Global training

When Arthur Brant, MD, started college he had his eyes set on tech, and that is what he did for a while as a software engineer at Google — a role that would make many people feel like they had made it in their career.

Then Brant found himself in a room listening to a talk by Geoffrey Tabin, MD, Fairweather Foundation professor and professor of ophthalmology and global studies at the Byers Eye Institute at Stanford. Tabin has devoted most of his career to bringing desperately needed eye care to parts of the world where resources and specialists are scarce, offering treatments that preserve or restore vision for people who would otherwise be out of options. By the end of Tabin’s talk, Brant was inspired to pursue a new career path.

Brant is now wrapping up his final year of residency at the Byers Eye Institute. He’s logged 16 trips to India, Ghana and Nepal and worked on multiple initiatives to improve access to eye care globally. In 2023, Brant co-founded the African Eye Imaging Imaging Centre with Akwasi Ahmed, MD, MBA, who is currently the only vitreoretinal surgeon in the Ashanti Region of Ghana. The pair are focused on detecting and managing diabetic retinopathy and sickle cell retinopathy.

“Dr. Tabin took me under his wing, guiding my early work in India and Nepal,” Brant said. “I got a lot out of going and seeing those programs and building relationships.”

As impressive as his path is, Brant isn’t alone. He is one of many current and former residents and fellows who have made an indelible mark on people around the world with the global ophthalmic training and mentorship they’ve received at the Byers Eye Institute.

Those global opportunities are a major draw and benefit for prospective trainees, said Carolyn Pan, MD, clinical associate professor and residency program director at the Byers Eye Institute.

“There are seven US-based Global Ophthalmology fellowship programs, and resident involvement varies greatly,” she said. “Stanford’s range of opportunities is not only broad, but also deeply enriching, fostering meaningful engagement for our trainees.”

While tackling global vision disparities and health is a critical part of the work doctors and trainees do at the Byers Eye Institute, it is also a daunting task.

Today, 90% of the world’s blind population live in areas with limited or no access to eye care, according to the Cure Blindness Project, a nonprofit co-founded by Tabin in 1995 to improve access to eye care in those areas.

“The statistics are terrible,” Tabin said. “There are 18 million people who are blind from cataracts, but each person we treat is no longer a statistic because they're 100% cured. There are few things in medicine where we can fully cure people — particularly in global public health.”

To date, the Byers Eye Institute’s Global Ophthalmology program, which is funded by philanthropy and grants from the Cure Blindness Project, has accepted seven fellows since 2018. Tabin aims to expand the program and fund additional equipment for the clinics so more fellows can access such training, and more patients can access care.

Rachel Scott, MD, the current global ophthalmology fellow at the Byers Eye Institute, says the most valuable skill she’s adopted from her training so far is adaptability.

“You get the opportunity to learn techniques to which you otherwise may never have been exposed, and to learn from colleagues what pro-tips they have when certain equipment is not available,” she said.

But one doesn’t need to be a global ophthalmology fellow to get global training and mentorship at the Byers Eye Institute. In fact, all residents at the institute have the option to complete a fully funded elective working in a low-resource country at a clinic where Stanford has partnered. Pan estimates that between 40% and 50% of residents in recent years have taken the leap abroad to work and train in another country.

“Much of the work in global health is centered around education, equipping existing providers within local health systems with the necessary skills to deliver effective and sustainable care,” she said. “As learners themselves, residents can offer creative solutions while understanding the existing challenges and barriers to care in these communities.”

Many of those residents help staff the Stanford Belize Vision Clinic, on the tropical island of Ambergris Caye, an area that lacks ophthalmic providers located more than 3,300 miles away from the Byers Eye Institute home base in Palo Alto, California.

Caroline Fisher, MD, clinical professor of ophthalmology, helped found and run the partnership between the clinic and Stanford. The Belize facility is staffed largely by Byers Eye Institute residents and faculty clinicians who travel to see patients throughout the year. Faculty from NYU, USC, the University of Wisconsin, and the University of Washington have also participated. More than 1,700 patients have been treated at the clinic since its opening in 2017.

A new AI-enabled camera helps triage patients and detect diabetic retinopathy and diabetic macular edema that warrant follow-up with a board-certified ophthalmologist. When Stanford ophthalmologists arrive, they get to work seeing all of the patients recommended for further examination.

“It's really about building a global community that is aware of the needs which exist beyond our national borders and creating thoughtful solutions,” Fisher said. “Although the strategies we use in global health can be applied to clinical care in the U.S., there are lessons which we can also learn from global health practices.”

The Belize clinic was founded thanks to the generous philanthropy of Don Listwin and his wife, Hilary Valentine, co-founders of belizekids.org. The clinic is supported by belizekids.org and the Ferroni Foundation.

These kinds of global opportunities and faculty mentors who are deeply versed in treating patients in low-resource settings set Stanford apart in ophthalmic training, Tabin noted.

“This is unique among ophthalmology residencies in the United States, and it's one of the things that makes our residency the top choice for many of the top applicants around the country,” he said.