Joel S. Glaser, MD, is widely considered one of the great scholars of neuro-ophthalmology. Educated at Duke University, the University of Miami, and the University of California, he has trained over 50 fellows. He is the author of Neuro-Ophthalmology, a highly respected and widely read single-volume textbook of neuro-ophthalmology first published in 1978 and shortly to emerge in its fourth edition. He has had a long and fruitful career at the Bascom Palmer Eye Institute, which at one time employed the largest roster of neuro-ophthalmologists ever to be assembled on one faculty. Recruited by Edward W. D. Norton, MD, then the chair of ophthalmology and himself a passionate neuro-ophthalmologist turned retina surgeon, these neuro-ophthalmologists were known as the “Miami Seven” (Lawton Smith, Noble David, Robert Daroff, Todd Troost, John McCrary, Norton, and Glaser). Having joined the Bascom Palmer faculty in 1970, Glaser is the longest running member of the Miami Seven. In collaboration now with neuro-ophthalmologist colleagues Norman Schatz and Byron Lam, Glaser is in his 37th year as a major contributor to the field.
This interview took place at his home in Coconut Grove, Florida, on December 22, 2006.
JDT: Joel, where were you born?
JSG: In Brooklyn, New York. Both of my parents were born and raised there. My father was in the practice of eye, ear, nose, and throat in Flatbush.
JDT: And your grandparents?
JSG: My mother's parents were from Ukraine. Her name was Umansky. The little town she came from-Uman-is still there. There are, of course, no Jews there now, but it was once a great Talmudic center. My father's parents were from Riga, Latvia-Prussian Jews. They would all have come to the United States by boat in the late 19th century. It's a great pity that I don't know more about my ancestry. I had only one living grandparent when I was a child-Fanny Umansky, who lived with us. I did not record and I cannot remember much of what she told us. She loved my father. Although she kept kosher, she would cook one of his favorites -bacon-once a month. She was a great cook. Probably how I got fat…
JDT: What language was spoken at home?
JSG: English. They saved Yiddish as their code language-for when they didn't want us kids to understand.
JDT: Were your parents religiously observant?
JSG: Not really. But my father was very knowledgeable. Later, when we were living in Orlando, Florida, the rabbi left town and, as president of the congregation, my father felt responsible to lead the Friday services-which he did! He had done a tremendous amount of reading to prepare for that. He also read about two or three nonreligious books a week in addition to practicing medicine. He also played the violin and flute. I like to think that I am like him in many ways.
JDT: Where did your father train?
JSG: He went to medical school at Columbia University. He started in ENT at Columbia and then he went to the University of Pennsylvania to study with a famous bronchoscopist named Jackson.
JDT: And where did he learn ophthalmology?
JSG: Mostly self-taught. I've looked at his ophthalmology textbooks and, judging from the heavy underlining, I think he learned a lot of it on his own. Some he learned as a preceptor in other people's practices.
JDT: How did the family get to Orlando?
JSG: We wound up there because my father was in the Medical Corps during the Second World War. Toward the end of the war, he was stationed at Camp Blanding in Starke, Florida, just outside Gainesville. When the war ended, my parents did not want to go back to Brooklyn. They took a tour of Florida and chose Orlando. As time went on, my father did more and more ophthalmology and less ENT.
JSG: I think he found the eye and its diseases more interesting than the nose. But one day he would do a cataract and the next day a tonsil and everyone seemed to survive. This is the life that I saw and it made me think that medicine as a career was pretty good.
JDT: What was good?
JSG: His example. He took very good care of his patients. He practiced a bit of psychology, as all good physicians must do. He was personally sensitive to his patients' needs and genuinely enjoyed the practice of medicine. Orlando at that time was segregated. My father had one waiting room at his office. Whites and blacks could not sit in the same waiting room in Orlando in the late 1940s. My father did not understand this at first. The black patients certainly did. They would not come into the waiting room even if it was practically empty. As was customary, they sat outdoors on the hot curbside. He knew he could not change the system, so he built a comfortable waiting room for them off the side porch.
JDT: What was it like otherwise to grow up in Orlando?
JSG: Wonderful, ideal. This was pre-Disney. Maybe 50,000 people lived there. Every two blocks there was another lake. I eventually left in 1955, to go to college at Duke University.
JDT: Why Duke?
JSG: At the suggestion of a family friend, Joseph Weil, dean of engineering at the University of Florida. His good friend was the dean of the medical school at Duke-Wilbert Davison, brought in from Johns Hopkins University by the Duke family. Weil favored Duke Medical School. I was told that if I became a Duke undergraduate, I would have a better chance of getting into Duke Medical School. I also did not want to go where all my friends were headed, which was to the University of Florida in Gainesville.
JDT: To get into Duke, you must have done well in high school. Were you a scholarly guy?
JSG: Not really. I had a carefree life. I rode a motor scooter. I fished. I dated girls. I pitched on the baseball team. I did as much-or as little-school work as I needed to do. I got Ds in algebra. Teddy McNeil and I blew up a sink in the chemistry lab because we did not believe that elemental sodium would react vigorously with water!
JDT: What did you take away from the undergraduate days at Duke?
JSG: Half the freshman class seemed to be pre-med. I did my work. Many late nights in the library. My main outlet was fraternity life-ZBT (Zeta Beta Tau). I especially remember the annual football game that we played against the other Jewish fraternity-the TEPs. We called it the “Nose Bowl.” We played in front of at least 400 people at Wallace Wade Stadium where the Blue Devils play (or don't play very well!).
JDT: Were you also involved in leadership activities?
JSG: I was president of the fraternity, if that's what you mean. My main job was to explain to the Dean of Men why the gully behind the ZBT fraternity dormitory was always filled with beer bottles.
JDT: How about scholarly activities?
JSG: I majored in biology, minored in English. I remember reading the part of Lady MacBeth at the professor's house, with Elizabethan music in the background. I took three years of French and read the original versions of Sartre, Baudelaire, and St. Exupery-the books about his experiences as a solo pilot carrying mail from the western tip of Africa to Buenos Aires, and his flying experiences during combat in World War II. These works are deeply moving. I reread them to this day.
JDT: And then came Duke Medical School…
JSG: Where every rotation was excellent. In the back of my mind was my father and the possibility of going into ophthalmic practice with him, but the rest is mostly accidents, or I should say, extraordinary luck.
JDT: Meaning what?
JSG: For my 6-week senior elective at Duke, I applied to do cardiology with Dr. Harvey Estes, but all spots were taken. I had seen a doctor named “Red Smith” (Editor: aka J. Lawton Smith, MD) cruising the wards with a cluster of ophthalmology residents in tow. He seemed to be having more fun than anyone else and luckily for me he agreed to take me on his elective for Fall 1962. In the summer of that year, I decided to go out to California to look over internships. I started in San Francisco. I had heard that ophthalmology was an excellent department, so I went by the chair's office to get some information. While I was talking to his secretary, in came this burly bear of a man-Dr. Michael Hogan, the chair. Although suffering from a bad cold, which made his ample nose remarkably swollen, he surprisingly and abruptly invited me into his office, knowing nothing about me. When he learned of my plans to study with Lawton Smith, he suggested I go talk to Bill Hoyt.
JDT: Did you know Hoyt?
JSG: I had never heard of him! I found him in his office at 5th and Kirkham Streets with his feet up on his desk. When I explained that I was a Duke medical student about to take an elective with Lawton Smith, he quickly pulled his legs off the desk and invited me to come spend 3 months with him after I finished with Smith. He arranged for a Fight for Sight Fellowship, which I redeemed during those 3 months by putting together plastic cut-outs of the optic nerves and chiasm. So, my career was set in motion by a substitute elective with Lawton Smith, a chance meeting with Michael Hogan, and an unplanned interview with Bill Hoyt.
JDT: What do you recall about your elective with Lawton Smith?
JSG: When I returned to Duke, I learned that Smith had accepted a position at the Bascom Palmer Eye Institute, University of Miami. Barnes Woodhall, a great neurosurgeon, was then medical school dean at Duke and, with a wide grin, gave me permission to “go and take your winter vacation with ‘Red’ Smith.” And so I followed Smith down to Florida. There I regularly had lunch with him and his close colleagues Ed Norton and Noble David. With his infectious enthusiasm, he would say that “every case is a neuro-ophth case.” I became infected, in a nonspirochetal sense. I recall especially helping to prepare teaching material for a case of acromegaly with chiasmal defects, and another patient with third nerve misdirection.
JDT: And what of the 3 months with Hoyt?
JSG: This is where I learned that it is not what you know, but when you know it. This is how it happened. We would make ward rounds on the inpatients. There was always a crowd-ophthalmologists and neurologists from Letterman General Army Hospital and from the Naval Hospital in Oakland, one or two visitors from abroad, the fellows, and, of course, the residents. Hoyt would ask a question of the group. He would go around the circle, ruthlessly prodding stomachs with an enormously long British direct ophthalmoscope. We stopped to discuss a pale middle-aged man who had visual loss in both eyes. Hoyt asked the trembling assembly: “What is the first test you would do on this man?” The dreaded ophthalmoscope pointed around like the hands of a clock, and no one seemed to come up with the right answer. Exasperated, Hoyt finally turned to the little medical student-me. Well, the patient was pale and lethargic on a neurosurgical ward, and I had just experienced pituitary tumors with Smith, so I suggested doing “a peripheral field examination.” Hoyt beamed! The youngest, least experienced member of the circle had gotten it right. And with the next patient, no one recognized third nerve misdirection but me. I was made.
JDT: So by the time you had finished medical school, you had already done almost 6 months of neuro-ophthalmology. A residency in ophthalmology would have seemed natural…
JSG: Yes, I was accepted at Bascom Palmer. They had just expanded the residency to six positions, and I am convinced I got the sixth spot. The faculty members were Norton, Smith, John Flynn, Victor Curtin, Don Gass, Bob Sexton, and Arnold Kroll. Very good teachers. They were on the ground floor and the resident clinic was on the second floor. Space was cramped, but this was good. We would simply walk the patient a short distance downstairs and say “Would you take a look?” Or the faculty could come upstairs-and they always did. We had exposure to great ideas and great talent. And of course, there was Lawton…
JDT: How so?
JSG: His Saturday morning neuro-ophthalmology rounds were SRO. The neurology residents usually came. Lawton had also charmed the key faculty members into attending. Always in attendance was Nobby David, an outstanding neurologist/neuro-ophthalmologist who, along with Smith, had been recruited from Duke. Even David Reynolds, the chief of neurosurgery, was there! So was Freddy Gargano, professor of neuroradiology. This was in the pre-CT (much less, MRI) era, so Freddy showed plain films, polytomes, catheter cerebral angiograms, and pneumoencephalograms.
JDT: Already primed, you could hardly avoid becoming a neuro-ophthalmologist…
JSG: Yes, and remember that Norton, the chair of ophthalmology, was himself originally a neuro-ophthalmologist. Lawton considered himself overworked, so Norton asked me if I'd consider going for a full year fellowship with Hoyt and coming back on staff.
JDT: And so you came to Bascom Palmer as faculty in 1970…
JSG: And so did Bob Daroff, who had also done a fellowship with Hoyt. As a neurologist, he was especially interested in eye movements. He was recruited by Norton and Peritz Scheinberg, chair of neurology. With Daroff came Lou Dell'Osso, a nonphysician scientist, and Todd Troost, another neurologist interested in neuro-ophthalmology. At that time, there were seven card-carrying neuro-ophthalmologists at the University of Miami: Smith, Daroff, Troost, David, John McCrary, Norton, and me. (Editor: see Glaser JS. The golden age of neuro-ophthalmology at the Bascom Palmer Eye Institute. J Neuroophthalmol 2002;22:222.)
JDT: You came into a situation in which Lawton Smith was already ‘the king.’ Was this difficult?
JSG: Well, I had to politely shoulder my way in. We had different styles. People began to recognize that I was less guided by parables and rules and that I was not his assistant. My additional training with Hoyt was indispensable in these distinctions. Then along came another unexpected fortuitous event that was a major boost for my career.
JDT: What was that?
JSG: Tom Duane, then chair at Wills (Eye Hospital), was putting together his loose-leaf textbook called Clinical Ophthalmology. He approached Bill Hoyt, who had his hands full with Walsh's book. Hoyt suggested that I write the neuro-ophthalmology chapters for Duane's book, which appeared in 1976. Two years later, my chapters came out as a separate book (Glaser JS. Neuro-ophthalmology. Hagerstown, MD: Harper & Row; 1978). It had contributions from Daroff, Troost, and Dell'Osso.
JDT: What impact did the book have on your life?
JSG: I had to learn a lot. I wrote carefully and edited plenty. When you have to force things out in your own words, you discover how marginal some publications are. I would often say “there has to be something better than this,” and I would look again and often find nothing. I had to learn how to collect references and decide how much of the old and how much of the new material to put in. Remember that this was before computers; it was all library work. I also worked very hard on the illustrations, many of which I had done. The book is short enough so that it could become the source of basic information on common neuro-ophthalmic diseases for ophthalmology and neurology residents-and maybe even a few neurosurgery residents.
JDT: Did you have any models for your book?
JSG:Walsh & Hoyt of course, but that was already a 3-volume encyclopedic work. Alfred Kestenbaum's book (Kestenbaum A. Clinical Methods of the Neuro-Ophthalmic Examination, New York: Grune & Stratton; 1946). A fine writer. And Freddie Huber's neat book, Eye Signs in Brain Tumors. But I felt my book should be short and comprehensive, and a good “starter” guide.
JDT: Haven't you also been an editor?
JSG: Yes, Fred Blodi invited me onto the editorial board of the Archives of Ophthalmology and then I really had to read other people's stuff carefully. I would spend a lot of time on editorial comments and suggestions. It was educational as well as career-building. But there comes a time when family concerns take over.
JDT: As in…
JSG: I met Irena in 1977. She was secretary to Dick Forster, my colleague, and working at a desk next to my office. She was born in Czechoslovakia. Her father was actually a Czech national hero who had flown airplanes for the free Czech air force and the British Royal Air Force during the Second World War. He was shot down several times. Irena started medical studies at Charles University in Prague, but her family fled to the United States in the late 1960s when the Soviet army invaded Prague.
We were married in Miami, in 1978, and our oldest child, Larah, was born in 1982 at Hadassah Hospital in Jerusalem, where I was doing a sabbatical with Moshe Feinsod, a neurosurgeon interested in visual evoked potentials.
JDT: What of that year in Israel?
JSG: It was wonderful. The first war in Lebanon was going on. But we had a very stimulating experience living near the hospital and meeting fascinating Israeli physicians and seeing interesting patients. One of my patients was Gideon Hausner, the prosecutor of Adolph Eichmann, who was brought out of hiding in Argentina in 1961 and tried (and executed) in Jerusalem for genocide. This was when the Holocaust was “outed.” Until then, survivors did not want to talk about it-either because they wanted to keep their bitter memories to themselves or because people simply didn't believe them. Hausner's job was to get the story out and for survivors to finally respond, “Yes, that's right, it happened that way.”
JDT: And then you returned to Miami. What do you consider most memorable from that period?
JSG: My sons Ben and Jacob were born soon afterward. Then Irena underwent a 4-year course of study to undergo orthodox conversion. The kitchen was rebuilt kosher and we began to observe Shabbos-a big change for me, as I had grown up nonobservant. I had to give up playing tennis and watching baseball and football games on Saturdays! But every choice Irena made was correct for the family.
JDT: Do you retain your interest in Judaic studies?
JSG: Well I study less now, but I still know enough to spar with an occasional rabbi who mistakenly thinks I know more than I do. The wisdom of Jewish ethics and home life is very worthwhile. My Judaism leans less on faith and creed and more on ethical teachings. I suppose one may be an atheist and still be profoundly Jewish-many individuals are. We lost my wife Irena to stomach cancer in 1998, and I found wisdom and comfort in rabbinic writings that were directly applicable to raising three young teenage children by myself. Irena still lives in their bright eyes and generous spirits. And in my heart.
JDT: As you look back on the years at Bascom Palmer, what most do you take away?
JSG: The faculty was superb, and useful exchanges of information a constant source of illumination. Then there was the interaction with students, residents, and fellows. I get great satisfaction in knowing that I had a small hand in training them-and that they have come from all over the world, and represent the best of neuro-ophthalmology: Ivor Levy in London; Pierre LaFlamme, Mark Gans, Jim Lewis, and Martin ten Hove in Canada; Avi Safran, François Borruat, and Oliver Jobs in Switzerland; Hannah Leiba and Haneen Jabaly-Habibin in Israel; Kong Yong Goh in Singapore; and Adriana Silva-Lepe in Mexico. The residents and fellows bring their own palette of interests. They ask questions for which I often do not have good answers.
JDT: What about your publications?
JSG: In the long run, I do not think I've made enormous contributions to the academic literature. Maybe there are some dozen or so papers that are vaguely worthwhile. I'm thinking of my first paper: myasthenic pseudo-internuclear ophthalmoplegia. Nobby David, Don Gass, and Lawton Smith all made corrections, and Norton saw the last draft and evidently found no need to make any further corrections. There were the two papers in Brain, one on ischemic optic and the other on extraocular muscle ischemia in giant cell arteritis. There were good papers on aneurysms and meningiomas of the cavernous sinus, radiation-induced optic neuropathy and chiasmopathy, and transient third nerve misdirection in migraine. Interesting case material still comes my way, but I no longer have the electricity to write it up.
JDT: Joel, what was your role in founding NANOS?
JSG: It started with the Rocky Mountain Neuro-Ophthalmology Society, which was Tom Carlow's baby. Bill Hoyt, Bob Daroff, Norm Schatz, Tom Carlow, Joe Bicknell, and I skied and still had time for teaching. The Rocky Mountain eventually turned into the NANOS.
JDT: And speaking of Schatz…
JSG: Extraordinary in every way: a great neurologist, an empathic physician, and my best friend. Only we two could put up with each other.
JDT: Looking back, what do you consider your major professional contribution?
JSG: Taking good care of patients. As a neuro-ophthalmologist, you are often the end of the line. The patient has gone to Switzerland for goat gland injections or to Mexico for almond pits. Of course, recognizing the problem and applying reasonable diagnostic tools are critical in patient care. There are also medical problems that no one can fix. For all that I might differ from the approach of Lawton Smith, he certainly taught me how important it is to spend time with people who need it. Ed Norton used to say that when you have a complicated patient, you must see them 10 times more than a patient who is not complicated or has enjoyed a good visual outcome. You have to find a way to help the patient adjust and support a family's concerns. If we ignore the psychological aspects of being physicians, there is nothing to separate us from veterinarians except our clientele.