This transcript has been edited for clarity.
Hello, I’m Eugene de Juan, MD. I’m an ophthalmologist at the University of California, San Francisco, and also a serial entrepreneur.
I’m very honored to be giving the Sutro Lecture. It’s very important to me. There’s a long list of people who have given this lecture every year at Glaucoma360, and it has been very impactful to me personally and to the field. It’s important to understand how important philanthropy is. I’ve been in university settings my entire career—over 45 years—and it just can’t be emphasized enough how important it is. It’s a great honor to give the Sutro Lecture.
From a personal standpoint, you might have seen that I’ve fallen—I’ve got a Band-Aid on my cheek. I was just walking and doing some texting and fell. As you know, in glaucoma, falls are much more common because of visual field loss, accidents when driving, and many other things that affect quality of life.
One aspect that is really important to me goes back 45 years. I was a first-year resident at Johns Hopkins at Wilmer, and a patient came in—an 11-year-old boy with a syndrome called Klippel-Trénaunay-Weber, which is a vascular disorder that can affect the eyes and can lead to glaucoma. His pressures were elevated, his optic discs were 95% cupped, but his visual fields were good.
We didn’t really know how to manage this type of patient, because if you operate and lower the pressure, you can get choroidal effusions, hemorrhage, and other complications. The risk of surgery was higher, but there was no medical therapy left—he was already on medications he could tolerate, and there was nothing more we could do medically.
As a first-year resident, I called around the country, talking to pediatric glaucoma specialists about how best to manage this patient. The person who helped me the most was H. Dunbar Hoskins Jr, MD. Everybody in the Glaucoma Research Foundation knows Dr. Hoskins. He was one of the founders of the Glaucoma Research Foundation, along with Dr. Shaffer and Dr. Hetherington, and he was also CEO of the American Academy of Ophthalmology for many years.
He was a wonderful doctor and guided us not to operate on both eyes—to operate on one and see how the other did. Of course, the worst case happened: the eye we operated on developed a choroidal effusion and took a long time to heal. Eventually, after years, it came back to its prior state, with elevated pressure. The visual fields were still full, but essentially nothing had been achieved.
On the other hand, the other eye remained stable. Now, 45 years later, the patient is doing well. I think Dr. Hoskins probably saved this patient’s vision by being conservative and guiding us to the best therapy. It had a lasting impact on me, and I wanted to share that story. GP