Morton F. Goldberg, MD, Director Emeritus of The Wilmer Eye Institute, has certainly made plenty of waves during his illustrious career. A firm believer in the so-called ‘ripple effect,’ his considerable influence on the field and the lives of trainees and patients continues to be felt through his scientific contributions and the army of fellows and residents he has trained through the years. “I find it very gratifying to think about those infinitely spreading ripples,” said Dr. Goldberg.
A preeminent researcher and scientist, educator and clinician, Morton Goldberg graduated from Harvard College and Medical School with honors, served his internship at the Peter Bent Brigham Hospital in Boston, his residency at the Wilmer Eye Institute at Johns Hopkins, spent three months as chief resident at Yale New Haven Hospital, and then returned to Johns Hopkins for another 12 months for his chief residency there during 1966-1967.
In 1967, he was appointed assistant clinical professor of ophthalmology at Yale while serving two years in the U.S. Public Health Service. In 1970, he became professor and head of ophthalmology at the University of Illinois College of Medicine, and ophthalmologist-in-chief at the University of Illinois Hospital and Eye and Ear Infirmary. He returned to Johns Hopkins in 1989 as the William Holland Wilmer Professor of Ophthalmology and director of the Wilmer Ophthalmological Institute. In 2003, he stepped down from the directorship and became the Joseph E. Green Professor of Ophthalmology, and was named director emeritus of the Wilmer Eye Institute.
Dr. Goldberg has written over 600 scientific publications (original articles and chapters) and 10 books on his research and clinical experience, which focus largely on diabetic and other vascular retinopathies, persistent fetal vasculature, laser therapy, ocular trauma, hyphema, incontinentia pigmenti, and genetic and sickle cell eye diseases. Nearly 60 of his articles are about the effects of systemic medical disease on the eye. In 1968, Dr. Goldberg and Dr. Stuart Fine co-hosted the Airlie House Symposium on the Treatment of Diabetic Retinopathy, resulting in a 900-page book that set the stage for the Diabetic Retinopathy Study (DRS) and virtually all future clinical trials in ophthalmology.
He takes particular pride in having led construction and development of The Lions of Illinois Eye Research Institute at the University of Illinois College of Medicine in Chicago (for clinical care and basic research) and the Clarice and Robert H. Smith Building, at Johns Hopkins University School of Medicine in Baltimore (for eye surgery and basic research).
Dr. Goldberg holds membership in many professional organizations and has served on ten editorial boards and as Editor in Chief of the Archives of Ophthalmology for ten years. Over the years he has received numerous awards, including the Retina Research Foundation’s Pyron Award from the ASRS. Endowed professorships in his name have been established at the University of Illinois College of Medicine and also at the Johns Hopkins University School of Medicine. A portrait of Dr. Goldberg is displayed in both institutions. An endowed lecture in his name is delivered annually at the University of Illinois. In addition, the endowed Morton and Myrna Goldberg Prize is presented each year at the Wilmer Institute for a resident who has demonstrated exemplary intra-departmental citizenship and superb patient care.
We are pleased to share his reflections here.
Please share an impactful moment that shaped your early, middle, and/or late career.
Early in my life, during medical school and residency, I was lucky enough to have outstanding mentors, like Arthur Hertig, MD, Chairman of the Pathology Department at Harvard Medical School. He was the world's expert on arteries and veins in the uterus and was a wonderful teacher. I've carried an interest in new blood vessel formation from 1962 to the present day.
In my fourth year of medical school, Dr. Hertig sent me to the Massachusetts Eye and Ear Infirmary to work in the Howe Laboratory, directed by Dr. David Cogan, who subsequently became chairman of ophthalmology there. He was perhaps the most brilliant ophthalmologist I've met. I could have gone in 20 different specialty directions after medical school, but Dr. Cogan was doing the earliest and best research in diabetic microangiopathy. I thought it was fabulous and asked if I could stay on as a resident, but Dr. Cogan wanted me to go to the Wilmer Eye Institute of Johns Hopkins. I’d never heard of it! He phoned then chairman of ophthalmology Dr. A. Edward Maumenee, who immediately agreed to take me on and became another great mentor in my early life. I wanted to be just like him. He was a great administrator, great clinician, a great diagnostician, a great technical surgeon, a great fundraiser, a great everything. And that was a very fortuitous, impactful experience in my life.
I think Dr. Maumenee had only four full-time faculty members at the time, including the father of neuro ophthalmology, Dr. Frank Walsh, who was also a great mentor, as was my chief resident David Paton, MD, who taught me everything I knew in my first year of residency (1962-1963). Shortly thereafter, we wrote a book together on ocular trauma that has withstood the test of time and we remain very close friends.
After my residency and chief residency at Wilmer, I had a fellowship in genetics with the father of human genetics, Dr. Victor McKusick, who was another great mentor at Johns Hopkins. Then, at age 32, I went directly from my fellowship to full professor and chairman at the University of Illinois, which turned out to be one of the greatest experiences of my professional life. I was the first full-time academic faculty member at Illinois in ophthalmology. The total initial budget was $350,000, and we grew it to $7 million. There was no research or formal teaching, but I loved both aspects of ophthalmology. I therefore concentrated on building a full-time faculty of 35 and a huge research effort -- one of the largest in the country. We were also able to build The Lions of Illinois Eye Research Institute, a free-standing structure connected to the Illinois Eye and Ear Infirmary. It was a phenomenal experience.
At the age of 52, I went back to Wilmer and took with me the editor-in-chief position of the Archives of Ophthalmology. At Wilmer I was surrounded by world-class clinicians and scientists, but they were very cramped for space. I had the great opportunity to help raise money to build the 6-story Clarice and Robert H. Smith Building for surgery and research, and also added two stories to the Maumenee Building.
I served about 14 years as director of the Wilmer Institute, and I'm still there in 2021 as a full-time professor. I resigned from the chairmanship in 2003, and since then I've been teaching, thinking in depth about eye disease, and writing numerous publications – both original papers and chapters.
Was there a time in your career when you witnessed history in the making?
Many times, but I’ll share three “biggies.” Number one, the invention and use of lasers. When I first saw the green ARGON laser used on a slit lamp delivery system, I thought it was the most amazing thing ever. It revolutionized ophthalmology. Soon after, in about 1969, came the YAG laser, which has an invisible light beam -- like the original Buck Rogers ray gun. You throw out an invisible beam, and it creates a controlled explosion inside the eye, therefore cutting unwanted tissue. Unbelievable! And because there is no manual invasion of the eye -- no instruments to put inside the eyeball -- you could do surgery inside the eye without any chance of infection whatsoever.
Number two is the advent of surgical pars plana vitrectomy. I saw that with my own eyes, because the first person I recruited to my new faculty at the University of Illinois in 1970 was a surgical and technical genius named Gholam Peyman, MD. At that time, he was doing what every ophthalmology textbook said you should not do – “touch” and remove the vitreous. It was considered unethical. He developed a full-function pars plana closed vitrectomy system, and so did Dr. Robert Machemer at Bascom Palmer. They published their inventions in the ophthalmic literature within four weeks of each other in 1971. Dr. Machemer is often called the father of vitrectomy, and he had a large number of American fellows who understandably propagated that opinion, but I think Dr. Peyman is at least the co-father. He went on to have dozens of patents on new surgical instruments related to vitrectomy – a new microscope, new illumination system, new gases, and new intraocular fluids. He also invented and popularized direct intraocular injections for treating infections, bacterial and fungal, that ultimately hit an apogee with the use of anti-VEGF agents that are now so commonly used in ophthalmology.
Dr. Peyman and I published our first 100 consecutive human pars plana vitrectomy cases in 1976, but the first month or two of human usage were close to disastrous. Like any new surgical technique, there are always complications. And the complications with the first vitrectomies were frequent in both Miami and in Chicago. My house staff saw Dr. Peyman and me doing vitrectomies and having complications, so they came to my office as a group and said they could not assist in the operating room anymore because we were doing ‘unethical surgery’ (since the textbooks said to never touch the vitreous). I said, ‘Well, look, I'm not in the business of legislating personal ethics. That's your own individual decision. I'm not going to make you go to the operating room.” After a couple of months, we got much better at vitrectomy, and the same group came back and asked if they could spend the next year learning how to do vitrectomy themselves, having seen dozens and dozens of patients who had received the new operation and had gotten much better, including some who previously had been blind but postoperatively were able to read and ambulate without assistance.
The third major advance was medical therapy for diseases that had previously been untreatable or had been treated only with surgery. Dr. Peyman developed intravitreal injection of antibiotics for many different infectious diseases, and others developed the use of anti-VEGF for wet macular degeneration, diabetic retinopathy, retinal vein occlusion and cystoid macular edema.
What career accomplishment provides you with the greatest sense of satisfaction?
Kirk Packo, MD, the outstanding vitreoretinal specialist, who was my resident and chief resident at the University of Illinois, will attest to my strong belief in the ‘Ripple Effect.’ He once heard me refer to it, and it has stayed with him throughout his spectacular career. He believes in it too. In fact, he once attended a conference where two foreign ophthalmologists approached him and thanked him for training them on how to do vitrectomy. He said, “How could I have trained you when I've never met you before?” They said, “Well, your former fellows came to our country and taught us how to do it.” That's a ripple effect; like throwing a pebble into a calm pond of water and watching the ripples spread out infinitely. To commemorate our friendship, Dr. Packo once gave me a bottle of Ripple wine.
Thinking about all the residents and fellows I've had the pleasure and privilege of training, I find it very gratifying to think about those infinitely spreading ripples.
It is also very gratifying to have had the opportunity to build new buildings and floors at the University of Illinois and at Wilmer, and setting very high standards for both research and clinical care at those institutions. I have also published a lot of papers and chapters with my students and colleagues that are digitally retrievable now and forever, and that appeals to me greatly as I get older. I'm retrievable!
What do you feel is the most significant development or change in the practice of retina?
Lasers, vitreous surgery, and medical therapy. These are three very, very significant milestones in the history of therapy and for all of us in ophthalmology worldwide.
Can you share any advice for future generations of retina specialists?
I would tell them what I tell myself, which is to keep on reading, keep on thinking, because if you don't, within 10 to 20 years you'll be hopelessly behind. In patient care, you have to keep up with new developments. Most of all, I would tell them to keep writing if they have observations that are of use to the rest of the world. Writing original papers and chapters sharpens one’s thinking.
I believe one’s own learning is best achieved by teaching, because, if you hope to teach effectively, you have to know what you're doing, you have to know the literature, and you have to codify, standardize and improve your own clinical skills.
How do you imagine the practice of retina will change by 2040?
I can't see that far; it's impossible to predict. Although I was involved in the development of the following major therapeutic techniques, I never would have predicted the tremendous success of lasers. I never would have predicted the success of vitrectomy or the success of medical therapy with intravitreal injections. So, I can't predict accurately, but I think telemedicine is going to become more common with home monitoring of conditions like macular edema, macular neovascularization, and intraocular pressure elevations.
Certainly, artificial intelligence is going to take over, at least partly, sometime in the future. I think there will be better systems delivering laser energy into eyes and for getting drugs into eyes. I think there will be new medications developed to replace a lot of surgeries.
Going way out on a limb, I think, perhaps, that development of new technology may make it possible to do vitrectomy with such techniques as high energy ultrasound (or other modalities) that liquefies the vitreous without inserting instruments inside the eye.
One thing is for sure, the future is bright!
Our sincere thanks to Dr. Goldberg for sharing his retina reflections.
(Retina Reflection published 2021)