Drawing from his vast experience in ophthalmology and as a cornerstone of the Detroit Institute of Ophthalmology, Dr. Philip Hessburg discusses his pioneering work, the ever-evolving landscape of bionic vision, and the challenges and aspirations for the future.
Dive into this candid conversation as Dr. Hessburg retraces his journey and shares valuable insights on a subject close to his heart.
Dr. Hessburg, you have had a long and impressive career that brought you from Wisconsin to Detroit and culminated in you being named the inaugural Chairholder of the Philip C. Hessburg, M.D. – Art Van Elslander Chair in Ophthalmic Research at Henry Ford Health. What inspired you to dedicate your career to research and treatment in ophthalmology?
[Philip Hessburg (PH)] The path I took to become an ophthalmologist was not straightforward - in fact, I actually began my medical career studying urology at the University of Marquette in Wisconsin. It was during this time that I was invited to join the Air Force where I trained and served as a flight surgeon. It was there that my career path and interests took a turn. As a flight surgeon I encountered various medical conditions, including those related to visual impairments, and I became enchanted with the study of the eye. During these years, I began to develop a deep fascination with the field of ophthalmology.
After several years in the Air Force, I found myself reevaluating my career choices. I decided to shift gears from urology and reapply for a residency in ophthalmology at the Henry Ford Hospital. From then on, I knew I had found my true calling and I've never looked back since. I stayed at Henry Ford for about 13 years until entering private practice, and returned to the Henry Ford Hospital about 20 years after. I can honestly say that pursuing the study of ophthalmology was one of the best decisions I have ever made. In fact, aside from the day I married my wife Betsy, the day I officially became an ophthalmologist was the greatest day of my life. The study of vision and the eye is so rewarding and captivating, and I’ve wanted to contribute to it through research ever since my time as a flight surgeon. Now, I get to contribute to this field with the Henry Ford Health System as a physician, and with the Detroit Institute of Ophthalmology through conferences, research, and education.
In 1972 you co-founded the Detroit Institute of Ophthalmology (DIO). What inspired this venture, and what factors contributed to its success?
[PH] After a four-year residency in ophthalmology, I started a research lab in the Henry Ford Health Systems. We studied the aqueous - the liquid inside the eye - in patients diagnosed with sterile uveitis. A substantial government grant enabled me to hire a dedicated team including Patricia McDade and Lloyd Dutcheshen. However, during Lyndon Johnson's presidency and his consecutive coronary artery episodes, governmental research priorities shifted towards heart disease. Even though our grant was approved annually, one year, it was approved but not funded. That meant that I had to let go of my dedicated staff. It was a terribly upsetting, pivotal moment that made me vow never to rely on government funding.
Around this period, my wife Betsy and I faced the challenge of funding our five children's impending college educations. Recognizing that my current salary wouldn't suffice, I left academia for private practice. An esteemed ophthalmologist, Jim Marshall from Grosse Pointe, had extended offers to collaborate. I finally took him up on it, and together we started a practice.
However, after two years, I became anxious to return to some level of education and research. I missed that so much that I talked Jim into allowing me to start an eye institute. In order to do that, I put together a plan and obtained a tax-exempt status known as IRS 501(c)(3). Our next hurdle was finding a location. Nearby, an unused Chrysler car dealership piqued my interest. I tried to convince Chrysler that it was to their advantage to give away their building for free, but initial negotiations were unsuccessful. Undeterred, we presented a financial strategy highlighting the tax benefits of donating the building to a 501(c)(3) entity. Convinced, Chrysler generously handed it over. With the building secured, we approached potential donors. Successfully raising $300,000 from 30 mini mortgages, each valued at $10,000, we transformed the car dealership into an eye institute. And that’s how the DIO got started.
What inspired you to start The Eye and the Chip congress and what was your vision for it?
[PH] After launching the DIO, my longing for research intensified. While at Henry Ford, we had aspired to buy a $300,000 electron microscope, but funding constraints made it unattainable, so the board urged me to pursue a low-cost research area. With a team of physicians, we brainstormed around a dozen potential projects, seeking answers in areas like glaucoma and retinitis pigmentosa. After careful deliberation, we narrowed our focus to two primary subjects: artificial vision and driving in ophthalmology. This led to the inception of The Eye & The Chip congress in artificial vision and The Eye & The Auto in drivers and vision.
Recognizing our limited expertise, we sought prominent investigators in these fields who would be interested in co-organizing these events. For driving and vision, we collaborated with Cynthia Ousley from the University of Birmingham, Alabama. Even two decades later, she remains the leading authority on the visual requirements for safe driving and is the co-organizer of the eye in the auto initiative.
For artificial vision, our research led us to Joseph Rizzo from Harvard Medical School. Renowned for his contributions to the field, Joseph became the organizer for The Eye & The Chip congress and maintains that role 20 years on. We followed a similar model to the Auto congress. We are the only research congress I know of that allows each presenter 20 minutes (carefully timed) and then includes a 10-minute challenge period. This format was very important to us from the beginning, since at other conferences, if you don’t want to tolerate any questions, you would just talk past your assigned 20-minute slot. That wasn’t going to be the way our congress worked. Our speakers knew that if they were going up on the platform, they would have to answer to experts in the field during the challenge period. And we have kept this format to this day.
How has the field of bionic vision evolved since the first The Eye and the Chip congress?
[PH] Our understanding and expectations of electronic imaging and vision from devices have evolved considerably. Despite hundreds of implants worldwide, a recurring feedback is dissatisfaction from recipients due to unmet expectations. This led to the dissolution of some developing companies and significant changes in our approach.
One key realization is our limited understanding of neuron interactions. Previously, medical school teachings emphasized three primary retinal components: rods, cones, and retinal ganglion cells. However, we now know there are up to 30 types of retinal ganglion cells. Their intricate communications, still largely uncharted, are pivotal to unraveling neural coding – how the brain deciphers visual stimuli.
Moreover, the sophistication of our implants must advance. An early model, developed by two brothers in Chicago, proved disastrous. There was also a notorious figure, Dr. Dobelle, who hastened to market an imperfect device that inflicted harm due to its unregulated electric outputs. In my opinion, it would have been better to improve the device before commercializing it. Dobelle’s actions considerably impeded our field’s progress, as it made potential patients wary of the technology and scared away potential investors.
There are varied strategies for placing retinal devices: atop, within, or behind the retina. Though none have yielded desired results, they have offered invaluable insights. Although conditions like retinitis pigmentosa and macular degeneration progress with age, the afflicted individual retains the ability to perceive visuals even with dysfunctional rods and cones. Their existing neural pathways to the cortex remain intact, and our challenge lies in leveraging that potential. In addition, cortical approaches are equally important - historical attempts at implanting the visual cortex date back several generations. Such an approach is critical for those with complete retinal damage, such as individuals with retinoblastoma and soldiers suffering injuries to their eyes. In October, experts will discuss their experiences with these devices, broadening our understanding of the interaction between these devices and the brain.
What major challenges does the field of bionic vision face today, and what are your hopes for the future innovators and research in the field?
[PH] The ultimate goal in ophthalmology is to preserve or restore vision. There are four principal approaches to artificial vision: gene therapy, optogenetics, nanoelectronic devices, and stem cell research. It remains uncertain which will prove most effective. My focus has been on visual neural prosthetic devices because of the human body's proven tolerance for other electronic devices. For instance, my heart continues beating due to an electronic pacemaker.
While I've championed electronic devices, there's significant debate surrounding the other approaches. Gene therapy is complex; manipulating one gene might have unforeseen consequences on neighboring genes. Moreover, we can't fully predict the long-term outcomes of altering one's genetic makeup. Stem cell therapy has similar uncertainties. There's a commercial lure, especially in places like California, promoting stem cells as a miraculous solution for various ailments. But introducing stem cells into a body part, like the eye, is unpredictable. There's no guarantee they'll develop into desired cell types. Worse still, these pluripotent cells could uncontrollably multiply – the very definition of cancer. Hence, the promise of stem cells, while tantalizing, comes with great uncertainty and potential risks.
In October, experts will convene to discuss and debate these strategies. Many will question the continued investment in electronic devices, advocating instead for newer methods like optogenetics. As for predicting the future of these treatments, I can't say. I leave that to the next generations, like my grandchildren, who may provide the answers we seek.
What advice would you give someone who is just starting out in the field, or is considering a career in vision restoration?
[PH] That it is an angelic pursuit. I sincerely hope you consider delving into it, take lessons from the past missteps, and employ your youthful intellect to help conquer the challenge of vision impairment. I'm ardently hopeful that my talented grandson, an athletic yet brilliant young man, will choose to contribute to this field. While some might dissuade him, I genuinely believe that those dedicated to alleviating the suffering of others will earn a special place in the afterlife. This is a virtuous path. Whether or not one believes in an eternal journey or fate, I do. And I'm convinced that true sainthood is reserved for those who dedicate their lives to bettering others.