Gerald W. Zaidman, M.D., Provides Insight into the World of Pediatric Corneal Transplants
A distinct specialization, Dr. Zaidman is one of 40 pediatric corneal transplant surgeons in the nation with a global reputation
If the eyes are windows to the soul, then the cornea is the window to the eyes. Yet when the cornea is cloudy, it is like looking through dirty glass and not being able to see clearly. It occurs rarely, especially in children, which makes Gerald W. Zaidman, M.D., professor of clinical ophthalmology and vice chair of the Department of Ophthalmology, who specializes in pediatric corneal transplant surgery, one of the most sought-after ophthalmological surgeons in the world.
Dr. Zaidman is one of just 40 pediatric corneal transplant surgeons in the United States. “Children are the least common group of patients who need transplants,” he said, noting that of the 50,000 corneal transplants in the U.S. each year, approximately 500 occur in patients younger than age six. In his four decades of practice, he has performed close to 4,200 corneal transplants, including 500 on children. “I probably do 80 transplants every year on adults and maybe six or eight a year on children,” he says. “Very few people do anywhere close to that number of children.”
The most common reasons for corneal surgery in adults include Fuchs dystrophy, a disease that causes the cornea to swell; keratoconus, in which the cornea changes shape; genetic conditions like corneal dystrophy; glaucoma; or an infection from a contact lens, scarring or some other trauma.
In children, most corneal transplants aim to correct birth defects. “Corneal transplant surgery in any child born with a cloudy cornea is unique,” Dr. Zaidman says. The surgical specialty exists in so few countries that patients from around the world come to see him. “If a child is born with an abnormal cornea, then they should be examined as soon as possible,” he says.
His global reputation gives no hint that Dr. Zaidman never planned on a career in medicine. “I loved science in college and thought I would do basic science,” says Dr. Zaidman, who earned his bachelor’s degree in 1972 at the City University of New York’s Queens College, and his medical degree three years later from the Albert Einstein College of Medicine. But what really interested the warm, chatty ophthalmologist was people—children especially. “When I told my advisor I was interested in people and science, she said, ‘Have you ever considered medicine?’ It was the best advice anybody ever gave me.”
During medical school, Dr. Zaidman discovered he loved pediatrics. By specializing in ophthalmological surgery, he could care not only for children but also for adults, while treating all types of diseases. And ophthalmology allows for continued patient care. “Patients can be with you for 30 years,” he says.
Recently, Dr. Zaidman performed a second corneal transplant in an eight-year- old Israeli boy who was born with a cloudy, opaque left cornea. “I did his first corneal transplant in 2015 when he was about four or five months of age,” he says. He stayed in close touch with the boy’s family, as he does with all his patients, and learned that the first transplant had failed. After unsuccessful treatment in Israel, the family decided to return to the United States to see Dr. Zaidman. Their seven-week stay included another transplant surgery and multiple follow-up visits. After the surgery, the young boy exclaimed, “I can see 1,000 times better now!” Dr. Zaidman explains, “Well, he does see things out of that eye that he could not see before the surgery, but 1,000 times is very nice and generous. Now, he is doing very well.”
Following pediatric patients closely is critical because they cannot monitor or effectively communicate problems after surgery. “Corneal transplant surgery in any child is unique and never the same as taking care of a transplant in an adult,” Dr. Zaidman says. “You can ask adults to make sure they can see out of their eye as it heals but you cannot expect a five-month- old to do that.”
This explains the lower success rate of pediatric corneal transplant surgeries— 70 to 85 percent— versus 90 percent or more for adults, and why he insists on seeing his pediatric patients twice weekly for four months. “A baby may get used to using one good eye and not realize that they have a second eye that is not healthy,” he says. “I have to educate parents how to monitor the eye that is having problems. I teach them to buy a pocket flashlight and how to look at their child’s eye. If their cornea is clear, then their pupil should be easily visible.”
Pediatric corneal transplant surgery has come a long way since the days when an ophthalmologist sewed shut the eyes of an infant for lack of knowing how to treat cloudy corneas. When, as a fellow, Dr. Zaidman first transplanted a baby’s corneas, he recognized the need for greater education and information sharing among doctors treating corneal disease. Thus, he founded and directs the Pediatric Keratoplasty Association (PKA), a worldwide organization that encourages doctors to share information and treatment methods on children and infants with corneal diseases. “It is a way of furthering knowledge and educating parents so they know that we can do something to help their children see.”
Founding the PKA has been one of his greatest achievements, along with maintaining ongoing relationships with his patients and their families. “Some kids I operated on are now in their twenties,” he says, referring to a woman whose cornea he transplanted during her infancy. “Now she is going to medical school,” he boasts. His satisfaction is profound, so much so, that he has no plans to retire any time soon. “I am having too much fun.”