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Leading with vision

Medicine@Yale, 2010 - July Aug


Yale glaucoma specialist is also helping to bring eye cancers into the light

Patients go out of their way to see Yale ophthalmologist James C. Tsai, M.D., M.B.A. One traveled four-and-a-half hours from Long Island. Another takes a car service each week from Garden City, N.Y., for post-operative care. For his weekly follow-ups, a Wall Street trader journeys to New Haven each Wednesday on the Metro-North Railroad.

Tsai, an expert in glaucoma research and treatment, came to Yale in 2006 from Columbia University College of Physicians and Surgeons, where he was director of the Edward S. Harkness Eye Institute. Now chair and Robert R. Young Professor of Ophthalmology and Visual Science at the School of Medicine, Tsai is also chief of ophthalmology at Yale-New Haven Hospital (YNHH) and director of the Yale Eye Center.

Liz Whall, one of his patients, says Tsai’s stamina is matched by his empathy: “I don’t know how he has time to take care of so many people and still stop and listen.” But for Tsai, listening is key. “You have to tailor every treatment for every individual,” he explains. “It’s not one size fits all.”

Characterized by elevated pressure of fluid inside the eye, glaucoma can damage the optic nerve and cause irreversible vision loss. But in as many as one-third of cases, low to normal pressure measurements (a thin cornea can skew test results) can leave glaucoma undiagnosed until there is significant visual damage. Whall’s undiagnosed glaucoma was affecting her ability to do basic tasks as a mother and interior designer. After a proper diagnosis, a New York surgeon performed pressure-reducing surgery on her left eye, but it yielded only short-term results. Medication to lower pressure in her right eye had severe side effects.

Whall consulted Tsai, who suggested “revising” the previous surgery on her left eye, and advised against surgery on her right eye altogether. Today, with glasses, the combined vision of Whall’s eyes is 20/20.

Born in Taiwan and delivered by his grandmother, an obstetrician, Tsai is a fourth-generation physician. But there is also a darker family legacy. “I’m in a family where there definitely is a cancer gene,” says Tsai. As a teenager, he watched his father fight lung cancer; three decades later, his father is being treated at Yale for a brain tumor. At just 5 months old, Tsai’s eldest daughter underwent chemotherapy and surgery for liver cancer. (She is now a healthy and athletic 12-year-old.)

This history inspired Tsai to raise the profile of ocular oncology at Yale. Though little-known, eye cancer can cause blindness and can even be fatal. Metastasizing breast cancers often reach the eye, and the most common cancer that originates in the eye, choroidal melanoma, can spread to the liver, lungs, and brain. The recent opening of Smilow Cancer Hospital at YNHH helped Tsai to recruit “the first fully trained ophthalmic oncologist in the state of Connecticut,” Miguel A. Materin, M.D., assistant professor of ophthalmology and visual science and director of ocular oncology.

In his personal life, Tsai’s abundant energy fuels a passion for tennis. A recent bout of tendonitis, which brought him to a physical therapist, was a worthwhile result of winning a match against his coach. “The physical therapist asked, ‘How did you do this?’ And I said, ‘I tried to learn a kick serve,’ and he said, ‘Yeah, but you’re not in your twenties anymore!’ ”