Carmel Valley: Physician who was diagnosed as a ‘glaucoma suspect’ devotes practice to helping others combat glaucoma

By Arthur Lightbourn

Contributor

When he was a young physician doing his residency in ophthalmology at USC Medical Center in Los Angeles, Dr. J. Rigby Slight made a startling discovery that impacted the direction of his career.

He was confirmed as a likely candidate for glaucoma due to the “look” of his optic nerve.

Glaucoma is an eye condition that results in optic nerve damage causing vision loss and even blindness. It is usually associated with aging, but it was detected as an unwelcome sword of Damocles hanging over Dr. Slight’s head when he was in his early 30s.

That’s when Slight chose glaucoma as his subspecialty.

“I decided to learn everything I could about it,” he said. “And to this day, I’m still what you call a ‘glaucoma suspect’ and get my checkups every year, but I have not yet developed glaucoma and that’s now 45 years, but I still watch it.”

In the interim, Slight has devoted a major part of his practice during the past four decades to treating thousands of patients in North County for a disease that afflicts 4 million Americans — “2 million who know they have it and another 2 million that have it but don’t know it.”

Glaucoma is the collective name of a group of diseases sometimes called the “silent thief of sight” because it often damages a person’s vision so gradually that any loss of vision may not be noticed until the disease has reached an advanced stage.

UCSD’s School of Medicine recently honored Slight with the 2010-2011 “Outstanding Clinical Teaching Award ” for his contribution to teaching ophthalmology residents and fellows glaucoma diagnosis, management and surgery.

He has served on UCSD’s medical school faculty for 41 years.

We interviewed the 76-year-old clinician and surgeon in his private practice office in Solana Beach.

With a full head of pure white hair and a relaxed demeanor, Slight said that “People keep saying I look like Andy Rooney.”

Right, not only looks like, but talks like Andy Rooney, the curmudgeon writer and TV commentator who gives his amusing take on life’s peculiarities weekly on CBS’s “60 Minutes.”

“I’d like to meet him someday,” Sight said, “because when he’s talking on the show, I have to agree with almost everything he says. I just wish I had his money.”

Slight was born in Bartlesville, Oklahoma, of English and Dutch heritage. The name ‘Slight’ is an Anglicized derivation of the family’s Dutch ancestral name ‘Van Sleight.’ His father was a hotel manager.

Initially, Slight was considering a career in engineering when he enrolled at Westminster College in Fulton, Missouri. “But it happened to be a very strong pre-medical school and the more exposure I got to the idea of medicine, the more I got interested in it…and changed my major out of engineering into pre-medicine.

“It was the best move I ever made,” he said, “and that’s why I’m here.”

He earned his pre-med degree in 1957 and his medical degree at University of Oklahoma, College of Medicine, in 1961. He completed his internship at UCLA Medical Center in 1962; and after three years in the U.S. Air Force as a flight surgeon, did his residency in ophthalmology with a subspecialty in glaucoma at USC Medical Center, Los Angeles, 1965-68.

He worked for a year at a practice in LA before he learned that local physician Dr. Jack Novak was about to build the Lomas Santa Fe Medical Center in Solana Beach and was looking for an ophthalmologist to lease one of the offices.

“And I said, ‘Solana Beach is better than Los Angeles.’ That was in 1969 when I moved here, the same year the Padres got started. And I kind of adopted the Padres and loved them ever since. Win or lose.”

He’s been a baseball fan all his life.

“One of my heroes was Mickey Mantle because he grew up not far from where I grew up. He was just a couple of years older than I was; and I remember seeing him play in the Minor Leagues in Oklahoma when he was just 16 years old — and he could hit home runs at that age. So he was always my favorite.”

Mantle, of course, morphed into the legendary New York Yankees’ slugger who hit 536 home runs in his 18-years in the Major Leagues.

Slight and his wife, Lynn, who have been married 40 years, lived 25 years in Solana Beach, before moving to Carmel Valley.

Despite his age and a curvature condition of his upper back called kyphosis, Slight has no intention of retiring. “Since I enjoy what I’m doing, I wouldn’t know what to do with myself,” he says. He works four-and-a-half to five days a week and treats 20 to 25 patients a day.

In addition to teaching, he performs glaucoma surgery at Scripps Memorial in Encinitas and La Jolla and is a glaucoma consultant to Sharp Rees-Steely Medical Group, and at the Veterans Administration Medical Center.

“If you can diagnose glaucoma early,” he said, “most people can go a lifetime with normal vision.”

He recalls one patient who was 18 when she came to him and had already lost half of her vision due to glaucoma. To prevent her from becoming blind, he performed incisional surgery. “Today, her children are on their way to college and she’s led a normal, productive life for the last 30 years,” he said with satisfaction.

Glaucoma is generally characterized by increased pressure within the eye caused by a buildup of the eye’s natural fluid (aqueous humor) when the microscopic drainage channels in the angle formed by the cornea and the iris are narrowed, blocked or partially blocked.

When the fluid can’t filter out of the eye at its normal rate, the pressure builds, often resulting in damage to the optic nerve.

“It’s a combination of the absolute height of the pressure and the resistance to the pressure,” Slight said.

Damage to the optic nerve is painless and so slow that it often occurs before patients are aware of the problem.

Regular eye exams are essential for early detection and treatment, Slight said.

“The treatment is to lower the pressure,” Slight said

“Ninety percent of the people with glaucoma in the U.S. have open-angle glaucoma,” he explained.

In open-angle glaucoma, the drainage channels are partially blocked and the pressure build-up is gradual.

A second and less common form of glaucoma is angle-closure glaucoma, also called closed-angle glaucoma, which occurs when the iris bulges forward and narrows or blocks the drainage angle formed by the cornea and the iris — resulting in an abrupt increase in eye pressure.

“Glaucoma laser surgery will lower the pressure in about 70 percent of patients for a period of time,” he said. “For some, as the years go on, it loses its effect.

“With conventional incisional surgery you actually make a new drain and that’s effective in about 90 percent of the time, but with a greater risk factor of infection or hemorrhage, so you often wait until the other eye drops or laser fail before you do it.”

But, he added, some incisional surgeries for glaucoma over the years can also fail; “then you do another one.”

Other forms of glaucoma are the less understood low-tension glaucoma in which the optic nerve is damaged but the eye pressure remains normal; and pigmentary glaucoma associated with the scattering of pigment granules in the eye that interfere with eye fluid drainage and causes an increase in eye pressure.

Medical statistics reveal that African-Americans are five times more likely to develop glaucoma than do Caucasians, and much more likely to suffer blindness as a result. Also at increased risk are Mexican-Americans, Asian-Americans, anyone 60 and older, anyone with diabetes, hypothyroidism, nearsightedness, or anyone who has suffered a severe eye injury.

Asked if there anything that can be done to prevent glaucoma, Slight said, “Not yet. There is some marvelous work being done in genetic and stem cell research. They haven’t got to the point that they prevent glaucoma yet, but I perceive, in the not too distant future, they will.

“It makes you think that 10 years from now we’ll be treating the disease rather than the symptoms.”

Quick Facts

Name:

J. Rigby Slight, M.D., F.A.C.S. (Fellow, American College of Surgeons)

Distinction:

Solana Beach ophthalmologist, who has specialized in glaucoma for more than 40 years, was recently honored by UCSD’s School of Medicine with the 2010-2011 “Outstanding Clinical Teaching Award ” for his contribution to teaching ophthalmology residents and fellows glaucoma diagnosis, management and surgery.

Resident of:

Carmel Valley

Born:

Bartlesville, Oklahoma, 76 years ago

Education:

B.A. (cum laude), Westminster College, Fulton, Missouri, 1957; M.D., University of Oklahoma, College of Medicine, 1961; internship, UCLA Medical Center, 1962; residency in ophthalmology with a subspecialty in glaucoma, USC Medical Center, Los Angeles, 1965-68.

Military Service:

U.S. Air Force, flight surgeon, 1962-65. “They were going to draft me. In those days, they drafted everybody…. So I called up just before they drafted me and enlisted in the Air Force.”

Family:

He and his wife, Lynn, have been married 40 years. He has one son, John, from an earlier marriage. His first wife, Sarah, died of breast cancer shortly after earning her medical degree in Oklahoma.

Interests:

His patients, his dogs (three Golden Retrievers), and baseball.

Hero:

Mickey Mantle

Favorite getaways

: None. “When I travel, I’m always glad to get home. I think we live in paradise.”

Favorite TV:

“Two and a Half Men,” “House,” and “Crossing the Cumberlands.”

Philosophy:

“Every day is a good day and, to me, the glass is always half full.”


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