that patients waiting for routine care are often impatient when he runs behind. “They don’t realize that you may be in the process of making complex arrangements to keep someone from going blind, or maybe a patient has just told you that their spouse of 40 or 50 years recently passed away and you need to give them a hug and spend some extra time with them.”

The reserved surgeon is known for maintaining intense, caring relationships with his patients. He’s aware of the multiple dimensions of medical care, and that often a person’s psychological condition enters the equation. “What most people don’t realize is the psychological importance people place on their vision,” Epstein observes. “There’s something very intimate, personal and important about vision… There is a deep psychological connection between people’s eyes and their souls that is absolutely undeniable. Anyone who takes care of eye patients will tell you that. I never realized that such a high percentage of my time would be devoted to attending to the emotional needs of my eye patients.”

Ophthalmologists, he says, are second only to dermatologists in the number of patients they see daily. Dr. Epstein may treat 40 or 50 people a day. “You can’t imagine how many stories can be generated from those encounters.” One of his recent patient stories concerns the plight of Jackie Stillmaker, a high school student who contracted an infection after wearing contact lenses while swimming. She was referred to Dr. Epstein after emergency treatment for excruciating pain in her left eye. While treatment is critical to recovery, Dr. Epstein realizes the importance of bonding with his patients. During the long, arduous treatment process, he provided Stillmaker, a promising young basketball player, with the reassurance she needed that she would not lose her sight. More importantly, he became a role model for the young scholar, encouraging her to pursue a career in science.

“He was basically my second dad,” says the senior at Maine West High School in the Chicago area. “I was with him pretty much for two years.  He made me want to go into the medical field – not necessarily into eye care.” Currently thinking about a career in research science, perhaps microbiology, Stillmaker says, “If I were to become a doctor, he inspired me to want to be the strongest person there, learn everything I can. He’s so knowledgeable. Even though he doesn’t say much, he knows exactly what he’s doing and how to do it. He saved my eye. He cared about me. He wanted my vision to come back.  Not all doctors do that.”

Dr. Epstein is working with Stillmaker and her mother, Mary Beth, who is actively lobbying Congress to mandate better education and product information for people wearing contact lenses. “There’s ignorance on the part of the American public regarding the danger of wearing contact lenses,” he says. “Almost every reporter I’ve spoken with on this subject has been amazed that this is even an issue, because many of them wear contacts and no one told them that this was even a potential downside. If you consider the millions of people wearing contact lenses, it’s a huge problem. Every month, I see at least one other new Jackie Stillmaker, another young person who may wind up needing a corneal transplant because of a contact lens-related infection… No one educated them properly with regard to the risks associated with wearing contact lenses.”

It’s not surprising that Dr. Epstein would encourage a young person to explore research science. While at Rush University Medical School in the 1970s, he was impressed by one of his professors, Dr. Frank Hughes. “One day I asked him if I could watch him use an electron microscope; I had never seen one in use. We talked about what he was researching – corneal neovascularization.” Dr. Epstein joined Dr. Hughes in researching the causes and treatment of corneal neovascularization, which led to his decision to become a corneal surgeon even before he decided to specialize in ophthalmology. Dr. Epstein was able to present his original research at a number of the annual meetings of the Association for Research in Vision and Ophthalmology (ARVO). He received a National Eye Institute Research Service Award, which funded further studies he performed during his corneal fellowship at Emory University in Atlanta. He later continued to research corneal neovascularization upon his return to Rush.

More recently, preventive medicine and advocacy have become areas of interest for Dr. Epstein.  His research is exploring ways to prevent ectasia or “corneal bulging” that may occur during LASIK surgery. A major article on this subject was published in the journal Cornea. Dr. Epstein notes that corneal bulging occurs most often in younger patients. “It caused us to become more conservative about doing LASIK surgery on younger patients with risk factors such as high astigmatism, myopia or thinner corneas. They may be at risk for developing keratoconus, which frequently requires a cornea transplant. If they’re only 21 years old, they may not yet have developed the disease. It may be best to wait until they’re closer to 30 to offer LASIK, if they do have risk factors.”

Along with his partner, Dr. Parag Majmudar, Dr. Epstein has been recognized internationally as an expert in the treatment of corneal haze, or scar tissue, that may form after surface corneal refractive surgery, such as PRK. Dr. Epstein’s research has led to the prophylactic application of the “off-label” medication, Mitomycin-C (MMC), to the cornea following procedures to prevent the haze from forming. “It has become a standard treatment for post-operative corneal haze, and we are now investigating its use for prevention,” he says. “Thousands of patients worldwide have benefited from our research; that has been very gratifying.”

Dr. Epstein was also active in promoting the passage of a change in the Illinois organ donor law that increased the availability of eye tissue by requiring hospitals to notify the organ procurement organization of deaths.

Dr. Epstein also feels it’s natural for an eye surgeon to support the local eye bank. “Having a dynamic eye bank can make a tremendous positive impact on the career of a corneal surgeon,” he says, adding that he started his practice about the time that Chuck Pivoney was a technician at the Illinois Eye-Bank. Pivoney, who now serves as the Eye-Bank’s Vice President, Illinois Operations, fondly recalls his early work with Dr. Epstein.

“I remember him as an active, supportive physician when I started,” Pivoney says. “As far back as I can remember, he was a member of the Chicago Ophthalmological Society’s Eye Bank Committee.” The committee served as a medical advisory board, providing clinical advice to the Eye-Bank. Committee members also volunteered to evaluate eye tissue prior to transplantation.

“These physicians took time out of their practice and personal schedules to travel to the Eye-Bank and evaluate tissue for us,” Pivoney explains, adding that eye tissue evaluations were performed day and night and often on the weekend. “I am still impressed by the obligation Dr. Epstein and others felt in helping us. Dr. Epstein has always helped in the promotion of the Illinois Eye-Bank. He chaired the first several golf outings, joined the [Eye-Bank’s] Illinois Advisory Council, is a regular contributor and always present at our charitable functions.”

Dr. Epstein places value on community giving as part of his heritage. “The most rewarding thing for me, personally, is something I never really anticipated – the concept of giving back. It’s something a lot of people give lip service to and many people don’t do it at all. You get caught up trying to make a living and getting ahead professionally… but being involved in a charitable organization isn’t at the top of a lot of people’s lists.”

Dr. Epstein takes great pride in his children. Sarah is a sophomore at Penn State, majoring in Communication. Joshua is in Junior High School in Northbrook, Illinois.  When Epstein’s oldest daughter, Rachel (who graduated Phi Beta Kappa from the University of California-Santa Barbara, and is now pursuing pre-medical studies) began her “Bat Mitzvah” class, the rabbi brought all of their parents together with the children and explained that “mitzvah” is the Hebrew word for “good deed”. He then asked parents to talk about what good deeds they were doing for society, and what activities they were involved with that were voluntary or altruistic in nature. Dr. Epstein said that he became a little anxious as they worked their way toward him. “I was thinking to myself, there are people here who were volunteering for this and that, doing great things for society, working in soup kitchens… and I was thinking that they would come to me and I’d say, ‘I see patients and I work really hard.’ I was afraid that I would be embarrassed that I had nothing more to say.”

Then, suddenly, it occurred to him: “I volunteer my time to help the Illinois Eye-Bank. We raise money to be able to provide donor corneas for people who can’t afford surgery, and fund research to help keep people from going blind.”

He smiled. “I felt very good about that.”

Surgeon Profile: Catharine J. Crockett, M.D.

Eye Surgical Associates is a busy clinic on the campus of OSF St. Joseph Medical Center in Bloomington, Illinois. This is where Catharine J. Crockett, M.D. sees most of her patients. Although some of her patients come into the city from as far as an hour away, Crockett travels many miles on a routine basis to provide care at other clinics across the vast rural area.

“We have a lot of Apostolic Christians, farmers and other folks in the rural areas around here,” she explains. “They don’t always like to come downtown, so I work in other places where it’s easier for them to see me.”

Crockett has been a Board-Certified ophthalmologist since 1991. She performs three major types of surgery: cataract surgery, cornea transplants and Lasik procedures. For several years, she was the only specialty-trained corneal surgeon in the Bloomington/Normal area; however, others have recently begun practicing in Springfield, Peoria and Champaign.

In addition to the growing number of corneal surgeons, Crockett notes growth in the field of transplantation. “Corneal surgery is evolving,” she says, pointing to such new developments as Deep Lamellar Endothelial Keratoplasty (DLEK) in which the surgeon removes only the diseases endothelial tissue and replaces that tissue, rather than removing the entire cornea. Other advances include new types of contact lenses for patients with keratoconus, and new tissue adhesives for treating pterygia which help to minimize surgery time, avoid complications from sutures, and reduce pain following surgery.

Since 1996, Midwest Eye-Banks has operated the Illinois Eye-Bank, Watson Gailey, with Crockett as its Medical Director- a position she had held since 1994. The Eye-Bank is located on the southern edge of Bloomington, a short drive from Crockett’s main office. It was formerly housed at the BroMenn Regional Medical Center, and was then known as the BroMenn-Watson Gailey Eye-Bank. Dr. Crockett notes that the relationship between the Eye-Bank and surgeons has improved tremendously in recent years, ever since Midwest Eye-Banks and the Illinois Eye-Bank assumed managements of the Watson Gailey facility. “Now there is more equitable distribution,” explains Crockett, “and we can have surgeries when we want.”

Today, in addition to serving as a volunteer Medical Director for the Illinois Eye-Bank, Watson Gailey, Crockett is also a member of Midwest Eye-Banks’ Board of Directors. “They are co-dependent roles,” she says. “Serving on the Board is an extension of being the Medical Director.”

Crockett’s professional memberships include the American Academy of Ophthalmology, American Medical Association, Illinois State Medical Society, Illinois Society of Ophthalmology & Otolaryngology, and the McLean County Medical Society.

Emergency Cornea Shipment Rescues Humanitarian Mission

Just-in-time shipment of corneas doesn’t usually require a surgeon to meet an incoming flight, within minutes of catching his outgoing flight to the island of St. Vincent, near Grenada. But on January 26th, Dr. Mark Lister picked up a package of five corneas at Newark Airport, shipped hours before by Midwest Eye-Banks’ Tissue Distribution Coordinator Holly DeMasi in Ann Arbor.

Dr. Lister, co-medical director of the Lions Eye-Bank of New Jersey, was leaving on a medical mission arranged by the medical school in Grenada. He was scheduled to perform six corneal transplants with Dr. Robert Fucigna. On the morning of his departure, he learned that there was only one cornea available from another eye bank that had agreed to supply tissue for the mission. Dr. Lister immediately called DeMasi, realizing the critical time sensitivity of the situation.

The normal procedure to obtain eye tissue for a humanitarian mission involves a letter of request in advance, detailing the tissue needed and humanitarian purpose. The letter is reviewed by Midwest administration and a determination is made whether to provide the tissue and waive the processing fee. In this emergency, DeMasi scrambled to get administrative approval quickly.

“I told Dr. Lister that we were very lucky,” says DeMasi. There happened to be an extra supply of corneas available to meet the surgery schedule each day. The only problem was that the corneas were all in Michigan and Dr. Lister was in New Jersey.

The corneas were shipped via airplane to the Newark airport terminal where dr. Lister, waiting to board his flight, could pick them up. They arrives an hour before Dr. Lister’s flight was to leave, and he was able to pick up the box of corneas in time to depart.

DeMasi likens this experience to emergency surgery requests. “A surgeon will call and say he’s had a patient come in with a cornea perforation, and needs a cornea right away. I have to find a cornea and find the fastest way to get it to the surgery center or hospital.”

For DeMasi, it was more or less business as usual. “A lot of times, if I get a call from a surgeon returning a cornea because the patient didn’t come for surgery, I usually have that cornea redistributed to another surgeon before we even get it back to the lab,” she says. “when it gets back to the lab, we quickly repackage it and send it to the other surgeon.”

DeMasi works along, with lab staff assisting during peak periods. “My phone never stops ringing,” she says. Still, she hates a slow day.

Michigan Corneal Surgeon Participates in Historic ORBIS Mission to Libya

There is a considerable reward in teaching. There’s even more reward in performing the first corneal transplant in a nation’s history.

When you are one of the first non-Libyans to do both in the Tripoli Eye Hospital, “that’s pretty exciting,” notes Kevin Lavery, M.D., a cornea surgeon in Jackson, Michigan, and clinical professor of Ophthalmology at the Wayne State University School of Medicine.

Dr. Lavery was one member of an international team of ophthalmologists that conducted an eight day mission in Libya through ORBIS, a humanitarian organization whose mission is to preserve and restore eyesight by strengthening local resources in developing areas. Ophthalmologists volunteer to travel to developing countries through the world, performing procedures together with surgeons from the host countries, teaching them current techniques and offering standards of practice for ancillary staff.

This was the eighth mission for Dr. Lavery, who has been to Cuba, India, Bangladesh, Kurdistan, Peru, China, and Ethiopia. In Ethiopia, he helped establish the first eye bank in Africa.

Midwest Eye-Banks collaborates regularly with its affiliated cornea surgeons who participate in ORBIS missions. In this case, the Michigan Eye-Bank provided three corneas for use in Libya. There are more than 1,000 people on the waiting list for a corneal transplant in Lybia, and no corneal surgeons are available to serve the six million people in that country.

“I enjoy teaching,” says Dr. Lavery. Although ORBIS has fully equipped operating rooms suites on its transport plane, its philosophy is to “go into their hospitals with their equipment and show them what’s possible,” he adds. “You need to show them a cogent argument of where they are, where the rest of the worlds is and where they should be” in terms of corneal transplant surgery.

The ORBIS team includes biomedical technicians who repair malfunctioning equipment. More than 60 percent of the medical equipment in countries visited by ORBIS does not work, Dr. Lavery says.

Being an American in a North African Arab nation like Libya may seem intimidating. However, Dr. Lavery found it rewarding in its truest humanitarian sense. “Libyans were very supportive of Americans,” he says. Wherever he went he was told, “We love America.”

Despite the years of animosity between the governments of Lybia and the United States, he says at the “people level” the United States is revered as “the land of opportunity, freedom, and economic prosperity.”

Quality of life is as important as the length of life, whether you’re an infant or 99 years old. The ability to see is critical to personal freedom and a satisfying life, according to David Verdier, M.D., a corneal surgeon in Grand Rapids, Michigan

Dr. Verdier is one of the more active corneal surgeons in Michigan, performing about 100 cornea transplants procedures annually. Bit it’s not the volume of procedures or even the procedure itself that interests him as much as his ability to relate to patients on a long-term basis.

Prior to selecting ophthalmology as his specialty, Dr. Verdier began a family medicine residency at the University of Michigan Medical Center. That, by nature, offers a physician the chance to establish a long-term bond with the patient. “That really attracts me,” he says.

When he focused his practice on ophthalmology and corneal surgery at the University of Iowa, Dr. Verdier discovered that he could have similar experience with his patients. Corneal surgery requires about a year and a half to follow-up.

“I was attracted to transplants from the day I started my ophthalmology residency…I like the procedure, I like the challenges, I like the long term commitment and I love the results.”

Dr. Verdier returned to the Grand rapids area- his hometown- in 1984 to become the first corneal surgeon in west Michigan. He has had many memorable cases. However, three come to mind immediately when considering the value of cornea surgery.

His ultimate clinical challenge was to transplant a cornea in an infant- the youngest cornea recipient on record. At three months, the infant weighed less than a pound. A nurse noticed what appeared to be a tear on his cheek. It was his cornea.

“He’d had a silent cornea melt- a ruptured eye and melted cornea,” Dr. Verdier explains. He needed a cornea or he would lose his eye.

At the time, there were no instruments to cut the cornea to fit the infant’s eye, so Dr. Verdier had to improvise. “It was a challenge, yet it actually worked quite well,” he says.

Now 10 years old, the boy is well. He has some sight in his eye, but most importantly, the eye was saved. “By restoring the integrity of his eye with the new cornea [as an infant], he was still at an age where his skull was growing. Had we done an enucleation [removal of the eye], he would have ended up with a misshapen eye socket. Now he has little vision and a normal appearance.”

Few people, other than astronomers, appreciate the stars as much as one of Dr. Verdier’s patients. The man in his 60s had experienced poor vision thoughtout his life because of childhood eye infections. “He got by,” says Dr. Verdier. “He wasn’t totally disabled, but he was never able to do what sighted people could do. He never drove. Interestingly enough, he could read, but it was difficult.”

The man was a candidate for corneal transplants in both eyes. During a follow-up clinic visit with the patient after his surgery, Dr. Verdier noticed that the man was crying.

“He was a big, strong guy. I’ve never seen him down about anything, he recalls. “I asked him, ‘Is there anything troubling you?’ He said, “No, these are tears of joy. I saw stars for the first time last night since I was six years old.’ You can’t make that up in movie scripts. It was probably one of the happiest moments I’ve had with a patient- to have him share that with me. Sometimes, we don’t realize how important vision is…what a wonderful operation this is.”

Dr. Verdier would also learn that the man undertook “a whirlwind of activity around the house…making up for the 50 years of lost vision.”

The value of vision has no age barrier, as Dr. Verdier learned with a 99-year-old man. At such an advance age, a physician must weight the benefit of the procedure against its cost and relative value. The usual screen- ‘Is the quality of vision preventing a patient from doing the things they live to do or need to do?’- doesn’t apply when the patient is approaching his centennial birthday. However, this patient was different.

“You’re 99. Is it worth it?” he asked his patient. “I don’t know how long you or I will live, but you will have a year of follow-up.”

He had one good eye and one bad. In most lives, one eye is enough to read, move about and generally visualize life satisfactorily. However, for this man- vision in his bad eye was progressively compromised by painful complications from a cataract surgery- two eyes were definitely better than one.

He was a hunter who brought home a deer every year since 1926.

“It’s my shootin’ eye,” he told Dr. Verdier.

“That didn’t even register to me,” the surgeon recalls. “Your shooting eye?!” The man’s daughter told Dr. Verdier that he has shot a deer every year since 1926. That was one of his passions in life. He was bound and determined to go out the next year and shoot another deer.”

The procedure was successful and the patient shot a deer the following hunting season. In fact, he experienced three more hunting seasons before his passing at age 104.

This is what Dr. Verdier values in corneal surgery- not just the challenge of the procedure, but the opportunity of knowing people whose lives are enhanced because of the procedure.

Dr. Verdier is sensitive to the importance of the donor family’s gift of corneas, as well as the importance of cornea recovery, evaluation and distribution by eye banks. As a member of the Medical Advisory Board of the Eye-Bank Association of America, he reviews eye banking procedures regularly.

“I have come to appreciate what a challenge it is, and how complicated it is to make this all happen.  ...We [in Michigan] have an as good an eye bank as I know of.

“I’ve done over 1,000 corneal transplants in Michigan,” with most of the corneal tissue coming from the Michigan Eye-Bank. “There is nothing that beats experience in knowing what to expect. I’ve been impressed with the service and the quality of the [Michigan] Eye-Bank. We’re very lucky.”

The Michigan Eye-Bank also provided eye tissue for Dr. Verdier’s humanitarian mission to China last year. He was a member of a delegation of surgeons who trained Chinese eye surgeons in corneal transplantation techniques. He’s planning an upcoming mission to India.

Whether teaching a corneal surgeon, performing transplant procedures or examining a patient whose life is changed by restored sight, Dr. Verdier’s own life is enriched.

“I think that quality of life is just as important as length of life,” he says. “When you talk about other transplant procedures (and their ability to extend life), a corneal transplant doesn’t extend life, but in a lot of ways improves the quality of life more than anything you could do for these patients.

“Patients are often afraid of any eye surgery- cataract surgery or corneal surgery- because they recognize that their vision is their independence to a large extent.

“In terms of quality of life and maintaining someone’s independence, the ability to see or regain sight is near the top of the list. It is very fulfilling.”