Institution builder, laser researcher: Carmen Puliafito

A basic interest in laser-tissue interaction evolved into a lifetime influence on ophthalmology.

From early in his life, Carmen Puliafito, MD, MBA, began to emerge as a leader. Growing up in Buffalo, N.Y., he was editor of his high school newspaper and president of the student council. Who could have foreseen at the time that these early leadership roles would be formative experiences for a man who would become a leading retina researcher and the head of two prestigious ophthalmic institutions?

As the son of an electrical engineer, Carmen Puliafito developed an interest in science from an early age. But it was not until he went off to Harvard University that he became interested in vision problems through a chance room assignment. One of his roommates was blind from bilateral retinoblastoma. In learning to live with this individual, Dr. Puliafito’s interest in vision problems and the people suffering from them was born.

His initial interest was fed later in his education when Dr. Puliafito began his medical training at Harvard Medical School.

“I had the chance to work with a number of really outstanding ophthalmologists, like Daniel Albert, MD, a professor of ophthalmology at Harvard, who became my mentors. I worked with Dr. Albert for a year as a medical student, doing experimental ophthalmic pathology. That’s how I got started,” Dr. Puliafito said.

In an interview with Images, a magazine published by the University of Miami, Dr. Puliafito spoke about his long-standing interest in ophthalmology.

“By the time I was a second year medical student I decided to specialize in the field,” he said. “I thought it presented an interesting mix of technology and medicine.”

This early interest soon blossomed, and Dr. Puliafito went on to become one of the most widely recognized retinal specialists in the United States.

Lasers

Dr. Puliafito said in his ophthalmic studies he was drawn to the retina, feeling that “in many ways it’s the most high-tech aspect of ophthalmology.”

Working as a resident at the Massachusetts Eye and Ear Infirmary in 1981, he participated in research in the use of lasers in ophthalmology with Roger Steinert, MD.

Dr. Puliafito and his wife, Janet Pine, MD.

“This further increased my interest in the retina because lasers were first used in medicine for treatment of retinal problems,” Dr. Puliafito said.

In his subsequent subspecialization in retina, Dr. Puliafito built a reputation as a thorough an innovative researcher with an impressive series of firsts.

He was the first surgeon to successfully perform experimental retinal photocoagulation with the semiconductor diode laser. He laid some of the foundations for LASIK with his early work on excimer lasers, publishing one of the first papers in the literature on ablation of the cornea.

Dr. Puliafito was also the first surgeon to perform digital indocyanine green angiography (ICG), and he had a hand in the invention of optical coherence tomography (OCT) along with several other individuals.

OCT is the invention of which he said he is most proud.

“I was working with Jim Fugimoto, the laser physicist at the Massachusetts Institute of Technology. We were looking at potential applications of ultrashort, femtosecond laser pulses in the eye. We first explored the use of femtosecond laser pulses for measuring distances inside the eye. Then we became interested the concept of using low-coherence interferometry, figuring out that with a CT scan we could use a computer to make a tomograph, putting cross-sectional images of the retina together. This gave a three-dimensional view of the retina,” Dr. Puliafito said.

“We described this technology in an article in Science magazine in 1991, and it was subsequently commercially adapted for retinal imaging. It is also being explored for cardiovascular and other endoscopic applications,” he said.

Other appointments, activities

Dr. Puliafito’s career over the past 2 decades includes a roster of prestigious academic appointments and professional positions. He has held teaching positions at institutions including MIT and Tufts University School of Medicine. He was director and chairman of the New England Eye Center.

“I directed the Morse laser center at the Massachusetts Eye and Ear Infirmary,” Dr. Puliafito said. “In that job, we basically looked at a variety of laser technologies for applications in a number of ophthalmic disorders. Retinal disorders, glaucoma, as well as refractive disorders.”

“I’ve had just a basic interest in aspects of laser-tissue interaction and lasered tissue in the eye, no matter what part of the eye,” he said.

“Laser research has been a very large portion of my time for more than 10 years. It has been an important interest of mine,” Dr. Puliafito said.

Important indeed. Dr. Puliafito has had the unique opportunity of participating in several technologies from their earliest conceptual stages through to their use for treating ocular and visual disorders in human clinical practice.

Dr. Puliafito was one of the early researchers into ophthalmic applications of excimer lasers. He started with excimer laser ablations using experimental targets such as plastics and moved on to cow eyes and then living animal studies.

“I was the first ophthalmologist to perform laser vision correction on a patient,” he said.

Dr. Puliafito was also involved in developing the concept of photodynamic therapy (PDT) for the treatment of macular degeneration.

“I did experiments that evaluated the concept of using PDT agents in the late 1980s and was very involved in the clinical application of Visudyne (verteporfin, Novartis Ophthalmics) over the past several years,” he said.

New England Eye Center

Dr. Puliafito said one of the highlights of his career was his chairmanship of the New England Medical Center and development of the New England Eye Center.

The New England Eye Center is a clinical and research eye institution in Boston. Dr. Puliafito took the initiative in creating the center in 1991 after leaving Harvard Medical School, where he had served as an associate professor of ophthalmology.

During the 10 years he was chairman of the NEEC, 1991 to 2001, the institution built a faculty of more than 20 clinical ophthalmologists who saw more than 50,000 patients each year, performing several thousand surgical procedures per year.

“We felt that there was room for another excellent ophthalmology center in Boston. We felt that [the NEEC] was the optimal way to provide first class patient care along with excellent research as well,” he said.

“I think it was the highlight of my career to date,” Dr. Puliafito said. “That was one of the best things I’ve ever done. Having the opportunity to build essentially a new entity is a real terrific opportunity.”

LASIK Institute

Dr. Puliafito’s interest in lasers was instrumental in creating the LASIK Institute, a not-for-profit, public service entity that promotes patient and physician education about refractive surgery in general and LASIK in particular.

“It was apparent, after several years, that there was a great demand for reliable, non-biased information about laser vision correction, particularly for patients. We put together an advisory board of outstanding ophthalmologists. They really helped develop the materials posted on the Web site. In addition, we had a number of physician education programs,” Dr. Puliafito said.

“It’s been very useful. We feel that the LASIK Institute Web site is the most frequently visited Web site that has anything to do with laser vision correction. That’s very exciting,” he said.

Dr. Puliafito organized the LASIK Institute in early 1998, and it was launched in its entirety in April 1999.

The LASIK Institute became a division of the American Society of Cataract and Refractive Surgery this past January.

Dr. Puliafito is also a past president of the Association for Research in Vision and Ophthalmology.

MD, MBA

“I like challenges. I always try to do the best possible job I can do,” Dr. Puliafito said.

This thirst for challenges may be what led him to continue his education following his medical training and pursue a master’s of business administration from the Wharton School of the University of Pennsylvania. He achieved the degree in 1997.

“I think it’s helped me with the administrative responsibilities that come with running major eye centers,” he said. “I found the program was intellectually stimulating and practically quite useful. It has helped me out.

“I think formal business training is useful for ophthalmologists who are physicians involved in managing relatively large enterprises. It provides help in analyzing problems, marketing, etc.,” Dr. Puliafito continued.

The MBA has not, however, affected Dr. Puliafito’s approach to patient care and to practicing medicine.

“I think the individual doctor-patient relationship really should not be affected by financial considerations. I went to business school to do a better job taking care of patients, not to somehow economically rationalize what we are doing for them,” he said.

“Direct patient care activities are the highlight of my day-to-day life. I still see patients and still do retinal surgery. I think this is very rewarding, exciting, and really is central to what I do,” Dr. Puliafito said.

In the summer of 2001, Dr. Puliafito became professor and chair of the department of ophthalmology at the University of Miami School of Medicine and the director of Bascom Palmer Eye Institute.

“I came here because I thought it was the best department of ophthalmology in the world, and that I could help Bascom Palmer build on its tradition of excellence, both clinically and research-wise,” he said.

Hey, ump!

Dr. Puliafito completed the 1999 Boston Marathon in just under 5.5 hours.

There is more to Carmen Puliafito than the builder of institutions and the experimenter with lasers. Dr. Puliafito is also an avid sports fan, both as an observer and participant.

“I really got interested in exercise when I was about 46 or 47. I went from a situation where I could barely run half a mile to successfully completing the Boston Marathon in 1999. It was thrilling for me to do that since I lived in Boston and spent many years watching the marathon. Most of those years I never dreamed I would be running a marathon,” he said.

“It’s one of the great sporting events in the world, and it’s one of the great sporting events that an ordinary person can participate in. Not everyone can participate in the World Series, the NCAA basketball championships or the Masters Tournament. But anyone who can run reasonably well can compete in the Boston marathon,” he said.

While speaking of sports, Dr. Puliafito recounted a personal anecdote involving some bad calls against his home team.

“In the 1999 World Series there were some horrible calls made against the Red Sox while they were playing the series against the Yankees. As a Red Sox fan, I offered free laser vision correction to any American League umpire who felt they might need it, because I felt the only explanation for the horrible calls was that these umpires were secretly nearsighted,” he said.

Dr. Puliafito remains a Red Sox fan, watching as many games as possible.

“I still have my season tickets and plan on going to six or seven games this year. But I also like the Florida Marlins and the Miami Hurricanes. I’m a big sports fan in general,” he said.

He has also been an avid stamp collector for most of his life.

“I’ve collected U.S. stamps and have had a specialized collection of independent mails, which were independent entrepreneurs that issued their own stamps in the mid 1840s,” he said.

Dr. Puliafito has exhibited his collection, and he won first prize in the American Philatelic Society’s WESTPEX 2001 stamp show in San Francisco last year.

He also enjoys vegetable gardening, bicycling and golf.

Future in ophthalmology

Dr. Puliafito said he sees a very exciting future for ophthalmology.

“Because of advances in technology, I think we are soon going to be able to offer patients with some serious blinding conditions like glaucoma, diabetic retinopathy and macular degeneration some real advances. We are going to have some good drugs to treat retinal problems, and I think surgery is going to improve. We’re basically going to have a fantastic opportunity to help patients,” he said.

“I’m optimistic that maybe in 100 years blindness will be a thing of the past,” Dr. Puliafito said. “I think that’s what everyone is working toward. We’d like to prevent or eliminate blindness. I think that is a big challenge, but some day in the future it will be achieved.”

For Your Information:

• Carmen Puliafito, MD, is currently the Director of the Bascom Palmer Eye Institute. He can be reached at 900 NW 17th Street, Miami, FL 33136; (305) 326-6303; fax: (305) 326-6308; e-mail: cpuliafito@miami.edu.