The US retina community has a widely acknowledged and well-deserved reputation for collegiality, collaboration, and cooperation in both formal and informal settings. Numerous retina specialists have graciously offered their knowledge and insights to the community as a whole and especially to younger ophthalmologists through mentoring, the sharing of best practices, surgical videos, research findings, and presentations at meetings. The longtime contributions of Tarek S. Hassan, MD, of Associated Retinal Consultants and Oakland University’s William Beaumont School of Medicine in Royal Oak, Michigan, have been second to none in all of these areas.

Dr. Hassan is a past president of the American Society of Retina Specialists and currently serves as president of the global Retina World Congress and the Retina Hall of Fame. He is the founder of Club Vit and for 2 decades has been a founder and co-course director of the annual Retina Fellows Forum.

Dr. Hassan has been an investigator in scores of clinical research efforts, with a primary interest in vitreoretinal surgery, retinal detachment, surgical instrumentation, and macular degeneration. Retinal Physician recently caught up with this busy physician to get his insights on the positive impact of collaboration, collegiality, patient care, and the emerging landscape for potential new therapies for retinal disease.

Q. What attracted you to ophthalmology as a career, and retina as your specialty?

A. I always wanted to be the doctor who steps into an emergency situation and saves the day, so my first thought was to become a cardiothoracic surgeon. The long-term lifestyle didn’t appeal to me, so I looked for another specialty that also managed end-of-the-line emergency and critical situations. When I was 11 years old, a baseball to the eye left me with a retinal tear. From dealing with this, I at least knew something about the retina and its emergencies and was drawn to it, so I actually chose retina before I chose ophthalmology.

Q. Can you cite any specific mentors who had a positive impact on your career?

A. Fortunately, my parents, both doctors, never pushed me into medicine but did give me great guidance and displayed leadership by example. They were my first and greatest mentors.

When I was an undergraduate at the University of Michigan, Dr. Kenneth Mathews, a world-class allergist/immunologist, showed interest in me and gave me a lot of his time despite him being a giant in his field. He taught me a great deal about research but above all else, his humility, despite being such a renowned thought leader, made a lasting impression on me.

Dr. Kaz Soong, a cornea specialist at the University of Michigan, introduced me to ophthalmology research, and later, Dr. Mark Johnson, a leading retina specialist at the University of Michigan, who became my first great retina role model, showed me how to humbly excel at clinical care, surgery, and research. Finally, during my fellowship and early career at Associated Retinal Consultants and the William Beaumont School of Medicine, I was fortunate to have tremendous mentors — who then later became my partners and friends — most notably, Drs. Gary Abrams, George Williams, and Michael Trese. They have all guided me in many ways over the years and have shaped me into the retina specialist I became.

Q. You are in private practice with an academic affiliation. How does that combination give you the latitude to both see patients and pursue your research interests?

A. We are fortunate to practice in a type of hybrid model that we were among the very first to pioneer and that many other retina specialists have adopted in recent years. Our medical school affiliation and lab spaces allow us to perform all the basic science research we would like while our huge patient population and busy clinical service allow us to conduct numerous clinical projects and participate in many multicenter clinical trials. All the while, we have been able to function efficiently and under our own practice control rather than that of an overarching institution.

Q. You are a major advocate of collegiality and cooperation in the retina community. How do these qualities positively impact the community and patient care overall?

A. I was very fortunate to begin practice and become academically active at the same time as a number of other retina specialists who wanted to cooperate instead of compete with one another. Many of us became involved together through the ASRS (formerly the Vitreous Society) because it was open to all of us early in our careers. We have found legitimately great friendships among us and have done exciting work together. I founded a group called Club Vit, established to marry top-level science with great friendships in a very informal setting. Over the years, it has grown to more than 500 members and has fostered many fantastic lifelong relationships among many retina specialists and their families from around the world. In the spirit of fostering such collegiality in generations younger than ours, I cofounded the Retina Fellows Forum along with Drs. Carl Awh and David Chow. For more than 2 decades now, we have been able to bring many younger retina trainees and early career doctors together. We are particularly happy to see that the next generation of collaborative academicians have come along to form other groups, such as the Vit-Buckle Society, for example.

I have been committed to mentoring and to furthering the free exchange of ideas during my entire career and it has been the foundation on which I have planned educational programs, collaborative initiatives, and worldwide societal growth. Fortunately, such efforts have been successful in creating high-quality meetings and forming many mutual personal, industry, and organizational connections, like the Retina World Congress, which I have been honored to lead as its president.

Q. If we were to come back and talk 3 or 4 years from now, what changes could we expect to see in how retinal disease is treated and what would be the emerging trends in therapy? Could you comment on such concepts as the PDS, gene-derived anti-VEGF, and complement inhibition for geographic atrophy?

A. I expect the advances will be mainly on the pharmacologic side, with longer-lasting therapies for macular degeneration and diabetic eye disease leading the way. Hopefully, we will get away from doing so many injections. I have high hopes for the Port Delivery System (PDS; Genentech), which greatly reduces the treatment burden, but we have to remember that this, and many new drugs and concepts, will enter our world with significant technology and reimbursement challenges. For example, with PDS, we may need to take many people to the operating room to do the implant procedure. How will we handle that kind of surgical volume? Hopefully gene-derived anti-VEGF therapy such as those in development by Adverum and Regenxbio results in “one and done” treatment; if not, it will be helpful but not a home run. For treating geographic atrophy, we hope complement inhibition will at least be a springboard for use in combination therapy, if it is ultimately not the answer itself.

I also have great hope for work in neuroregenerative medicine. This could open new frontiers for us to actually reverse retinal and optic nerve damage thought to be previously irreparable.

Q. Do you see any place for oral or topical therapies for the treatment of retinal disease? A new trial for an oral therapy has just been announced by Ocuphire.

A. The search for an oral or topical therapy for retinal disease continues to be like the search for the Holy Grail. So far, both have been tried without success. The problem has been getting enough stable drug into the back of the eye to have a sustained therapeutic effect, something that injections are currently best at being able to do.

Q. What are your thoughts on the prospect of FDA-approved ophthalmic Avastin now in pivotal trials with Outlook Therapeutics?

A. I don’t think there is an obvious great need for it. The current federal regulations for compounding pharmacies are stricter than before and practitioners have gone to using nonsilicone syringes much more, so compounded Avastin has become much safer to use recently. Retina specialists who currently use Avastin often do so because it’s less expensive for the practice, patient, and payers and has a generally good efficacy and safety profile. If we get FDA-approved ophthalmic Avastin at a notably more expensive price, it will raise costs for all parties given that compounded Avastin will then become much more difficult to be justifiably used.

Q. You have done a great deal of research on the causes, prevention, and treatment of endophthalmitis with intravitreal injections. What advice do you have for your colleagues on the best way to prevent this frightening infection?

A. The best way is certainly to use povidone-iodine for antisepsis prior to injection. However, our findings from a large series we recently published confirm that povidone-iodine is the best preventive, as long as not used with viscous topical lidocaine as we showed this to be associated with a significant increased likelihood of endophthalmitis. Gloves, masks, and not talking have never been proven to raise the level of safety.

Q. What do you enjoy doing in your small amount of free time?

A. I love spending as much time as possible with my family. Fortunately they like sports like I do — playing and watching. I play as much tennis and basketball as I can and continue to practice martial arts, which I learned many years ago. RP