A Great Conversation With Larry Frohman

Rachel Calix (RC): Today, we have the pleasure of having a great conversation with Dr. Larry Frohman, who is a professor of ophthalmology and neurosciences at Rutgers-New Jersey Medical School. He has held many roles in the North American Neuro-Ophthalmology Society (NANOS) leadership, which I hope we will talk about today.

Great Conversations Section Editors: Meagan D. Seay, DO Rachel Calix, MD A Great Conversation With Larry Frohman Meagan D. Seay, DO, Rachel A. Calix, MD, Kathleen B. Digre, MD R achel Calix (RC): Today, we have the pleasure of having a great conversation with Dr. Larry Frohman, who is a professor of ophthalmology and neurosciences at Rutgers-New Jersey Medical School. He has held many roles in the North American Neuro-Ophthalmology Society (NANOS) leadership, which I hope we will talk about today. Welcome Dr. Frohman. Larry Frohman (LF): Thank you. RC: Can you tell us a little bit about your background before medical school? LF: Sure. I was born in the Bronx. I lived there for my first 6 years, and that accounts for my speech pattern and accent. I moved to Long Island when I was 6. I am the oldest of 3 children; I have 2 younger sisters (Fig. 1). After high school in Long Island, I went to Swarthmore College and there, I was a biology major and I made one of my big mistakes in life. I rushed through college in 3 years in a hurry to get to medical school. In retrospect, I think I sacrificed what would have been one of the most enjoyable years of my life, the senior year of college. Then, I went on to medical school. RC: What got you interested in medicine during your undergraduate years? LF: My father was a pharmacist in the days when pharmacists compounded medicines and, actually had some clinical interaction with their customers. Although he never talked about it, I think his plan was to use pharmacy as a pre-med training. I think he was going to plan to go to medical school, but I came along and I think that ended that plan. My mother, who was a teacher, had a much younger brother who is only about 10 or 11 years older than me. And he was almost like a big brother to me. He went on to medical school and became a very prominent academic physician, so that encouraged me as well. RC: What specialty was he in? Did he have any impact on what direction you wanted to go after medicine? LF: He sort of did. He was a clinical immunologist, and I almost went into immunology. That was my other choice. Kathleen Digre (KD): But also, I would say that is part of why you are interested in neuro-immunology even today. LF: Probably, yes. KD: Tell us a little bit about your journey getting into medical school. LF: When I was a senior in college, the first semester of my third year of college, my uncle at that point was at the University of Wisconsin. So, I had previously spent a summer doing some immunology research with him. He had some colleagues who allowed me to work at the University of Pennsylvania (Penn) in their labs. It was 4 full days a week, almost a whole semester, and I really enjoyed working at Penn. So, when it came down to applying to med school, because I already lived near Penn in the suburbs of Philadelphia, that was my top choice. RC: How did you end up in ophthalmology? LF: Okay, this is one of the good stories. So, in my last rotation of my third year at Penn, I had my neurology Departments of Ophthalmology and Neurology (MDS, KBD), Moran Eye Center, University of Utah, Salt Lake City, Utah; and Departments of Ophthalmology and Neurology (RAC), Ochsner Medical Center, New Orleans, Louisiana M. D. Seay and K. B. Digre are supported in part by an Unrestricted Grant from Research to Prevent Blindness, New York, NY, to the Department of Ophthalmology & Visual Sciences, University of Utah. The authors report no conflicts of interest. Address correspondence to Meagan D. Seay, DO, 65 Mario Capecchi Dr., Salt Lake City, UT 84132; E-mail: [e-mail] Seay et al: J Neuro-Ophthalmol 2023; 43: 277-285 FIG. 1. Larry’s first sharkskin suit, cufflinks and all, about age 10- “Maybe I had Graves’?” 277 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations rotation. The neurology service at Penn was largely an inpatient service, and it had 2 services. I forgot their names, but one had neuro-ophthalmology as the main feature, the other had the rest of neurology. I was assigned to the rest of neurology. But I knew I may be interested in ophthalmology, so I kind of begged the Dean in-charge of scheduling to let me switch. And he said, yes, if you get someone else to switch, and there was another student who did not want to do the neuro-ophthalmology side. So, we switched and I got permission to do that rotation. LF: The first week of that rotation, I got exposed to this wild, crazy, and enthusiastic faculty member teaching at a clinical presentation, a clinic conference, where a live patient was being used for demonstration. The patient was to be presented as an unknown, but the unusual part was that this particular professor did this backward. What he did was instead of getting the patient’s history and then examining the patient and trying to figure out what is wrong, the way he liked to do it was that he basically examined the patient without knowing the history and tried to make up what the patient’s history would be to match the examination. And it was hilarious, but very respectful of the patient. LF: He was trying to see how close he could get to the true history. And it kind of reminds me, if you know the movie “Young Frankenstein,” when Gene Wilder is examining a patient in front of his class, that role of Gene Wilder in this situation was played by Norm Schatz. It was Norm who I had been seeing doing this, and after that, I really was interested in neuro-ophthalmology. And I went to him and asked him whether there was a way I could do a student rotation with him. They really did not have a student rotation then. But he allowed me to do it, and I spent somewhere between 2–3 months at the end of medical school with Norm Schatz and his very young partner at that point, Peter Savino, and their fellow, Sue Benes. So, the experience with these 3 wonderful people cemented my plans to train in neuro-ophthalmology. Now, as for ophthalmology, what I did is, I independently asked Dr. Schatz and Dr. Savino, “If I want to do neuro-ophthalmology, should I train in ophthalmology or should I train in neurology?” They both gave me exactly the same answer. Train in ophthalmology, because it is easier for an ophthalmologist to pick up neurology examination skills than vice-versa. So, that is why I did ophthalmology. RC: That is a great story. I wonder, did you ever go back and do the same type of educational exercise that Dr. Schatz did? LF: No, I actually never have. Norm Schatz, as we all know, is one of a kind and I am not as good a showman as he is. [chuckle] RC: Okay, so I am assuming he is one of your major mentors. Who are your other biggest mentors? 278 LF: Yeah, those 3 were early mentors. But the big mentor who has been a part of my development over a very long period of time is Mark Kupersmith, who used to be at New York University (NYU) and has moved through various places in New York. When I was finishing medical school, family illness led to my needing to move from Philadelphia to New York to continue my training. I asked my mentors in Philadelphia, “If I’m going to go to New York and I want to train in neuro-ophthalmology, where should I go?” And they said, “Well, there is this really bright, young neuro-ophthalmologist there that you should talk to. You should go meet with Mark Kupersmith.” I met with Mark during my residency interview (Drs. Schatz and Savino greased the skids for that one). Mark, at that point, did not have a fellowship. He was really just in his first year or 2 of being an attending, and I mentioned to him what I had done and what I was interested in. He basically said, “That’s great. I know I can get funding. You will be my first fellow.” And that is why I did my residency there, so I could have some interaction with him during that period of time (Fig. 2). FIG. 2. Larry introducing his mentor, Mark Kupersmith, when he received the NANOS Distinguished Service Award at the NANOS 2009 meeting in Lake Tahoe. NANOS, North American Neuro-Ophthalmology Society. Seay et al: J Neuro-Ophthalmol 2023; 43: 277-285 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations LF: It turned out that I became his second fellow because when I was a senior resident, Floyd Warren, who was a year ahead of me at a different residency program in New York, basically had a fellowship slot open up and he became Mark’s first fellow. But I set up the fellowship with Mark. [chuckle] RC: That is great. LF: Mark may not remember that. But that is what happened. RC: When you were in your training with Dr. Kupersmith, where did you envision yourself being down the road? LF: I think pretty much where I am now. I really like the New York City metropolitan area, so I wanted to stay and I wanted to do academic medicine, and what actually happened is when I finished the fellowship and was looking for a job, there was one academic job in the New York metropolitan area in neuro-ophthalmology. It was at a place called New Jersey Med School, and I did not even know New Jersey had a medical school at that point. But I went to the interview, and they were really, very, very nice to me; they had not had a neuro-ophthalmologist for 3 years. They were really suffering from lack of coverage and teaching, and they were very welcoming. So, the interviews were great, and I decided I could become a Jersey guy and move across the river and work there, and I have been there ever since. As a Jersey guy, I had to learn to drive badly. RC: Would you say that there is anything about your training or your career that has surprised you or was unexpected? LF: Yeah, well, the program that I am at has had a long tradition for 50 or 60 years of not allowing faculty to have fellows. It sounds very odd, but we were the only ophthalmology training program in the state, and the feeling of the founding Chairman was that if we are going to train great comprehensive ophthalmologists for the citizens of our state, if we take fellows, it is going to water down their education, so I do not want you to do it. And they really stuck to that over the years. I had not been thinking about developing a fellowship training program when I first started out, but I did thereafter. But I knew it was not permitted, so I never did, and I think not training a fellow has affected me over the long-term much more than I really would have believed from the beginning. It is only really in the past few years that I have realized how much having fellows builds networks and connections and collaborators, and how much harder it is without that, besides missing the chance to mentor people. RC: Is there anything you would go back and tell yourself during your early career? Would you push harder for fellows or anything else? LF: No, pushing harder for fellows would not have done anything, it just would have made me leave. I do not think that would have been a good choice, because I think the Seay et al: J Neuro-Ophthalmol 2023; 43: 277-285 state and the institution have treated me well, and I think vice-versa is true. I think we have been a good fit. I think I should have focused more on my own career and developing my own areas of expertise than some of what I really did in volunteering, which was helping other people develop their own careers and their own expertise. KD: But that means that you are a very good mentor to many ophthalmology residents and other neuroophthalmologists along the way. Were there other mentors for you besides Mark, Norm Schatz, and Peter Savino? LF: Well, I mentioned Sue Benes earlier. Ron Burde, when he came to New York, was really very good to me. He quickly got me involved in some projects when he was involved with the academic ophthalmology Chairman’s group and had me help them on that and he helped me with some papers and academic projects. He was very, very good to me. That was over about an 8–10-year period, until he got sick. But he was very supportive. KD: Larry, tell us a little bit about how you came into NANOS. What was your first NANOS meeting? How did you get involved in NANOS? LF: Well, okay. So, when I was a fellow, Mark remembered to tell me about the Frank Walsh Society. I was a fellow in 1984–1985. So, in 1985, I started going to the Walsh meeting, but he forgot to tell me of the existence of NANOS. So, I actually did not go to a NANOS meeting or hear of NANOS until 1989. My first meeting was the cold weather meeting in Cancun. [chuckle] LF: For the readers who do not know, that was our first out-of-the-country meeting, it was our first warm weather meeting and a hurricane had ripped up Cancun a few months before we went there. The week we went, there was only one day that was above the 60s. It was often in the 50s; it was very cold and unexpected. You asked the question about my first meeting attended, but here is how I think I got involved in NANOS. There were 2 things that happened right around the same time. I had a lot of experience already volunteering at my school. I had been involved in bylaws committee for the medical school, bylaws committees for my faculty practice, and bylaws committee for the hospital. So, a lot of bylaws and other related stuff. Around 1990, Walsh and NANOS were starting to plan to merge, and they were looking for people to help write the bylaws of the combined group, and I think Mark told some of the elders that I had a lot of experience with bylaws. LF: This is my second or third year as a member of NANOS, only my fifth or sixth year of being a neuroophthalmologist. But, they threw me in and I helped them as Stan Thompson and some of the other senior people wrote the first bylaws for the combined group. So, that was one thing. The other thing, and Kathleen will smile about this because this is the precursor to NOVEL, actually, if you really look at the lineage. John Keltner, who was another 279 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations one who was very helpful, nice, and supportive of me, ran a teaching slide exchange for the chairs and the residency directors at the Association of University Professors of Ophthalmology (AUPO) meeting. I went to an AUPO meeting when I was transiently residency director at my place. LF: So, I basically asked how he did it and I set up something for NANOS where I got people to bring in their great teaching slides and we would project them and people got order sheets and they could say, “I want Slide 42; I want slide 47.” And in the first year or 2, there were very few, but we did it for about 7 or 8 years, and we were getting, toward the end, about 100 teaching contributions each year. What happened is the members would pay a dollar a slide and I would get all the slides copied, and I would have my then 8and 10-year-old kids fill the orders in slide sheets, and we would mail them out. With help from Andy Lee, that material actually became a combined American Academy of Ophthalmology (AAO)-NANOS Atlas of neuroophthalmology and later on became incorporated as one of the early assets for NOVEL. KD: It is still there on NOVEL, and some of those cases are really outstanding. LF: Yeah, I think those couple of things got me sort of involved a bit. Kathleen and I basically, were almost on the same time cycle. She was, I think, 2 years ahead of me moving up through NANOS. I became Vice President and then President, and I have worked my way back down. Now, I am chief cook and bottle washer, and I guess I have been Executive Vice President for 11 years now. KD: That is unbelievable. It seems like time has really flown on that one. Right? LF: Yes. Where did it go? RC: Well, what would you consider to be your biggest successes between mentoring and leadership and research? LF: Well, my biggest success, I think, is helping my wife, Judy, raise our 2 kids (Figs. 3–5). They have come out very well. But I will tell you a story about that in a minute. But the NANOS thing, I really think there are probably several others who played a bigger role than me, but I think I was there as NANOS moved from being just a meeting to being a society that supports its membership. I would like to think I played some role in that, and I think that is a success that I will always be proud of. KD: A huge, huge success, and it is a huge turn in NANOS, because it really was just a meeting for so many years and then getting new committees and doing more activities, and you have been right at the heart of it for so many years and now the Executive Vice President to be overseeing the whole thing. LF: Yeah, if only you knew how many emails I get from NANOS on any given day, because I am on every committee list server. KD: I just remember being on the board and having a 100 emails almost every day during that period of time, I 280 FIG. 3. Larry’s parents, Pete and Arlene, with his wife, Judy, and sons, circa 1991. can only imagine what it must be like now when it is so much bigger and more complicated than it was 20 years ago. So, NANOS Executive Vice President has got to be up there in one of your life successes because you have had a tremendous impact on the direction of the organization and how it is set up now. LF: Thank you. I will tell you what stuns me still is a couple of months ago, this happens like once every few years. A couple of months ago, a very senior member emailed me thanking me for all I had done for NANOS, and that just blows me away because I just look at it, and think that I was just trying to behave the way we should all behave; that we should help each other do what we need to do. KD: Yeah. How did things work with you and Tom, because Tom had been the Executive Vice President for years and years and years, and that was a major change in shift in the organization to see the Executive Vice President go to a different person, and they could not have picked a better person, of course. But how did that all work? LF: I do not think there was any friction whatsoever, and the reason why is that Tom made it known to everyone that he did not want to stay as Executive Vice President forever; Seay et al: J Neuro-Ophthalmol 2023; 43: 277-285 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations FIG. 4. Larry’s older son Daniel, who earned a doctorate in chemistry, with his cat Alfred. that he was getting tired of it. And I never campaigned for this, but the board just asked me to do it. So, he is another one I should have added as a mentor, not a mentor in my practice, not a mentor in the academic work I did, but a mentor organizationally. He helped me to understand what I had to do, and actually after him, I should also say that you too, Kathleen, you mentored me. You were the Board Chair when I was President; you were the President when I was President-Elect, so I should not forget that. Neil Miller, over the years has also helped me. I believe when you were President-Elect, Neil was President, and I was Vice President. He was instrumental in some of the reorganization of NANOS and was very helpful at teaching me the right direction to go. KD: Another thing I am really curious about, Larry, is your big interest in sarcoid and the neuro-inflammatory disorders. You told us about your uncle and the neuroimmunology, but there has got to be some more to that story. LF: Not really, I had always been interested in immunology, and as I said, I almost went into that field. And I believe in my residency, internship, and fellowship in 5 years, I had seen one patient with sarcoid, that is it. Then, I came across the river to New Jersey, and I do not know why, I think it was maybe because there was no neuroophthalmologist there for 3 years, and I just got inundated with these interesting cases. But we were finding all this sarcoid, which I really think was pretty endemic in the Seay et al: J Neuro-Ophthalmol 2023; 43: 277-285 FIG. 5. Larry’s younger son, Charles, who has a doctorate in food science chemistry and works for Coca-Cola. Newark, New Jersey area. And it was just a matter of the patients teaching me, and me teaching myself what the patients did not teach me that I needed to know, and I got really lucky. So, I should include as a collaborator, he I s really not a mentor, the Chief of Allergy and Immunology at our school. He was more a clinical immunologist than an allergist, a gentleman named Leonard Bielory. In fact, he has actually spoken at NANOS on the platform once or twice. LF: He and I started at the med school on the exact same day just by chance, and we met in some meetings. So, I learned that I may not have gone into immunology, but I had a guy to rely on who had almost gone into Ophthalmology, that was his other interest. And very interesting, all these years later, his son is an ophthalmologist in our area now. So, I was lucky I had an immunologist available who was interested in ophthalmology, and we collaborated a lot. He probably wrote 20 papers with me, and I worked in his lab for a while when I was trying to do some basic work and he was very interested in sarcoid. He was actually trained by Dr. Fauci, and his real area of interest was not sneezing and sniffles and allergy, it was vasculitis and autoimmune disease. Sarcoid was one of his interests. 281 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations KD: Wow, and you have written so much about autoimmune disease in neuro-ophthalmology. LF: Well, also a good piece of it came from Ron Burde and Mark Kupersmith. Remember Ron is the person who described autoimmune optic neuritis, and many of these cases were probably what we would now label as myelinoligodendrocyte glycoprotein (MOG) antibody disease (1). And he got me interested in that area. RC: Well, going back a minute, you said that there was a funny story you wanted to tell about your kids or your family. LF: Oh, yeah, yeah, yeah. So, you asked me what I am proud of. I am proud of what my kids did and as I said, it is mostly my wife, Judy’s, doing. My sons are 2 years apart, they both went on to get PhDs in Chemistry and we had this wonderful experience of getting to go to their PhD graduation ceremonies, except they were both on the same weekend, 400 miles apart. KD: Oh, wow. LF: So, what do you do? Do we split up, with one going to one graduation, and the other to the other? So, what we did is, and fortunately, they were both day-and-a-half events, so we both went to one. And then, through the night, we drove 400 miles to go to the other for the second half. That does not happen too often, I don’t think, to too many people, but it was great. KD: That is a good story. Wow, and they must have been really pleased to see you both come to both of their graduations at the same time. LF: Well, you know the way it is with sons; they may be, but they would never admit it. KD: Yeah, kids do not admit it until they get older. When they get older, then they say how happy they were. Well, you probably do not have a lot of free time, but what do you do with your free time now? (Figs. 6–8) FIG. 6. Larry and his wife, Judy, being served high tea in the wilds of Kangaroo Island in Australia when he was invited to speak at the 2013 Neuro-Ophthalmology Society of Australia (NOSA) meeting. 282 FIG. 7. Larry and his wife, Judy, working hard for NANOS checking out the Hilton Waikoloa about 18 months in advance of the 2018 annual meeting. NANOS, North American Neuro-Ophthalmology Society. LF: A lot of my free time is devoted to being a foodie. I do not mean a foodie in the sense that I may plan a vacation around going to a particular restaurant elsewhere in the world or the country. Also, I cook, but I do not as much as I used to. It is interesting that I found in my younger days when I was a resident, in particular, I had more time to cook in my early years of being a faculty member. I think the difference was I cooked more before I had children. But I still do it intermittently, and I do not know if you know of this ridiculous thing that happened with the first remote NANOS meeting. Did you know that I had to make a cookbook? FIG. 8. Larry and Judy enjoy nature photography as a hobby —here, an observer helped by taking their picture at Spirit Island in Maligne Lake in Jasper National Park in Alberta, 2019. Seay et al: J Neuro-Ophthalmol 2023; 43: 277-285 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations KD: No. LF: No? Okay. So, this was not my idea. Someone on the board had the idea that if we were not going to have a banquet where the members would be sitting and eating together, that what we should do is have a meal that people could all cook remotely, and they could get on the phone or talk to each other afterward about the meal that they shared remotely. And I still do not know, it is a secret, who was the person who volunteered me for this. It certainly was not me. But they said, “Well, could you do this?” So, if you go back around January 2021, you will find emails from NANOS that has an 8-course dinner with various options in it for veggie main courses or meat main courses, desserts, side dishes, sauces that I actually made up and sent out (Fig. 9). And I will tell you a secret. This is, actually, very touching. It turns out that about 6 people admitted that they actually, made the recipes, and one was Tom Carlow. And a few days before he died, Tom emailed me saying how great that recipe was. KD: Oh. That is so wonderful. Oh, so cute. Would you share those recipes with us that we could include in your great conversation? LF: Okay, so that is one thing I do in my free time. I cook, I eat, but the other thing is, I like live comedy very much and prepandemic, we would go to live comedy shows all the time. KD: Oh, that is cool. I want you to tell us a little bit about your gourmet group at NANOS, where you would bring wines. Tell us a little bit about that group and how it started? Also, about the time at Snowbird where there were issues with the state liquor laws. FIG. 9. The menu created to allow NANOS members to “share” a meal together during the virtual meeting in 2021. NANOS, North American Neuro-Ophthalmology Society. Seay et al: J Neuro-Ophthalmol 2023; 43: 277-285 LF: I will tell you the whole story. Now, let me start with the name. The name is NO GIRLS. Now, I have to tell you the origin of NO GIRLS, because it was not a sexist name at all, but here is what happened. There were always 6 or 8 people who got to see each other twice a year at the Academy of Ophthalmology and at NANOS meeting who really liked going out to restaurants. And they would talk in advance and say, “Do you want to go try this restaurant? Do you want to go try that restaurant?” It started growing where other people heard that we were going to nice restaurants, and they said, “Could we join you? Could we join you?” Sure, but it got to the point where you almost had to take over a whole restaurant or have a catered event for 30–40 people. LF: One year, we were talking in one of the hallways at NANOS and disturbing some other people, so we said, “We’ve got to talk and plan this inside a room.” So, we ducked into one of the huge meeting rooms. And far away on the other side of the room, Cheryl Zaret, was meeting. And I am talking at least 50 yards. This is the big meeting room, the opposite sides. She was meeting with a few members of what was then Women in Neuro-Ophthalmology (WINO), and she came running back and said, “You cannot be in this room at this time.” We said, “We just need a place to talk for 5 minutes. We are nowhere near you. We cannot hear you. You cannot hear us.” She threw us out. So, we named ourselves then, and it was Neuro-Ophthalmology Gourmet Imbiber and Restaurant Lovers Society, NO GIRLS. And, of course, we had many female members. We had gotten big enough that we would go to the hotel’s nicest restaurant and talk to them months in advance about having a group dinner with a set menu, and at many of the places they would let us bring our own wines. Utah, of course, had those rules that you alluded to, and we met with the assistant catering manager months in advance over the phone and she okayed the whole thing. LF: She knew we were bringing wine and we did it. After our dinner, she got fired, and the reason she got fired is no one had told us that you could not do that in Utah. She just thought because we were a big customer with 500 people coming into the hotel that she should bend over backward. The catering manager fired her, so we then went and met with the catering manager, and said, “Listen, this wasn’t her doing. I think she was just trying to be nice.” They hired her back, but it was an uncomfortable 12–24 hours once we learned that, but we do not do these giant meetings anymore. LF: It had gotten too hard to arrange, even before COVID, we were starting to break it down to 8–12 people. As the meeting schedule got tighter and tighter and tighter with more things scheduled, at NANOS and at the Academy of Ophthalmology, it got harder to do that. So now, there is a group of like 6 hardcore people that meet all the time, and usually in any one location, 2–6 other people will say, “Can we join you this night?” And we just set up these dinners. 283 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations KD: Oh, that is really a good story, I love Cheryl Zaret too, because I can imagine her going over there and saying that. That is funny. LF: I am going to get into so much trouble for this interview. RC: So, what advice do you have for those in their early careers? LF: No matter how hard you are working in your early years to just scrape by and do the essentials, you sort of have to try to remember what your long-term goals are and try to reserve some time for those. That is also a thing that volunteering can get in the way of, and that is one of my regrets, so I counsel people not to make those kinds of mistakes. You cannot fill your time with everything your Chair wants you to do, you have to retain some time for doing what you want to do. And I am not talking about leisure activities now, I am talking about academically what you want to do, so it may mean developing an area of research that you want to foster over the years, but you have to retain some time for that. The other thing that I think those in their early years need to remember is that NANOS provides young members with a large pool of similarly likeminded people, and most of them are more than willing to use their experiences to help teach you and help you through your travails. RC: That is great advice. And if you were trying to influence someone to go into neuro-ophthalmology, what would you tell them? LF: Well, how many fields are there where you can go in in the morning and not know if you are going to see something that you have never seen before, or maybe that no one has ever seen before? And how many fields are there that you may still, 85% of the time, be able to make the diagnosis that has eluded others without using any technology, such as genetic testing and MRI scans? I am not besmirching those, but our field still lets you use your detective skills in the history and your examination skills to make diagnoses and, to me, it is a career where you are never bored because every day you can go in knowing you may see something you have never seen. Also, of course, one of the things that is so unusual about our field is that there is not much competition between the members and it is because we are all so busy. So, you have this funny feeling, if someone moves into your area, you start off with the reflex feeling and you think, “Oh, I don’t want someone else here stealing my patients,” and then when you really think about it, you say it is a good thing. LF: I am not going to be working until 10:00 every night, and so that leads to some very interesting local collaborations. And, really, the big point is we do not compete with each other for patients, and that leads to a better ability to foster different kinds of relationships with colleagues. KD: I totally agree. Larry, is there anything else that you have not touched on? I know you have been really active in 284 your department in ophthalmology, you were active in AUPO and the AAO, and you have not even mentioned any of that. LF: Okay, okay, alright. I was sticking to the NANOS stuff. I will tell you, there was a period of time, when I was President of NANOS and I was President of my school’s faculty practice plan, and I was President of my school’s faculty, all at the same 2-year time. And you know, I was such an idiot for taking those on simultaneously. It was just overwhelming. But I just make the point because, if you are asking, I was involved in a lot of things, and at the same time, my involvement in the AAO has sort of dwindled. And the reason why is there used to be people at the AAO when I was younger who, like the Senior Vice President for education, really liked me and would let me do a lot of things, and we, actually, did the first patient simulations for the AAO. It was on a CD-ROM, and they won some very major awards nationally. I would spend about 20 hours in the 4 days at the AAO meeting at the booths demonstrating stuff and different products we had come up with. Then, this supportive Senior Vice President retired. LF: Let us just say that the next Vice President for Education and I did not see eye to eye on what priority should be in educating people, so I sort of backed out after about 12–15 years of doing that. So, I had been very heavily involved with developing materials to let people self-assess and self-educate, but backed away from that. I really was not involved with AUPO very much, just for a year or 2; I went to the meetings. It is at my school, I have had just about every role you can have. The practice plan one was another all-consuming role. As our school merged its practice with a large hospital network 2 years ago, the practice plan was gradually intentionally absorbed into that network. But for 30 years, I was an officer of the practice plan and President for 13 of them. So, that is how I learned about a lot of this economic stuff for NANOS. When I started with the coding stuff and all that, I was not an expert. I got involved in the practice plan because I tried to find out why they were only collecting 0.3% of my billings, literally, in my first year. LF: And I started exploring it, and then I ended up just learning a lot and getting very involved, and it helped me with the NANOS stuff because then I got to meet the people at AAO who were the ophthalmology coding experts. And we brought in consultants that I had learned of from being in the practice plan. We brought them into NANOS to help teach the NANOS members, and I think it was a good synergy. KD: And what a great contribution to NANOS because the business side of it is so important for neuroophthalmologists to keep their positions in academics, but also to be in private practice and everything else. Sometimes little attention is brought to that side, but it is critical. If you do not have resources, you cannot continue the mission, so that is really a great contribution, another great contribution. Seay et al: J Neuro-Ophthalmol 2023; 43: 277-285 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations KD: Larry, we are just so proud of you and all your accomplishments, and we want to acknowledge all of them, and especially to NANOS. Oh my goodness, you have been the heart and soul of NANOS ever since you took over from Tom, and it has just grown exponentially. We are all the beneficiaries of your tremendous involvement and sacrifice, because you did a lot of administrative roles that as you say, it takes away from other things that you might have enjoyed doing more. LF: Thank you, I will go public with this. My term expires in about a year, it is a 6-year term, and I would like to sign up for at least one more. KD: Wow, we are happy for that. That is tremendous. I am glad you are going to do that, that is just great. LF: I figured, I could get the word out. I should add that I have been fortunate to have Roger Turbin as my Seay et al: J Neuro-Ophthalmol 2023; 43: 277-285 partner in crime in our department for about 20–25 years. Without someone so competent to watch my back when I was out volunteering, I would not have been able to do so. KD: This has been a great conversation, just awesome! Larry we are so honored that you could spend the time with us so that we could have this conversation. LF: It is the reverse. I am honored that you asked me. KD: Well, we are the beneficiaries believe me. RC: Absolutely. Thank you so much. REFERENCE 1. Kupersmith MJ, Burde RM, Warren FA, Klingele TG, Frohman LP, Mitnick H. Autoimmune optic neuropathy: evaluation and treatment. J Neurol Neurosurg Psychiatry. 1988;51:1381– 1386. 285 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.