The Paths to Clinical Care

IN MEDICINE, new treatments generally start with an idea, go through a laboratory stage, and seek validation in human testing, a long and rigorous process before reaching their final destination in the clinic or the operating room, where those discoveries can improve patients’ lives. 

In fact, at the Byers Eye Institute at Stanford, “from lab to clinic,” is practically a mantra among the innovative and award-winning researchers and doctors striving toward a shared goal of fighting blindness and preserving sight. However, laboratory discoveries are just one of the ways the team is working to expand care and make the clinical experience more effective for patients, both across the Bay Area and around the world. 

“We have faculty who are leading in clinical work, bringing new therapeutics and surgical approaches to patients, all with compassion and empathy and the attitude that the patient comes first,” said Jeffrey Goldberg, MD, PhD, the Blumenkranz Smead professor and chair of ophthalmology at the Byers Eye Institute. 

The clinical footprint

The Byers Eye Institute is comprised of a fast-growing cohort of clinician-scientists, fellows, residents, and visiting scholars and instructors from around the world as it expands ophthalmic care to an increasing number of communities and people. 

Over the past eight years, the number of faculty members at the Byers Eye Institute has more than doubled, and the number of trainees, research, and administrative staff in the department has increased from about 30 to 187 since 2015. 

As the team has grown, so too, has the physical footprint. In July 2023, the department’s brick-and-mortar network opened its latest addition in Livermore, California, a suburb 35 miles east of the Byers Eye Institute’s primary Palo Alto location. The new offices, part of Stanford Health Care Tri-Valley, offers a full range of diagnostic and therapeutic care in the clinic and operating room. “There is nowhere on the planet that will be able to give the same kind of ophthalmology care unless you drive across the bridge to Palo Alto,” Rick Shumway, president and CEO at Stanford Health Care Tri-Valley told a group of supporters and journalists during the clinic’s unveiling last summer. 

The Livermore addition joins other Byers Eye Institute clinics, two in Palo Alto and one in Los Gatos for pediatric care. Byers Eye Institute clinicians also see patients at Palo Alto VA Medical Center and Santa Clara Valley Medical Center, a large public healthcare system in San Jose. 

And leaning into the digital revolution, Byers Eye Institute’s top-notch ophthalmologists also consult over video link with patients in the privacy of their homes and get remote imaging and interpretation for diabetic eye care or examination of infants around the country. 

In short, the Byers Eye Institute’s “clinic” is wherever the Stanford Ophthalmology department’s research and training, and its experience and expertise, meet the patient. It’s a place of care and hope for thousands of people each year. 

Vision, meet performance

Meanwhile, on Stanford’s Palo Alto campus, the university’s first Vision Performance Center (VPC) clinic opened in 2023 at the Arrillaga Center for Sports and Recreation. “The clinic serves Stanford athletes with injuries that may affect their eyes, vision, or cognitive function, and those who are looking to improve their performance and up their game,” said Khizer Khaderi, MD, MPH, clinical associate professor at the Byers Eye Institute and founder and director of the Stanford Vision Performance Center and the Stanford Human Perception Laboratory.

More VPC clinics are in development around the Bay Area, extending the VPC's technology and innovative practices to the broader public. There, doctors will focus on helping people reach their highest possible level of performance in whatever they do—whether that be excelling in sports, helming a Fortune 500 company, or anything in between, Khaderi said. 

 “We wanted to create a new kind of clinic where patients proactively learn about their health and how to augment their lives to reach peak performance,” Khaderi said. “People are living longer, but that doesn’t mean they are living healthier. We will treat people looking to grow not just their lifespan but their healthspan.” 

Myopia Center of Excellence

One of the newest clinical initiatives underway at the Byers Eye Institute is the launch of the Myopia Center of Excellence. 

When most people think about myopia, also known as near-sightedness, they might imagine a kid who has trouble seeing the blackboard in class. Actually, the prevalence of myopia in young people is growing fast, and those with severe cases are more likely to struggle with serious complications—like retinal detachment and glaucoma—as they age. 

Around 42% of Americans are nearsighted, according to NIH data published in 2017, up from just 25% of the U.S. population in 1971. The World Health Organization estimates that nearly half of the world will be myopic, or nearsighted, by 2050. 

Meanwhile, doctors and researchers aren’t certain why more people are struggling with nearsightedness, says Ann Shue, MD, clinical assistant professor at the Byers Eye
Institute. Genetics contribute, and lifestyle likely plays a role as well, but more research
is needed to know for sure, Shue says. 

It was this growing worldwide need for research, along with more access to medication
and specialized care, that prompted the efforts to launch the Myopia Center of Excellence, where a multi-disciplinary team of doctors will work together to collect data,
conduct research, and, most importantly, help patients.

“The team is made up of optometrists, pediatric ophthalmologists, retina specialists, glaucoma specialists, and more, all in one place,” Shue said. “We’re bringing together everyone’s expertise together at the Myopia Center for Excellence so that we can reach this problem from every angle.”

Going virtually anywhere

Just as the physical clinic footprint has expanded, so too have the Byers Eye Institute’s virtual treatment options. In fact, in the future, some faculty at the Byers Eye Institute would like to come to the patient. 

Geoffrey Tabin, MD, Fairweather Foundation professor of ophthalmology and global medicine, envisions a mobile facility van in which clinicians perform laser treatments and cataract surgeries targeting low-income patients, unhoused people, rural communities in Northern California, and others with limited access to high quality care. 

“Many patients aren’t able to come to a clinic, so we want to bring care to them,” Tabin said. The department is currently seeking funding for the initiative.

STATUS

One particularly high-tech form of remote care at the Byers Eye Institute at Stanford is the Stanford Automated Teleophthalmology Autonomous Testing and Universal Screening (STATUS) program, which evaluates patients for diabetic retinopathy at their community primary care clinics and lets them avoid an extra trip to the ophthalmologist. 

More than 400 million people worldwide have diabetes, which puts them at risk of diabetic retinopathy, the leading cause of blindness in working-age American adults, according to the Centers for Disease Control and Prevention (CDC).

Despite the prevalence of the disease, many diabetic patients—as many as 50%, the CDC estimates—don’t make it to their critically important annual eye exam. That means many people with diabetic retinopathy go undiagnosed or get diagnosed too late for effective treatments. 

STATUS is about reaching those who might otherwise miss eye screenings by bringing technology to their primary care doctors, whom they may see more often.  

SUNDROP

Among the institute’s most established remote screening initiatives is the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP), launched in 2005 by Darius Moshfeghi, MD, professor of ophthalmology and retina division chief at the
Horngren Family Vitreoretinal Center, a part of the Byers Eye Institute. 

The SUNDROP program operates out of a dozen neonatal intensive care units in an increasing number of states around the U.S., helping doctors swiftly identify a serious disease known as retinopathy of prematurity (ROP) in infants born prematurely. 

Infants born at less than 30 weeks’ gestation or weighing less than 3.3 pounds are at the highest risk for ROP, which can impair vision or cause lifelong blindness due to abnormal blood vessels in the retina. Early diagnosis and treatment of the disease, however, can dramatically improve long-term outcomes. 

During the SUNDROP screening, specialized cameras photograph babies’ eyes and retinas, and then transmit those images to a Byers Eye Institute pediatric vitreoretinal surgeon for evaluation. The program reaches fragile patients at a critical time when it may be challenging to be seen by an ophthalmologist.

Global reach

One of the Byers Eye Institute’s most established international support and education programs sits more than 3,300 miles away from its Palo Alto campus at the the Stanford Belize Vision Clinic, where an AI-enabled camera has been operating since 2017 on the tropical island of Ambergris Caye, an area that lacks ophthalmic providers. 

When clinicians arrive, they see the patients recommended for further examination, said Stephen Binder, OD, one of the faculty volunteers, reached by email during a week he was volunteering on the island. 

“The patient population is very appreciative and easy to work with,” Binder said. “The children are especially cooperative, even volunteering to have us put eye drops in their eyes.” 

The Belize clinic was founded by Don Listwin, co-founder of belizekids.org with his wife, Hilary Valentine. The clinic has been supported by belizekids.org and the Ferroni Foundation. 

Caroline Fisher, MD, clinical associate professor of ophthalmology, also helped found and runs the partnership between the clinic and Stanford. The Belize facility is staffed by Stanford residents and clinicians and has treated more than 1,700 patients since its opening. 

In 2023, seven Byers Eye Institute faculty and trainees and another six clinicians invited from other institutions around the U.S. traveled to the clinic to see patients, train local care providers, and collect data.

In India, the Byers Eye Institute has developed strong relationships with the L.V. Prasad Eye Institute in Hyderabad and Aravind Eye Care in the southern state of Tamil Nadu. Clinicians and residents at the Indian clinics regularly come to Stanford to observe, learn, and assist in the classroom or clinic. In turn, faculty and trainees from Byers Eye Institute visit those clinics to do the same, and to foster collaborations in research as well. 

"It is important to see how care is done at a high-quality, but lower-resource center in a developing nation,” Tabin said. “Hopefully, they will make that kind of work a portion of their own careers in the future.”

The department is also building education and research programs with eye hospitals in Bahir Dar, Ethiopia, and Cape Coast, Ghana, and pursuing partnerships to build eye care facilities and help train clinicians in Syria and Lebanon. A strong collaborative relationship with one of the leading foundations for global eye care,
CureBlindness.org, has facilitated opportunities to deliver high quality, low cost care across the world.