As the University of Iowa Health Care’s Department of Ophthalmology and Visual Sciences celebrates its centennial, Chair and Head of Department, Keith Carter, talks us through some of the faculty’s key contributions to eye care and research.
How has the department evolved over the last 100 years?
The department was initially focused on clinical care, then clinical research. Part of our reputation comes from doing a lot of clinical research, and teaching practitioners in the private sector how to implement these findings into their practices.
The department eventually grew and specialization became more important, and now we cover everything – clinical research, basic science research, clinical care, and education. Those are the big pillars of our department.
How did the department become regarded as a pioneer in genetic ophthalmology?
Much of this was started by Edwin Stone, who had a strong interest in genetics. When I first met him, that was one of the things his lab was working on during his residency.
What Ed wanted was to allow everybody to participate in this advancement. He didn’t view it as a revenue generator. He was able to get philanthropic money to develop the Carver Nonprofit Genetic Testing Laboratory in 2002. He was doing genetic testing years before then, but this was a way to consolidate the effort and assure patients got the testing they needed, without having to worry about affordability.
What types of gene editing therapies are you currently working on?
Dr Stone and his team are working on both gene therapy and stem cell transplants – manipulation of genetic material and differentiating stem cells to reproduce elements of the retina. So far that work has been successful, but they have to be very careful. For stem cell research, you must prove to the government agencies that they're safe.
The tissue we were making was always from the patient’s own tissue; it wasn't pool tissue. Pool tissue can cause inflammatory reactions because a person’s body doesn't like other material, it likes its own material. His plan was to try this on people who are going to go blind and see if we can restore their vision. We didn't want to use it on people who only have partial vision loss because it's too risky.
Their stem cell work has not been approved by the government yet; they hope to have some movement on that this year. We want to make sure we're successful and avoid the stigma of any failure, because that can set developments back before people will try it again.
Looking at your research into artificial intelligence, what did the development and FDA approval of IDx-DR* mean for the department?
Michael Abràmoff, a faculty member, was the one who had this vision. I distinctly remember him telling us about AI when he arrived; he understood exactly what potential AI and machine learning had for ophthalmology, even in those early days. He took pictures of the retina in diabetics and non-diabetics, and taught the machine how to interpret what level of diabetic disease the patient has. The machine was developed using lower-level trainees and it is now the first approved AI device on the market. This is extremely useful because there are more diabetic individuals in need of eye exams than we have eye care providers in the country.
As department chair, what have been some of your proudest moments?
In terms of education – if you mention Iowa to ophthalmologists around the world, they would probably say EyeRounds. EyeRounds is an online educational tool we developed that probably keeps us out in front in ophthalmology education across the world.
Where would you like to see the department heading in the next 10-20 years?
I want to make sure the department remains a leader in ophthalmology research, ophthalmology education, and clinical training. Whatever it takes to do that is where my vision for the future is. This is primarily about who we recruit and who we provide resources to. A person in my position is charged with recruiting talented people, and then providing the appropriate resources so that they can develop their vision that in turn moves the profession forward. That's our future.
* In 2023, the system’s maker, Digital Diagnostics, changed IDx-DR’s name to LumineticsCore
