As part of our ongoing series, we sat down with RCA’s world-renown pediatric retinal specialist, Dr. Philip Ferrone, Vitreoretinal Consultants, Long Island, to learn what it takes to care for our youngest patients and what inspired him to pursue this specialty.
Why did you pursue pediatric retina care?
While growing up, one of my cousins was born with severe developmental issues. Although he grew physically, he never advanced past the cognitive development of a two-year-old and suffered from limitations stemming from cerebral palsy as well. His situation gave me great empathy. I knew I wanted to help children from that point. I was close to him as I grew up and witnessed firsthand the amount of care he required from my aunt and uncle to parent him and help with his physical and mental needs. To say it was a full-time job is a woefully inadequate understatement. Unfortunately, he recently passed away due to Covid-19.
What was your path in studying pediatric retina care?
After being the first of my extended family to attend college, I received my medical degree from Harvard Medical School. While in medical school, I was greatly touched by Dr. Michael Ehrlich, who was chief of pediatric orthopedics at Massachusetts General Hospital at the time. Although he had a different medical specialty from what I presently do, the way he empathetically dealt with the parents and affected children was incredibly instructive and rewarding for me. I eventually decided to pursue ophthalmology as opposed to orthopedics, but nevertheless learned much from my time with Dr. Ehrlich.
After an internship in Boston, I did my residency at the Duke University Eye Center. While at Duke, I met Dr. Eugene de Juan, who was influential in my pursuit of pediatric retina. He was well known for being innovative and an expert in pediatric retina. I was lucky enough to work under him, as well as Dr. Robert Machemer and Dr. Brooks McCuen while I was there.
From Duke, I went to Associated Retinal Consultants in Michigan for my fellowship and was fortunate to work under and subsequently with Dr. Michael Trese (the preeminent authority in surgical pediatric retina). He was and continues to be a wonderful teacher and role model with a kind and caring soul. Ultimately, he was the guiding force to fully cultivate my interest in pediatric retinal disease and its treatment.
Over the years, I have developed an expertise in all aspects of pediatric retinal care: genetic disease; developmental disease malformations of the eye and retina; premature babies with retinal detachments; trauma; and medical retinal diseases involving children.
What makes children’s eyes so challenging?
The size of an adult eye is much larger than a child’s eye. Children’s eyes do not reach adult size until approximately the age of 13, so there is a lot less area to work inside those eyes surgically. To give you a numerical perspective, a pediatric eye is a third to half the size of an adult eye. In children with some types of retinal detachments when the retina stretches and is tented up, it is much more difficult to get inside the eye to address the pathology. A child’s eye is considerably less forgiving compared to any adult eye. There is no room for error.
Why do you love working with children?
I love working with children and the challenges they bring for successful treatment. You are not only treating the patient, but their parents as well. Many times, someone will bring their child to me after seeking several other treatment opinions. They have heard from others that treatment is not possible and that being partially blind or fully blind is inevitable, which is heartbreaking for anyone to hear, especially the parents of a young child. We accept that as we grow old our eyesight will deteriorate, but not for children. I take each patient and look at them through the lens as if they were my own child, of which I have four sons. Everything is different with a child, starting with the examination, where you have them sit still and cooperate, to whether to perform the exam under anesthesia. Everything that is a standard adult protocol is different with a child. They are not just little adults with respect to disease or the approach you take.
And helping restore the eyesight of these children is so rewarding! It is like hitting a homerun, not a single or double. I could not imagine being in any other field. For example, in the recent past, I treated a 3-month-old from New Jersey for bilateral retinal detachments which were greatly affecting her vision. Her retina was pulled up and touching the front of her eye in both eyes. Most would say these large congenital retinal folds were inoperable. I knew that if we did not act, then she would be unable to see, and will have no functional vision. If I tried to do the surgery and reattached her retinas with success, then of course it is a big win. After reviewing the case, I realized that doing nothing was not a suitable option. So, we undertook the surgery one week apart for each eye. Fast forward to a year and a half later, her retinas are completely attached, and she has no significant cataract. Her parents were ecstatic that with her restored vision she can pick up small items like Cheerios-- fantastic!
Are you undertaking any clinical research?
I am always conducting clinical research. In my specialty of children, we perform ongoing surgical studies and look at unusual diseases like Stickler Syndrome, which can cause severe retinal detachment in one or both eyes. I have also been conducting research on combined hamartoma of the retina and the retinal pigment epithelium, which is a rare benign lesion found in the macula, juxtapapillary, or periphery and consists of glial and pigment epithelial cells causing retinal swelling and detachment in some cases. We have had great results operating on our patients with these uncommon diseases, amongst a host of other diseases.
What are the benefits you have seen in partnering with Retina Consultants of America?
RCA has helped greatly from infrastructure to best practices. As a pediatric retinal specialist, I not only see patients and run trials, but also, I must run the logistics of a practice. RCA’s depth of field and experience running businesses takes a lot of pressure off us on the local level. Their help lets me do what I love to do, pursuing research and helping patients.
Lastly, what piece of advice would you give your younger self entering the field?
You always must be cognizant of every detail and aspect of things. Though you can only guess how things may change over time, you need to be happy in what you pursue. For me that was working with children and understanding the challenges they face, as well as gaining comfort with the intensity of this field. In the end, it is extremely rewarding to follow your passion and do what you love.