Thomas J Carlow MD, Founder of NANOS (1940-2021)

In Memoriam Section Editors: Kathleen B. Digre, MD Meagan Seay, DO Thomas J. Carlow, MD, Founder of NANOS (1940–2021) T homas J. Carlow (Fig. 1) was born in Cincinnati, Ohio, and was an only child. This circumstance accounted for the treasuring of his many friendships, some lifelong. In high school, he joined the band, played an alto saxophone, and performed at dances and weddings with 3 other members. He also planned parties and events with friends. He disappointed his parents in their desire that Tom pursue a career in engineering and negotiated a scholarship switch toward a career in medicine. No surprise, he was an honor student at the Xavier University and the University of Cincinnati School of Medicine. Fascinated with neuroanatomy, he entertained neurosurgery as a career choice but opted for neurology over psychiatry with a residency at the University of Michigan. There, he was advised to speak to a gentleman “doing something with eyes” and spoke with Todd Troost who sparked his interest in neuro-ophthalmology. A fellowship at the Bascom Palmer Eye Institute in Miami, Florida, followed. There, a model for what was to follow, was an annual winter neuro-ophthalmology symposium conducted by the fun-loving enthusiast, J. Lawton Smith. Seeking a university appointment in 1973, Tom was the first hire by the chair of neurology at the University of New FIG. 2. Tom and his wife Susan. FIG.1 Tom Carlow. 404 Mexico, Joe Bicknell. Dr. Bicknell was soon impressed with his “enthusiasm, ideas, and friendliness.” A Research Day with presentations by faculty and residents was proposed by Tom that included a fun-filled social activity, such as a run or tennis match. In 1975, he organized a neuroophthalmology meeting for general physicians at a ski resort. He coined the meeting, the Rocky Mountain Neuro-Ophthalmology Society (RMNOS) and designed the format. There were early morning lectures, time out for midday skiing, and presentations before dinner in the late evening. Interested in learning more himself, Tom invited presentations by accomplished academicians and skiers, such as William F. Hoyt, Robert Daroff, Joel Glaser, and Norman Schatz. Realizing that participants were pleased with the academic discourse as well as the ski runs, he invited additional neuro-ophthalmologists and advertised the meeting in neurology and ophthalmology journals. Attuned to the need for Continuing Medical Education credits and the benefits of independence, he had the Society incorporated in 1980. At each meeting, he unassumingly greeted as many newcomers and returnees as he could with a smile and attentively fixed blue eyes. All along, he signed meeting contracts, designed the course, invited speakers, edited a syllabus, and managed the finances. And woe to Selhorst: J Neuro-Ophthalmol 2021; 41: 404-408 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. In Memoriam those who were not timely with submissions or fully prepared for presentations. As Course Director, he was deeply dedicated to educational excellence and having all arrangements be as correct and as economical as possible. This included a modicum of time for recreational activities, too. In doing so, he kept a tight grip on the Society. And it grew from 50 or so to a subspecialty meeting of several hundred neurologists and ophthalmologists. International attendees were also welcomed from continents around the globe. Importantly, participants honed their teaching skills and expanded their research interests through these annual meetings. In 1986, bringing the conference out of the mountains, Tom renamed it the North American Neuro-Ophthalmology Society (NANOS). Warm weather meeting arrangements followed. In 1989, he supported the sponsorship of a neuro-ophthalmology symposium at the annual meeting of the American Academy of Ophthalmology. Then in 1990, a 20-year transition began. After 15 years of arduous attention to details, he began to ever so slowly loosen his firm guiding hands and draw upon the considerable talents of fellow neuro-ophthalmologists. An administrative structure was established with the Board of Directors and Officers. He was, not surprisingly, the first president and the second was his very trusted cofellow at the Bascom Palmer Eye Institute, James A. Sharpe. At that juncture, Tom became the first Executive Vice President of the Society. The next president, Steve Feldon, provided this insightful perspective: “Like every successful entrepreneur, Tom combined passion with diligence and skill .. Unlike most entrepreneurs, Tom’s humility and humanity never let his ego interfere with his mission. His personal integrity and collegiality are deeply embedded in the current culture of the organization.” The annual meeting continued to grow from several hundred to hundreds of attendees. Poster presentations and merger with the Frank Walsh Society occurred in 1991, and responsibility for the Journal of Neuro-Ophthalmology was accepted in 1994. One criticism of NANOS in these years was that the topical meeting format was too much like a series of book reviews. So, in 1997, Tom countered. With $25,000, he endowed an annual research award for the best presentation by a young investigator at the annual NANOS meeting. This gesture initiated a trend toward charitable contributions from members that in later years has become a notable strength of NANOS. Research presentations also subsequently flourished and necessitated a change to an allday, early morning to late evening meeting format. Amazed with the progress, he summarized the evolution of NANOS to that time in 1999 (1) and later added an oral history (2). In 2000, a professional management company was hired. This was much to the relief of his most trusted confidante, his very competent wife Susan (Fig. 2). She was serving as a fulltime, but unofficial, uncompensated administrator for NANOS. On occasion, his daughters Kathleen and Beth assisted as well. If Tom is the father of NANOS, it is no exaggeration that Susan is the mother. Consequently, Susan Selhorst: J Neuro-Ophthalmol 2021; 41: 404-408 was deservedly awarded one of the first of 5 Distinguished Service Awards. In 2002, he joined others in advocating NANOS support of an exceptional educational website, NOVEL, that continues in popular use to this day. Through all these years, Tom maintained a busy practice of neuroophthalmology in Albuquerque, New Mexico, actively published, and lectured independent of NANOS. He was especially honored to give the first William F. Hoyt Lecture for the American Academy of Ophthalmology in 2002 (3). In 2010, the 20-year transition to an open, self-guided organization ended. He stepped down as Executive Vice President and became a nonvoting ex officio member of the NANOS Board. In this capacity, he listened, admired the enthusiasm, dedication, and innovation in the leadership. Occasionally, he offered his own perspective. The succeeding Executive Vice President, Larry Frohman commented that Tom often whispered to him, “I never thought when we started that we would get this far.” Thus, with the combined efforts of numerous NANOS leaders and members, the Society now resembles current-day professional organizations. Many have contributed to the subspecialty of neuroophthalmology, but no one has advanced it more than Thomas J. Carlow. In 2020, he confidentially confided that no less than one of the 20th century giants of academic neuroophthalmology, William F. Hoyt, paid him the ultimate compliment. Dr. Hoyt told Tom that he admired him for bringing through NANOS the knowledge of neuroophthalmology to innumerable physicians and thereby benefiting countless deserving patients, more than he had himself. Tom died on March 15, 2021. May he rest in peace in recognition of NANOS as his outstanding lifetime achievement. He is survived by his wife Susan; son Thomas and daughters Kathleen and Beth; their spouses and 7 grandchildren. May they find much comfort in his extraordinary accomplishments. VIGNETTES I was the first woman president of NANOS, and Tom Carlow was there to always give his support and guidance. He was so proud that NANOS was flourishing. At almost every meeting of NANOS, Tom would say to me, “Can you believe this? Look at all of these people!” His warm welcome set a culture of “family” at NANOS. Blessed be our “father’s” memory! Kathleen Digre, MD Tom Carlow always saw himself as the conduit for others to enjoy the neuro-ophthalmology community as much as he did. And when I say, Tom, I mean Tom and Susan. They were a team, and her commitment was as unwavering as his. Of course, they are the predominant reason that the RMNOS, and its successor, the NANOS existed. They worked tirelessly to make them happen. What pleased them most, in my opinion, was not to see the meetings work for the senior members, who were all their good friends, but rather that NANOS worked for the newest members who 405 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. In Memoriam were destined to become their friends. Tom loved to meet and encourage and to befriend the new generation. Eventually, of course, that became nearly impossible when NANOS succeeded and its membership exploded. But although Tom was the very definition of the old guard, he was always forward thinking. I’ll never forget his powerful welcome to me 40 years ago, his support for all new members, and our little talks, in an alcove or corner when I would ask every year, “Did you think all this was going to happen when you started things?” His response was always a huge smile. Alfredo Sadun, MD, PhD The Division of Neuro-Ophthalmology at the University of Pennsylvania is forever indebted to Tom’s generosity and vision. We are proud and thankful for the support provided by the “Thomas and Susan Carlow Young Investigator Award” to many of our junior faculty. In addition, annually, we look forward to gathering with our colleagues at Tom’s NANOS meeting to learn from the experts and share scientific knowledge. To Tom’s credit, this conference has become the most important neuro-ophthalmology meeting in the world. Robert Avery, DO I had the privilege of taking a 2-month rotation with Tom when I was a senior neurology resident. He was a master clinician, teacher, friend, and associate. He and Susan treated me and my fellow residents like family. John De Witt, DO Thirty-five years ago, Dr. Carlow said to me, “Hey, Hershewe, I’ll get you into the meeting for free if you run the slide projector.” From the first time, I ran a slide projector for him, to the last time, I saw him walking on the beach with Susan in Florida, I grew to profoundly respect his gift for lifting up his patients as well as lifting up his colleagues with his knowledge and expertise. Tom was a mentor and a friend, and he will be dearly missed. Gerard Hershewe, DO Dr. Carlow was one of the great doctors, one is lucky to encounter! Most kind and understanding gentleman. I will miss him very much. Irene Vanek, MUDr, MD, FRCS Tom Carlow was always so welcoming and kind to new and returning members. He made a point to get to know each person and always went out of his way to make everyone feel a part of the neuro-ophthalmology family and was always a friendly face and a perfect ambassador for NANOS—one in a million person. Randy Kardon, MD, PhD I first met Dr. Carlow at the RMNOS meeting in Colorado, 1982. He waived my tuition as a fellow from Richmond, as long as I agreed to work the projector—yes, the projector! Richard Selbst, MD, FAAN I consider Tom the engine of today’s NANOS. No one else could have disciplined that group of multiheaded mon406 sters behemoth gentle giant, Tom. I don’t know how he managed both Schatz let alone Glaser and Hoyt and their offspring. I treasured Tom and what he accomplished. The friendship that brings joy remains in all my memories. Norman Schatz, MD Tom was the quintessential gentleman scholar—wry smile, quick wit, humble, and always present with NANOS best interests in mind. He remains a permanent part of the NANOS fabric. Eric Eggenberger, DO Tom and Susan were always very kind and welcoming, and I always looked forward to seeing them at NANOS meetings. What a great and valuable organization is NANOS. Neuro-ophthalmologists (and their patients) certainly owe much to its creator, Tom Carlow. John Charley, MD After I joined the NANOS board, Tom went out of his way to compliment me on my work and to make me feel that I was part of the team. Prem Subramanian, MD, PhD Tom was such a kind, cheery, and positive person, devoted, with Susan, to NANOS. And what a mind for detail he would display at NANOS Board meetings! Leah Levi, MD There would be no NANOS without Tom Carlow. Many, many years ago, he founded a ski meeting with a few of his buddies, who happened to be the leading lights in neuro-ophthalmology: The Rocky Mountain NeuroOphthalmology Club. He kept them coming year after year. Tom turned it into NANOS. Jonathan Trobe, MD I met Dr Carlow through Dr Feldon during my first NANOS meeting in Park City, UT, in 1991. Since then, my husband and I were always looking forward to see and talk with Dr Carlow and his wonderful wife Susan, during many NANOS meetings. Sending our heart-felt condolences to Mrs. Carlow and family. Dr. Carlow will be greatly missed by all! Vivian Rismondo, MD I met Tom in the early 1980s at the Rocky Mountain Neuro-ophthalmology Club meeting. Almost from the beginning, we shared our love for neuro-ophthalmology, skiing, good food, and fine wine. He recruited me to become the third President of NANOS, following Jim Sharpe and Jack Selhorst. We blue skied the future for NANOS together at his home in Albuquerque. Tom managed the educational component and Susan did all the administrative functions. At that time, we did not even imagine the success NANOS has experienced. For decades Tom, Susan, my wife Diane, and I enjoyed a tradition of sharing a meal at every NANOS meeting. . While eating and sharing a bottle of wine, we talked shop, but we also talked about politics, religion, professionalism, and shared our personal joys and disappointments. We shared war stories from our practice as well as from our residency and fellowship experiences. We were not just colleagues, we Selhorst: J Neuro-Ophthalmol 2021; 41: 404-408 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. In Memoriam were lifelong friends. Diane and I will miss Tom terribly. May he rest in peace. Steven Feldon, MD, MBA I met Tom at an early NANOS meeting when I was very new to the field. He always had time to chat and a kind word. We also shared a Michigan connection; he did his residency here. Wayne Cornblath, MD My first NANOS meeting was in 1990 at Steamboat Springs. I was a very green skier and a slightly less green neuro-ophthalmologist. Tom was more kind than I deserved in his evaluations of both my skiing and my presentations that year .. Anthony Arnold, MD I met Tom when he invited me to the RMNOS, who knows how long ago. He was a consensus builder and got all the naysayers to support NANOS, and we are all better for it. Without Tom, there would be no NANOS, and neuroophthalmology would have an inconsequential place in medicine. Mark J. Kupersmith, MD Tom and I went to high school together. After that we were in premed at the Xavier University, in Cincinnati, then attended University of Cincinnati College of Medicine. FOREVER IN COMPETION . Richard Welling, MD Fresh out of my first fellowship in peds ophtho, I was fortunate to work with Tom at the University of New Mexico. He immediately took me under his wing and convinced me to do a Fellowship in Neuro- Ophthalmology. He saw the potential in me and I will be forever grateful. He was my first mentor and a great man. I will miss him deeply. Chantal Boisvert, OD, MD Tom and Susan welcomed me into their home after fellowship with Simmons Lessell when I wanted to learn how to do Botox injections and had not learned that at Massachusetts Eye and Ear Institute. He said to come stay with them in their home and watch him inject for a day and I would be “good to go.” Well, he was right and I returned to Seattle and developed one of the larger practice for Botox for injections. I will never forget how gracious he and Susan were to me at that time. I am sad to hear this but have only wonderful fond memories of Tom. Steven Hamilton, MD I first met Tom when I came to Albuquerque to practice. He and Susan invited my family and I over for dinner. He was nearing retirement at that point but always looked out for me and supported me any way he could as I was starting out and stepping into his big shoes. He was a wonderful man and I owe him more than I could ever hope to record here. Kevin Sitko, MD During my fellowship with Norm Schatz and Peter Savino, Roy Beck, and I attended one of the first RMNOS Selhorst: J Neuro-Ophthalmol 2021; 41: 404-408 meetings, meeting Tom and his wife, Susan—and with his warmth, helpful suggestions, and presenting an environment of family (Susan radiated warmth and support for all of us as well) and intellectual challenge, realized that my decision to enter the discipline of neuroophthalmology was a good one. Later, as I entered a career in global health, Tom was still giving me good advice and fellowship. Craig Smith, MD Dr. Carlow’s vision and dedication established our community of neuro-ophthalmologists and allowed us to thrive by creating collegiality and friendship while maintaining medical and scientific rigor. Lynn Gordon, MD, PhD I first met Tom at the Durango NANOS (1994) as a first year ophthalmology resident. He was genuinely interested in knowing more about me. He introduced me to several of the pioneers of NANOS. He was an amazing individual and I will always respect him. RIP Tom. Anil Patel, MD I am so grateful to Tom for his vision of NANOS, and his love for the society, which never wavered. He was a kind and generous man and was interested in everyone! Patty McNussen, MD I met Tom and Susan in 1995 or 1996, I was just starting my career as a neuro-ophthalmologist and they were both very kind and welcoming, as they have been throughout the years. I will miss him. Michael Vaphiades, DO I am deeply saddened by Tom Carlow’s passing. I met him through John Keltner at NANOS meetings and also interviewed with him at New Mexico Eye Associates when I graduated fellowship. He was inspirational as a leader and a do-gooder. He set an incredibly high standard for neuroophthalmology in his state and was beloved by all his colleagues. His leadership and insight into bringing us all together has indeed created a legacy over generations, and I continue to benefit from it and the friendships made here. May he rest in peace. Kimberly Winges, MD I remember meeting Tom at my first NANOS meeting in 1999, when I was a fellow. The genuine enthusiasm that he and Susan had toward new members was so welcoming and I will never forget his kindness. Victoria Pelak, MD My condolences to Susan and their entire family. I will so miss his kind and most welcoming smile. May his memory be for blessing. He treated even the newest member as an important colleague and equal . with a winning smile and sincere pat on the back. What a lovely human. Norah Lincoff, MD Tom welcomed me to NANOS with his warm bright smile and encouraged me every step of the way. He is the ultimate role model, leading by example and from the heart. 407 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. In Memoriam Jack Selhorst introduced me to Tom and Susan in 1990, my first Walsh and NANOS meetings, the latter in Steamboat Springs, CO. I was a newbie, excited but intimidated. But Tom made me feel like part of the family and greeted me year after year with his genuine smile and open arms. We will continue your mission, Tom, and continue to nurture and grow NANOS, for you and our NANOS family. Sophia Chung, MD A kind, modest and wonderful person. He and Susan were a great team. Robert Lesser, MD Tom was the fellow who preceded me with Joel Glaser. He was a true visionary and had a major impact on our world. Peer Savino, MD Tom represented the best in integrity, understanding, compassion for his patients and peers, and a wish to grow the Neuro-Ophthalmology community in a collegial fashion. He was an example of Osler’s prime quality for physicians—Equanimity. There was a peacefulness about him that was reassuring and inspired confidence in his judgement. He gave some of the best lectures in the history of NANOS. He told me that he considered a theological career it is not surprising. He guided his flock gently. Jeffrey Odel, MD Pediatric and Adult Neuro-ophthalmologist whose first job out of fellowship was as Tom’s first partner at UNM in 2012. He was like a father figure to me, and I love him dearly. Timothy Winter, DO Two hours ago, I sent an email to Tom asking for news. As I checked my inbox to read his reply I find out that he has died. So unexpected! He was a friend and a wonderful person. His fellowship at the Bascom with Bob Daroff, Joel Glaser, and Lou Dell’Osso was 1 year after mine and we shared this experience as well as the beginning of the RMNOS. It is a sad moment. My sincere condolences to Susan. Dan Boghen, MD, FRCP I read with great sadness that Tom has passed away. He and Jim Sharpe were our second pair of Fellows in 1974 at the Ocular Motor Neurophysiology Lab in Miami. I began attending the RMNO ski meetings from their earliest years and continued for many years. Charlene and I send our condolences to Sue and their family. His vision for NANOS will be his legacy. Louis Dell’Osso, PhD Tom will be missed. John Keltner, MD Professionally, I feel so lucky to have gotten to know Tom these last few years through involvement on the board. His passion for the welfare of NANOS and its members was 408 always apparent in his thoughtful comments and questions. On a personal level, during a difficult period while I was recovering from a physical illness, Tom reached out and wrote me the kindest letter. So grateful for him and all he has done for our subspecialty. Melissa Ko, MD Tom and Susan babysat Rachael Lee (age 5) when I came to New Mexico to give a talk. We then went to the Albuquerque Balloon Festival and Rachael still remembers that day. Tom was the beating heart of NANOS and we will remember him, always. Andrew Lee, MD We will never be able to replace our founder, Tom Carlow. Tom was an inspiration to many of us, most certainly including me. Tom was not the first neuroophthalmologist in the United States. But he certainly had a vision of colleagues working (and playing) together as a means of advancing our specialty, helping each other practice, and ultimately, giving better care to our patients. Besides his personal achievements, he did something that no other neuro-ophthalmologist can claim—he brought us together. First for a meeting, and then as a society. Without him, I am not sure our specialty would have survived. Everything that NANOS does for its members can ultimately be traced back to Tom. He was always very serious about our specialty and our Society. He had a nice word for everyone, but if you did something that he believed could potentially harm our specialty or Society, you would likely hear about it. I will always remember and value how he supported and encouraged me. We will all miss him. In the upcoming days, NANOS will share with its members ways by which we can honor his memory. Larry Frohman, MD John B. Selhorst, MD E-mail: [e-mail] REFERENCES 1. Carlow TJ, History of NANOS. J Neuroophthalmology 1999;19:219–221. 2. Neuro-ophthalmology Virtual Education Library. NeuroOphthalmology Interview With Tom Carlow. March 29, 2019. Available at: https://collections.lib.utah.edu/details? id=1409360&page=3&q=carlow&fd=title_t%2Cdescription_t% 2Csubject_t%2Ccollection_t&rows=50&sort=sort_title_ t+asc&facet_setname_s=ehsl_novel_%2A. Accessed July 10, 2019. 3. Carlow TJ;First Hoyt Lecture, American Academy of Ophthalmology. Oculomotor ophthalmoplegic migraine: is it really migraine? J Neuroophthalmol 2002;22:215–221. Selhorst: J Neuro-Ophthalmol 2021; 41: 404-408 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.