Lawrence J. Singerman, MD, FACS, with Retina Associates of Cleveland, has been a stalwart member of the retina community for more than 40 years, having been mentored by the legendary Dr. Arnall Patz at Johns Hopkins and going on from there to found the Macula Society at age 33, develop a major 9-office practice in northeast Ohio, and serve as a lead investigator on more than 120 clinical trials. While doing all that, Dr. Singerman has still found time to see patients all day every Saturday so that they could schedule an appointment time convenient for them. The Macula Society recently celebrated its 40th anniversary meeting in Singapore, so we thought it timely to ask Dr. Singerman to participate in this Q&A to look back at a remarkable career and also to look ahead to the future of retina practice.
Q. Why did you choose ophthalmology as a career?
A. Actually, I was offered a fine residency positon in urology; however, I didn’t like my general surgery rotation during internship. I was fortunate to secure an ophthalmology residency late in the game. I had always had an interest in ophthalmology and I could see that the specialty was advancing, with more research being done and new treatments being developed for major causes of blindness, so I made the switch into ophthalmology.
Q. During your fellowship at Johns Hopkins, you had the opportunity to work under Dr. Arnall Patz, who had already made a huge breakthrough by proving that ROP was caused by high levels of oxygen. What was that experience like?
A. This was a great opportunity because I could see that the biggest challenges in ophthalmology were in the retina. Dr. Patz was an inspirational man and a true mentor to me. He was among the first to manage DR and macular degeneration through interpreting fluorescein angiograms and using thermal lasers for treatment.
The Diabetic Retinopathy Study during my fellowship proved that laser treatment reduced the risk of blindness by about 50%. It also helped set standards and provide a springboard for the many National Institutes of Health-sponsored clinical trials that followed, not just in ophthalmology but in all of medicine. With macular degeneration, we found, again through clinical trials, that laser treatment reduced the risk of blindness. Later on, with advances in imaging technology and treatment modalities, we were able to treat certain types of closer to the center. Many such advances, both then and now, evolved through research and interactive discussions among the investigators in the studies.
Q. You were only 33 when you founded the Macula Society. Wasn’t that a very bold move for someone who was relatively new to the retina community?
A. Yes, but I did first consult with highly respected retina specialists, including Dr. Patz, who said it was “a nice idea,” and they encouraged me to go ahead. I could see that we were accelerating advances in managing important medical retina diseases, and I wanted to create a forum where these papers could be shared and discussed.
Q. You used a little “showmanship” to get the retina community interested in the Macula Society, correct?
A. I don’t know if I would call it showmanship, but the highlight of our first meeting was a debate between Donald Gass and Jerry Shields on the topic of ocular melanoma and that got everyone’s interest. I brought the first meeting to Key Biscayne because that’s where Don Gass lived.
We had a famous ophthalmic pathologist, W. Richard Green of Wilmer Eye Institute, sitting in the front row. Everyone was watching his contributions to the discussions, because he was considered one of the most knowledgeable among us. I also was able to get Dr. Patz to serve as the first president of the Macula Society and Donald Gass as the second president, which gave us instant credibility and a good start with 63 original members.
Q. The retina subspecialty has been remarkable in the number of organizations, meetings, and mentoring opportunities that are available to the members of the community. Do you think you set the tone for this kind of collegial environment by starting the Macula Society?
A. I’ve attempted to set the tone for sharing ideas and advancing research, but all the retina-related organizations and meetings are helping to advance the subspecialty. We have a very good relationship with all of these groups. The Retina Society, the American Society of Retinal Specialists, and the Macula Society have created a committee of 6 members, 2 from each society, to rapidly respond to urgent retina-related issues brought to us by the AAO or branches of the US government. We really have developed this wonderful collegial spirit that makes it a joy to be in retina.
Q. How does one gain membership in the Macula Society?
A. It’s a rigorous process, with 8 separate criteria that are used to assess an individual who applies. The application is reviewed and graded by 8 different members independently before a meeting to discuss the final choices. It’s a similar process for accepting research papers for presentation. A lot of very good ones don’t make the cut. But we now have more than 450 members worldwide, and we normally hold an annual meeting outside of the United States every 5 years.
Q. You have served as a lead investigator in approximately 120 clinical trials for ophthalmic drugs and devices. Why do you believe so strongly in the value of the clinical trial process?
A. I have tremendous respect for the whole process. It’s very rigorous and challenging, but that’s important for the safety of our patients. Conducting a good clinical trial requires excellence on everyone’s part — the pharmaceutical company, the FDA, the clinical investigators, the study coordinators, and the patients, who have to commit to the study as well. While the studies are a lot of work, when a treatment is approved by the FDA, the payoff in benefits to patients is huge.
Q. Though I’m sure you have very little of it, what do you like to do in your free time?
A. I do play golf, but poorly. I spend a lot of time with my family. But really, I am passionate about my work, and I would rather spend my time doing something of value rather than doing something, like golf, badly. I do spend time in the winter in Florida and I have a faculty position with Bascom Palmer that allows me to see patients in their Palm Beach Gardens facility, which works out very well. I must say that, as the years go by, spending more of the winter in Florida has become appealing to me. RP