George A. Williams, MD

I am honored to accept the nomination as a trustee-at-large of the Academy. Since my first meeting in 1979, the Academy has played a central role in my professional development through its annual meeting, journal, educational programs and leadership as the voice of Ophthalmology. Like all Academy fellows, I continue to benefit from the educational and advocacy missions of the Academy and I welcome the opportunity to serve this outstanding organization.

The future of ophthalmology has never been so promising or so challenging. The promise is evident in the continuing evolution of breakthrough therapies for blinding disease. These therapies are testimony to the innovation and dedication of our ophthalmic colleagues throughout the world. During my career there has been an explosion of remarkable advances across all of ophthalmology. The recent advent of effective therapies for neovascular age-related macular degeneration is revolutionary. The despair and depression that characterized neovascular age-related macular degeneration has been replaced by hope and optimism for both patients and ophthalmologists. Driven by our improved understanding of the molecular and genetic mechanisms of visual loss, we now stand on the threshold of an era with the realistic expectation of therapies which can prevent or reverse blindness for millions of people. It is probable that within the next decade we will have genetic therapies, stem cell-based therapies and even artificial vision. The implications of these new treatments for our profession and our patients are staggering.

Unfortunately, there are significant challenges to our nascent therapeutic wonderland. Not surprisingly, these challenges involve money and the very real question of whether we will have the financial resources necessary to bring these therapies to fruition. A perfect storm is rising in health care in general and ophthalmology in particular with a confluence of factors involving patient demographics, physician manpower shortages, new technologies, macroeconomics and, perhaps most ominous of all, politics. There is consensus that the growing proportion of gross domestic product consumed by health care is not sustainable. Therefore, significant change is coming to the practice of medicine. This change will involve how physicians are paid, what drugs they may prescribe, what procedures they may perform, which patients they may see and even how many hours they may work. Central to these changes will be the requirement that physicians demonstrate the value of their care. Treatments with high value, proven by evidence-based analysis, will be rewarded and treatments with low value will be discarded. As always, the devil is in the details, and exactly how and by whom value will be determined is uncertain.

Fortunately for ophthalmology, the Academy has already recognized the impending storm. As a member of the Health Policy Committee and as the Academy’s alternate delegate to the Relative Value Scale Update Committee, I have been impressed by the leadership and vision of the Academy as it addresses the future of ophthalmology in a changing health care system. With a strong focus on the value of ophthalmic care, I am confident that we can achieve our therapeutic potential.