1. How did you come to choose retina as a profession?
Ophthalmology is a beautiful field of medicine, so to choose a specific area of it to devote your life to may be difficult. In my case, I had the influence of my father and mother, who are also ophthalmologists. My father, Jorge Fromow, who is 85 years old and professionally active, was one of the first glaucoma specialists in Mexico. My mother, Ana Maria Guerra, focused on pediatric ophthalmology. Although my father was primarily focused on glaucoma, he practiced at a time when ophthalmologists worked in almost all areas of the field. While I was in medical school, I assisted him in many retina surgeries, particularly intrascleral buckles, and I was fascinated by them. So, I have been exposed to the subspecialty since I was a young boy.
However, everything changed when I did my rotation as resident in the retina department of the Association for the Prevention of Blindness in Mexico (APEC). There, I found a new dimension of challenges in the medical and surgical aspects of retina. One of the first things I was attracted to was the degree of difficulty of the workup and exploration of a retina patient required to make a diagnosis and plan a treatment strategy. Second, I was astonished by the beauty of retina surgery, especially vitrectomy, and the skill level required to be a good retina surgeon. I was also impressed by the surgical skills of the retina department staff and their profound knowledge in medical retina.
Another aspect that attracted me to retina was the focus on clinical research. I have had inclinations to actively participate in research since my university days. Since 1990, I have worked in the Department of Surgery and the Department of Cellular Biology at the National Autonomous University of Mexico (UNAM), the largest public university in Mexico. So, when I learned that Hugo Quiroz-Mercadi, MD, former head of the retina department, was an active and prolific researcher and that he placed high importance on this area, I knew this was the right place for me to be.
Last but not least, the competitive environment along with the friendship and honesty of those in the field was the perfect scenario to help me make my decision. Once I was accepted into a program, the daily practice of retina confirmed my decision. At that time, I also had full support from my former teachers and now extraordinary friends: Dr. Quiroz-Mercado; Virgilio Morales-Canton, MD; Jose Dalma, MD; and Juan Manuel Jimenez, MD. I especially have to thank Hugo, who supported me in completing my retina fellowship while earning my master's and doctorate degrees.
2. What inspired you to participate in the founding of the Pan-American Collaborative Retina Study Group (PACORES), and what has the group meant for research efforts in Latin America?
To talk about PACORES is to discuss a new paradigm in the way clinical research and researchers organize to be able to contribute to the knowledge of our profession. In Latin America, the governments' and universities' support of research is, unfortunately, not a priority, and, therefore, resources are often insufficient. Therefore, if you want to develop an idea and test a specific hypothesis, very often, you are required to supply not only your time but also all of the economic resources required.
PACORES was initially conceptualized during the 2005 American Society of Retina Specialists meeting in Montreal and was founded 1 year later during the World Ophthalmology Congress in Brazil. It was formed by a group of friends from 11 centers in 8 countries who shared a marked interest in research and solid academic backgrounds. The aim of PACORES was to bypass the individual circumstances and limitations for conducting research and to combine efforts to start organizing different studies to address important research questions. Since its foundation, PACORES has published more than 28 articles, and we are now developing prospective trials in clinical and surgical projects. PACORES is an independent group, and we have no financial interests in or support from any company. We recently expanded to include members from 12 centers in 9 countries.
PACORES is an excellent example of how to organize and overcome limitations, and groups in other parts of the world have started to organize in similar ways. There is likely no other international ophthalmic research group in Latin America that has contributed more to research than PACORES. To be one of its founding members is a great honor, as is to be part of a group of retina specialists and researchers from many countries who I personally admire. Also, the ability to contribute to the scientific knowledge that usually is done exclusively in developed countries is encouraging. All PACORES members constantly contribute to the group's development and growth; however, we must specifically recognize 2 active engines of the group: Lihteh Wu, MD, of Costa Rica, and Fernando Arevalo, MD, of Venezuela.
3. What has been the focus of your most recent clinical research?
I am directly working in 4 research areas in retina. First, last year, we started a new line of research related to proliferative vitreoretinopathy (PVR) that is different from previous efforts. This work involves a range of aspects, from basic clinical research to the development of new potential drugs to prevent PVR. These studies involve APEC, UNAM, and the National Rehabilitation Institute of Mexico. PVR is one of the most important challenges in retina, and very few important advances in its treatment have been developed lately.
Second, I am a fan of retinal imaging, especially with the Spectralis (Heidelberg Engineering). I am coordinating a study line of PACORES of retina, choroid, and optic nerve imaging in different physiological and pathological statuses and among different populations. Third, I am working with Dr. Morales-Cantón and Clearside, exploring a new therapeutic strategy in the suprachoroidal space.
Last, diabetic retinopathy (DR), the leading cause of blindness in Mexico, is one of my main areas of interest. We are developing a national program for early detection and treatment of DR with the use of telemedicine. Although there are some other programs worldwide that use this strategy, we have had to translate and adapt other experiences to the Mexican public health reality. This study explores the determination of the sensitivity and specificity of different technologies for the detection of DR, through its implementation in a community-based program (either with mobile or office-based measurements), to the measurement of its impact and cost-effectiveness. Parallel to these public health studies, last year, we started a study to measure the psychological profile (depression) of low-vision patients with various retinal diseases (including DR) and ocular pathologies.
4. What do you consider to be your greatest achievement?
My greatest achievement in the personal sphere, and the most important one overall, is having a wonderful unity and lovely family with my wife, daughters, and parents, as well profound friendships of a long time throughout my academic and professional life.
My greatest achievement in the professional arena is probably the trust and confidence that I have from my patients who give me the opportunity to help them with their ocular problems. The fact that a patient who is suffering from a sight-threating disease places trust in you to resolve a circumstance that will make a difference in his or her life is something that cannot be taken for granted. Of course, I have other achievements related to personal satisfactions such as being able to continue studying and completing an MSc and a PhD and, more recently, a DipHE-BA. It has also been an honor to be involved in university teaching since 1990 and to belong to high-standard groups and institutions such as APEC, UNAM, PACORES, and Mexican-ARVO.
5. What are your interests outside of ophthalmology?
I have various interests outside of medicine. I love music in all its expressions. Every time I can, I try to visit concert halls in different countries. I am a constant reader, especially of history and literature in general and poetry and novels in particular. In the past 10 years, I have also been interested in lectures about all types of religions and the ways humans develop spirituality and conscience. The Jüngian psychological approach to thinking is particularly attractive to me. I love to play chess and try to get together with a group of friends to play guitar, sing, and dance at least every 2 weeks.
Since 1991, I have belonged to and participated in the International Physicians for the Prevention of Nuclear War (IPPNW). IPPNW is a nonpartisan, global federation of medical organizations dedicated to research, education, and advocacy relevant to the prevention of nuclear war. To this end, IPPNW seeks to prevent all wars, to promote nonviolent conflict resolution, and to minimize the effects of war and preparations for war on health, development, and the environment. For this work, IPPNW has been recognized with the “Beyond War” Prize from UNESCO and, in 1985, with the Nobel Peace Prize. I have been able to serve in IPPNW as Vice President from Latin America and now as International Councilor.