Kentucky Lions Eye Center: Fighting the Good Fight

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Henry-Kaplan-thumbThe Kentucky Lions Eye Center is home to the University of Louisville’s Department of Ophthalmology & Visual Sciences, which is a member of the School of Medicine’s multispecialty practice, the University of Louisville Physicians (ULP).

Founded in 1967, the Kentucky Lions Eye Center is also home to the charitable non-profit Kentucky Lions Eye Foundation; the University of Louisville Lions Eye Bank; the University of Louisville Physicians – Eye Specialists, the private practice of the Department of Ophthalmology & Visual Sciences; and the University of Louisville Eye Clinic, which comprises its indigent eye-care clinics.

According to Dr. Henry J. Kaplan, director of the Kentucky Lions Eye Center and chair of the Department of Ophthalmology & Visual Sciences at the University of Louisville, there are two divisions to the department’s work: research and clinical.

Historically, he said, the department has a tradition of excellence in basic-science research related to eye disease and vision. Most of the 15 faculty members in the research division are Ph.D.s, while some are M.D.s and others are M.D.-Ph.D.s.

Likewise, the clinical division has an equal number of faculty who are mostly M.D.s, with some   O.D.s. They provide clinical care in each of ophthalmology’s subspecialties, including the Low Vision Center, which provides the region’s most comprehensive low vision care.

Kaplan was clear: although the infrastructure they have in place with the University is solid, he and the staff of Kentucky Lions Eye Center are facing challenges both in the research and clinical divisions that have the potential to endanger their overall success and progress in the future.

Hindered by politics

Although the Congressional budgetary sequester’s impact was not immediately apparent, the consequences it has wrought have become all-too-clear, including dramatically reducing the funding from the National Institutes of Health (NIH) and the National Eye Institute.

“This will create many significant problems, not only through the immediate termination of staff that assist our scientists, but eventually the release of the scientists themselves,” Kaplan said. “This act of Congress is going to dramatically hamper the future of basic-science research in the United States in ophthalmology and other disciplines.”

Most of the students who are planning careers in research are discouraged from entering the field when only one out of every 10 research proposals are judged worthy of funding, especially when the other nine proposals are frequently excellent.

Kaplan said the discouragement and frustration this is having on bright, young people who have much to offer the field should not be underestimated in its long-term impact.

Furthermore, less than two decades ago the clinical side of academic medicine would cross-subsidize with the research programs of an organization. But, Kaplan said, there is less and less clinical revenue so cross-subsidization of research is no longer possible.

“The result is that the loss of financial support for research will impede the ability of scientists and clinicians to innovate and to explore novel treatments for patients,” he said. “Being in an academic medical center, we are frequently at a disadvantage when competing with private practices for participation in clinical trials sponsored by the pharmaceutical industry.”

In order to stay afloat, the doctors of the Kentucky Lions Eye Center have had to branch out beyond the campus and become competitive within the community, at sites throughout metropolitan Louisville and the regions of western Kentucky and southern Indiana.

And even though these satellite offices are expanding the Kentucky Lions Eye Center’s ability to deliver eye care, the organization is at a significant financial disadvantage compared to community practices, since over 50 percent of its patients are receiving charity care with little or no reimbursement.

An attempt at self-sufficiency

Kaplan is pursuing several initiatives designed to maintain the Center’s contributions to the Commonwealth of Kentucky.

The first initiative is the aforementioned satellite offices throughout the community. The second is participation in the University of Louisville’s 700-member multispecialty physician group –ULP–which is providing a fully integrated system of health care.

Third, in order for the Center to provide sufficient care for indigent patients, insurance payment for these services must be identified. Therefore, the University has staked its hopes on the success of the Affordable Care Act.

“It is hoped that this will provide a revenue stream that will allow us to be able to provide care for these people and pursue our other missions,” Kaplan said.

The University is also looking to establish a Center for Neurosciences that would include clinical specialties like ophthalmology, neurology, neurosurgery, and psychiatry and basic sciences such as biochemistry, neurobiology, and molecular genetics. This Center would function much like the University’s cancer and cardiovascular centers. The goal is to bring together a core of talented people who can collaborate and conduct clinical translational studies that would allow the University to compete in these specific areas.

A field that has outsourced innovation

Kaplan pointed out that major innovations are being made in ophthalmology in Europe and Asia, but not in the United States, which at one time was the undisputed leader in ophthalmological innovation. Now, United States eye doctors can’t afford the newest surgical and diagnostic equipment that many of their foreign counterparts can.

“We can’t afford it because the hospital systems don’t see us as a necessary component of their financial sustainability,” Kaplan said. “I think that’s a major issue in the decline of our leadership position.”

Overall, he thinks both American medicine and science are in a fragile state, and this fragility is the result of congressional priorities. He believes the decreased funding for education and research at both the federal and state levels are harming the competitiveness of the United States in medicine and science.

“I say this because our most important resource, bright young men and women, are being discouraged from committing themselves to these fields by the nation’s leaders,” Kaplan said. “It’s difficult to attract intelligent, dedicated, motivated individuals to a field which is being constantly hampered by the crippling politicization of issues.”

-by Pete Fernbaugh

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