Chapters Transcript Video Building a Research Powerhouse: The Evolution of the UCI Gavin Herbert Eye Institute As a leader I'm always true to myself and I try to be outspoken and my, but my integrity is important and I think leadership sees that too. So I encourage young people to be still diplomatic. You can be nice about being outspoken. You can say things, try to be thoughtful about it, try to make sure that it can resonate with people. Don't be overreactive, but please be true to yourself, be honest with yourself, be, have integrity. I think that resonates always. Hi, I'm Lindsay Carrillo, director of business development at UCI Health. Hi, I'm Doctor Sunil Verma, associate Chief Medical Officer of ambulatory at UCI Health. I'm also an otolaryngologist here. Welcome to Physician Huddle by UCI Health. Today we're joined by Doctor Barry Cooperman, the Standard Endowed professor and Chair of the Department of Ophthalmology and director of the Gavin Herbert Eye Institute at the University of California, Irvine. Welcome, Doctor Cooperman. Thanks, Sil. Thanks, Lindsay. So, Doctor Cooperman, take us through your career here at UCI Health. What brought you here and how has your career evolved? Well, I've had a long career here. I'm one of those fortunate few that came here from fellowship. I came here for a lot of it for geographic reasons. I grew up in Pasadena. Uh my father was a professor of chemical physics at Caltech, and so, and they had a beach house in Laguna. So I want, I knew after all my training, which like all of us, took me all over the country, east coast and back, uh, but I knew that I wanted to come back to California at least, and when it was time to make a decision at the end of fellowship, there's a couple of options in Northern California, a couple of options in Southern California. Each one had a private practice option and an academic option. So kind of academically came down to Stanford or UC Irvine. And I felt more comfortable staying in Southern California, coming back to Southern California, knowing that I would have family close by. Again, my parents an hour away, but they also had a beach house in Laguna, 10 minutes away from us. And so, um, it made sense to come to UC Irvine. I also liked the opportunity here. It felt like UC Irvine. was an opportunity that had not yet fully was more of a diamond in the rough, so to speak. Also at the time, this was again. The 90s, I was very interested in the ocular manifestations of AIDS. Um, and so that became a big thing. I've trained at USC Doheny, LA County. All that's changed because LA County is now LA General and Doheny has migrated to UCLA, but it was USC uh Doheny. Uh, LA County and I had a large practice of people with AIDS, um, that were dying and going blind. It was for me an epiphany. It was kind of what I discovered then why I became a doctor. They were guys my own age, same mustache. They were gay and I wasn't. We had all the same interests, and they, because of the AIDS epidemic, were dying and, of a, and going blind from this, you know, cytomegalovirus retinitis. So part of my decision when I was making the choice of where to come for my faculty position was the fact that, A, there was Laguna Beach, and B, there was no real player in, in cytomegalovirus retinitis treatment in Orange County. So that became another motivation when I came here. Amongst the many serendipities with that decision. Was in that era in ophthalmology and in retina, right now we're very linked to the pharmaceutical industry because we're busy giving injections all day long, these anti-VEGF vascular growth factor injections for wet macular degeneration. Back then there was no involvement with the pharmaceutical industry except for cytomegalovirus retinitis. And by sheer chance, the chair at the time, Dick Keats. Was on an advisory board or on the board of Chiron Vision, which had a G cyclovar implant, a device that would deliver drug to the back of the eye for people with CMV retinitis. So they had just closed the last. Not the trial, but the selected, the the principal investigators for the trial, they decided I was brand new out of fellowship to open the door to let me in and close the door behind me. And I started enrolling patients in clinical trials for the first time. I ended up succeeding at it and became actually the lead of that trial, the youngest member of that trial, the youngest principal investigator, but I'm the one that presented the data to the FDA. So it turned out to be a huge amount of serendipity. I chose it for family, for geography, for CMV retinitis, a passion. Uh, an epiphany, as I mentioned, in residency, and it just turned out to be this wonderful experience that's blossomed ever since, including very healthy and productive relationships with the pharmaceutical industry, I would say. Cool. Talk to us a little bit about your tenure as chair. So, that's actually a complicated story too. I hate to be long-winded, but actually this is act two of my year as chair. Amongst the many crazy serendipities, when I came here in '92, in '95, Dick Keats, the chair, said he was gonna go on sabbatical and asked me, the youngest faculty member, to be the acting chair. So I said, I, OK, sure, and I've got some ideas. I said, do whatever you want. So I changed how we pay our faculty. I changed this, I changed that. We were at Center Point, I met camp, uh, I brought us onto campus. Um, I mean, we were already at Gottschalk Medical Plaza in Irvine, but our, uh, academic offices were off campus, so I moved us onto campus. So a lot of things happened and then he came back after a year and said he was gonna retire, which I didn't know you did, you did all that in a year. You had the, the gumption to start changing things because yes, yes and no. So that I kind of, what happened is after a year he came back and said he was going to retire. So they made me. The interim chair. So I'd lost track of when I did what, but I was acting for a year and interim for several years. This is the era of Tom Cesario being the dean, a lovely man. Tom was the dean and wanted me to be the permanent chair, and I begged him not to because I was a young person. I was willing to do it for a limited period of time. But during those few years, I was able to bring this on campus, eradicate a $2 million debt, create an endowment. I got a lot of things done, create a new payment plan that persists to this day, which was back to the, the, we're one of the few departments to do that P&L statement, and my faculty still love that, and all the chairs since me, uh, that period of time have used that too. But then I stepped down as chair when we recruited Peter McDonald from USC. So how was that for you though? I mean, you seem like such a, I, I mean, I know you well enough, but. You're, you're such a dynamic person. What was it like to cede control after those years? Because even if it was an interim and in your heart, you knew you were too young as you, as it was, like, I'm sure it tore at you to give it up. I couldn't have been happier. I loved it. I convinced Peter McDonald to leave Doheny. I had to take him surfing at Huntington Beach. We hung out in the parking lot there, and that's how the deal was made. He came and he was chair for about 4 years, and he was a successful chair. And, but he met a lot of the criteria of Johns Hopkins. If you're, if you, so Johns Hopkins to be chair there, which he now has been there for 20 years, after leaving us, you have to have been a resident, a chief resident, and a chair somewhere else. Check, check, check. I didn't realize that I was helping him cross off the chairs. And so it came down to him and another person who met all those criteria, and then he's, so he was recruited to be chair of Johns Hopkins Wilmore Institute, world-famous, um, and he's been there now for about 20 years. And then after him, George Barfeldt became chair, who subsequently sadly passed away, but he was a world-famous glaucoma specialist. Then Roger Steinert, a world-famous cornea specialist that we all adored and was the really the one that built the Eye Institute. I still call it the house that Roger built. And he sadly passed away of glioblastoma, and then it came back to me, now on a permanent basis, um, to be chair. And honestly, I didn't even really apply. I was asked to apply. Because, and then I figured they wanted to have a reasonable looking internal candidate when they made their decision, and I made it clear in my interview process that please don't worry about me. Whatever, whoever they chose, I was happy to work with them and I was going nowhere. I love this place. And then they ended up choosing me and I have embraced it. It took me a while to warm back up to being chair. Uh, but after a couple of years, I realized what an amazing Dean. I give a lot of shout out to Michael Stainless. He's been a remarkable Dean. And then we had Rick Janata was the CEO at the time, and then Chad Lef Terrace. He's an amazing, both of them were amazing CEOs. Chad has been amazing, and again, we've partnered well. And they invested in me and there's been a good ROI. We trust each other, so it's been a thriving experience. So I've loved being chair, but again, I wasn't, I didn't necessarily mind when I wasn't chair a million years ago after Peter McDonald showed up, nor did I rush to be chair this time, but I have to say that I am loving being chair. What did you, what, what have you learned this go around? Are you more, um, do you have more perspective? I mean, you just gave shout outs to the leaders. Do you have more of a perspective of The balance between representing the faculty and understanding the mission of the enterprise. Great question. So, what, amongst the things I've learned is I went from feeling like, like I don't think most of our faculty never think of the chair as their boss. The chair is there to serve them. So I've, I've embraced servant leadership. I feel like everybody's my boss. Everybody with an MD or a PhD in my department, if I'm not doing something to make their lives better, I have not succeeded in my job. At the same time, I have two real bosses, Michael Stainless, the dean of medical school, number 1, and Paired with him, Chad Chad Lefterras, the CEO of UCI Health. So I've also had to learn more so than when I was an interim chair, how really to manage up. But they're amazing leaders, and I follow their leadership where I make sure that I'm in alignment. I get them in alignment with my vision. And it's been a thriving experience where they see the value in what I'm proposing to them. They see the the investments they make in our department have paid off well. At the same time, they know that I'm gonna fight tooth and nail for my faculty, my residents, my trainees. And so while I have divided loyalties, so to speak, I managed to make them be. Uh, unified, so that I help guide my faculties, so that what we're asking for, what we're trying to build is in alignment with the philosophy and vision of the institution. So it's a win-win, and that's what I've learned about also is how to make these decisions that everybody wins. I'm always looking for the win-win. So you touched on already P&L sheets, ROI. How did you already have some skill in thinking about like the business side of medicine, or is this something that you've had to like pick up over the years and try to use it to be a successful department chair? So the P&L started kind of selfishly, um, back when I was the junior assistant, I mean, acting slash interim chair, the reason I wanted to switch from a salary structure to a P&L model is that I was trying to develop. My lab space and my research and I wanted to make sure that I was handsomely paid when I was in with patients. What I didn't realize that when I created that model for us is that it would work in so many ways. Those that want to go after it clinically, get to make a lot of money, those that wanna have. Less time in clinic, but they may want to spend more time with family, um, or other factors. It was a way to accommodate them. Nobody would ever have to come to the chair and ask, please, sir, or please, ma'am, may I have a cup of gruel or negotiate the salary. It's simple. You wanna make more money? Which half-day clinic do you want me to open up for you? You wanna take time off, that's fine. You know that'll have an impact on your income, but everybody plays by the same rules. So. I discovered the joy of that back then, and literally, as I mentioned, Peter McDonald, followed by George Barfelt, followed by Roger Steinert, all embraced that notion because they saw the value of that. So it kind of came to me in another epiphany, but it's worked for now 25 years or so. Um, the investments in research is what I really do. I do have a PhD from Caltech as well in neuroscience, and I felt that for all that, the the chairs before me had invested beautifully in clinical development, I felt like we could do more on a research side. And so, I. I committed myself to expanding our research focus. And I was very fortunate. I was able to recruit, and with all, again, shout out to both Michael Stamos and Roger Steinert, who preceded me. They had initiated a communication with this amazing scientist named Chris Palcheski, who is a Case Western, but is maybe the world's most famous ocular pharmacologist. But for whatever reason, I was able to close the deal, shall we say, when I became chair. He had been hesitant. USC had been recruiting him, uh, Wilmer, Johns Hopkins had been recruiting him, but we were able to recruit him and we were the lesser known of those three. Um, but it's been an amazing success story because we've created, uh, we created an organized research unit, ORU called the Center for Translational Vision Research. We've been able to recruit a ton of other scientists, and again, Michael Stamos, Dean Stamos has been an incredible partner with the FTEs and has been on the FTEs have brought us in with, uh, people with great, you know, R01 grants, etc. And we've now have got a lead donor just this past few months for our CTVR Center for Translation Vision Research, a $15 million gift, $5 million for bricks and mortar, and $10 million endowment from the Brunson family. So it's the Brunson Center for Translational Vision Research, and we were given the top floor of the penthouse of the Falling Leaf Foundation, a brand new, uh, building that we have, the Medical Innovation Building. So we're booming on a, on a research front, so much so that I'm still shocked to Brag about this, that somehow we now have more NIH funding than UCLA Department of Ophthalmology has. So again, when we, when they, there's this, uh, Blue Ridge Medical Research Institute that rates, ranks people based on data, NIH funding. Whether I don't know if their methodology is flawed or not, all I know is that we went from like 40th in the country to 12th in the country with since I've become chair with the recruitments, and we're now ahead of UCLA, which still astonishes me because I have nothing but respect for the Jewel Stein Institute in UCLA, but we are now ranked ahead of them in our research fund. So what makes you, what has made the department able to do that? Was it that key first recruit that you talk about, or is it you constantly putting your foot on the gas to push this? Both of the above. So, so two things. First, when we recruited Chris Palcheski, he came, it was a, it was a cluster hire. So at the time, Dean Stamos had an initiative of cluster hires. Now, I was the last to the table with the cluster, but I was, for whatever reason, and I don't know why, the first to make it happen. But along with Chris Palcheski. It was really initially 4 people, but I expanded it to 5 people, because 2 of the people that came from Case Western, Tim Kern and Philip Kaiser, ended up having appointments with the VA there and was able to translate appointments to the VA here, so they only needed a half FTE. So even though I was, there were 4 FTEs, we're able to use it for 5 people. We then recruited Doroda uh Skanska Krawchik from UC San Diego, and then Vladimir Keilov from Washington University, who's the vice chair of research now for us. So we ended up with 5 there, and then Dean Stamos saw how productive they were and where, how many RO1 grants we had. So then we got another FT and we recruited more person and then more and more. So we now have since recruited a world-class, we've also, again, Chris Palcheski. has had incredible vision, i.e., the Center for Translation Vision Research, but beyond that, he approached me and Dean Stamos about building a program. He saw that the future in medicine, not for ophthalmology alone, though it was applied to ophthalmology, was genome editing, precision medicine, precision genome editing. So we went to Dean Stamos and we're all three partners, the CTVR, the Department of Ophthalmology, and the School of Medicine in a program in precision genome editing. And we've recruited, for example, our first recruit for that, Audrey Lapanati. came from Arizona, but she trained with Jennifer Doudna at Berkeley, the world-famous Jennifer Doudna that got the Nobel Prize in Chemistry in 2020 for the CRISPR Cas 9 technology. She trained for five years with her. And she was a psych, she was a cystic fibrosis researcher. We didn't care. She didn't know how to spell off, well, I barely know how to spell ophthalmology, we're almost as bad as otolaryngology. But, uh, um, so she, we just begged her to every once in a while think about the eye. So she's now thinking about inherited retinal diseases, but this technology, CRISPR Cas9 technology can be applied to any disease. State, any, uh, if there's a genetic basis for the disease, you can use that technology. So she's thriving and building new methodologies for, for treating genetic diseases. We recruited Ray Chen from Baylor, maybe the world's most famous ocular geneticist. So we've had incredible success in recruiting people from, and again, we just recruited Kim Gokosi from US. She's a neuro-ophthalmologist that is working on whole eye transplants, a mind-boggling concept through the ARPA-H pathway. So ARPAH is the Advanced Research Projects Agency hyphenH Health, kind of like DARPA, but ARPAH. So she's one team that's trying to do this whole eye transplant and somebody that's arriving in January. Um, Franz Vinsberg from, uh, Utah is working for the competing team. So now we're gonna, we had no participation in this incredible competition for whole eye transplant. Now we are members of both teams. There's 2 teams competing. We've recruited a member from each of those teams. So it's an exciting time. But a lot of it is the vision of Chris Palcheski. He has set the standard high. And it's because of him that we're able to recruit the best scientists in the world. How does doing all this world-class research change clinical medicine here? Because a lot of the folks that you've mentioned may not be in the, you know, they may be born in the lab, not so much seeing patients, but how does it affect that, uh, the physician that you just mentioned that maybe wants to take ingrained it out in an extra clinic. It's a great question. Again, so, for example, Kim Gokovsky that we hired is an MD PhD, actually an MSTP from UC Irvine, um, and then went off to UC Davis for her residency and then was at USC on faculty. So she brings RO1 grants and the ARPAH grants and all that. So she is a, you know, classic. You know, we, the only one we have that, well, that's at that level. We also have Andrew Brown, an MD PhD that has a KO8 award, Ali Langadiakrema, who also has a KL2. So we have several people we're trying to develop as clinicians, scientists. But having this research powerhouse, especially now that they've moved literally next door to that Falling Leaf Foundation. The Building is separated by a two-lane driveway essentially from our building in Irvine, in Irvine, next to the Gavin Herbert Institute. It's literally from my office to walking into Chris Palcheski's office. I don't think it takes 2 minutes for me to go downstairs, walk across the lane upstairs to his office. It's right there. I look out the window and I see it, that I can touch it. That excitement spills over into all of our faculty meetings, our grand rounds, uh, we have a bench to bedside, um, uh, annual meeting where the researchers and the and the clinicians get together and exchange ideas. We're trying to figure out all the ways to collaborate. And also we're now recruiting new clinicians and what's interesting is the clinicians that are now applying are a lot more MD PhDs. They hear about the research going on here, so it's actually changing the quality and character of the type of clinician that's applying to us. We love our clinical, our clinicians that are. Busy seeing patients doing surgery that's still paramount to us, and many of them do a lot of clinical research and publish many papers. My busiest clinicians also write the most papers, you know, there's those, that group of people that do everything, but we are also recruiting now more MD PhDs that really wanna do more bench research while they're doing their clinical work as well. So it's been transformative for our department. Talk to us a little bit about your vision. Obviously you've accomplished so much in your time here and your time as a leader, but where do you see it going? What role do you see it playing, you know, across the enterprise at UCI Health? Um, this is such an exciting time for UCI Health. Literally yesterday, I don't know if we have to reference the date for posterity, but yesterday we opened up, we opened up the hospital, for goodness' sakes, Irvine Medical Center. That was yesterday. The rest of the operating rooms opened up. The ED opened up. The rest, so the whole thing. So again, the focus of UCI Health is going to be more on Irvine. And we're, we were sort of the first ones, uh, in Irvine, uh, with that, even before the Gavin Herbert Institute when we were in Gottschalk Medical Plaza. So, what I see more of is all of us growing together. Um, already day one yesterday, all 18 operating rooms were operational. That was amazing. So, shout out to everybody that made that happen. We're opening up our first satellite in Brea. I hope to open, open up another satellite. We're going to move into the rest of the second floor of, of the, of GHEI as DUM moves out. We're the number one gateway of entry for patients new to UCI Health. Something like 14 to 15% of patients that have never been to UCI Health, they're coming in the doors of ophthalmology, either in Irvine or an orange. Number 2 is like 5%. I can't explain it. Maybe that's true of other institutions, but somehow, we're the number. One gateway of entry. So we continue to thrive. And as I hire people, it's not if you build it, they will come. I hire people because we're all so busy right now. I am, I'm going to hire 4 people that are going to come before Durham's Durham moves out. Everybody's agreed to it, but I'm gonna have to jam into space that we don't have. I'm waiting for Durham to move out patiently, but the, the day they move out, we're going to start occupying that space. We already have people on board. What, what advice do you give to young leaders that see your passion, that see your energy? You just mentioned being outspoken, always being an advocate for what you believe in. What advice do you give them? Because it's a special personality trait you have, and I don't know if a young leader was as outspoken, uh, would they be received as well in, in big circles? I think it's a very valid point. So I've sort of always been true to myself, but as a leader. I'm always true to myself and I try to be outspoken and my, but my integrity is important and I think leadership sees that too. So I encourage young people to be still diplomatic. You can be nice about being outspoken. You can say things, try to be thoughtful about it, try to make sure that it can resonate with people. Don't be overreactive, but please be true to yourself, be honest with yourself, be, have integrity. I think that resonates always, whether it's with the pharmaceutical industry or with academic leadership. Your name is your your word is your bond, and I think you have to be honest and candid and thoughtful about what you're willing to do. And yet at the same time, being conscious that you look at the long term, sometimes you. Compromise up to a point, bend but don't break. I think that's part of it too. How do you see, uh, UCI Health? Uh, there's, you've talked so much about the clinical ophthalmologists here. You talked about faculty, but then what's the interaction you see? What's the successful interaction with? There's so many other ophthalmologists in the county providing great care here as well. How do you partner with folks in private practice or large groups that I'm, I mean, you've been here kind of forever, so you must know them pretty well. What's that partnership like? It's interesting. I, I think all of us have struggled with it a bit, um, I think. It depends on the department, but there is a relative town gown separation. Um, we've been able to thrive and grow somewhat amazingly, and we are far and away the biggest ophthalmology clinical unit in Orange County, despite there being some other big ones. But we've been able to grow and they've been able to grow, and we've not met, we've not stepped on each other's toes. We get some referrals, sometimes certain practitioners send us all their complications, others don't. Some So we do, we do have referrals, but we mostly have the community support of patients rather than the community support of practitioners. So, we are working to develop that further. But I would say that we have thrived while they have thrived. The pieies continue to get bigger for everybody. None is at the expense of another, and the patients are benefiting because they're getting great care. OK Well, you have been very generous with your time. We really appreciate it. Thank you so much for joining us, and I do wanna shout out UCI Health has been an amazing place. I've grown up here. I came here out of fellowship. I anticipate retiring here, and I just couldn't have been happier. It's been a wonderful place to thrive and grow. We've raised a family here. It's been an amazing place to have a career, and I. And I wish that everybody out there listening to this podcast to have that similar benefit of, of thriving and growing in this wonderful place. Well, we absolutely appreciate your leadership, and I've personally learned a lot from you both here today and as well from afar at times. So thank you. Thank you both. This has been Physician Huddle by UCI Health. Thank you for joining us. This was an episode of the Physician Huddle podcast by UCI Health, produced by Brett Shaheehan, Angelica Yagubi, and Victor Ting. For more episodes, information on clinical trials at UCI Health, or to refer a patient, view the show notes or visit clinical connection. UCIhealth.org. Created by
