Mid-year check-in with Dr. Jeffrey Goldberg, Chair of Ophthalmology at Stanford

ONE THING TO KNOW about Jeffrey Goldberg, MD, PhD is that it’s always a good idea to bring a notepad to any meeting with him, because you’ll want to take some notes.

As Professor and Chair of Ophthalmology at Stanford University School of Medicine and director of the Byers Eye Institute at Stanford, Goldberg has gained a reputation not only as a renowned clinician-scientist, but also as a visionary leader with big, exciting ideas, as well as a caring mentor to faculty, staff, and trainees.

Luckily, his track record as an ideas guy is good: for the past eight years, Goldberg has led the team at the Byers Eye Institute on a course for strong growth with a focus on translating promising and effective treatments from the laboratory to the clinic.

During his tenure as chair, the faculty has grown from 27 to 59, and the number of trainees, research, and administrative staff in the department has increased from about 37 people in 2015 to 185 as of 2022. Meanwhile, researchers in Stanford’s Ophthalmology department have attracted a growing amount of funding to study an array of ocular diseases, injuries, treatments, and novel technologies — NIH funding alone has risen from $2 million to $12.9 million in that same period.

In his own work, Goldberg, who is also the distinguished Blumenkranz Smead professor, has focused heavily on a group of diseases known broadly as glaucoma, which is the leading cause of irreversible vision loss worldwide. He helms a lab working to identify glaucoma risk factors and advance disease management, as well as studying cutting-edge approaches to regenerative medicine that could make glaucoma-related vision loss reversible for the first time.

Goldberg sat down for a mid-year reflection on promising technological advances in the field, his own research at the Byers Eye Institute, and his hopes for the future of ophthalmology.

This interview has been edited lightly for length and clarity.

Your primary area of study is glaucoma. What can you tell me about the latest breakthroughs in glaucoma treatment today and to come?

Here and across our field, we have made substantial progress, particularly in identifying new ways to measure eye disease, capturing structure and function at previously unprecedented levels. This research is allowing us to develop better risk factor assessments for who has early disease, who is at risk of getting worse, and who is responding to therapy, which will help us create more effective treatments.

New medication delivery systems, including implants that release treatment for the disease over a long period of time, are also promising advancements for long-term medical and surgical glaucoma management. But most exciting is the development of new treatments that directly target the degeneration of the retina and optic nerve — to stop that degeneration and to promote regeneration.

In that vein, much of your research has focused on regenerating these critical neurons in the eye called retinal ganglion cells, which receive visual information and transmit it to the brain. The problem is that once a disease, like glaucoma, has damaged those neurons, they don’t typically regenerate. Tell me about the latest advancements aiming to change that?

Well, one exciting avenue is the utilization of stem cells to replace damaged retinal cells and restore visual function. Researchers are working on developing safe and effective protocols for transplanting these cells into patients with degenerative retinal diseases, and we’ve seen great promise for this treatment in mice. There are still challenges ahead, but we are making progress to the point that we are beginning to ask more specific questions about how to coax these stem cells to reliably do what we want.

I’m also very excited about new medicines and gene therapies that could be translated from amazing data in the lab to new candidate therapies in the clinic. At Stanford, we’re deeply engaged in this sort of translational research — both the lab-based discoveries and the first-in-human testing of novel therapeutics. The idea that we could give patients a “booster shot” and improve their vision is very promising.

You’ve talked in the past about the role of artificial intelligence in ophthalmology. Could you elaborate on how AI is being used in the field?

Absolutely. One way AI is being used is through algorithms that can analyze retinal images and detect subtle signs of disease, including diabetic retinopathy and age-related macular degeneration (AMD). That’s exciting because early detection and prompt treatment are critical for the best patient outcomes in these diseases. AI-driven systems can also enhance surgical planning and optimize for better patient outcomes. A number of our faculty are using “big data” approaches leveraging AI to uncover better pathways for patient care on both the diagnosis and treatment ends.

Let’s imagine the future of ophthalmology considering the advancements we’ve discussed. What are you most excited about?

The future of ophthalmology holds tremendous promise, as doctors and researchers in this field have long been on the leading edge of technology testing and adoption. I’m looking forward to more advancements in minimally invasive surgical techniques that will improve outcomes and comfort for patients.  Nanotechnology may also open doors to targeted drug delivery systems and more personalized treatments. I also suspect that virtual reality and augmented reality will enhance surgical training for new doctors. We have made wonderful strides to develop innovative treatments for retinal diseases, including gene therapy and stem cell-based therapies, which hold great promise for patients with previously untreatable conditions.

What advice would you give to aspiring ophthalmologists entering the field and hoping to follow a similar path to yours?

There is a huge unmet need for more investigators — clinicians, clinician-scientists, and vision researchers — to tackle the many opportunities in our field. For clinician-scientists, I would emphasize the importance of a strong foundation in both clinical practice and scientific inquiry, as well as finding many mentors in those areas. Collaborate openly with colleagues across different disciplines to foster innovation and share ideas. Finally, hold onto your passions, as those will drive you to make the biggest impact every day.

BY JANICE TURI, WEB AND COMMUNICATIONS SPECIALIST AT THE BYERS EYE INSTITUTE AT STANFORD UNIVERSITY SCHOOL OF MEDICINE.