Contributed by Lawrence A. Yannuzzi, MD
Francis Anthony L’Esperance, MD, also known as “Franny” or “Fran” combined a natural intellect with his passion for photobiologic science to be one of the most important physicians in the retinal community of my generation.
The son of Francis Anthony L’Esperance, MD, known also as Junior, he had a coveted and prestigious academic background. Beginning as an honored graduate of Deerfield Academy in 1949, he matriculated to Dartmouth College, where he graduated magna cum laude in 1953. His leadership and scholarly accomplishments were recognized by his fellow students who elected him president of the senior class. He went on to Harvard Medical School where he graduated in 1956 and earned a position as a resident at Columbia University in ophthalmology. His residency was embellished with a fellowship at the Massachusetts Eye and Ear Infirmary.
Fran always had an interest in terrestrial geography, and beyond that, in astronomy where he was fascinated by light. Not surprisingly, he pioneered the use of ophthalmic lasers and authored over 100 clinical-scientific publications and a dozen medical textbooks. He also earned twenty-three patents in bioengineering, all based on his dedicated concentration throughout his career.
Well-known as the first person to use the Excimer Laser on humans, he founded Taunton Technologies in 1986, which eventually joined its rival, Visex, in 1990. A perennial leader, he served as president of the American Board of Laser Surgery and as a governor of the American College of Ophthalmic Surgery. Among the much deserved admiration and recognition for his contributions to medical science, he later became a member of the Overseers of the Geisel School of Medicine at Dartmouth College, where he endowed several research and scholarly funds. Former President Jimmy Carter appointed him to the National Health Resources Advisory Council in 1978, and later supported him for the Rank Prize for Opto Electioneers in 2010. Deerfield Academy also appointed him as a trustee and the recipient of its noted Heritage Award.
In ophthalmology, Fran was a retina specialist extraordinaire. His scientific advances benefited countless patients with diseases of the eye associated with severe vision loss. The development of ophthalmic lasers for the posterior segment of the eye provided therapeutic hope to patients with retinal vascular and choroidal-pigmentary epithelial diseases long before there was established treatment for such exudative chorioretinopathies. He also shared his knowledge and experience graciously and generously. I remember fondly, how he guided me through the photo optics of his original and innovative work on an Argon laser instrument assembled for him by Bell Labs. I witnessed this primitive Argon laser delivery system, escorted by a crane from a nearby group of construction workers, elevating it through the exterior at Harkness Eye Institute into his laboratory. It was too large to pass through the doors and corridors.
While others were using a new diagnostic adjunct, fluorescein angiography, to study disease mechanisms, Fran was focusing on the administration of laser light therapy with blue-green and eventually pure green laser to treat them. His early systems contained optical lenses and prisms which were converted to fiber optics in quest of a fine, short and intense nature to a focal spot in the posterior segment of the eye. He soon realized that such light of high energy had to be modified to reduce its potential complicating nature. He immediately realized that it was necessary to incorporate the concepts of other contemporary innovators like Drs. Gerhard Meyer-Schwickerath, Lloyd Aiello, and Arnal Patz to avoid potential complications like disruption of the pigment epithelial choroidal junction and predisposition to choroidal neovascularization or the fertilization of optic nerve preretinal neovascularization. With the emergence of clinical trials and imaging modalities, laser photocoagulation devices and techniques introduced by Fran, provided a sense of purpose for treating retinal physicians for permeability and proliferative vascular diseases. First and foremost was diabetic retinopathy followed soon after by retinal vascular occlusive diseases and eventually choroidal pigment epithelial ischemic and proliferative disorders. These photocoagulation therapeutic concepts catalyzed the medical-retinal studies on disease mechanisms which were now being managed with laser light photocoagulation based on Fran’s original research. This all occurred in an era that had not yet discovered the importance of anti-VEGF medication.
Fran’s numerous publications, presentations, and organized meetings gradually introduced light coagulation as a method of treating these diseases and expanded the retinal base for studying them with new concepts in multimodal imaging. The New York State Ophthalmology Society, American Academy of Ophthalmology and International Council on Ophthalmology rapidly adopted fundamentals that were introduced by Fran and his laboratory associates. Retinal diagnostics now could be enhanced by retinal therapeutics, expanding the sphere of the retinal physician who was principally focused on detection and repair of retinal tears and detachments with cryo surgery and scleral buckling. So, thank you Fran, for doing your best to provide retinal specialists with laser forms of treatment, fundamentally, the only available method and reliable form of therapy prior to the advent of the anti-VEGF era.
Additional contribution by Aravindh Nirmalan, MD.
Read an additional tribute to Dr. L’Esperance in this Retina Times article: ASRS Remembers Francis A. L’Esperance Jr, MD.