Overall, how different is the practice of ophthalmology today from when UCLA Stein Eye Institute opened its doors 50 years ago? Over the course of five decades, every aspect of our work here has been refined and redefined. We see developments almost every day: greater precision, smaller incisions, more detailed imagery, better ways to identify problems, new treatments for the previously untreatable. All of these elements are changing patient care for the better. What are some of the best examples of these advances? Take cataract surgery. When I started in ophthalmology, large incisions were necessary and patients were kept for several days in the hospital, after which they still required very thick glasses or contact lenses. Fast forward to the present day, when cataract surgery is an outpatient procedure and the patient goes home with a lens inserted in the eye to correct vision. We’ve also seen important advances in corneal surgery. Today, in many cases rather than replacing the entire central cornea, we have the option of replacing only the back layers, which means less chance of rejection, along with a smaller-sized wound and less suturing. Another dramatic example is in macular degeneration, a leading cause of vision loss among older adults, and previously untreatable. Now, with anti-VEGF therapy, we inject medications into the vitreous of the eye to prevent the growth of blood vessels, which have the potential to rupture and cause vision loss. At the Stein Institute, we were part of the early clinical trials of these agents, some of which also are being used for diabetic retinopathy, which is a growing concern with the epidemic of diabetes in our society. What other conditions do you see more of today than in the past? Age is the major risk factor for most of the conditions we see. So when you think about how much longer we’re living today than people were 50 years ago, it’s not surprising that we’re seeing more cataracts, more macular degeneration and more glaucoma, which have been the three biggest causes of visual disability in the United States. We don’t think much about cataracts because that condition is so easily treated now, but that would be a leading cause of blindness if it wasn’t treated. The conditions that are causing the most blindness now are glaucoma and macular degeneration. You spoke of the advances in treating macular degeneration. Where is the field with glaucoma? Glaucoma continues to be treated using topical drops and drugs, and if that’s not successful, surgery is performed. Today, there are less extensive surgical treatments for glaucoma using smaller devices, which makes for a faster recovery, but, unfortunately, the vision outcomes are not significantly improved. So glaucoma still is a big challenge and a major research focus. In addition to controlling the intraocular pressure, there is an ongoing focus on finding agents that will protect cells in the retina so that they don’t degenerate. Everyone wants to see well, but what’s the larger impact UCLA Stein Eye Institute makes by addressing vision problems? Just as an example, a member of our faculty conducted a study showing that cataract surgery reduced the risk of fall-related hip fractures among the elderly. So these advances have a public-health impact beyond the quality of life that comes with better vision. On the other side of the age spectrum, we know that vision problems can affect school performance, and too often, children in underserved communities are just living with those problems. So we are doing outreach in these communities to provide eye care and glasses, as well as to screen children so that when they go to school they’re ready. Our Mobile Eye Clinic, which Stein Eye Institute has operated for more than 40 years, goes to schools, senior centers, health fairs, homeless shelters, and low-income community clinics to provide eye care and screening. It’s easy to say Stein Eye Institute is helping patients who come to us from all over the world, but if people are struggling with vision problems in Los Angeles County, we still have work to do, and often that means we need to go to them. Bartly J. Mondino, MD Vital Signs Summer 2017 Vol. 75 9