1. What is the most important area of research that you have undertaken recently?
I have always been a firm proponent of combination therapy
for the treatment of retinal disease. It makes intuitive scientific
sense; however, only recently in retina have we developed
modalities that could work in concert with each other.
For macular degeneration, I have been involved in combining
photodynamic therapy (PDT) and improved radiation delivery
systems with drugs, including steroids
and anti-vascular endothelial growth factor
(VEGF) agents. This work will hopefully
lead to improved outcomes in age-related
macular degeneration (AMD) with
reduced treatment rates. I am also excited
to be working with newer drugs in combination
with each other. Similarly, in macular
edema, I have reported on the use of
steroids combined with laser and we are
seeing similar synergistic effects with anti-
VEGF agents.1 Ideally, we will be able to
replace laser with better, less destructive
therapies.
2. How will optical coherence tomography (OCT) technology
continue to evolve ?
The Fourier-domain and spectral OCT systems represent a
large leap in our ability to image retinal structures. This dramatic
improvement in speed of image acquisition allowed us
to obtain information from almost the entire macula. This
led to 3-D views, en face imaging, geographic atrophy measurement,
drusen volume analysis, and even the ability to
view the fundus as a reconstructed image. With drugs being
tested to treat dry AMD, the ability to follow patients in a
quantifiable, noninvasive manner is very appealing. As fast as
current scanners are, in the future we will see further improvements
in speed with ultra-high–speed, swept-source,
or time-encoded frequency domain OCT scanners that will
decrease motion artifact inherent in scanning the eye. These
devices will also offer better signal-to-noise ratio for higher
resolution images. Other technologies on the horizon are
Doppler OCT for imaging blood flow and adaptive optics
combined with OCT to image structures at the cellular level.
3. What challenges do you deal with as study chairman
of several major, multicenter, international clinical trials,
and as a principal investigator in multiple trials?
It is often difficult to balance the responsibilities of study chair vs investigator in a clinical trial, as the goals of the
two roles are not always aligned. Calling friends to discuss
problems can sometimes be uncomfortable. However, it is
very exciting to be involved in the design, recruitment, and
final reporting of new developments in retina. Study
design has become very complicated, and envisioning a
trial that can prove a hypothesis in a limited period of
time can be daunting as the sponsor of the study have
their ideas, the US Food and Drug
Administration has its own, and we, the
researchers, have ours. The back and forth
between parties can be contentious. In
the end, delivering better therapies to our
patients makes all this hard work worthwhile.
4. As a surgeon, who are your heroes?
My parents, first-generation Americans,
instilled in me a strong work ethic and a
desire to always do my best, no matter
what the circumstances. My Japanese
grandfather is my true hero in life. He joined Sanwa Bank as
a teller, worked his way up to President, and made Sanwa
the seventh largest bank in the world. I have never met a
more impressive individual, nor have I been more proud
than when my mother tells me she sees him in me. In medicine,
I have been lucky to have several great mentors during
my surgical training and to work alongside many great surgeons.
Donald D'Amico, MD, was a phenomenal teacher; he
is the main reason I am a retina specialist. He was always in
control and let everyone get involved in cases. I can still hear
my attending surgeons at Bascom Palmer Eye Institute
(Miami, FL) in my mind when I operate. They all served as
mentors throughout my development.
5. What are some of the perqs of being the team ophthalmologist
for Cleveland's professional sports teams?
Cleveland is a true sports town. Although it has been a long
time since we have won a championship, the fans never stop
supporting the teams. The most obvious perq of being a
team doctor is meeting some truly impressive athletes and
getting to know them on a personal level. Games, team jerseys,
and autographed items are also nice. And no, I don't
know where Lebron will end up!
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