Melissa Yuan, MD
2nd year retina fellow, Stanford University
Schepens Award Lecture: “The More Things Change, the More They Remain the Same: 40 Years After Starting Retina Fellowship in 1986”
The Retina Research Foundation’s Award of Merit in Retina Research, established by Dr. Alice McPherson in 1978, was presented this year to Drs. Susan and Neil Bressler, who then delivered the accompanying Schepens Lecture. Introducing them, Dr. Jennifer Lim, herself a former “Bressler fellow,” described a partnership that began at orientation at Johns Hopkins School of Medicine in 1978 and grew into four decades of pioneering work on the natural history and treatment of AMD and DME, leadership within DRCR Retina Network and the Wilmer Eye Institute, and mentorship of generations of trainees.
Dr. Susan Bressler used diabetic macular edema to show how much can change in one career. When the Bresslers were residents, DME was diagnosed by fundus biomicroscopy and stereo photographs, and the ETDRS had just introduced focal/grid laser. Today, diagnosis is OCT-based and quantitative, and DRCR protocols have guided the use of anti-VEGF agents, corticosteroids, and laser. Protocols T and V refined treatment further; in Protocol V, about 85% of eyes with good vision remained 20/25 or better regardless of initial strategy. On newer agents such as faricimab and aflibercept 8 mg, she noted that neither has shown superior visual outcomes to aflibercept 2 mg. She called for a head-to-head trial that allows aflibercept 2 mg to extend beyond 8 weeks, pointing out that 42% of Protocol T patients needed fewer than four injections in year two. She observed that trainees master “the state of the art available at the time,” and must keep building on those skills as the field evolves.
Dr. Neil Bressler traced a parallel arc in imaging, from the fluorescein angiography that defined CNV in the 1980s and the Macular Photocoagulation Study to OCT, which now largely replaces FA and ICGA, and now to AI-based image interpretation. Drawing on his experience as editor-in-chief of JAMA Ophthalmology, he reviewed how journals have adapted to AI. Current guidance bars AI authorship, uploading manuscripts to chatbots for peer review, and AI-generated clinical images. He also cited evidence of chatbot-modified peer reviews and fabricated references.
The lecture closed on life beyond work. The Bresslers described taking turns prioritizing family, being home for dinner and bedtime, and the resistance Susan faced as one of the first women nationally to have a baby during residency. They noted that the principles of both science and life hold constant even as the details change.
