1. After earning a bachelors in mechanical engineering at University of Minnesota and a masters in fluid mechanics at Stanford University, you decided to attend medical school at the University of Minnesota School of Medicine. What made you decide to pursue medicine instead of engineering?

As part of my National Science Foundation fellowship at Stanford University, I worked on a project using a NASA centrifuge to create centrifugal forces to reattach retinas in dogs. (Don't worry: Many of the dogs appeared to have fun!) We did not use photocoagulation or any type of permanent fix, so many of the retinas detached again. Still, I found the marriage of engineering and medicine fascinating. I felt that I could use my knowledge of mechanical engineering to advance the field of medicine, which led to me to the decision to pursue a career in medicine rather than pursue a PhD in engineering.

2. How has your engineering background influenced the way you practice medicine?

I try to apply engineering principles in the OR and in the clinic. During my residency at Stanford, I was introduced to laser treatments in the human eye early in my career thanks to H. Christian “Chris” Zweng, MD, and Hunter Little, MD, both of whom were in private practice in Palo Alto, California. These doctors were convinced that panretinal photocoagulation could effectively treat proliferative diabetic retinopathy many years before the ETDRS proved laser to be an effective treatment for the disease.

I was also fascinated by pars plana vitrectomy. Around the time that Drs. Zweng and Little taught me the finer points of laser photocoagulation for treating diabetic retinopathy, Robert Jack, MD, introduced me to methods of vitrectomy. Dr. Jack was 1 of just a handful of vitrectomy surgeons in the state of California, and I seized the opportunity to work with him. At that time I believe we were using the Visc X, a multifunctional device with manual suction, for vitrectomy surgery. Dr. Jack let me perform my first vitrectomy on a patient with a longstanding diabetic vitreous hemorrhage. The patient was ecstatic with the result. At that time we had no endolaser or endophotocoagulators so we had to add laser after the operation. There were very few vitrectomies being done back then within most residency programs, and I was very lucky to have the opportunity to perform this procedure on my own so early in my medical training.

3. Who are your professional role models?

I was fortunate to be trained by superb retinal specialists during 2 separate fellowships. At the Massachusetts Eye and Ear Infirmary, I was trained by Evan Gragoudas, MD, and Charlie Regan, MD. At Duke University, I studied under Robert Machemer, MD, and Reese Landers, MD. All of these doctors were experts in their field and taught me that superior physicians pay very close attention to the details during retinal examination and surgery and demonstrated the importance of understanding a patient's symptoms. Also, they all were very innovative in the OR.

These doctors interacted with their peers in a productive manner. They constantly challenged each other (in a professional and friendly way, of course), asking questions and approaching new teaching opportunities via Socratic methods. This dynamic helped propel the profession toward excellence, and it inspired me to take a similar approach when dealing with peers and students.

4. Describe a particularly rewarding experience you have had as a retina specialist.

I have had many interesting experiences in retina. The story that comes to mind involves a vitrectomy I performed many years ago with a system called an Occutome, which had a pneumatic pump that drove the vitrectomy system. I remember this surgery because the pump failed in the middle of the surgery and there was no backup. So I acquired some tools, took the cover off the machine, took apart the pump, fashioned new gaskets from the cardboard portion of a notepad, reassembled the machine, and finished the surgery. Because I was able to respond quickly, this unexpected difficulty resulted in a delay of only about 15 minutes. I could not even consider making such a repair on the fly with today's rules and procedures.

I like the challenge of difficult cases. One particular case involved operating on a monocular patient with a massive choroidal hemorrhage and retinal detachment. The patient was an avid hunter who made meatballs from the groundhogs he hunted. After the surgery, the patient, who was an expert archer, was able to shoot a wild turkey with an arrow just as he had before the onset of disease.

It is important to remember that the work we perform is not on eyes, but on patients. Getting to know patients over many years of follow-up is a source of considerable satisfaction for me. It is really what the field of retina—or any medical specialty—is all about.

5. What do you enjoy doing in your spare time?

I am an outdoorsman. I like the water, and I find great relaxation when sailing on the Adriatic or the Mediterranean. Even when I cannot find time to make it to Europe, a canoe trip suffices. In the winter I enjoy downhill skiing, especially in Aspen. Luckily, I have a wonderful wife and great friends with whom I can share these activities.