Compassionate Caregivers

With innovative and effective treatments, the Yale Retina Service, part of Ophthalmology and Visual Science, is meeting the needs of elderly patients who wish to maintain their independence, as well as many other patients who have specialty eye issues such as rare cancers and traumas. The team of physicians in the Yale Retina Service delivers compassionate care to answer the unique needs of these patients.

Ron Adelman, MD, director of the Yale Retina Service, said “seeing is believing” and, “we perceive the world through our eyes.” His research and clinical work are at the center of developing inventive treatments for macular degeneration, which is the most common cause of legal blindness in people over 50. Up until 2005 there was no effective treatment for wet macular degeneration. The disease is most frequently experienced by the elderly, and the onset meant these patients could no longer be independent and would lose quality of life.

Dr. Adelman operates with micro equipment when performing surgery on tissues that are 100 times thinner than hair. The procedural techniques are integral to positive outcomes, but these techniques do not tell the whole story. “I integrate knowledge from my research to inform my clinical work, and consider the whole patient and what their happiest outcome can be,” he said. After surgery, his patients can continue to drive, sew, read and perform other daily activities. “Many facets come together so we can provide compassionate care to our patients.”

Victoria Donaldson, who has worked with Dr. Adelman for ten years, said patients are like family to her and she looks forward to Monday mornings. “Dr. Adelman is very serious about his work in the best way and mellow and comforting to his patients,” she said.

A common thread runs through the patient care team in the Retina Service. Both Dr. Adelman and Miguel Materin, MD, feel strongly about treating the whole patient, not just their eyes. Dr. Materin amplifies the point: “We focus on improving a patient’s vision with treatments so they can be independent and continue their chosen pursuits.”

Dr. Materin, an internationally recognized ocular oncologist whose father was an optician, became interested in helping restore vision early in life. He works with patients who have cancerous eye tumors that can be internal or external. The most common primary intraocular cancer in adults is melanoma. “We know that melanoma of the eye is a systemic disease, not just an eye problem,” he said. He regularly collaborates with radiation oncologists, colleagues from the Yale Melanoma Program, medical oncologists, neurosurgeons and pediatric oncologists in his own practice to treat patients. “My patients are like my relatives, so I listen carefully and explain in detail what we will do to help them.”

Teamwork is crucial when treating patients with eye diseases since the problem often begins as part of another illness. Focusing on treating the whole patient, Dr. Materin works with several specialists including Andres Martin, MD, chief of pediatric psychiatry, and Flora Levin, MD, for eyelid and orbital cancer cases. In fact, he said, “I am privileged to be able to help my patients with my talented colleagues who provide extra support for the patient and their families.”

John Huang, MD, is charged with very difficult surgeries. He repairs retinas that have been severely traumatized —sometimes resulting from a car accident—or when an infectious disease impacts vision. “Any disease or illness that affects the central nervous system can affect the eyes,” Dr. Huang said.

One case a few years ago involved Jessica (a child whose name has been changed to protect her privacy), who crashed into a glass cabinet door and cut her eye open, causing her to lose vision in the eye. Dr. Huang performed surgery to repair the nerves and completed a corneal transplant. After additional surgeries drawn out over a year, Jessica could see again. During this period she experienced a range of emotions, became self-conscious and didn’t want to go to school. Dr. Huang provided a network of support to Jessica and her family by referring them to colleagues who were able to help address the impact of Jessica’s injury and surgeries on the family’s daily life.

After Jessica’s vision was restored, she put together a book for Dr. Huang recounting her accident, her surgeries and her feelings about the experience. There is a section thanking Dr. Huang, who experiences a deep feeling of satisfaction when he is able to restore vision.

Kathleen Stoessel, MD, noticed early in her medical training that patients who were challenged with other illnesses were afraid of losing their independence, and especially concerned about their vision. Dr. Stoessel believes that compassion is exhibited by treating the whole patient in the care plan and delivering the best standard of care available for the patient.

Many of Dr. Stoessel’s patients range in age from early childhood to early adulthood, and have diabetic retinopathy, sickle cell retinopathy, and retinopathy of prematurity (ROP). During the 1980’s doctors in the Newborn Special Care Unit at Yale-New Haven Children’s Hospital developed protocols using laser treatment for premature infants with this problem. The infant stays in the unit for familiarity and comfort, and is intubated and monitored so that Dr. Stoessel can focus the indirect laser through the dilated pupil without the baby moving or having pain.

Dr. Stoessel provides expert and delicate treatment, as well as comfort and hope for parents, who often have other ongoing medical challenges with their infant. “I feel it is a privilege when these parents trust me and tell me to go ahead with the procedure,” she said.

She is also mindful of her peers’ expertise. “When sending a patient to Drs. Adelman, Huang and Materin, I know the patient will be taken care of. In addition, Pamela Ramos and the Eye Center staff provide support to my patients and their families during their entire experience with us,” she said. ”