A vision to remember
Eleonore B. Iguban, MD,Prospero Ma. C. Tuaño, MD,Rolando Enrique D. Domingo, MD,Pearl M. Tamesis-Villalon, MD
On May 1911, the Department of Eye, Ear, Nose, and Throat (EENT) of the Philippine General Hospital (PGH) was established under the able leadership of Dr. Reinhart Remebe. As part of its commitment to pursue excellence and unconditional service, the graduates of what was then the Philippine Medical School (now the University of the Philippines College of Medicine (UPCM)) had to undergo a month of comprehensive training as an orientation to the department.
In 1914, Dr. Aristeo Rizal Ubaldo, Dr. Jose Rizal’s nephew, was appointed the first Filipino chairperson of the EENT department; he served for almost four decades. During his term, Dr. Ubaldo introduced the intracapsular method of lens extraction using the Ignacio Barraquer erysiphake, a milestone in Philippine ophthalmology.
After World War II, the Department of EENT saw its renaissance under the able leadership of Dr. Antonio S. Fernando Sr. The EENT residency program was reorganized to encourage scientific studies and research as part of training. Dr. Fernando also initiated the standard clinical-staff conferences, which became a regular interactive venue for great minds in the department. These endeavors were further improved on by his successor, Dr. Herminio Velarde Sr., from July 1955 to 1956.
The appointment of Dr. Geminiano Ocampo in 1956 as EENT chairperson ushered in momentous advances in Philippine ophthalmology. He introduced the concepts of akinesia and the use of sutures, as well as intracapsular lens extraction using capsule forceps. He also established the PGH Eye Bank in the early 50s. It was also during this period that the EENT department saw a need to further specialize its training program. Thus, the sections of ophthalmology and otoloryngology were established.
On November 9, 1961, the University of the Philippines (UP) Board of Regents approved the creation of the Department of Ophthalmology (Figure 1), with Dr. de Ocampo as its head. A formal residency training program in ophthalmology was introduced and subspecialty services were subsequently established; namely, plastic-lacrimal, cornea, glaucoma, uveitis, motility, neuro-ophthalmology, retina, and orbit. To promote the pursuit of research and technological advancement, the Philippine Eye Research Institute was established in June 1965 under Republic Act 4593 with Dr. de Ocampo as acting director. Dr. Emmanuel Almeda maintained these high standards of service and training as officer-in-charge of the department from February 1966 to October 1966 upon the recommendation of UP College of Medicine Dean Benjamin Barrera.
Dr. Liborio Mangubat took over as chairperson of the Department of Ophthalmology from July 1968 to June 1976. While promoting innovative teaching strategies as his primary thrust, the basic course in ophthalmology was introduced into the residency program. Likewise, a fellowship program and additional residency positions were offered. The department also established a photography section which enabled the residents to record and be familiarized with interesting clinical and histopathological cases. Dr. Mangubat also published the first training manual of the department in 1968 to serve as a guide for both the resident staff and administration.
The term of Dr. Romeo Espiritu in 1976 to 1979 paved the way for a more resident-oriented training program. Residents were made to rotate in all subspecialty services during each year of their residency. Research and thesis presentations were also required of each resident by the end of their training program. The basic course in ophthalmology was conducted for three months, and included lectures on must-know concepts in ophthalmology participated in by ophthalmology residents nationwide.
In 1979, Dr. Salvador Salceda assumed chairmanship of the Department of Ophthalmology, concurrent with his position as director of the Philippine Eye Research Institute, later renamed as the Institute of Ophthalmology. He was, subsequently, chosen to chair the PGH renovation and expansion project, marking the formal expansion efforts of the department. Dr. Salceda became the director of the Philippine General Hospital in 1984, becoming the first ophthalmologist to hold such an illustrious position.
Dr. Gloria Lim became the first female chairperson of the department in 1982. Various training advances and areas for community service were prioritized. She upheld the regular holding of case consultations and in-house scientific conferences, as well as world-class ophthalmology conferences for the Philippine Academy of Ophthalmology and Otorhinolaryngology, from which department residents benefited immensely. Moreover, through weekly visits to the Tala Leprosarium and yearly visits to the Culion Leper Colony, she introduced the residents to outreach programs for people who need ophthalmologic surgery and clinical care. Her term marked the advent of operating microscopes and anterior-chamber intraocular lenses in the department. The first vitrectomy machine, an Ocutome, was purchased in her last year, a milestone for the Retina Service.
During the term of Dr. Mario Aquino from 1985 to 1988, the department was relocated from its temporary home in Ward 8 to Ward 12, alongside its sister department (ENT). It was also during this time that extracapsular cataract extraction with posteriorchamber intraocular-lens implantation was introduced and made the gold standard of cataract surgery. This immediately put the department at par with the rest of the world in cataract surgery. The Retina Service was renamed Vitreoretina Service, marking the introduction of vitreous surgery with the return of foreign-trained vitreoretina faculty leading to more modern understanding of vitreoretinal diseases. Dr. Aquino served as concurrent director of the Institute of Ophthalmology.
Dr. Romeo Fajardo took on the responsibility as chairperson in 1988. He played a vital role in the establishment of the Eye Instrument Center (EIC) in 1989. This was made possible through a partnership with the Ophthalmological Foundation of the Philippines (OFPHIL), headed by Drs. Felipe Tolentino and Jose Pecson. One of the notable projects of the OFPHIL was the OFPHIL-Miyake Eye Operating Room at the PGH Department of Ophthalmology. Ms Chiyo Miyake, whose husband was a medical officer of the Japanese Army and was saved by two Filipino guerillas in Leyte during World War II, gave a generous gift to fully equip the operating room with new instruments for cataract and vitreoretinal surgeries. These undertakings made cutting-edge ophthalmologic technology available to the less fortunate.
The chairmanship of Dr. Prospero Tuano, that began in July 1991, ushered in the birth of new subspecialty services in the department: the pediatric ophthalmology clinic at the EIC, and the low-vision clinic at the PGH-OPD. The optics/contact-lens clinic was further enhanced by didactics with optometric educators, as well as linkages with the International Association of Contact Lens Educators (IACLE). Dr. Tuano is also credited with the formation of the UP Manila Trust Fund, and during his term the modified residency training program, a project of Dr. Evangeline Olivar-Santos, was introduced. He strengthened the ties between the department and various institutions, such as OFPHIL, Sta. Lucia Eye Bank of Manila, and St. Luke’s Medical Center. In 1998, Dr. Robert Tan was sworn in as the new chairperson. It was during his time that the department came to be known as the Department of Ophthalmology and Visual Sciences (DOVS) to embody a holistic and integrative approach to ophthalmologic care. Phacoemulsification as a means of lens extraction soon became the standard of care in cataract surgery, owing to its minimal tissue disruption and postoperative complications.
In the New Millennium
The department welcomed the new millennium with Dr. Manuel Agulto handling the reins starting May 2000. During his time, the DOVS participation in the teaching of second to fourth year medical students and interns of UPCM and PGH was given major importance. The quest for ophthalmologic breakthroughs from subspecialty-service-driven researches became a major concern as evidenced by the almost weekly research hours during which the different services discussed their research agendas. This objective was further strengthened when Dr. Agulto was appointed director of the Institute of Ophthalmology in May 2001. Also during this time, the DOVS residents were made to take the ophthalmologists’ in-service proficiency examination (OPEX), an assessment tool created by the training arm of the department. This was later expanded to include participation of other training institutions nationwide.
With a grant from the Spanish government through the Agencia Espanola de Cooperacion Internacional (AECI), a fully equipped eye center was built in collaboration with the University of the Philippines, PGH, the Department of Health, the Philippine Academy of Ophthalmology, and other stakeholders in ophthalmic health.
The creation of a national eye referral center was originally conceptualized in 1998 during the centennial of Philippine Independence. In 1999, the Agencia Española de Cooperacion Internacional (AECI) explored the possibility of realizing a health-related project in the country, the “Construction and Creation of a National Eye Referral Center Project,” to help achieve the national goal of reducing blindness, particularly in poor and underserved areas. A memorandum of agreement was signed in 2000 between UP and Spain; the Filipinas Eye Center Foundation Inc. (FECFI) was created to receive and administer the grant given by the AECI. PGH provided the land on which the modern eye center was to be built. The AECI provided funds for the building (US$6M) and a soft loan for the purchase of equipments (US$2M). A Project Management Unit (PMU) was activated and two heads were appointed, a Filipino manager, Dr. Eric Domingo of the DOVS, and his Spanish counterpart, Mr. Rodolfo Lacal. The building was completed in 2005 and, upon the request of FECFI, the Spanish government agreed to give the funds needed to procure the equipments as a grant instead of a loan. The PMU proceeded to procure the needed instruments and the remaining funds were used to purchase ophthalmic equipments that were donated to 10 regional government hospitals and medical centers around the country.
Sentro Oftalmologico Jose Rizal
The facility, named the Sentro Oftalmologico Jose Rizal (SOJR) (Figure 2) to honor our national hero and the bilateral cooperation of the two countries, was opened to the public progressively in between 2005 and 2006, during the last years of Dr. Agulto’s second term as DOVS chairman. The outpatient clinics were the first to transfer, followed by the offices, the inpatient ward, and the operating rooms. A sustainability plan was set in motion by the PMU which included a BOR-approved schedule of rates for the use of the operating rooms and diagnostic equipments and a separate trust fund for the SOJR assuring that all its income will be used exclusively for maintaining and upgrading its services. The final turnover of the SOJR to UP was done on June 15, 2006. It was the biggest project of AECI and given much importance by the Spanish government that their own Queen Sofia visited the project twice. As envisioned, it is now a fully functional and self-sustaining modern eye center serving the Filipino people.
The SOJR is the current home of the Department of Ophthalmology and Visual Sciences. It also houses the Institute of Ophthalmology, the Sta. Lucia Eye Bank Foundation of the Philippines, and the secretariat of the Philippine Board of Ophthalmology. The facility is complete, with the latest in diagnostic and surgical equipments, placing it at par with the best eye centers in other parts of the world. This has enhanced the training of ophthalmology residents and improved the services to the numerous financially disadvantaged eye patients, and private patients as well. In 2007, with the SOJR in its second year, its modernization and maintenance became the primary objectives of Dr. Ildefonso Chan who became chairperson. The department remained steadfast in its purpose to continuously acquire state-of-the-art equipment currently being used in modern eye hospitals in developed countries. New microscopes, an optical coherence tomography (OCT) machine, a Humphrey visual-field analyzer, and sterilization units were made available to the clinical staff.
Improvements in patient services were made, including acquiring SOJR’s own cashier and satellite pharmacy stocked with ophthalmic supplies needed at the operating room. It was also during his chairmanship that the SOJR RBE Auditorium, dedicated to Dr. Romeo B. Espiritu for his unwavering passion for teaching, was formally opened.It is now one of the favorite venues for ophthalmologic seminars and workshops. During his term, Dr. Chan also initiated the creation of the Romeo V. Fajardo Library from funds donated by Senator Juan Flavier, the Fajardo family, and the Ophthalmology Residents Alumni Association. This library was inaugurated in 2010 after his term. Today, the management of the premier ophthalmology training institution in the country rests in the hands of its current chairperson, Dr. Pearl Tamesis-Villalon. Early into her term, there were major improvements in the organizational setup of the DOVS and its training and research programs. Among such developments included the creation of an SOJR management arm headed by the current DOVS vice chair, Dr. Raul Cruz. A Cataract Clinic was created so that the pre- and postoperative assessment of cataract patients could be centralized. A pay waiting area to better serve the SOJR private patients was opened on the third floor. There were major changes in conferences and teaching and research activities befitting the residents and the consultants. Two other major concerns of the current administration were: (1) safety for its patients and staff, and (2) facility maintenance and improvement, repair and security, since the SOJR is 6 years old. Advanced life support training of DOVS residents was made mandatory, and a disaster-preparedness and fire-drill session was held in August 2010. Preventive maintenance of building utilities and equipments were employed with the goal of preserving the SOJR as a world class facility for the next generation. Five operating suites are now equipped with excellent operating microscopes.
There are two new Infinity phacoemulsification machines and a new 532`laser equipment to replace the original laser that was purchased in 2005, all these to serve the 250 or more patients seen daily in this facility. At the dawn of its 50th anniversary, the Department of Ophthalmology and Visual Sciences has truly come a long way from its humble beginnings. Since its inception, it has continually been a trailblazer in ophthalmologic training, research and development nationwide. Testament to its unparalleled mode of teaching are the numerous graduates who call the portals of this institution as their home, and who in their own right, serve as pillars of Philippine ophthalmology. Through its years of existence, the DOVS has always been guided by its mission and vision: We are a premiere institution dedicated to advancing the art and science of Ophthalmology in the Philippines, building leadership and pre-eminence; instilling commitment to the underserved Filipino communities; and promoting training, research, and service towards the ultimate goal of reducing blindness, as is consistent with the UP tradition of academic excellence and social relevance.
Drs. Gloria Lim, Salvador Salceda, Mario V. Aquino, Leo Cubillan, and the DOVS