RETINA REFLECTIONS

Alice R. McPherson, MD

Dr. McPherson with Charles L. Schepens, MD

Alice R. McPherson, MD, is a recognized retina leader and philanthropist. She is the founder of two leading vision research institutions –The Retina Research Foundation (RRF) founded in 1969 and the McPherson Eye Research Institute at the University of Wisconsin (UW) in 2005. In addition to serving as the President and Scientific Director of the RRF, she is a professor of Ophthalmology at Baylor College of Medicine, where she has trained over 100 fellows and countless residents.  

Dr. McPherson is a pioneering retina specialist, who holds many firsts. She was first female vitreoretinal fellow of Charles L. Schepens, MD, and the first full-time female retina specialist in the world. She pioneered a number of treatments for retinal diseases, including scleral buckling procedures, cryotherapy and xenon arc and laser photocoagulation. While initially controversial, her early advocacy for photocoagulation for the treatment of diabetic retinopathy was later supported by the National Eye Institute Diabetic Retinopathy Study.

Dr. McPherson completed her undergraduate studies, medical school, and ophthalmologic residency at the University of Wisconsin-Madison and completed her fellowship with Dr. Charles Schepens at the Massachusetts Eye and Ear Infirmary. Following her retina fellowship, Dr. McPherson married Tony Mierzwa and moved to Texas to accept a position at Baylor College of Medicine where she established the retina service. There she has developed a large retina practice, taught residents and post graduates, and launched a fellowship program.

Dr. McPherson receives the Gonin Medal at the 2014 World Ophthalmology Congress

Dr. McPherson has received numerous awards from universities and medical scientific organizations, including the Gonin Medal –the oldest and most prestigious medal in ophthalmology – and the Distinguished Alumni Award from the University of Wisconsin-Madison.

We are pleased to share her reflections here.

Please share an impactful moment that shaped your early, middle, and/or late career. Was there a time in your career when you witnessed history in the making? 

In the late 1950s, retina treatment was transformed, and history was made when Dr. Gerd Meyer-Schwickerath revolutionized retina repair by using light to produce retinal burns and resultant scaring to treat macular holes. His ocular therapy concept evolved into the xenon arc lamp photocoagulator, and by 1957, Meyer-Schwickerath had used light photocoagulation to successfully treat over 80 patients. At his specification, the xenon arc lamp became commercially available the following year (1958) and due to the steady, full light-spectrum that resulted in a non-tissue selective burn, the technology quickly was adopted as the primary media for repairing retinal tears, holes and detachments. Within the next decade, the technological development of lasers advanced so much that Meyer-Schwickerath’s xenon arc lamp’s usefulness was surpassed. With the 1968 introduction of argon blue-green lasers, which produced such a focused and powerful beam of light, their application for photocoagulation became much safer and more precise, capable of repairing minute lesions and blood vessels. In clinic, these new techniques were enthusiastically embraced because of the accuracy that could be achieved. Beyond sealing macular holes and tears, effective treatment of neovascularization was also possible. This opened up an entirely novel way to treat diabetic retinopathy. The policy, as part of the treatment protocol, was to take baseline fundus photos for all patients from which disease progression could be tracked. This became essential, particularly for patients with uncontrolled diabetes. By tracking change over time, issues were caught earlier and the laser techniques were used earlier, thereby allowing patients to see longer and even preventing loss of sight. The belief was that the benefits of early treatment outweighed the risks. This was proven to be the case when validation of early use of lasers in diabetic retinopathy therapy was conclusively proven by the Diabetic Retinopathy Study and later the large NEI prospective clinical study – the ETDRS (Early Treatment Diabetic Retinopathy Study).  What was learned in those landmark trials was extended - the use of lasers ultimately expanded to treat other macular diseases, including age-related macular degeneration. Lasers have revolutionized treatment, expanding procedural options in the clinic for a wide range of retinal diseases.  Vitreoretinal surgery is now reserved for more complex situations.

Dr. Alice McPherson in surgery in the 1970s.

What career accomplishment provides you with the greatest sense of satisfaction?

The impact that the Retina Research Foundation (RRF) has had on retina research is a source of great pride. At the time of RRF’s founding in 1969, no organization was specifically focusing on research in retina, and in the last 50-plus years, RRF has remained vibrant and active, and has been able to contribute so much toward the basic science that is driving innovation in clinical practices today. RRF has awarded over $38 million in research grants and educational opportunities to vision researchers, established and new, to advance research leading to greater understanding, prevention and treatment of retinal disease. This investment stimulates the development of novel clinical expertise and data, necessary initial research that is required for application for future support from organizations like the NEI/NIH.  

Likewise, remarkable work is being accomplished at the McPherson Eye Research Institute, founded in 2005, at the University of Wisconsin. The Institute brings together many research disciplines to focus on retina, and is now recognized the world over. Being a part of its story from the very beginning is immensely fulfilling. The scientists affiliated with the Institute produce pioneering work, furthering advancements in diagnosis and treatment of retinal diseases and degeneration.  

The Gonin Medal, named in honor of Jules Gonin, the pioneer of retinal detachment surgery, and given for the highest achievements in ophthalmology every four years is one recognition of accomplishment that I am deeply honored to have received. Another is receiving the inaugural Retina Hall of Fame Lifetime Achievement award. I highly value both of these recognitions bestowed by my peers, and it is humbling to be a part of ophthalmic history in this way.

Dr. Alice McPherson in discussion with a patient prior to an argon laser procedure in 1977

What do you feel is the most significant development or change in the practice of retina?

Some of the most exciting and significant developments today are advances in the understanding of the genetic causes of retinal diseases and the resulting development of medical therapies. There are now many preventative treatments for causes of infectious blindness, and the hope is that gene therapy will ultimately eliminate many of the genetic causes as well.

Can you share any advice for future generations of retina specialists? 

Dr. Charles L. Schepens is considered one of the most influential ophthalmologists of the 20th century and he is regarded by many as the father of modern retinal surgery. He strongly advocated that only from an understanding of the clinical and basic science research can the information and the tools necessary to improve patient care be obtained. As retinal specialists, we stay up to date on the latest innovations and bring them to patients. Patients look to us to give them hope for maintaining their vision, with answers. With this in mind, retina specialists need to be ready to fully embrace improvements in diagnostic tools and therapies as they become available and supported by data, and change their practice accordingly. Clearly communicate to patients the currently available options for treatment, and when appropriate, include those options in the clinical research stage too. Patients will appreciate and expect this. Never accept there is nothing more that can be done.

Dr. Alice McPherson doing a patient exam in 1989

How do you imagine the practice of retina will change by 2040?

The retina subspecialty practice will require less and less surgery as diagnostic tools and other therapy alternatives continue to evolve. New minimally invasive robotics and pharmaceutical options for treating all types of retinal dystrophies are now being developed. With the growing understanding of the genetic causes for many retinal diseases, retina specialists are able to treat retinal disease and degeneration earlier and even in some cases, preemptively with less invasive methods and gene therapy. The advances in imaging capability and the application of artificial intelligence to imaging holds so much promise and will be instrumental to early detection, accurate diagnosis and treatment. Adaptive Optic imaging and protocols are being perfected in clinical trials now that will allow diagnosis at the cellular level, in vivo, something that is truly remarkable. Today’s ophthalmologists are so well trained that they pick up things early, before other surgical techniques may even be needed. Fortunately, the surgical techniques are also evolving and will be there when needed. 

Our sincere thanks to Dr. McPherson for sharing her reflections.

(Retina Reflection published 2021)

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