Matthew R. Starr
Assistant Professor of Ophthalmology
Mayo Clinic
Retina Round Up – Assistant Editor
Charles P. “Pat” Wilkinson is a Professor Emeritus from the Department of Ophthalmology at Johns Hopkins University. He is originally from Oklahoma, received his medical degree from Johns Hopkins University, did his residency at Johns Hopkins Hospital, and completed his vitreoretinal fellowship at Bascom Palmer. Dr. Wilkinson is a monumental figure in the field of retina and is a pioneer in vitreoretinal surgery with too many accomplishments and past presidencies to list for a single blog post.
I myself am also originally from Oklahoma and thus grew up a huge Oklahoma Sooners Football fan. So to have the opportunity to interview not only a retina legend, but also the son of the famed Oklahoma Sooners head coach, Bud Wilkinson, was a once in a lifetime opportunity. Below is the transcription of our interview discussing his background, some pearls for those early in their careers, and also about the early days of the journal, RETINA. This interview also took place soon after last year’s football season, so we had a great time off camera discussing the recent events surrounding Oklahoma football. Enjoy.
Matt R. Starr: How did you choose retina?
Charles Pat Wilkinson: I’ll start off by saying I’ve been very, very lucky. I was resident in Ophthalmology at Hopkins, after going to medical school there. In those days, the rotation through Ophthalmology was mandatory, so everybody saw most of the subspecialties. I just really liked Ophthalmology and when I was on my two week rotation, retina seemed particularly attractive. It wasn’t until I was subsequently selected for the residency where I saw more of retina and decided to pursue that. Again, exceptionally lucky to be selected at Bascom Palmer for fellowship, when vitrectomies were just getting started. I was not there for the first, but some of the first vitrectomies performed by Robert Machemer and assisted him when we had no intraoperative lighting amongst other things that we don’t have to deal with today. It was a terrific experience. After leaving Bascom Palmer, I went back to Oklahoma where I became chair of the vitreoretinal department. This was three years before the VISC became available. Robert had relatively strict control over this device and so there were a very limited numbers of these devices available at that time. In the meantime, a fellow named Nick Douvas developed a “roto-extractor” which was designed for pediatric cataracts, but also would chew up the vitreous. That became my instrument du jour, well more than a jour, but maybe for a year or so. Then Conor O’Malley and Ralph Heinz came up with the three port vitrectomy system, a smaller device (20g) that separated the modalities of cutting, infusing, and lighting. Then that became the preferred device that we all employ, even up to this day, although with different names and improvements over the years. My tale is one of good fortune and being around at the right time.
MRS: On that note, is there anyone in particular that you felt helped guide you along your path?
CPW: Well, we were all stumbling initially, but certainly Robert Machemer, Tom Aaberg, and Ron Michels. We all kind of learned together. Robert had a vitrectomy meeting in Colorado every third year. This was an invitation you were dying to get. An awful lot of advances and ideas took place at these very early meetings.
MRS: Speaking of Dr. Michels, you currently are the most recent author of the textbook, Michels Retinal Detachment. That is still the gold standard for retina fellows and teaching vitreoretinal surgery. How did you get involved?
CPW: Well thank you. Ron and I were very dear friends. We talked about producing the book for years but never got around to it. Tom Rice co-authored many of the physics oriented chapters that neither Ron nor I were even close to being experts on. We sat down with our secretaries and divided up the chapters and produced the 1991 version. It is hard to imagine doing it back then without email or word processors. Our secretaries deserve a lot of credit, it was easy for us to dictate. It was a work of love and took a lot of work, but was eventually published by Mosby. Ron unfortunately died not too long after that first publication and so then Tom and I published a modest revision a few years later. Then the Ryan textbook took over the surgical retina arena. There still is an awful lot in the original textbook that is helpful for students, residents, and fellows. I’m always flattered and honored when someone will tell me how much they enjoyed the book.
MRS: There are countless pearls throughout the book with great images. The history and collection of historical techniques is unparalleled. For me, it was the resource in fellowship and to this day still go back to it when I have questions. Shifting gears, you have accomplished so much, what was the most rewarding highlight of your career?
CPW: It all seems so long ago, Matt. I’ve always felt my roles and president of this or that were attributed to the worker ants of the world. Virtually in every organization I was a part of, I started at the bottom and worked through committees and ultimately became chairmen. President of the Academy was an awful lot of work and responsibility. The Retina Society was a real honor on a much smaller scale. We had a terrific board and I remember that time very well. Chairing the American Board was perhaps the most tedious. Things were changing very rapidly during my tenure. The lifelong certification disappeared and we needed to develop an instrument to validate diplomates certification after 1992. A lot of people were quite hostile about it. That was a time I remember quite well. My experience on the FDA was very interesting. I can tell with the newspapers what goes on and nothing ever seems to change. Devices go from companies and then into the agency and then no one knows what happens, maybe sometimes it gets approved.
MRS: What devices were you involved with approving?
CPW: Mostly intraocular lenses and contact lenses, which I knew nothing about.
MRS: What was the most exciting moment of your career?
CPW: I’ve been blessed with so many, but really so proud along with Ron and Tom when the book was published. It was such an effort and would have been easier today. When I retired, I got a Masters in History of Medicine at Hopkins and when writing a thesis, realized how much easier it is to write now.
MRS: Speaking of history, is there any historical figure in ophthalmology you are most interested in?
CPW: I feel like I have lived with most historical figures. One in particular, though, I wish we knew more about was Custodis and his non drainage technique. He wrote in German of course and I think the war, even though it was well over, must have stifled communications between Boston and Germany. That’s a mystery I would like to know more about, but don’t think I ever will. It’s interesting to think that non drainage technique has been abandoned by everyone under 50. It was a pretty amazing observation by Custodis and I really wish I could learn more about it.
MRS: What career advice would you have for those early in their careers, residents, fellows, faculty?
CPW: My advice is to read everything you can. Get into every case you can. Work as hard as you can. Both Ron and I were fellows in Miami at the same time and had the fortune of having a fellow leave the program early and so our workload was tremendously increased. What a blessing that was. We saw at least 30% more than we would have. So, read all you can, do all you can, assist all you can. When you get into practice, try to find an organization that you can join and you can help, even at the real grunt level of committee and work your way up. There will always be those that love the profession and want to advance the progression. I think the Journal, RETINA, has done a great job of expanding. I remember when Sandy (chuckles), Ron, and I were kicking around even the title of that journal. What an amazing job he has done. And Terry (Dr. Brucker’s wife), we should not forget Terry.
MRS: Wait, there seemed to be a story around “kicking around the title”, tell me more.
CPW: Well, the only thing I remember that I think was funny, and I’m not sure Sandy does, but I’ve certainly teased him about it. It was around the time he was running the title by a few people and I know he got a note back from Dr. Schepens saying ‘There’s no such word as vitreal’ and we all got a big laugh out of that and so ‘vitreal’ was dropped.
MRS: Awesome story. Oh man. So you’ve obviously done so much for the field of retina, what do you enjoy doing outside of work?
CPW: Well diminishing as my poor body has deteriorated. I like golf, I used to play tennis, but I can’t play tennis any more. I have an avid tennis playing wife who plays almost every day. I end up walking a lot and have tried playing pickle ball, but my shoulder can’t hold up. So I’m approaching corn hole as my sport du’jour as the only sport I can compete in. these days.
MRS: Do you still golf a lot now?
CPW: Not particularly, but I should have mentioned golf because some of the more joyful times we experienced, particularly with Ron, who was a varsity player at Carolina where he went to college, was really good and really fun to play with. We frequently played with Danny Jones, Walter Stark, Mylan Van Newkirk. We were all thrown together at many many meetings and had a lot of competitions and lost many cases of beer (laughing).
MRS: What was your handicap?
CPW: I’m not very good, maybe an 18.
MRS: Same, I love golf, I used to be about an 18 too, but it’s been too long since I last played.
CPW: Well it’s hard to do when you’re genuinely working.
MRS: What was your favorite Ron Michels quote or quotes?
CPW: Well I have to give this some thought, Matt. I have a bunch. He was fond of putting people down, particularly in public or public forums. He frequently used the term, ‘Much ado about nothing’ to refer to certain steps of a given surgical case.
MRS: Last question, also being from Oklahoma, I’m a born and bred Sooners fan so I couldn’t go without asking you about your upbringing in Oklahoma and what it was like to be the son of Bud Wilkinson?
CPW: Well in retrospect, it was a surrealistic and very unrealistic time by todays standards. We lived in a small house and my dad was not paid a ton of money. He did, though, a lot of genuine innovations for the game of football and the players really did like him. It was truly a good time to be alive. Both my brother and I felt, and still feel, we were kind of in a fishbowl, always under the microscope. It was an unusual time, but we had many opportunities and travel, particularly within the states. I met a lot of people I would have never met. Again, I am a very very very lucky guy. Although he coached only 17 years, he then did TV for many years and so his exposure to the people of the nation was tremendous. Now, the coaches are making exponentially more money. Every coach in Norman, Oklahoma has a massive home (chuckling).
MRS: In Oklahoma, the name Bud Wilkinson was such a legendary name. And now, the football team is at such an interesting juncture with everything that happened at the end of last season.
CPW: I can tell you it was interesting. You may not know, my brother, Jay was an All American at Duke which was even worse than being Bud’s son. I can remember patient’s coming in saying, ‘I hope you’re as good a doctor as your dad was a coach.’ The second most common frustration was, ‘Are you Jay’ and I’d say, ‘No, I’m Pat.’ I’m only teasing him, those were flattering in their own ways.
MRS: Thank you so much for taking the time to chat with me today. It was truly an honor to get to talk with you and learn so much from you.
CPW: It was my pleasure.
