Evan “Jake” Waxman, MD, remembers one of his earliest missions with the Guerilla Eye Service (GES) company he helped create.
While performing eye examinations at the Birmingham Clinic on Pittsburgh’s South Side, the team met a 16-year-old student. She was having trouble in school because she couldn’t see well and didn’t have glasses.
“She was obviously a really bright kid,” Dr. Waxman says. “All we did was provide glasses for her, and it made all the difference in the world.”
Dr. Waxman points to small examples like that to show the impact GES can make. The program, created in 2006, provides vision care in some of southwestern Pennsylvania’s most underserved communities.
Many people in underserved communities have difficulty accessing vision care and other specialty care.
“We take our vision for granted, but our vision is so important for everything we do,” says Dr. Waxman, director, Comprehensive Eye Service, UPMC Vision Institute.
“Imagine, for instance, that you’ve got diabetes and you’ve got to fill your insulin syringe. You need to be able to see it. Imagine that you’re in the station of life where you’re trying to get a new job, but you don’t have the glasses you need in order to fill out a job application.”
Since its creation, GES has worked to address the needs of the people it serves.
“I think what I’m most proud of at this point is that it can exist without me,” Dr. Waxman says. “This is now an ongoing, undying concern that’s been up and running since 2006. We’re unstoppable, and that’s what I’m proud of.”
‘True Eye Care Out in the Community’
Dr. Waxman has worked at UPMC for 24 years as an ophthalmologist and cataract surgeon. He is also vice chair of education in the Department of Ophthalmology at UPMC, where he works with medical students and residents. He says he especially enjoys the education part of his job.
In the late 1990s and early 2000s, medical students often approached him about community service projects. The next year, another group of students approached him for a similar reason — and so on.
The department also participated in health fairs and other events, where they would do vision screenings. And residents would go on service missions to other countries, performing vision care.
Eventually, “a light went off,” Dr. Waxman says.
“We realized what we need to do is true eye care out in the community,” he says. “We need to go where people are getting their primary care for free and to be their eye doctors there. Not do a screening, but provide them with the same level of eye care that you’d get if you came into one of our offices.”
And so, GES was born.
Pittsburgh is a city of neighborhoods, and a few times a month, GES goes on missions in those neighborhoods. These missions often take place on nights and weeknights when people can come out for care more easily.
GES is student-driven — quite literally, at that. Medical students drive a van with portable equipment to primary care centers and health centers throughout the region.
They set up their equipment, then perform comprehensive eye exams for patients — not just screenings.
Dr. Waxman and medical residents also attend missions to consult and teach students.
“We take their history, we check their vision,” says Matt Driben, fourth-year medical student, University of Pittsburgh, and student volunteer and mission leader, GES. “We talk with Dr. Waxman and the residents about what we found, what might be best for the patient, and then, we work up a plan together. [We] send them on their way with an eyeglass prescription, a free pair of glasses, [and/or a] referral to more care.”
Missions can last from three hours on weeknights to four or five hours on weekends. They may see 10 to 12 patients on weeknights and 15 to 20 on weekends.
At the end of each mission, the medical students, residents, and Dr. Waxman hold a wrap-up session, going over what they learned.
If a patient does need follow-up care, they can come to UPMC Vision Institute. If they don’t have insurance, there is no cost for the visit.
“It’s just a wonderful thing to be able to do,” Dr. Waxman says.
‘This Is About the Service’
Many medical students go into GES missions thinking they’re there to learn ophthalmology, Dr. Waxman says. Many residents think they’re there to teach ophthalmology.
That’s part of it, but not the big part.
“Dr. Waxman always makes sure to ground us and just say that, ‘This is about the service,'” Driben says. “‘That’s what’s going to make you the best physician for your patients in the long run.'”
GES caters to underserved southwestern Pennsylvania neighborhoods. Many of the patients they see would not otherwise have access to this level of vision care. The Birmingham Clinic, one of GES’ earliest partners, sees many patients who face health disparities.
“It serves one of the most underserved populations in all of Pittsburgh,” says Baraa Nawash, fourth-year medical student, University of Pittsburgh School of Medicine, and clinical volunteer, GES.
“Some patients in particular that touch my heart are those who are immigrants or refugees, as it’s similar to my background. So, when we work with these patients, you get to see how those factors really impacted their vision and quality of life.”
Providing quality vision care to people who need it benefits all of society, Dr. Waxman says. GES allows medical students and residents to see the impact they can have on people. It also helps them remember why they got into medicine in the first place.
“Guerilla Eye Service is sort of an inoculation against cynicism,” Dr. Waxman says. “Everybody remembers, when they’re doing what we do, what we joined medicine for in the first place. We’re here to help people.”
Primary care clinics like the ones where GES sets up shop often do not have access to specialty care. GES was one of the first programs to bring specialty care to those clinics. And in the years since GES’ creation, other specialties have followed suit.
“I feel like we started a bit of a trend,” Dr. Waxman says.
‘Providing Service Back to the Community’
One of the major reasons Dr. Waxman got into ophthalmology was the chance to help people. GES is a large part of that. But it’s not the only part.
UPMC Mercy Pavilion — the new home of UPMC Vision Institute — is another venture that will help bring groundbreaking vision care to the community. The facility, which opened in May 2023, brings clinical care and research together under one roof.
But beyond Mercy Pavilion, UPMC Vision Institute is striving to remove barriers to vision care for people in the community.
One aspect of that is the concept of “Without Bounds.”
“Without Bounds” aims to make vision care more accessible to people. The idea is to put diagnostic, testing, and treatment tools into health settings people can get to more easily instead of making them visit a specialist for every appointment. That includes putting equipment in places like urgent care offices, pharmacies, emergency departments, and more.
“(It’s about) providing the right care to the right people, in the right place, at the right time,” Dr. Waxman says.
Providing more available resources makes it more likely that patients will attend a follow-up appointment, he says.
“The idea is to think about every point at which somebody might need eye care and think hard about whether they really need to come within the walls of the Vision Institute at the Mercy Pavilion, or whether we can really take care of them where they are in a more efficient way,” Dr. Waxman says.
In March 2023, UPMC Mercy and the Eye & Ear Institute received something else that will help them bring vision care to people in underserved communities. Brother’s Brother Foundation donated a mobile “eyeVan,” a vehicle that comes equipped with medical technology and allows them to provide mobile vision care.
Dr. Waxman says the eyeVan enables them to reach communities that even GES cannot, such as those that are experiencing homelessness.
Dr. Waxman is proud of the work he and GES are doing to address the need for vision care in underserved communities. And the need isn’t going away anytime soon.
“I truly believe that the reason to go into medicine is to help people,” he says. “And, frankly, I think helping people is what all of us should want to do.
“What I came to find out is that (ophthalmology) is a great field for providing service back to the community. I get to go out and help people who otherwise wouldn’t be helped. I get to teach students and residents to do the same.”