Alumni Profile: Stanley Chang’74

A Vitreoretinal Visionary

Peter Wortsman

Stanley Chang’74

To paraphrase journalist and social commentator Malcolm Gladwell, some visionaries start with a clean sheet of paper and reimagine the world. Another kind of visionary, Stanley Chang’74, who is one of the world’s leading authorities on the repair of vitreoretinal disorders, works with perfluoropropane gas and perfluorocarbon liquids and a panoramic viewing system he developed, in collaboration with Avi Grinblat, to repair retinal detachments and significantly restore or enhance the vision of countless individuals on the verge of blindness.

Dr. Chang is the K.K. Tse and Ku Teh Ying Professor of Ophthalmology, former chair of the Department of Ophthalmology at P&S, and former director of the Edward S. Harkness Eye Institute at Columbia University Medical Center.

Born in Shanghai, China, Stanley Chang emigrated to the United States with his parents at the age of 2 and grew up in the Bronx, where he attended the prestigious Bronx High School of Science. Initially following in the footsteps of his father, an engineer, he earned a bachelor’s degree in electrical engineering from MIT and a master’s in biomedical electronic engineering from the University of Pennsylvania, before pivoting to study medicine at P&S.

“I realized that if you become a bioengineer, you don’t really understand the biologic problems,” Dr. Chang says. “Engineering hones in on a little component of the big picture. If you want to have a global view of things, you have to be a physician to understand the problems you are going to solve with bioengineering skill. I wanted to use my aptitude for engineering but get more involved with people. Medicine seemed the perfect fit and P&S the perfect place to study it.

“Medical school was a great experience, probably one of the best times in my life,” he says, crediting the influence of mentors on the faculty, including his faculty adviser, the late Donald Tapley (“so generous with his time”); the late Glenda Garvey’69 (“the ultimate clinician”); cardiologist Thomas Bigger, with whom he collaborated on research while still a medical student; ophthalmologist D. Jackson Coleman, a pioneer in modern ultrasound technology; and David Abramson, a resident at the time with whom he co-authored a scientific paper and now chief of the ophthalmic oncology service in the Department of Surgery at Memorial Sloan Kettering Cancer Center.

Initially leaning toward cardiology, it was Dr. Chang’s elder brother, Henry Chang, MD, a researcher in hematology at the NIH, who urged him to consider ophthalmology, because of the precision and the fine work involved. “My brother said, ‘You might enjoy it.’ He was right.”

Dr. Chang pursued a residency in ophthalmology at the Massachusetts Eye and Ear Infirmary, a Harvard affiliate and at the time a center for innovative retinal surgery, and went on to complete a fellowship in vitreoretinal diseases at the Bascom Palmer Eye Institute at the University of Miami, where vitrectomy, removal of the vitreous as a preliminary procedure to facilitate repair of the retina, was first developed.

When his Columbia mentor, Dr. Coleman, was named chairman of the Department of Ophthalmology at Weill Cornell Medical College, he recruited Dr. Chang to join the team of topnotch faculty, including Harvey Lincoff, a pioneer in the use of gases in the repair of retinal detachment.

Making the Retina Do the Right Thing

“The eye is a sphere,” Dr. Chang explains to the interviewer. “The retina sits in its lining. Neurons in the retina convert the light energy in the image into a signal that goes to the brain. The retina projects the image into the brain. The brain decodes it and, in turn, puts together an image for you. Part of the retina, the macula, the central part, gives you the sharp reading image. The peripheral retina gives you the night vision and the peripheral vision.” But age and/or trauma can cause damage to this sensitive tissue. “Tears develop at the edges of the retina, which has no natural adhesive properties. A tear can progress to retinal detachment. In the case of a total retinal detachment, vision goes black.”

Dr. Chang established a reputation as the go-to guy for complex retinal detachments, cases in which previous surgical attempts at repair had failed and cases with a lot of scar tissue. “Each time the detachment occurs you lose photo receptor cells and neurons in the retina,” he says. “Our operative object was to preserve and/or restore the function of the retina after multiple detachments.” At the time, he said, “the operative technology was to insert tiny tacks to try to pin the retina down against the back of the eye,” but that can cause profuse bleeding. Also, the patient had to be turned upside down and operated on from below, a cumbersome and sometimes risky practice.

Dr. Chang helped to refine the use of long-lasting perfluoropropane gas and introduced perfluorocarbon liquids to do the job more smoothly and efficiently. He is best known for the innovative technique of injecting perfluoro-octane, a liquid heavier than water, as an intraoperative tool to flatten the retina against the back of the eye at the time of surgery and later replacing it with a gas bubble or silicon oil. “The liquid,” he explains, “flattens the retina, pushing all the bodily fluid out through the tear at the edges. It allows us to then apply a laser along the edges to repair the detachment.”

In the past, ophthalmic surgeons working with a flat lens were only able to see some of the central part of the eye and a limited part of the retina. Working in tandem with Avi Grinblat, an optical engineer, Dr. Chang helped develop a special lens with a wide angle that increased the field of vision and permitted the surgeon to see the entire retina during the operation.

“It is a great personal satisfaction,” he says, “to see methods and tools you helped develop in the lab now used throughout the world. No more tables to turn patients upside down. No more tacks to pierce the retina and make it stay up.”

Esteemed for his skill and precision, Dr. Chang is also prized for his personable rapport with patients and his sensitivity to their concerns and those of their families. “I think it’s important to have good communication with patients and to understand their worries. That’s the mark of the difference between what we learned at P&S vs. what was taught at other medical schools. We focused on the patient as a person, not just on repairing the eye.”

Patient satisfaction is more than a statistic to him. It really matters. “I went into the field because, in general, ophthalmologists are very happy about what they do. They can really make a marked difference and help change the quality of people’s lives.”

In 1995 he was recruited back from Cornell as the Edward S. Harkness Professor, chair of ophthalmology, and director of the Harkness Eye Institute, a position he held with great distinction for close to two decades. He helped boost the institute’s annual research funding from $1.5 million to more than $5 million. Under his aegis, the surgical volume increased from 1,700 cases to almost 4,000 cases annually. The ophthalmic operating rooms earned the highest patient satisfaction ratings of any unit at NewYork-Presbyterian, and the department’s endowment increased from $9.5 million to $45 million, including the establishment of nine endowed professorships and six named lectureships. He also helped refocus the department’s NIH-funded research to encompass the areas of macular degeneration and glaucoma.

Dr. Chang is particularly proud of having assembled an outstanding team. “What’s exciting about a chair’s position is that you get to hire great colleagues, mentor them, and watch them grow. It’s not the chair who really counts, it’s the people he brings in and the group effort.”

Stepping down as chair permitted Dr. Chang to devote more time to his own ongoing research projects. His interests include the development of vitreous replacements, the pathogenesis of retinal detachments associated with optic disc anomalies, and the improvement of outcomes in macular and vitreoretinal surgery. He is particularly excited about “a new technology called adaptive optics, by means of which we can image the individual photo receptors in the living eye, using technology NASA used to take high resolution pictures of the moon.”

He sees patients three days a week, operates once a week, and devotes an entire day to academic affairs, including making rounds with residents, meeting with research fellows, cultivating donors, and catching up with paperwork.

Dr. Chang still sees himself first and foremost as a teacher. “I came to the realization that I couldn’t do every complicated detachment, and the best thing I could do was to train young people who could hopefully do things even better than I could and carry on the field. I was lucky to have great mentors and I hope I’ve been a good mentor to others.”

Rather than attempt to clone him, his successor at the helm of the Eye Institute, George A. Cioffi, MD, recruited Dr. Chang’s son, Jonathan Chang’09, as assistant professor of ophthalmology whose surgical specialties include macular hole surgery, epiretinal membrane surgery, vitrectomy surgery, and scleral buckling. “It has rejuvenated me to work together.”

Another son, Gregory, is involved in video editing and freelance video.

Stanley Chang’74 with Dr. Henry Kissinger, member of the board of advisors of the Edward S. Harkness Eye Institute

Chairing the Faculty Committee of the New Wu Center for Global Health Initiatives

Throughout his career Dr. Chang also made time to help foster educational dialogue with China. His first return trip in 1979, as part of a medical mission to teach ophthalmic surgery with Project Orbis, came not long after the opening of relations with the United States, engineered by Secretary of State Henry Kissinger. Dr. Chang found conditions to be difficult and equipment scarce. (Having long revered Dr. Kissinger, Dr. Chang was pleased to get to know him personally when Dr. Kissinger joined the advisory board of the Harkness Eye Institute.)

Since that 1979 trip, says Dr. Chang, “Times have changed, China has caught up. I have visited eye hospitals much bigger than anything we have in the States, facilities with a thousand beds just for eye patients.” He has in recent years perceived a dynamic shift. “China wants to become a global leader in medical technology, medical science, and biotechnology.”

"The combination of Chinese and American values and work ethic is just mindboggling. It has made me succeed in my professional endeavors."

Dr. Chang welcomes the creation of the Wu Center for Global Health Initiatives (see story, Page 28) and is proud to chair its Faculty Advisory Committee. In his view, Columbia previously lagged behind other peer institutions in global outreach. “The Wu Center will do much to remedy that situation and hopefully restore Columbia to its historic role as a global leader in the exchange of educational models and ideas. China is definitely making a major push to invest in medical education. I am sure that in whatever way my colleagues at P&S choose to get involved they and our counterparts at Zhejiang University will derive great benefit from collaborations in research, clinical care, and teaching. I would also hope that our faculty members become interested in work done over there. The Chinese do a lot in herbal medicine, acupuncture, and plastic surgery, among other areas, that we could learn from.”

Proud of his Chinese heritage, he feels fortunate and proud to be an American as well. “The combination of Chinese and American values and work ethic is just mindboggling. It has made me succeed in my professional endeavors.”

He is cognizant, however, of a relative dearth of Asian senior faculty at Columbia and other schools of similar stature, a number hardly commensurate with qualifications and accomplishments. “As Asians,” he says, “we have the tendency to not speak up and toot our own horn but rather to be humble, do good work, and stay quiet about it. But from what I can tell, Asian chairmen have been pretty good at maintaining harmony and good relations among their faculty.”

Eye on the Future

Among countless encomia, he received the Hermann Wacker Prize of the Club Jules Gonin, the W.H. Helmerich Prize of the American Society of Retinal Specialists, the Lifetime Achievement Award and the Secretariat Award of the American Academy of Ophthalmology, and the Alcon Research Institute Award. He holds honorary memberships in a number of international retina societies and was recognized as one of three National Physicians of the Year by Castle Connolly in 2008.

Ever the visionary, Dr. Chang points out that “the eye is a perfect model for regenerative medicine and stem cell therapy.” He predicts that “it will probably be one of the first organs to use gene therapy effectively to treat conditions thought to be untreatable before.” He is also excited about the potential of new technologies to “see with greater precision and resolution than the naked eye permits.” But nothing, he insists, will ever replace “studied judgment and steady hands, the ability to detect tiny tears in the retina and to repair them with minuscule instruments. It’s still,” he says, “what matters most and what gives me the greatest satisfaction.”