The Legacy of Dr. Michael Trese | Episode #6
Episode 6
The Legacy of Dr. Michael Trese
In this special edition of the Through Our Eyes podcast, we are honoring the life of Dr. Michael Trese, one of the all-time greatest contributors to the field of pediatric retinal research and disease. He, along with his partner Dr. Antonio Capone and Dr. Patrick Droste share with us many of their experiences of working together over the past ten years to develop research that has effectively impacted the lives of countless children and will continue for generations to come.
This interview was recorded shortly before Dr. Trese's passing on 10/21/22 and we are very excited to have the privilege of sharing this intimate conversation with our listeners in this very special episode.
The “Through Our Eyes” podcast is brought to you by the Pediatric Retinal Research Foundation. We are a community of visually impaired young adults talking about what it’s like to navigate high school, college, career, and beyond. We share our experiences and cover a wide range of topics providing you with actionable tips and strategies that you can implement in your own life.
-
0:00:07.1 Patrick Droste: Hello, everybody. Welcome back to the Pediatric Retinal Research Foundation Through Our Eyes Podcast. This evening and this month, we are honoring Dr. Michael Trese, one of the great giants of pediatric retinal research and disease. He along with his junior partner, Dr. Antonio Capone are gonna share with us some of the great experiences they've had the last 10 years in designing, developing research that will affect the lives of children today and children in the future for many years to come. We have the special privilege of having Nicole Giudice to interview them. This interview was done shortly before Dr. Trese's passing and we are very excited to share it with you tonight. Thank you very much.
0:00:52.9 Nicole Giudici: Today we're here with Drs. Capone and Dr. Trese and we're just interviewing to see how things have changed over the time that you guys have been in practice and the differences between then and now and what you see for the future. So we want to start it off. Dr. Trese, thank you so much for joining us. One question we have is you've been doing this a long time. When you first started out in practice, what were the biggest concerns you had for children who were visually impaired?
0:01:23.4 Michael Trese: Well, actually when I came back to Michigan to practice, the one job that all the doctors hated was screening premature babies, and so since I was the low man on the totem pole, I was given that job, but I actually liked it. And the reason was I got to actually see the human retina growing from week to week and I became very fascinated with the growth and development of the retina, and that kind of led from one thing to another. And the retinopathy of prematurity, which was the name of the disease that they developed, was something that really had no clear not only treatment, it had no clear classification system. And so before you can try and test a treatment, you really have to have a classification system and so the classification system followed that and then treatment was developed from that point, and the treatment did help, and we worked to progress that more and more as time went on. And then I'll just finish up here for a minute, Tony. We realized that there wasn't a great deal of money being associated with any kind of progress with this disease. So we tried to form a organization which raised money to try and support research that led eventually to different treatments, and that's pretty much the motivation that went behind it.
0:03:01.7 NG: Great. Dr. Capone, do you want to add to that?
0:03:04.7 Antonio Capone: Yeah. I think a good way to talk about this is sort of the history of retinopathy of prematurity because for a long time, the majority of what we did in pediatric retina was retinopathy of prematurity and the other disease is certainly very, very important, but in terms of the impact on the population, ROP was definitely the primary pediatric retinal disease of concern. So it was originally described in the '40s, but as Dr. Trese is saying, there really wasn't a formal accepted classification system that was described or articulated until the mid '80s, and around the same time that some of the early treatment studies were beginning to be published. So at that time, Dr. Trese is around 10 to 15 years ahead of me in terms of career. So I was just finishing my residency training. Dr. Trese was... When all of that was starting to happen and I really kind of wasn't aware of it because I was kind of too young a pup, and Dr. Trese had already finished his training and really picked this as a focus. I mean, not only did people not want to screen babies, but people really didn't bring much to the table in terms of operating on these diseases in a material way.
0:04:15.6 AC: And so all that started to happen when I was in training and that's really kind of when Dr. Trese really was starting to make his mark on the field and the field started to really gain momentum and interest and the classification system was coming out. And so there was this kind of perfect storm of energy and enthusiasm, intellectual energy, and now enthusiasm for this disease when I finished my training. And I also... My story parallels Dr. Trese's in that no one else really wanted to do the work and I kind of really had a love for it, and I found it challenging and really, really impactful. To be able to change a person's life from infancy is obviously a big opportunity. A difference between my point of coming in and Dr. Trese's is A, it was him ahead of me, so there really kind of hadn't been a leader as much for Dr. Trese, but also surgery was starting to shift from most of the surgery being done on the outside of the eye for this disease to surgery being done on the inside, and that's one of the thing, vitrectomy surgery or operating on the vitreous gel.
0:05:15.5 AC: Ectomy always means taking something out in medicine, right? So appendectomy and so on. And so when I finished my training, all of this change was starting to happen. There was a big surge in babies with this condition. It also started to change in terms of how it looked so that surgery from the inside started to make more sense and at the leading edge of that curve was Dr. Trese and his work. And so really from afar, Dr. Trese was my idol in terms of the work in this field and the surgical expertise that he was bringing to bear and it was evolving at his hands. And it's kind of interesting to talk about all the things were happening at this time. Mike, this would probably be a good time to talk a little bit about when the foundation had its roots and ROPARD was formed 'cause it was also...
0:06:03.1 AC: So I talked about the '80s and then I finished my training in the '90s, which is when Dr. Trese's career was really starting to kind of really take off in this area of publications, new surgical techniques, so on and so forth, and in the latter part of the '90s, Mike, correct me if I'm wrong, is when the predecessor foundation or the founding foundation of the Pediatric Retinal Research Foundation or ROPARD, Retinopathy of Prematurity and Allied Retinal Diseases was formed. I think it'd be informative to this audience to learn a little bit about how our foundation got started at your hands.
0:06:35.6 MT: Yeah. So Tony's exactly correct with all of that. We started a 501 [c] [3] and there's a bunch of steps you have to go through to be able to start that, government regulation and that type of thing, and then we were able to enlist the help of some very well-known people in the State of Michigan, the retired and now dead attorney general and the head of Detroit Edison. And then we started to perform dinners and movies and all kinds of programs to raise funds, and we raised with the help of a lot of people before we changed the name, we raised a little over $5 million and we used that. Interestingly, even though we had played a big role in research, we thought it was being kind of self-serving if we continue to use all those funds ourselves. So we granted the funds to competitive applications and those raised some interesting points. The people that we awarded them to were all very scientific researchers and we then after a while realized that the applications we were getting were really not as good as the studies we were doing and so then we started funding ourselves a great deal more once we came to that conclusion.
0:08:09.1 MT: And it was the two families that actually contributed almost half of that $5 million, but it was a period of... It's difficult to raise funds and especially for a disease that may not have been a problem for people that were having babies that were not premature and so you had to have a group of people that either were affected by that or had great empathy for people that were having problems with premature babies. Of course, there's a lot of empathy for babies and their issues and blindness being one of the top two things that people fear. So it was a difficult time, but it was well worth the time spent to fund the project. And then we did that for many years. We had... You may be familiar with Erik Weihenmayer. Erik is a child, a young man who has another disease called retinoschisis and he is a motivational speaker and he was involved in helping us change from just ROP to other additional retinal diseases, which is the ARD of ROPARD. And he actually has made... You can look him up. He's made several movies and very successful.
0:09:42.3 MT: And he was not auditioned, but premiered I think his last full-length movie with us as a fundraiser and was very, very successful. And now with this larger population of diseases and more children affected, we then got together and Tony joined us and we changed the name and the focus, the Pediatric Retinal Research Foundation, and that's pretty much how things went. And we now have a following for diseases such as Familial Exudative Vitreoretinopathy, retinoschisis, the Coats disease, several pediatric retinal diseases.
0:10:28.1 NG: Can you tell us the difference between 20, 30, 40 years ago, the children that you were treating, what were you expecting their life to be like late teens, early 20s and compare that to today?
0:10:43.2 MT: Well, I can say something quickly and that is right now with the treatments we have for ROP, we actually back many years ago expected those children would be blind or legally blind and now I think we might anticipate that with proper screening, which is the least sexy part of the care, with proper screening, that these children may be driving cars and functioning at a very good vision level, and that's huge. As Tony mentioned earlier, you can change a person's whole life by doing that.
0:11:21.6 NG: Amazing.
0:11:22.0 AC: Yeah. I think one of the interesting things is as you get older, you get interested in things like sort of evolution of thinking in an area and so I'll take you back to that time in the '80s. So ROP was the most common, but even it wasn't very well understood and the other... Our kind of initial foundation, as I mentioned, was retinopathy of prematurity and allied retinal diseases. Well, the allied retinal diseases are all the other things that we include in the universe of conditions in the Pediatric Retina Research Foundation. So it's Familial Exudative Vitreoretinopathy, congenital X-linked retinoschisis, persistent fetal vasculature and others, and most of those diseases did not have a classification scheme as Dr. Trese said.
0:12:05.4 AC: And if you look at virtually every classification scheme, it has Dr. Trese's fingerprints on it and that was a critical step. Once you understand how a disease evolves, then you can start to understand how to attack it structurally. So then on the heels of all of those classification, publications start to come surgical, man. I mean, they overlap a little bit, but in essence, classification, as Dr. Trese mentioned, precedes the wave of interventional literature, if you will, initiatives and literature. And remember, I think everybody who's on this listening is aware these are all very, very rare diseases. So one way to become very busy in our business is to do what it is that no one else wants to do. So as we did this, and these diseases are rare, I've actually... We...
0:12:56.1 AC: As Dr. Trese preceding my arrival, but more and more children started to come here from across the world, first the region, then the country and then the world. So we started to develop a very deep experience in these very rare diseases that most other doctors would see just two or three cases in their whole lives many times, and generally not recognize them because they were so uncommon. So that started to give us an opportunity to become a center and specializing in this and the advantage of that was then seeing more and more of the children. We started to be able to put shape to the understanding of the respective diseases and things really started to take off in terms of volume in the '90s for sure and then in the first couple of decades to follow.
0:13:40.2 AC: So that interestingly, as Dr. Trese was mentioning, children do much, much better with retinopathy of prematurity now. It used to be 80 plus percent of what we took care of in a given surgical day and now it's the vast minority of what we do. A number of advances have been made in the Neonatology space so that fewer children get ROP. They've really kind of figured out the secret sauce in terms of caring for the children from the pulmonary perspective and the oxygen perspective and so forth. So it's gone from being most of what we do to very, very little of what we do in the pediatric retina world now. And there have been similar advances in the other fields, but I would say probably not to the same end or degree of progress in the other fields. So there's really the last 30, 40 years has been a tremendous era of change for the better in terms of our understanding and opportunity to have a positive impact on this group of conditions that we focus on as pediatric retina specialists.
0:14:40.0 NG: That's awesome. And some of these other diseases that are not ROP, those kids previously probably had very different outlooks as late teens, early 20s as far as what their life trajectory was compared to now. They may not be driving, but I imagine that their abilities in life are much better than what they would have been 20, 30 years ago. Is that a true statement?
0:15:03.9 AC: I think it is. Yeah, I think it is. We certainly can't fix everything. I think it's very hard to fix what would God have not wrought. In other words, if the anatomy is so grossly abnormal at birth, some of those things are hard to fix, but we certainly can do much more than we could do many years ago. Yeah, that's an absolute truth and we're just getting better and better.
0:15:29.4 NG: I think all of these babies, children, young adults were the inspiration for the podcast that we're currently doing and inspiration is probably a great word to use for all of these young adults now. How was this born, this podcast? How was this idea born? What were you seeing that you saw this gap in the world that we needed to help fill?
0:15:50.8 AC: Mike, do you wanna talk a little bit about Pat Droste's focus on the fish ladder?
0:15:54.2 MT: Yeah. No, you can do it, Tony. Go ahead.
0:15:57.9 AC: Yeah. So we have a wonderful board. A number of folks on the board actually have been with the foundation since Dr. Trese originally founded it decades ago now. So I think that speaks of the passion for our board members. One of our board members in particular has been working with Dr. Trese since they both started their careers. He's a pediatric ophthalmologist, Dr. Patrick Droste, and in a way, his job is the hard job. We take the trolley in the operating room and in a very short period of time, we try to impact the trajectory of their disease. Once we're done, the person who takes that child and then works with them with regard to eyeglasses, crossed eyes, patching therapy, glaucoma, and all the other problems that can ensue is the pediatric ophthalmologist and one of the stoutest among them is Dr. Droste with regard to his deep dedication to the kids. So again, another thing that happens as you get older is you see the children you've taken care of grow up.
0:16:55.0 AC: I know that Dr. Trese has a number of patients who are in their 30s. A lot of... I'm writing college application letters for a lot of the kids that I've taken care of. Dr. Droste has been taking care of these children for a long time and has really brought focus on us because they're all of our kids, right? And the children he's been taking care of since he started his career with Dr. Trese, watching them grow up, he's kind of seen all the milestones that they hit. And with supportive families, determined parents, getting a child through all the different levels of schooling is a big task, but it's achievable, and he astutely noted that the transition though from the education system to independent life as an adult, getting a job, living independently, so on and so forth, which he terms the last rung of the salmon ladder is unarguably the most challenging. And so we as a foundation have been focusing our attention on that and drawing attention to it and trying to bring the strength of community to bear on this issue.
0:18:02.8 AC: By that I mean, there are a lot of smart people who figured out different aspects of how to address this problem and instead of everybody having to learn all these things on their own, community offers an opportunity for us to pool understanding. It's the Wiki concept. And so the podcast has evolved fairly naturally from that and Pat, who is also a host of this podcast, really to watch him interact with the young adults who have been under his care many times since truly infancy, he has a unique connectedness to them. And really, I take care of those folks too and Pat understands them in a way that I don't, and I think it's because of the difference between what we did as surgeons or do as surgeons, and what he does in terms of everything else that these folks need. Mike, do you agree with that notion?
0:18:56.5 MT: Yeah. I totally agree with that. Yeah, I get... From time to time, I'll get the communications thanking me for 25, 30 years of vision, and it's very, very rewarding. Yeah, yeah, it's a marvelous thing to be able to do something that has that type of lasting result.
0:19:15.2 AC: And you guys should probably know that as I mentioned, we ended up being a center because of our... Basically the infrastructure that Dr. Trese put together to allow us to see so many children with these rare conditions and kind of develop the intellectual momentum in the field. And I think most of the thought leaders in the world now in pediatric retina have at one time or another spent time here in Royal Oak. And I think it's important to think about the kids, but when you think of impact, all these other folks who developed a passion for taking care of children and then developed the skills to take care of the kids, it really just amplifies the positive impact of the work that's been done.
0:19:52.8 MT: Yeah, you're right.
0:19:54.0 NG: Dr. Trese, you've mentored some amazing physicians in your career, and you have an amazing legacy. Where do you see things going five, 10, 15 years in the future? What do you think is possible with regards to children with visual impairment?
0:20:09.7 MT: Well, I'm a great believer in regenerative medicine, and regenerative medicine basically is being able to manipulate the micro environment of the cells and being able to grow what may be healthy retinal tissue, both neuronal and neovascular. And I think that's going to have a base for a lot of different congenital retinal diseases and a very exciting area. I would love to be able to see some of that in action.
0:20:41.6 NG: What advice would you give someone who could be a younger you, the ones to blaze a trail in something that other people don't want to do, what's your best advice for them?
0:20:51.8 MT: Don't listen to anybody, and don't give up. [chuckle]
0:20:55.8 NG: I think that applies to every single one of your patients, too.
0:21:00.1 MT: Yeah, it does. Right. It really is a... I faced a lot of criticism early on, and then some of those critics became big time supporters as time went on. Yeah. Yeah, it's true.
0:21:16.6 NG: What advice would you give to people knowing that the foundation is very reliant on generous donors? Can you give us a couple words? What makes this an organization so worthy of donating to and to continue to support?
0:21:32.1 MT: Well, Tony, I'm going to let you field that one.
0:21:35.2 AC: I'll say two things. The roots of the organization, as Dr. Trese mentioned with regard to the fund, the direction that fundraising was conducted to support was innovation, innovative therapies. Our motto is Quest for Cure, right? So in this space, really there's no one as uniquely dedicated to this constellation of conditions, the pediatric retinal disease we take care of in terms of generating science that is going to translate into therapies for the diseases. So I think that's a big part of it, and that's our legacy, if you will. But I think the other piece is... The other side of the community being unique is that almost all of the families who have pediatric retinal diseases, they're not just the only ones on their block or in their school. They're oftentimes the only one in their town, sometimes even in their state, depending on how rare the disease is.
0:22:27.3 AC: And so the sense of community that the Pediatric Retinal Research Foundation is devoted to supporting, again, allows people to come together, not only for support, but also for advice. So a mom who joins the foundation and says, "Gosh, my three-month-old was just diagnosed with fever. What's going to happen? What do I do? Is he or she going to go to school?" We have moms and dads with, as we mentioned earlier, with 20-year-olds and 30-year-olds who can chat with them and say, "Listen, here are the things that you need to do. This is what happens with school," and so on and so forth. So the sense of community, dedication to research and dedication to community for this constellation of conditions is really sort of our secret sauce. And there's no one that does this this way, is dedicated to both the Quest for Cure and community support in the same way that we are. So I think those are distinguishing features. Mike, do you want to add anything to that?
0:23:25.1 MT: No, I think that's perfect, Tony. You're absolutely right. You have to be thinking all the time about how those things overlap and how to direct them.
0:23:33.5 NG: Mentorship is so important in medicine because that's what keeps medicine going in a forward trajectory, and that's exactly what you're doing for the community. You're pulling everybody together to help push this community forward and press the limits of what all of these young adults can do.
0:23:48.7 AC: I think the critical piece that Dr. Trese mentioned earlier is, and this is something that I've learned from him in coming here is, you know that kid and you tell him that he can't do something and he just like refuses to listen to you? He grows up to be a guy like Mike Trese. [laughter] And I can't tell you how many times in the course of my friendship with Mike and partnership again, spans decades now that there've been situations where people have said, "No, that's never going to work." And the other friend Mike has. And I'll confess I on occasion was like be thinking, "All right, this one's a long shot." And Mike just never listened. He just like is single minded, eye on the horizon, keep plugging. And time and time again, success follows and is the person who will be able to lead in the face of that sort of adversity of opinion is an uncommon person, but that's what it takes to achieve extraordinary things.
0:24:46.1 NG: It sounds like some of Dr. Trese's tenacity has worn off on you as well.
[chuckle]
0:24:51.1 AC: Yeah. Hard not to if you spend enough time with him.
0:24:55.4 MT: Yeah.
0:24:55.8 NG: That's not a bad thing. [chuckle]
0:24:57.1 AC: No, not a bad thing at all. I learned a lot, not just about pediatric retina, but about getting things done. The structure that Mike brings to things to get them done is something that I've emulated as well, and it... But it really is, "Get it rolling, and once you get it rolling, stick to it." And it's remarkable that the momentum just builds upon itself.
0:25:18.1 MT: Years ago, I adopted a philosophy that if I didn't listen real carefully to anything good that was being said about me, I didn't have to listen to anything bad that was said about me. [laughter] Yeah. Yeah. True.
0:25:38.6 AC: So Mike, I have a question for you about your relationship with Patrick that I have never really understood. So Patrick's in Grand Rapids. How have you developed... How did you develop... Which for listeners who aren't aware is two-and-a-half hours away from where Dr. Trese's practice evolved. How did you and he develop such a close working relationship when you're on opposite sides of the state?
0:25:58.3 MT: He actually did a lot of the training in Detroit and then... And that's how we met, and we're both Irish. [laughter]
0:26:06.6 Patrick Droste: Can you hear me now?
0:26:08.1 AC: We can hear you now, Patrick. You should have led with that, Michael. You should have led with that...
0:26:10.8 NG: Yeah, you should have...
[laughter]
0:26:12.8 PD: Okay.
0:26:13.7 NG: Exactly.
0:26:14.3 PD: Praise the Lord. Praise the Lord. Michael, give me a minute to embellish on that. Turn the clock back 40 years, 1981 Henry Ford hospital. I was a first-year resident and Dr. Trese had recently come to Detroit and recently completed his training with Dr. Machomer. And he was the only retinal person in Henry Ford in the new modern department that [0:26:38.6] ____ is building of retinal specialists. So I spent my second year in retina with Dr. Trese as did all the other residents. And he also came to our hospital once or twice a month to do challenging patients together. But my biggest association was in 1986 after I graduated from Henry Ford, it was actually June-July of 1985. And Dr. Magario asked me to be the clinic director, the full-time clinic director for the residency.
0:27:09.6 PD: And I was scheduled to do a fellowship the following year in pediatric ophthalmology, so I was real happy to do that. And at that time, Dr. Trese was really just doing a lot of pioneering ROP surgical work as well as the starting of ROPARD as well as the starting of the PRRL lab and all these things together. And one day I was in a Beaumont clinic, and he came down. And there were three ROP kids, and they were all having struggle seeing. And he says, "Patrick, it's my job to put the retinas on, but it's your job to make them see." [laughter] And I said, "Okay, you got a deal." And that's how it started. And then a year after that, I went to Indiana and my research project was establishing a way of measuring vision in preverbal kids or even nonverbal kids that couldn't give you acuity. So we developed the visual function battery, and that visual function battery was published in 1991 in Ophthalmology, and also in 1986, it was my only platform presentation at the American Academy of Ophthalmology along with Dr. Trese. And that was probably one of the highlights of my career. And that was the yardstick that we used to measure vision in visually impaired kids before they could really see.
0:28:29.2 MT: Yeah.
0:28:29.6 PD: And then we started the ROPARD committee and... Not the ROPARD committee, ROPARD board. And I've been on that since I think the very beginning. I think the only person on the board who is longer than me now is Katie White.
0:28:42.6 MT: Yeah, that's true. The good old days.
0:28:45.8 PD: Those were those were the days. Yeah. Those were the days. And at that time, it was retinopathy prematurity associated retinal disease. Now it's the PDA Retinal Research Foundation, and we're working on not only ROP, but also Coats disease, Norrie's disease, all the proliferative retinopathy, especially Familial Exudative Vitreoretinopathy, and also retinitis pigmentosa. So it's a very, very exciting time.
0:29:11.4 MT: Yeah, it is.
0:29:12.8 PD: And a lot of the patients that we're seeing both in our podcasts and other things who are patients of Dr. Trese's and mine together.
0:29:23.6 MT: Very true.
0:29:24.7 NG: Dr. Droste, what's your vision for the podcast?
0:29:29.5 PD: My vision for the podcast is that it unites all the different sectors of the visually-impaired world to a common source that we would be valued as being a premier resource for the development of visually-impaired children, retinal and otherwise, mostly retinal, but not only just for getting jobs, which is what our main concentration is right now, but also develop strong, let's just say, platforms in the... Not necessarily the preschool, but the elementary, middle and high school. That's key time, and then college, and then of course a job. So I see us working on all fronts, and we're going to get a lot of people who are interested in all those areas, particularly the parents. And that's where I see the podcast going.
0:30:14.5 NG: Is it safe to say in the short amount of time we've been working on this podcast that you've been pleasantly surprised by the accomplishments of your kids, your patients?
0:30:23.4 PD: Oh, I've been very surprised, and I'm very pleased with how it's going. And I just think it's the tip of the iceberg. I think we're going to get more in Dr. Capone has a number. And once this thing starts getting out, people are going to start looking for it, and once they look for it, then I think things will be a lot better.
0:30:41.0 AC: Pat, we hit on some on some historical aspects of pediatric retinal disease. And I was speaking to something that probably you should speak to because you certainly would do so with the greatest authority and that is talk about the concept of the salmon ladder and kind of how that germinated in terms of your thinking and because certainly you've become a champion for our approach to addressing what I would call salmon ladder issues.
0:31:05.1 PD: Yeah, yeah. Well, actually, it starts in the NICU. All right. And the NICUs where our goal is to get the children out of the NICU and get them seen. And that's kind of like the very lowest level of the fish ladder. We worked very hard from years one through five to get the best vision we can. As you know, amblyopia is a big enemy. Amblyopia means decreased vision that you can't just improve with glasses and you have to use patches and atropine and everything at your disposal to maximize the vision and not let the brain turn an eye off. And then it comes to school. That's the next step in the fish ladder. And parents are very concerned about how their children interact with not only visually-impaired, but also non-visually-impaired. Are they going to be stigmatized in school? And are they going to be able to participate in sports and things like that? And that's why we started the Visually Impaired Sports Day to bring visually-impaired children out of their box, so to speak, and force them, encourage them to do things they wouldn't otherwise do.
0:32:08.4 PD: And then we had some really good parents that started a goalball league and a beat baseball league and lots of people not only from our side, but also from other parts of the state joined. Then we got into the development of the music because most of these children are extremely talented music-wise. They would have camps in the summertime. Camp OUB was a place that they would go and when Gwen Botting would run a camp for visually-impaired kids and to teach them the activities of daily living, how to cook, barbecue, and they also had a big music part. They are very gifted musicians. They play several different instruments, sing songs, and have led a lot of other kids. When we have the sports day, we have a part in the auditorium where the kids come up and they sing their own songs.
0:32:58.6 PD: And then that's the big transition from the next ladder is from high school to college. And that's a big one because not everyone is able to go to college, or it's really not their best thing. They have other talents, and it's just like the non-sighted kids. Not everyone is destined to go to college, but they still have to have fulfillment. So we work on finding occupational things. Then we have a number that have gone to college, but as in the non-visually challenged world, just getting a college degree doesn't guarantee a job. So to me, that's the ladder, that fish ladder that we're currently trying to work on to get them... We want them to swim strong in that fish ladder. So there are about four stages, and I want our podcast to address all those states. Does that help?
0:33:56.8 MT: It's very cool.
0:33:58.5 AC: That's perfect. I never really thought about it as starting in the NICU, but you're right. I mean, that's the first rung.
0:34:05.0 PD: You’ve got to just to get them so they're fully vascularized and not worry about having to have laser treatment. Then the next thing you say, "Well, doctor, this eye sees well, this one doesn't. Well, what we're going to do about that?" Well, I said, "Well, we’ve got to work on it. We're going to put glasses and patching. If necessary, we do surgery and so on."
0:34:22.7 AC: Well, they're different than the other kids in so many other ways.
0:34:23.9 PD: I have something to share with you. This just gives you an idea of how important what we do. 22 years ago, I had a patient to reach threshold RLP, which means the retinas were bleeding, and we had to do a laser treatment, put like 1400 burns in each eye. And she did well. And I followed her for a year, and then she disappeared. I mean, like disappeared. And we did find out that they moved and that she was being followed. And that's what really concerned me. But last month I got a letter from her, and she's getting married and she wants me to come to her wedding. [chuckle] So what do you think of that? Well, in Boise, Idaho of all places, but she wrote me a very nice letter and a very nice invitation. And I said, "Man, that was worth it."
0:35:12.2 MT: Yeah, that's a good one.
0:35:16.2 AC: It's a great one.
0:35:55.2 PD: Yeah. Well, I was really glad that I was able to join in on this. The Lord blesses. I got through my schedule faster than ever, and I got home in time.
0:36:03.3 AC: Glad you could make it out, Pat.
0:36:05.4 NG: Yeah.
0:36:05.5 PD: Yeah.
0:36:05.5 MT: Yeah.
0:36:06.5 NG: Dr. Trese, do you have anything...
0:36:06.8 PD: Louisa, do you have anything to add, Louisa?
0:36:09.6 Louisa Recchia: What's that?
0:36:10.3 PD: Do you have anything to add?
0:36:13.1 LR: I was just going to say, this was wonderful. And I want to thank Dr. Trese for, first of all, for you to make it happen today. And Dr. Trese, thank you. Thank you so much.
0:36:23.4 MT: You're very welcome.
0:36:24.4 LR: It's been a privilege.
0:36:26.1 PD: All right.
0:36:26.9 NG: Honestly, like Dr. Trese, this has been an absolute honor to meet you. And I probably can't get through this without crying, but I have a nephew who is profoundly visually impaired from fever, who got connected to Dr. Capone when he was an infant. And through Dr. Capone, I've been able to experience the work that you have worked your whole life to do. And I just, I can't thank you enough for everything.
0:36:55.1 MT: Oh, you're very, very welcome.
0:36:56.4 PD: Yeah. We all feel the same way, Michael. It's been just a tremendous honor to work with you, both patient to patient, side to side. I told the group a couple of horror stories, but I'll omit that for now. But when I was with you.
[laughter]
0:37:10.2 LR: Don't worry. He shared stories before you hopped on.
0:37:12.8 PD: Yeah. All right. That's good. Okay. Very good.
0:37:15.4 LR: No, I'm just kidding.
0:37:16.8 MT: You're very welcome. Thank you so much.
0:37:19.6 NG: Thank you.
0:37:19.6 LR: This is wonderful.
0:37:21.0 MT: Okay. Yeah.
0:37:22.4 NG: Thank you. Dr. Capone, I have one more question for you.
0:37:26.3 AC: Of course.
0:37:27.4 NG: Do you have someone currently that you are mentoring to continue the legacy?
0:37:31.3 AC: Well, I think that all of life is a circle. When I first came into town in 2020, Dr. Trese warmly welcomed me not only into the practice, but really also fundamentally as a member of the family. We've remained close friends ever since, and at that time there was a 16-year-old young man by the name of Matthew, who is Dr. Trese's son. And Matthew is now grown up to be quite a young man, and the apple has not fallen far from the tree. And as of just a month or so ago, young Matthew Trese joined Associated Retina Consultants. And it is really my pleasure and privilege to walk Matthew down the first few paths of the trail, the same way his dad did for me.
0:38:14.2 MT: Yeah.
0:38:14.9 PD: That's pretty exciting.
0:38:16.6 MT: Yeah. That's great.
0:38:17.7 PD: That's got to make you feel pretty good, Michael.
0:38:21.0 MT: Oh, it does indeed. Yeah, very proud of him.
0:38:23.0 NG: I did not know that that was not [laughter] a leading question, and that is absolutely awesome.
0:38:30.1 MT: Yeah.
0:38:31.5 AC: The conversation wouldn't be complete if we didn't mention Kim Drenser. Dr. Trese and I and Dr. Drenser are really kind of a triumvirate, and we each have different sorts of skills and aptitudes and attributes. And the three of us really, it's a great combination. We work really marvelously well together. And Kim is an MD PhD with her PhD in molecular genetics. And she is really the brain trust of our laboratory initiative. So she kind of, not kind of, she really anchors our laboratory work. And Dr. Trese is very, has a strong translational medicine inclination, very one foot firmly in the clinic, one foot firmly in the lab in terms of how he thinks. And my strength is the clinic, and Kim's a fantastic surgeon, a fantastic clinician as well.
0:39:21.2 AC: But she's the one who has got the real cred in the lab, and it wouldn't be a fully rounded out conversation without acknowledging Kim's membership in the team. And she was a fellow with us. And so Dr. Trese and I both had a hand in helping her walk down the first few paces of the path like we're talking, as we're talking about with a young Matt Trese. So it's been a pleasure and privilege watching her career blossom and seeing she's an internationally recognized authority. So it's a fun thing. We talk about the impact we have on the kids, which of course is why we all do what we do, but it's a privilege to have an opportunity to impact such bright, talented, dedicated young people as their careers develop as well. And Mike has done a ton of that in his life, a ton.
0:40:09.1 MT: That's how things grow.
[music]
0:40:13.0 PD: The podcast is called Through Our Eyes. Make sure to like and follow our Discord channel, Facebook, Instagram, and TikTok. And let us know if you have any questions or have a topic you would like us to cover. We have tremendous things planned, and we hope you tune in again for our next podcast. This is Dr. Droste saying, "Goodnight to all of you on behalf of our staff, the PRRF." Thank you.