Wilmer's new glaucoma chief Thomas V. Johnson III on his vision

Thomas V. Johnson III, MD, PhD, the Shelley and Allan Holt Rising Professor of Ophthalmology at the Wilmer Eye Institute at Johns Hopkins University School of Medicine in Baltimore, Maryland, was recently named chief of the Glaucoma Division. He is the division’s third chief, following Harry A. Quigley, MD, and Pradeep Y. Ramulu, MD, MHS, PhD.

In this Q&A with Ophthalmology Times (OT), Johnson discusses his vision for the role, including mentoring junior faculty and building infrastructure for multicenter clinical trials. He also reflects on how leading residents through the early COVID-19 pandemic shaped his approach to leadership, how his work founding a community vision screening program informs his view of access to care, and how close optic nerve regeneration is to reaching patients.

Note: Transcript edited lightly for clarity and length.

OT: Congratulations on being named chief of the Glaucoma Division. What are your top priorities as you step into the role?

Thomas V. Johnson III, MD, PhD: Thank you very much! Fortunately, as the third chief of the Wilmer Glaucoma Division, I am standing on the shoulders of Drs. Harry Quigley and Pradeep Ramulu, who built and led this division for many years. Together, they did an incredible job of recruiting some of the best clinicians and scientists in our field and establishing a culture of clinical excellence, scholarly rigor, and collegiality that makes this an incredible place to spend a career. So, my top priority is simply to not break anything!

Beyond that however, I have two major foci at present. First is to continue building the careers of our junior faculty, five of whom completed fellowship within the past few years. Thankfully, I anticipate that this will be an easy job since they are all outstanding glaucoma physicians and brilliant scientists who are already making important contributions to the research in our field.

Second, I am working to increase our infrastructure to lead multicenter clinical trials. As a glaucoma specialist and a neuroscientist, I am incredibly excited by the neuroprotective therapies coming down the R&D pipeline and I want Wilmer Eye Institute to be at the forefront of this work in the coming years.

OT: The Wilmer Eye Institute’s announcement highlighted your time as Assistant Chief of Service (ACS) during the COVID-19 pandemic, leading residents through such an uncertain period. How did that experience shape the kind of leader you want to be as division chief now?

Johnson: The ACS year at Wilmer Eye Institute is a transformational experience that not only provides an opportunity for service to the institution and education for our residents, but also a unique capacity for leadership development. I think this has borne out in the sheer number of former Wilmer ACSs who have gone on to become department Chairs, society/professional organization presidents, and other prominent leaders in our field.

Peter J. McDonnell, MD, our department Chair, prioritizes leadership development for our trainees and faculty, and through that I’ve read a lot about leadership styles. The one that speaks to me most directly is Servant Leadership, wherein one leads by example and serves to empower and prioritize the growth of those they are leading. I really try to embody that ethos whenever I can, and my ACS year provided a unique opportunity for this with the initial surge of the COVID-19 pandemic.

As many will recall, this was a scary time when exposure to infected patients was associated with real risk; the mortality rate was significant. Nonetheless, sick patients in our hospital had to be treated and if they had an eye problem, they needed to see an ophthalmologist. During the first few weeks of the pandemic, I didn’t feel it was reasonable to subject our residents to that uncertain risk if not necessary, so I saw all of the inpatient consults myself.

Fortunately, Johns Hopkins adapted to the uncertainty very quickly and put clear protocols in place to ensure the safety of all the clinical staff, so the residents were able to get back to experiential learning rather quickly. But the experience helped instill in me a mentality that a leader shouldn’t ask anyone to do something that they wouldn’t readily do themselves.

OT: You founded the SightSavers program as a medical student to identify community members with potentially blinding eye disease. Does that early experience in access-to-care still shape how you think about glaucoma care and screening today, and could you see it influencing priorities for the division?

Johnson: Absolutely. We started the SightSavers program (now called the Vision Screening In Our Neighborhoods or ViSION Program) in 2011 and once again, I have to credit Harry Quigley with helping to make it happen. One of our founding tenets that we continue to adhere to today is that screening for eye disease is unhelpful unless it also provides a mechanism to clinically address newly discovered pathology.

I am grateful that Wilmer Eye Institute has the capacity to care for patients regardless of their insurance status or ability to pay, through a generous, anonymous philanthropic gift that we lovingly refer to as the “Angel Fund.” Through that mechanism, the ViSION program and Wilmer Eye Institute Glaucoma Faculty have the ability not to worry about insurance reimbursement and instead focus on the care of the patients in our clinics and operating rooms. Putting the patient first has always been a central part of the Wilmer Eye Institute culture, and I certainly intend to continue fostering that mentality as glaucoma chief.

OT: You’ve built local and international collaborations around optic nerve regeneration—a real departure from the field’s traditional focus on slowing glaucoma progression. How close is that science to having real relevance for patients, and what's the biggest hurdle still standing in the way?

Johnson: I am tremendously excited for the future of regenerative medicine in ophthalmology and in glaucoma specifically. While restoring vision to people who are blind from glaucoma through optic nerve regeneration has been a distant dream for decades, it is clear to me that neuroscience, stem cell biology, molecular biology, and biomedical engineering have advanced to the point that restoring lost sight will be possible. I think the scientific community is recognizing that, too, and the enthusiasm of the more than 300 international members of the RGC Repopulation, Stem Cell Transplantation, and Optic Nerve Regeneration (RReSTORe) Consortium underscores that point.

In our own laboratories, we are now able to take human stem cell derived retinal ganglion cells, transplant them into the eyes of preclinical models of glaucoma, and observe not only functional (synaptic) connectivity in the retina but axonal growth through the optic nerve and into the brain. I think that full-length anterior visual pathway regeneration in animal models is just around the corner.

That said, it is always challenging to predict how long this will take to translate to human patients, and a first-in-human clinical trial likely remains several years away. At this point, the biggest hurdle is going to be increasing the efficiency of RGC replacement from a few hundred neurons to tens of thousands—a number that will ultimately be required to restore a meaningful level of vision to patients blind from glaucoma and other optic neuropathies.

OT: Looking ahead, what would you consider a meaningful marker of success for the Glaucoma Division under your leadership in the next 5 years?

Johnson: Continued success for the Wilmer Eye Institute glaucoma division will involve first and foremost, maintaining our leadership in clinical excellence, education, and vision research. Beyond that, I strive to continue mentoring and helping to build the careers of our junior faculty.

For some, that will mean developing and growing a clinical and research program at Wilmer Eye Institute and for others that will mean taking on new leadership opportunities outside our institution. Indeed, while we were terribly sad for ourselves to see Pradeep Ramulu move to become the Chair at Bascom Palmer Eye Institute, we also recognize that such a transition to a prominent leadership role is exactly what our institution and our glaucoma division are all about: cultivating and building clinical, educational, research, and leadership excellence so that we can impact our field beyond the walls of our own institution.

Thomas V. Johnson III, MD, PhD

E: johnson@jhmi.edu

Johnson is chief of the Glaucoma Division and the Shelley and Allan Holt Rising Professor of Ophthalmology at the Wilmer Eye Institute at Johns Hopkins University School of Medicine in Baltimore, Maryland.