The Doheny Eye Institute at 50

The experts told Estelle Doheny that eye research was in its infancy and that L.A. lacked research and clinical facilities. She vowed to change that.
by Al Kildow
Stephen J. Ryan, the Doheny Eye Institute's president, was the first USC faculty member in ophthalmology: "I wanted to help establish a world-class eye institute." The institute continues to be guided by its original charter to provide cutting-edge eye care.

Photo by Irene Fertik
When Robert A. Smith III, president of the Carrie Estelle Doheny Foundation, stepped to the Century Plaza Hotel podium Tuesday, Nov. 11, to accept the gratitude of the Doheny Eye Institute on the 50th anniversary of its founding, he was playing a historic role.

Smith, as president of the board, serves as custodian of the legacy of Estelle Doheny, someone who saw from afar the needs and potential of modern vision research and patient care tied to community service.

In the 50 years since its founding, the Doheny Eye Institute has played a central role in transforming the way that vision is protected, nurtured and corrected.

To Stephen J. Ryan, the eye institute's president and the first USC faculty member in ophthalmology, it is both wise and the natural order of things at Doheny to take what is learned at the institute to the community, because that is the way Estelle Doheny wanted it. As the success of research at the institute has helped community physicians address more difficult eye problems in their patients, the faculty of the institute has become increasingly dedicated to tackling the most difficult research problems in ophthalmology.

Today, research and clinical activities at the Doheny Eye Institute have coalesced into these areas, among others:

* Corneas. Cornea transplants and excimer laser surgery for nearsightedness are performed. Diseases and injuries to the surface of the eye are treated routinely just 10 years after a Doheny physician first began looking at excimer lasers as a potential treatment.

* Optic nerves. Tumors on the optic nerve are now removed; mysterious vision loss is solved; distortions of the eye socket are surgically repaired, and the eye is a window through which to see diseases elsewhere in the body.

* Eye pathology. A thousand times a year, eye pathologists at the Doheny examine tissue specimens rushed from ophthalmologists throughout the Western United States. Faculty experts utilize a half-century of experience and a huge data base of specimens to advise physicians on sight-saving treatments.

* Retina and vitreous. The leading cause of blindness in the elderly is macular degeneration. Doheny physician scientists, working to develop the techniques to diagnose and search for a cure, study the molecular basis of this and other retinal and sub-retinal diseases, seeking answers to such questions as how new blood vessels form in the eye.

* Glaucoma detection and treatment. Another leading cause of lost vision is slowly yielding to research in the Doheny laboratories.

In addition, close collaborations among Doheny faculty and their colleagues in the department of ophthalmology who are based at Childrens Hospital Los Angeles focus on difficult eye diseases and problems affecting children.

CREDIT FOR THE decision to move from St. Vincent Hospital to the Health Sciences Campus in 1975 is shared among the Rev. William G. Ward, Hugh Edmondson and the Doheny boards. Father Ward was the spiritual adviser and counselor to Estelle Doheny; Edmondson was a former chair of the USC pathology department and then the president of the Doheny

Eye Foundation. Then-medical school Dean Franz Bauer appointed Edmondson as chair of the search committee that resulted in the recruitment of Ryan to USC as the first full-time chair of ophthalmology in 1974.

While the legacy of the Doheny began with establishment of the foundation in 1947, the intellectual and entrepreneurial leadership that brought it to fruition at the USC Health Sciences Campus began at the Wilmer Eye Institute at Johns Hopkins. There, two ophthalmology residents, both graduates of the Hopkins Medical School, met for the first time. One was Ryan, on the eve of his selection to the prestigious post of chief resident in 1969; the other, Ronald E. Smith, followed two years behind in Ryan's footsteps.

RYAN CAME TO USC after a prolonged, three-year recruitment. He recalls 13 trips to Los Angeles, "and the dean and I could not come to agreement during the first two search processes."

USC under Dean Bauer went through a third process and third set of candidates and, together with the leadership of LAC+USC Medical Center, met Ryan's demands, which had nothing to do with usual issues, like salary. "I wanted to help establish a world-class eye institute," Ryan said. "One that would be involved in cutting-edge research, treat patients with difficult problems who were referred by area ophthalmologists and teach the next generation of ophthalmologists. We needed major improvements at LAC+USC to provide modern eye care for patients and to attract great medical students to our residency program."

The early days were hectic. "Some of the people who were pivotal in my recruitment, and whom I had counted on for major support, moved on to other jobs or retired about the time I arrived," Ryan said, "among them Robert Tranquada (then medical director of the medical center, subsequently USC dean of medicine and now an emeritus professor) and Bauer, who resigned as dean a month after I came."

Stability appeared in the person of Allen Mathies, who became acting dean and then permanent dean for a total of 11 years. Sol Bernstein, medical director of LAC+USC, got to know Ryan well, as Ryan and Al Marrone and other supervisors lobbied on behalf of the tiny ophthalmology department. Ryan recalls that "Allen and Sol were really the key in building world-class ophthalmology here. They deserve the credit for making the great success in USC ophthalmology possible."

A year later, Ryan recruited Smith, and shortly thereafter, Mike Allen, as the first two faculty members - who arrived to a full-blown crisis.

Crucial to the development of the department was the ability to see patients in private faculty practices. Young and lacking in personal resources, the three faculty members faced a major stumbling block in the form of malpractice insurance. In the midst of a physician malpractice crisis in the state, USC decided it couldn't pay the premiums - and the premiums were escalating rapidly in those days. The new faculty also needed equipment for examining and treatment rooms.

Since neither funds nor guarantees nor collateral were available from either the university or Doheny, Ryan and friends went to the bank - Security Pacific - and convinced it to lend them $250,000, using their already highly mortgaged homes as collateral. "Fortunately, it all worked out," Ryan recalled, "and we were able to make our payments on time."

Malpractice insurance premiums were capped not long after, largely through the efforts of Los Angeles attorney James Ludlum of Musick, Peeler and Garrett, who "convinced Gov. Jerry Brown to call a special session of the state Legislature, and the cap was placed," Ryan said. "Without Ludlum, we would have been early casualties and had to leave."

MAJOR CRISIS became routine. The original Doheny Eye Institute, on the southeast corner of Zonal and San Pablo streets, had set aside shell space with potential for an eye hospital. But because of the threat of earthquakes, building standards were changed, and the original Doheny building didn't meet seismic requirements for hospitals.

"Lacking our own hospital, we scrambled to do our surgery on a rotating basis at Hollywood Presbyterian, Huntington Memorial and Alhambra Hospitals," Smith said. "Meanwhile, we went to work to try to raise money for a new hospital."

The institute's charter ruled out ever incurring debt, so all construction and other capital funds had to be raised from private philanthropy. The Carrie Estelle Doheny Foundation, under the leadership of Father Ward, led the way, pledging large sums of money while requiring the institute to match them from other donors. The building was completed in the fall of 1991.

"Over the years, the foundation has been incredibly generous," Ryan said. "Father Ward, Rob Smith and others have given us assistance and advice, assuring that we always operated in the spirit of Mrs. Doheny's desire to serve the public good."

One measure of the institute's success is its desirability for advanced training. Each year, more than 400 medical school graduates apply for five prestigious positions as residents in training in the ophthalmology residency program.

Another measure is the fact that the Doheny Eye Institute is one of the top recipients of grants from the National Eye Institute, the federal agency that funds 85 percent of all vision research in the country.

The list of achievements is lengthy. The foundation's Smith can share liberally, on behalf of his foundation colleagues past and present, in the pride that Ryan and his colleagues share in the edifice they've helped create: a world-class institute.

Doheny Success Stories
A Rescuer's Vision Goes From 20/1200 to 20/20

Sharon Smith of Yorba Linda had a passion for helping Search and Rescue teams ply the rugged canyons and mountainsides near her home, helping to find lost or stranded hikers. She was handicapped by thick glasses that corrected her 20/1200 nearsighted vision. "If my glasses had flown off my face," Smith said, "I would have been as helpless as the victim I was trying to save."

Sharon's ophthalmologist referred her to Peter J. McDonnell, professor of ophthalmology and medical director of the Doheny/USC Refractive Surgery Center. In procedures lasting just a few minutes on each eye, McDonnell reshaped her corneas with an excimer laser. Her vision is now 20/20 without glasses.

Solving A Cuban Vision Crisis

In 1993, tens of thousands in Cuba suddenly began losing their eyesight, and no one knew why. International health organizations were called in to help, and they turned to Doheny's Alfredo A. Sadun. Sadun is a neuro-ophthalmologist, studying the nervous system that empowers vision.

Sadun soon solved the mystery. Noticing that certain fibers in the optic nerve were missing, he concluded the patients had a dietary deficiency, which he identified as folic acid, brought about because of severe rationing and consumption of homemade rum.

Cuban officials quickly responded with an extensive program to supplement diets with folic acid and other vitamins - and cracked down on production of homemade rum.

"Those patients who had not suffered from the disease for any great period of time had their sight restored very quickly," Sadun said. "But patients who had suffered from the disease for a year or more had irreversible vision problems."

A Present Tie to Doheny's Past

Ophthalmologist John A. Irvine has an interesting connection to the Doheny: His grandfather was Estelle Doheny's ophthalmologist and instrumental in the founding of the institute. Ophthalmology runs deeply in the Irvine family. Besides his grandfather, Irvine's father and several uncles and cousins are ophthalmologists.

Irvine specializes in cataract surgery but has broad interests. He performs cornea transplants, treats inner-eye problems, often with surgery, and rebuilds eyes. He frequently performs cornea transplants on patients with scarring from herpes, bacterial or fungal infections. "We see a lot of bacterial infections in the cornea from contact lenses, especially improper use of extended wear lenses," Irvine said.