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Up Front | Apr 2005

5 Questions With Edward J. Holland, MD

What would you like to achieve during your term as Chair of the Eye Bank Association of America (EBAA)? The EBAA is a wonderful organization with an outstanding track record in the US for maintaining the safety of corneal transplantation. One of its important roles, which I plan to emphasize, is to branch out and promote international eye banking. Corneal disease is one of the leading causes of blindness worldwide, and international eye banking in developing countries is significantly behind what we have in the US and other countries. I also need to work with the EBAA regarding the US government's aim to increase regulation of the eye bank. The EBAA has done an excellent job with this thus far. More government involvement may interfere with our present system, which works well for corneal transplant patients.

Having served in various capacities for the AAO, it is clear that you value continued medical education. Why? Previously, I had been appointed Associate Secretary of the Skills Transfer Committee. In ophthalmology, technology and procedures are changing so fast that one can fall behind quickly. There are a variety of ways to keep oneself abreast of developing trends. Reading journals and trade publications is important, but attending meetings and postgraduate courses is mandatory in order to stay ahead in the field. We owe it to our patients to be as up to date as we possibly can. Currently, I am Secretary for the Annual Meeting, a much bigger responsibility than my previous position. The AAO Annual Meeting is one of the most fantastic conferences in all of medicine, and, with the support of the outstanding AAO staff, I hope to continue the tradition of making education in ophthalmology fun and exciting.

Did you have a mentor when you started in ophthalmology? My father was an ophthalmologist, and he was extremely influential in terms of my interest in pursuing a career in this field. During summer breaks from college, I worked with him in his office. I had the opportunity to work in a busy practice and see how enjoyable the specialty could be. The other person who was a great mentor of mine was Richard Lindstrom, MD. After my corneal rotation, Dr. Lindstrom told me that I was going to do a fellowship in cornea and then join him in practice at the University of Minnesota, and that is indeed what happened.

What led you to become a corneal and external disease specialist? Prior to entering ophthalmology, I had an interest in immunology, which is related to much of what happens in corneal disease. As a result, I completed a corneal fellowship and then a second fellowship in ocular immunology at the National Eye Institute in Bethesda, Maryland. At that time, I thought that preventing transplant rejection was key, and my background in immunology served me well in exploring this concept. However, I soon discovered that the individuals who were visiting my clinic were not high-risk corneal transplant patients, but rather ocular surface disease patients who had epithelial as well as inflammatory disease. By default, I inherited these patients with severe surface disease and thus became interested in the field.

What do you believe the future holds for corneal transplantation? It is an exciting time for corneal transplantation. During the last few years, surgeons have begun approaching this treatment quite differently from when penetrating keratoplasty was the main procedure. We are exploring lamellar procedures. Of the various techniques used, endothelial transplantation is particularly worth mentioning. During this procedure, rather than transplant the entire cornea, the posterior half or third is transplanted to provide a more rapid rehabilitation and a safer operation. There is still a long way to go with corneal transplantation because patients can experience a decrease in vision due to interface haze. However, the Intralase laser and similar technologies may present ways to get around this problem. The other lamellar procedure that surgeons are now performing is the epithelial transplantation of severe ocular surface disease. My colleagues and I are working with the transplant immunologist at the University of Cincinnati on some exciting immunosuppression protocols that have fewer side effects and are more efficacious in terms of preventing rejection. Ocular surface transplantation has advanced significantly in the last 15 to 20 years, and we now have the ability to treat patients with severe chemical injuries and autoimmune conjunctivitis, such as Stevens-Johnson syndrome.

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