Few ophthalmologists have had as profound an impact on an eye disorder as Michael T. Trese, MD, has had on pediatric retinal detachment. He is a preeminent practicing pediatric vitreoretinal surgeon, who revolutionized his field in the late 1980s with the concept of lens-sparing vitrectomy, and a dedicated educator, who has shared his surgical skills with a generation of fellows and colleagues. And the techniques he developed are now performed around the globe and have restored sight to untold thousands of children. Dr. Trese has also changed the face of telemedicine. Recognizing the difficulties in providing timely screening of babies for retinopathy of prematurity (ROP), he spearheaded the development of photographic screening protocols used worldwide. Last but not least, he has investigated numerous pathways in the pathogenesis of retinal disease. Most recently, he and his colleagues have explored the application of regenerative medicine to cellular signaling pathways in the retina—a possible game-changer for preventing visual loss and restoring sight. For these and countless other reasons, the Academy is recognizing Dr. Trese with its highest honor—the 2021 Laureate Award.
Starting Point
What drew you to ophthalmology, particularly to pediatric retina? My path to ophthalmology was very circuitous, to say the least. I originally attended the University of Michigan with the intent of playing professional football. Back in elementary school, I lived a block away from the university’s practice field and I’d poke my head through the fence, watching the players and thinking, “That’s what I’m going to be when I grow up.” As it turned out, I wasn’t very good at football in college, but that experience still served as a springboard. The university set up each player on the team with part-time jobs to make a little money. One of the positions I landed upon was as a scrub tech at St. Joe’s Hospital in Ann Arbor. After an intensive two-day training period, I was thrown into the OR and noticed that the only surgeons who seemed remotely happy each day were the eye doctors. So when a knee injury ended my brief football career, a family friend, who was with the U.S. Department of Health, Education, and Welfare, told me that I should become an optometrist given my interest in physics, biology, and optics.
So I entered optometry school. And during my third week, as the faculty lectured on the differences between an optician, an optometrist, and an ophthalmologist, I suddenly realized that I was in the wrong place for what I wanted to do. But this was during the Vietnam War, so I was advised to complete the program and avoid enlistment. Shortly thereafter, I applied to the Georgetown University School of Medicine, which of course cleared my path toward ophthalmology. And it was during my residency at the Jules Stein Eye Institute in Los Angeles that I first was struck by pediatric retina and witnessed how I could change the entire life of a person. I was following a baby in the clinic with ROP—and at the time, we had no criteria and no real staging of the disease. So I told the family to come back a month after the child was discharged for a follow-up. Upon his return, the child presented with stage 5 ROP and total bilateral retinal detachment. I literally ran to get the attending, who told the family there was absolutely nothing that could be done. Their son was now blind. I was in total and complete shock. I just couldn’t believe it. So I left residency with that experience always in my mind and never looked back.
Changing the Paradigm
What do you consider to be your most important contribution to medicine? I’ve always prided myself on advancing the understanding of pediatric retinal diseases and developing therapeutic approaches for treating some of ophthalmology’s most difficult pathologies. And what’s likely made the biggest difference in the lives of surgeons and children is lens-sparing vitrectomy for retinal detachment due to ROP.
The history of this procedure’s development is interesting. Back when I was an intern, I saw a female patient with very proptotic eyes who had been stabbed with a hair pick through the ciliary body pars corona (pars plicata) and out the other side via the pars plana. We quickly closed the wounds with sutures, and the patient ended up 20/20 without any bleeding. Fast forward to my residency, and I was now being taught that if a surgeon entered the eye through the ciliary body pars corona (much like the hair pick) the eye would most likely bleed out—that is, the eye would not be able to sustain such a procedure. But that didn’t mesh with the reality that I saw firsthand.
Fueled by this experience, my colleagues and I eventually developed a pars corona vitrectomy that 1) saves the lens, 2) doesn’t make the eye aphakic, and 3) doesn’t create tremendous anisometropic amblyopia. This allows us to now operate on children who have extraordinarily high chances of blindness. I see many of those same children again as young adults who are very thankful and who are able to function normally. Some of them have maintained 20/20 vision even for the last 20 to 30 years. That’s extremely rewarding. And that’s one pearl of wisdom I’d like to impart to all ophthalmologists. We are all very success-oriented as physicians and surgeons. As a result, many of us tend to stay away from those patients who have real and serious potential for blindness. Yes, these cases require extra attention and can lead to failure, but success can be fantastically satisfying.
You have decades of experience creating and shepherding pharmacologic therapies for treating conditions such as symptomatic vitreomacular adhesion. What do you think are some of the keys to successful innovation? Let’s take first things first: When I started out, the regulatory environment was much different than it is today. For example, I would design a lot of handheld surgical instruments decades ago, and that process basically involved me providing a company with a hand drawing of the tool for an almost immediate production turnaround. I provided the sketch on Monday and would be trying it out in the OR on Friday. That’s obviously no longer the case. Every step of the way is now much more detailed, complicated, and regulated. And going through this process takes education—it’s almost like getting a PhD. You have the medical knowledge. You believe in your idea. And maybe you even know more about your idea than anyone else in the world. But you also need to learn the business side and how to sculpt a path for regulatory success. That’s why we’ve started a Center for Ocular Innovation at Oakland University for young ophthalmologists—to teach them the rules of the game, including funding, proof of concept, and designing the right experiment. It’s also to teach them that perseverance is of the utmost importance, because turning an idea into a product can take more than decade, especially if it’s a pharmaceutical.
So for all of the young ophthalmologists out there who aspire to be tomorrow’s physician-innovators, check and see if your programs offer similar types of fellowships and reach out to established colleagues and faculty. At the moment, you’re likely not prepared to maneuver around the nonmedical side of innovation, but there are a lot of us here to help you acquire a skill set that can help you make your own lasting contributions.
What other advice would you give young physicians who are just starting out, either in training or in practice? Find something that you find to be exciting. One of the things that keeps me going, for example, is the area of regenerative medicine. For well over a decade, my colleagues and I have been working on a retinal therapeutic that regenerates both the neuronal and vascular tissue, and we think that’s going to be an important part of ophthalmology’s future.
It’s essential that residents, fellows, and trainees take the time now to think down the road. They need to envision what they want from their careers and what they want to achieve in 15 or 20 years. Yes, performing surgeries will of course be rewarding for you and helpful for your patients. That goes without saying. But what’s going to make you especially excited about getting up in the morning and coming in to work?
Because, in the current moment, physician burnout has become a serious problem in ophthalmology. And this stems from simply no longer finding that special joy in what you do each and every day. Personally, I need something that’s new, something that pushes the profession forward—for example, taking an eye disorder with little to no hope for treatment and changing the paradigm. It will be different for each ophthalmologist, but that’s what continues to keep me entirely fascinated with our profession.
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