• Stephen J. Ryan, MD: Scholar, Innovator, Mentor, Executive, Advocate

    Stephen J. Ryan’s birth brought his mother and military physician father, then stationed at Pearl Harbor, Hawaii, some months of joy before the surprise attack that would plunge this country into war.

    But his life was only beginning. He would go on to become a leader at the Wilmer Eye Institute, National Academy of Sciences, National Institutes of Health and the Macula Society and founding president of the Alliance for Eye and Vision Research and contributor of hundreds of scientific articles on eye diseases.

    Dr. Ryan graduated from Providence College and enrolled in the Johns Hopkins School of Medicine determined to follow in the footsteps of Alfred Blalock, the chair of surgery whose development of the “blue baby” operation earned him the appellation the “Father of Open Heart Surgery.”

    Dr. Ryan was an avid weightlifter when he wasn’t studying, and his love of laughter and social events resulted in his becoming a major figure in the Pithotomy Club, a student social club famous for its extremely politically incorrect humorous skits that mocked the normally revered (and feared) medical school professors.

    A couple of meetings with Hopkins colleagues had profound impacts on Dr. Ryan’s life. When a beautiful Hopkins nursing student needed an emergency appendectomy, she found herself receiving the best possible care and attention from the obviously smitten medical student on his surgery rotation. Before long, Anne would become Dr. Ryan’s wife and later the mother of Patricia.

    The second fateful meeting occurred during Dr. Ryan’s ophthalmology rotation when he encountered Dr. Edward “Ed” Maumenee, the Wilmer Eye Institute’s third director. The exposure to eye surgery and time with Dr. Maumenee in the clinic and lecture room upended Dr. Ryan’s carefully laid career plans and cardiac surgery promptly disappeared off the radar screen.

    Dr. Ryan often spoke warmly about his time as a Wilmer resident and his additional year after fellowship as chief resident. During his residency Dr. Ryan found he had an aptitude for clinical and laboratory research; after a day in the clinic or operating room, he spent his evenings in the lab or vivarium. While he was a resident, Dr. Ryan and his mentor Dr. Maumenee recognized that they had 13 patients with quiet anterior segments, vitritis, retinal vascular leakage and cream-colored spots at the level of the retinal pigment epithelium. Dr. Ryan smiled whenever he told the story of how the publication was delayed for years as journal reviewers refused to credit that this resident had really stumbled upon a new entity and mocked the two authors’ proposed name of “birdshot retinochoroidopathy.”

    Dr. Ryan’s bright and curious mind was paired with a literally tireless work ethic, so that in addition to being acknowledged as a remarkable diagnostician and surgeon during his residency, he published extensively and spoke at national meetings. But while he worked hard, he also played hard as a lifelong fierce competitor in tennis, many sports and outdoor activities. He enjoyed the occasional happy hour with his colleagues, which earned him the nickname of “The Beast.” On occasion Dr. Ryan’s ebullience could get slightly out of hand, and once when he was Wilmer’s assistant chief of service (chief resident) Dr. Maumenee “counseled” Dr. Ryan about his professionalism. His residents memorialized this moment in that year’s resident skit with a photo showing the chairman playing tennis using Dr. Ryan’s head as a tennis ball.

    As Assistant Chief of Service, Dr. Ryan stands amongst his residents and beside his chair and role model, Ed Maumenee. Dr. Ryan spoke frequently about how much he had learned about Ophthalmology and leadership from Dr. Maumenee.

    Obviously destined for great things, Dr. Ryan was offered department chair positions even before he finished his training. After only three years on the Wilmer faculty, he found the opportunity that excited him. In 1974 he became the first full-time faculty member and department chair in the University of Southern California Department of Ophthalmology and he soon became the president of the Doheny Eye Institute.

    In a somewhat unusual arrangement, the Doheny Eye Institute was a separate legal entity with its own funds, with physicians seeing patients at USC facilities and in the Los Angeles County hospital system. Dr. Ryan, with his excellent personal skills, persuaded government, academic and philanthropic organizations to work cooperatively, such that the program thrived and developed into one of the most respected departments in the country.

    I first got to know Dr. Ryan when I traveled to his department for my fellowship in corneal and refractive surgery. I came to know him better when, after returning to Baltimore for my term as chief resident, Dr. Ryan’s faulty judgement led him to offer me a position on his faculty. My faculty colleagues and I appreciated many of the qualities Dr. Ryan possessed that made us feel fortunate to have him as our chair.

    Dr. Ryan cared about his faculty and frequently would walk around the institute and pop his head into our office doors or wherever we were working to ask us what we were up to. He would then listen to us and give the impression that whatever we were telling him was the most brilliant and fascinating piece of information he had ever heard.

    Dr. Ryan meant what he said and said what he meant. If he made a commitment to a faculty member, that faculty member would never have to bring out the written document to have the commitment honored. If there was a disagreement, Dr. Ryan would listen to all sides, make his decision, and then meet with all parties to explain what he had decided and why. On occasion people would say that Dr. Ryan had made a decision that they disagreed with, but they admired that he had listened to them and was very honest and respectful in how he delivered the news himself and not through intermediaries or via memos.

    An annual evaluation with Dr. Ryan was a master class in mentorship. He would ask, “What do you need to be successful?” and then, if he could, provide it. He would celebrate a faculty member’s accomplishments, discuss the plans for the coming year, and give specific actionable advice regarding any difficulty’s faculty were having or things they could work on to improve.

    Unlike leaders who want to be liked so they don’t give completely honest feedback, Dr. Ryan would be very clear in his recommendations about what he thought we needed to do. But he did it in a way that made clear his motivation was to help us be successful. He never insisted we follow his advice and would leave it to us to ultimately make our choices; he said that we would only learn if we took responsibility for our decisions and the outcomes (good or bad).

    Unlike some academicians, Dr. Ryan considered leadership and management to be a discipline that could be learned and he was a determined student. One of his brothers was an executive coach, and Dr. Ryan asked him for constructive criticism while he also read voraciously the literature of his counterparts in American business schools (such as W. Edwards Deming and Peter Drucker). Like his mentor, Dr. Maumenee, Dr. Ryan cultivated leaders that he admired from outside the world of medicine to join the board of the eye institute so he could learn from their experience in the “real world” outside of academia. He would tell his young faculty members about insights he had gained from his board members.

    Just as he tried to make the management of complex proliferative vitreoretinopathy into a science by studying animal models of complex detachments and spearheading the Silicone Oil Vitrectomy Study, Dr. Ryan tried to implement the advice of acknowledged management gurus to become a more effective leader. Some on the faculty who will go unnamed would quip, “Oh no, I wonder what Dr. Ryan read in Business Week magazine on his flight home this weekend that he is going to make us start doing on Monday.”

    We faculty also marveled at how Dr. Ryan was a very transparent and effusive communicator. His friends and faculty would say he had the Irish “gift of gab.” A fairly straightforward question at a faculty meeting would often elicit a remarkably lengthy response as Dr. Ryan reviewed the history of the issue, the various alternatives, what options he had considered and rejected and why. When he was finally to the point of rendering to us his bottom-line answer, he would begin with the phrase: “Pardon my ramble.” One of my faculty colleagues would always say that “Pardon My Ramble” would be the title of Dr. Ryan’s next textbook.

    Dr. Ryan downplayed his own accomplishments while taking overt pride in his faculty. Despite the administrative burdens and time, he spent fundraising, Dr. Ryan remained extremely scientifically productive and published as much as probably anyone on his faculty (285 original scientific articles and 9 books).

    Figure 1: A strong advocate for federal funding for vision research, as President of the national Alliance for Eye and Vision Research, Stephen Ryan testified to The House of Representatives Committee, met in the Senate Office Building with Senator Tom Harkin and visited with two Presidents.

    If an organization needed a leader willing to spend long hours to get things accomplished, Dr. Ryan was frequently called upon. He served in key leadership roles for the National Academy of Sciences, National Institutes of Health and the Macula Society. He served on the boards of both non-profit institutions (Johns Hopkins Health System, the Arnold and Mabel Beckman Foundation, the W.M. Keck Foundation) and of publicly traded corporations (Allergan). He was founding president of the Alliance for Eye and Vision Research, educating the American public about the value of vision research and frequently testified to Congress on the importance of funding research into blinding eye disease (Figure 1).  

    Although he underplayed his own achievements, Dr. Ryan took obvious and vocal delight in the achievements of his trainees and his faculty. He would speak about how he wanted to help junior people master the skills that would make them effective leaders, and was proud of the many trainees and faculty in his department who went on to become department chairs in the U.S.

    Dr. Ryan loved meeting people and welcomed fellows from other countries. Perhaps because he was born just as the world was plunging into the horrors of World War II and the threats posed by the subsequent Cold War, Dr. Ryan took pride in the idea that American medicine and biomedical science could be a force to build strong positive ties between countries at a time when other forces were trying to effect the opposite. He traveled extensively to visit colleagues around the world, mostly in Europe and Asia, and forged relationships with academic ophthalmology leaders in many nations.

    On multiple occasions he mentioned how 26 of his trainees from outside the U.S. had returned to their countries and eventually assumed department chair positions. He claimed he was a failure at trying to learn other languages (if true I suppose it represents the only time I heard that he was defeated at something) and never do I recall him trying to speak a word of Spanish or any language besides English. But his infectious grin, self-deprecating humor, enthusiasm for learning, and respect for and kindness to others prevented anyone from feeling resentment at always having to speak with Dr. Ryan in English.

    As a punishment for being such a capable academician, leader and teacher, Dr. Ryan ended up pretty much being forced to take on the role of medical school dean when the school ran into financial difficulties and things were not going well. He agreed to take this role on an interim basis while the search committee found a new dean and insisted that it be confirmed in writing that Dr. Ryan would not be a candidate for the permanent position.

    When the committee could not find a replacement they thought compared favorably to Dr. Ryan, the written agreement that Dr. Ryan would not be considered for the role was ignored and, it seemed to me, he was pushed into accepting the position on a permanent basis on the basis of his having a duty to not let our school flounder.

    It must have been a difficult time for Dr. Ryan, who was tasked with fixing a huge deficit not of his making and putting in place new compensation systems, to address the financial and nonfinancial challenges and put the school back on a firm footing. When he was initially thrust into the role, rumors abounded that the school would be closed. After a few years of Dr. Ryan’s leadership, morale was high, finances were sound, the campus was expanding, and the idea of closure was unthinkable. Despite his obvious success in the role, Dr. Ryan would say in private that ophthalmology was the best discipline within medicine and serving as ophthalmology chair was the role that had made him happiest in his career.

    Although grateful for the philanthropy of others that had helped him throughout his career, Dr. Ryan was philanthropic himself, supporting both the Doheny Eye Institute and his alma mater in Baltimore. Before his death, Dr. Ryan established three endowments at Johns Hopkins. The Ryan Prize goes to the top student in the medical school class who will pursue a career in ophthalmology. He created this because he was grateful for his medical school training, but particularly because he wanted the awardee to have what he called “some pocket money” so he or she could take a spouse or significant other out to a nice dinner, to a movie or play, and do some fun things when not working. He said that he had never forgotten being a poor resident newlywed and not having any funds to spend on treats or gifts for his beloved “Annie”.

    Dr. Ryan also endowed the position of the Wilmer assistant chief of service (chief resident). He often said that being in this role had given him his first chance to develop as a leader and was largely responsible for his subsequent career success. Third, he endowed a Ryan Scholar, providing funds for a Wilmer assistant professor each year that he or she could use to get started on a research idea. He spoke about how early in his career relatively small sums of money had gotten him started on projects that blossomed into major research programs, and he wanted to do the same for some current assistant professors.

    When Dr. Ryan became ill at the age of 73, and it became clear that his prognosis was poor, Dr. Ryan spoke about having occasional nights when he was very uncomfortable, and sleep would not come. At those times, he said, he would go to his home office and read some of the letters he had received over the years from students and young faculty who had benefitted from his endowed funds. He would read about what they planned to do with their careers and how they thought they would use his funds. Reading these letters, he said, would alleviate his pain and allow him to rest. Until the very end of his life, he found joy in trying to help young ophthalmologists find success and happiness.

    Editor’s Note: We are grateful to our History of Ophthalmology editor, Daniel M. Albert, MD, MS, and his editorial assistant, Ms. Jane Shull, who contributed to the editing of this article.