A Great Conversation With Dr. Shirley Wray

Dr. Shirley Wray is a Professor of Neurology at Harvard Medical School.

Great Conversations Section Editors: Meagan D. Seay, DO Rachel Calix, MD A Great Conversation With Dr. Shirley Wray Kathleen B. Digre, MD, Rachel A. Calix, MD, Meagan D. Seay, DO K athleen Digre (KD): I’m Kathleen Digre. I’m a professor of neurology and ophthalmology at the Moran Eye Center, University of Utah. With me here today are Dr. Meagan Seay also from the University of Utah and Dr. Rachel Calix from Tulane University. And today we are interviewing Dr. Shirley Wray. KD: Dr. Shirley Wray is a Professor of Neurology at Harvard Medical School. Shirley thank you for being with us for Great Conversations. I’ll have you start out by telling us a little bit about your background before you even went to medical school? Shirley Wray (SW): Well, first of all I’ll say hello to you Kathleen. Then.you should probably know that I was the seventh child of 7 children. I was born in a town called Harrogate in Yorkshire. It was named Harrogate because it was at the entry to the forest of Harrow. It was really a very beautiful town, which was occupied during the war by the American forces as a convalescent center. I was 7 years old when war broke out, and I never saw a light on the street at night until the end of the war. But it was an extraordinary time to be a child. I had 4 brothers and 2 sisters. All my 4 brothers went to the war. My eldest brother was killed in the Battle of Britain, and I remember when he came home in his sports car—I remember saying, “Eric, where’s your airplane?” And he said, “We don’t have enough airplanes. I am going to drive to where they have an airplane.” I’ve never forgotten that. KD: And did that experience get you interested in medicine at that time? SW: No. The experience... Well, in a way. Eric had a fiancée, and her father was a country doctor in a lovely little town, and I used to go and do his patient rounds with him as he went to the farms. When we came out of the farm, the back seat in the car would be full of eggs and chickens. At the age of 8 I thought this isn’t a bad career to have. You get paid with all the goodies. And that actually was the beginning. The interest. Figure 1: Shirley growing up in Harrogate. Departments of Ophthalmology and Neurology (KBD, MDS), University of Utah Moran Eye Center, Salt Lake City, Utah; and Departments of Ophthalmology and Neurology (RC), Ochsner Medical Center, New Orleans, Louisiana. The authors report no conflicts of interest. Address correspondence to Kathleen B. Digre, University of Utah, Department of Ophthalmology, 65 Mario Capecchi Dr., Salt Lake City, UT 84132; E-mail: [e-mail]. Digre et al: J Neuro-Ophthalmol 2021; 41: e767-e773 KD: So how did you progress then? From age 8 and onward in school. Did you know you wanted to be a doctor the whole time or was that something that you kind of fell into? SW: No, I didn’t fall into it. I went to school in Harrogate and my 2 sisters as well. We went to an Episcopalian boarding school. And we learned all our school history in Anglo-Saxon. My eldest sister, Joy, went into a house called Eoforwic which is Anglo-Saxon for York. Yvonne, my other sister, went into Cantwara, Anglo-Saxon for Canterbury. When I followed them, I went into York. It was a very classic girls boarding school at that time. They didn’t teach science. And I spent most of my school career playing games, literally. Playing cricket, playing tennis. And that was what I occupied myself with. Then, at the end, I took my higher exams to get into university. There was no science. But I was only 16 when I did that, and so I had another year to go in school. I asked if I could do science and they said, “Well, we can arrange that.” Up the road from my school was a US Airforce base and they were training their cadets. I joined them with 2 other school friends. We went up to the base to learn physics and chemistry. I actually got into Sheffield University to read medicine as soon as I left school with an Arts Higher, which would be impossible to do now. KD: Wow. SW: I couldn’t even write a formula for water [chuckle], when I signed up for medical school. So, I was lucky. KD: Yes. So, Sheffield is where you went to medical school? SW: Yes. KD: And then how did you choose neurology? SW: Well, I think like most people... I guess my interest certainly began with an interest in the brain. I found it sort of fascinating, like we all do. And then when I started doing my clinical rotations through the hospital, there was an extremely good neurologist who was also interested in teaching and welcomed me as an elective going to his rounds when I actually should have been on medical rounds. But that’s how it happened. KD: Cool. SW: I realized too, that it’s good to go to a university in the United Kingdom to do medicine, as opposed to going somewhere to read medicine as a postgrad, because as an undergrad you had access to everything else that was going on. I designed the stage and lighting for the drama club. Things like this. It kept you moving ahead in all sorts of different directions. Not just sticking to medicine. And so, e767 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations FIG. 1. Shirley Wray about age 8 growing up in Harrogate. when I played tennis and went away in the summer, friends of mine just videoed, well not videoed but recorded the lectures I was missing. That worked out. KD: Tell us about how you got interested then in neuroophthalmology. And when did that occur? SW: I was not interested in neuro-ophthalmology. I planned to be a neurologist. When I finished medical school, I went to the Hammersmith Hospital, which is a postgraduate hospital as a fellow in cardiology. It was an interesting 2 years. We were right opposite the Wormwood Scrubs prison. I had this very nice patient admitted who was dying with chronic heart failure. He asked me what I was going to do on the weekend. And I said, “Well, I’m going to look for a MINI (the MINI cars had just come out), and I’m looking for a green one, under 10,000 miles to buy second hand.” “Good luck,” he said. And then he went home. Six weeks later, the hospital porter phoned me up and said, “Dr. Wray, there is a guy here with your car.” I said, “With my car?” He said, “I think you better come down.” I went down and there was my patient, the former prisoner. And there were 3 cars, 3 MINIs. One was green, one was red, and one was white. He had 2 possibly exprisoners driving the other 2. He said, “So which one would you like? I couldn’t remember the color.” Well, of course I had still not gotten one but I realized that they were probably all stolen cars. I said, e768 “I’m terribly sorry, I got one last week.” Oh, he was so upset. My mother was coming for Christmas and by then I had found a MINI. I went shopping. I parked my car in the wrong place and it disappeared. I felt like phoning the prisoner and saying, “Have you stolen my car for somebody else?” [laughter]. SW: So where did you leave me? KD: How did you get interested in neuroophthalmology? SW: I was not in fact at all interested in neuroophthalmology. After the Hammersmith, I went to Queen Square to do a resident house job for 6 months. The Chief Resident at that time was Roger Bannister. It was Roger who said, “Look, you should come here. Shirley. If you want to do neurology, this is where you have to be.” To get into Queen Square, you have to have Membership of the Royal College of Physicians and a postgraduate degree. In other words, an MD. In the United Kingdom that requires a thesis. My next move was to the Middlesex as a Junior Registrar in Medicine (Cardiology and Neurology.) The consultant in Neurology was Roger Gilliatt. And he said, “Look, you could come and do a job with me, and you could write your thesis at the same time.” I agreed. Roger had just been appointed first chairman of the newly created Institute of Neurology at Queen Square, and when I joined him thinking I would do an MD, I found I was actually into to 4 years of research for a PhD. The topic for my thesis was to determine the size of the motor unit in a primate (a baboon), copying Sherrington’s work in the cat. SW: I was “on the house” towards the end of my PhD, and I had begun to see a gap in the subspecialties of Neurology. Vision was missing. At the time, there was only one neurologist experienced in vision, Dr Swithin Meadows. He was on the faculty at Moorfields Eye Hospital, and when I was working with him, he did all his visual fields charting them literally by confrontation. He would send me down to the eye room to use a perimeter and bring the chart back up. The perimetric chart looked exactly like his confrontation fields. SW: I won an award when I completed my PhD in 1967 which enabled me to go to the United States. I applied to come to Boston and work with Dr. David Cogan, but he actually refused my application saying he had never had a neurologist to work with and actually never a woman. He did suggest I come and work with Raymond Adams and then look over his, Cogan’s, shoulder. Well, that was touch and go because it was already January of the year I wanted to come. I knew from corresponding that Raymond Adams usually chose his fellows in July of the year before they came. I hadn’t a chance. SW: Well, again, a piece of luck. Lord Brain, who was a friend of Raymond Adams, was visiting him. I had never worked for Lord Brain, but I had met him at the Physiological Society meetings in Oxford and in London. Digre et al: J Neuro-Ophthalmol 2021; 41: e767-e773 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations I guess Adams was selecting his fellows and my name came up. Lord Brain said, “You should take her. I know her,” which was what happened and I came really to work with Raymond Adams. Then Cogan decided before I got here that I could work with him after all! I had been given both a Harvard Postgraduate Fellowship and one from the United Kingdom. Roger Gilliatt said, “Well, of course, you know which one you should keep,” meaning I should keep the United Kingdom one because after all, we know the prestige value! I kept the Harvard Fellowship. SW: So, I arrived with a Harvard-funded fellowship and Cogan came and met me off the plane, which would never happened in the United Kingdom. We drove to The Eye and Ear for him to show me where I would have lunch, which was down in the basement with a machine that I could get peanut butter sandwiches from and then take them upstairs and sit around a table. Of course, I don’t eat peanut butter, but that’s by the by. KD: Yeah [chuckle]. Well, that’s a great story. SW: Yeah. The really great story was that Cogan left after I got there, 3 weeks later, to go to his summer home in Michigan and at that point I hadn’t even learned how to turn a light on or use a Goldmann Perimeter or anything. I don’t know whether he thought I had already been trained to do that, but I hadn’t. I was in sort of a state of shock but that’s how you learn fast, I guess. KD: So then for the summer, you learned how to use a Goldmann and learned ophthalmic examination techniques? SW: And strabismus and refraction and tests like that. Cogan at that time had just received the fluorescein angiography equipment, and so I did fluorescein angiograms for The Eye and Ear every afternoon. I was a bit staggered by this and I thought, “Gee, I’m not here to do this.” It taught me a lot about the retina. KD: Wow. Your biggest mentors then were Cogan early on and were there other mentors that were part of the training in getting you to be a neuro-ophthalmologist? Figure 2: Dr Shirley Wray and Dr David Cogan. SW: My other mentor was Raymond Adams. I did look over his (Adams’) shoulder because he was interested in eye movements in terms of the function of our elevator muscles. And he knew that I could count muscle and nerve fibers. He asked me to work out the innervation of an eye muscle. What is the size of the motor unit? The size of our motor units is very small; we have one nerve fiber to 10 muscle fibers. That’s what I worked with Ray on—and I thought I was coming to Boston to get away from counting fibers! But it fitted in. It fitted in fine. KD: When you were in training, did you ever envision that you would be at this point in your career, a Professor at Harvard Medical School, working in Neurology at Mass General and doing neuro-ophthalmology? SW: Well, it began at the end of the first year of my fellowship. Ray Adams and Cogan invited me to lunch and asked me if I would take over directing neuroophthalmology at The Eye and Ear. And I said no. They asked why I was turning them down. I said, “Well, I’m a neurologist, and I would like to be on the faculty at Mass General. I would like to be able to admit my patients under me. I’d like to be on the ward teaching service. I’d like to retain my lab.” SW: At that time, I was doing research in neuroimmunology, with Barry Arnason, so I wanted to retain my lab over in the Warren building. A friend said to me, these jobs do not grow on trees! But I still had another year of fellowship to come and I had plenty to do. About 2 months went past, and I was invited to lunch again. I accepted and Ray Adams stood up, arms up like this, and said, “Shirley, you’ve got a deal.” And I did, I got all 5 things in place. KD: Wow, that’s amazing. SW: Well, after that, I taught my fellows to negotiate. A number of my fellows were referred from their home hospitals who wanted them to come back trained and set up. I said, “What you need to do towards the end of your fellowship is to find out exactly what they are going to give you.” 2 or 3 of them did that and found out exactly what they were going back to. One of them you know very well, FIG. 2. Dr. Shirley Wray at work and Dr. David Cogan looking on. Digre et al: J Neuro-Ophthalmol 2021; 41: e767-e773 e769 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations David Kaufman, said he didn’t need to do that. “In Michigan” he said, “we don’t need to do such things.” I said “Yes you do. People move, people forget. Write out exactly what they promised you and get them to agree to it in writing.” He did and it was a huge list, down to the screwdrivers for his visual electrophysiology lab. He sent it to his Dean on the Harvard stationery he was entitled to use and got a very quick reply—the list was exactly what their agreement was. When David arrived at Michigan State, his Dean sat him down and said “I don’t know who guided you with your start up but give them my compliments. I’m lucky I don’t have to negotiate with them ever again!” Figure 3: Shirley Wray and David Kaufman. I do encourage people to look ahead. In London, we had to change jobs every 6 months so when you were looking at one job, you had to look for the second to come and see if it was going to work out. That’s what I recommend most people do who are moving ahead in an academic career, look for the second step as well at the first. KD: Your first job then was at Harvard/Mass General Hospital/Mass Eye and Ear doing neurology, having a laboratory, starting to train fellows in neuro-ophthalmology. With time, what have you thought of as your greatest success? SW: I think training more than 30 fellows. That’s such a responsibility, as well as a big interest. I never called my fellows when they were training with me by their first names, because if you want to straighten things out a bit, you can’t say, “Well Joe, come and sit down and now do this, that and the other.” It’s much better to say, “Dr. Soand-So,” this is what you need to do.” That’s the way I trained my 30 plus fellows. I kept in touch, and I am really proud of them. I think teaching is one of the best things to get interested in. KD: Yeah. SW: With your support, Kathleen, I got the Baker award for longevity in education. Oddly enough, now we’re locked down, I am going back to teaching residents because our FIG. 3. Dr. Shirley Wray and Dr. David Kaufman. e770 patients have not come back to the clinics. And we have a shortage of patients in the clinic, and here, we have 17 new residents every July with patients to see in their clinic. I took chiefs’ rounds with Marty Samuels the other week, and they all liked that but as I said to the person who organized it, this is the wrong way around. The residents know how to present a case, but they don’t know how to discuss one. We should do it the other way around. Now I’ve been asked to do that with each first-year resident one on one. Since we have 17, I’m going to be busy. KD: You’re going to be very busy. Another one of your great successes is your book and your collection. Tell us a little bit about how you collected all these patients that went to make up your book in clinical practice and part of the NOVEL collection. SW: Early on when I first got to Boston, the people teaching neuro-ophthalmology were all in Florida: Norman Schatz, J. Lawton Smith, and Joel Glaser. They were n’t actually teaching they were holding a series of 3-day meetings. I suggested to Cogan that we run a 5-day course of teaching, and we did for close to 12 years, plus 3 pediatric ones. We never taught the same case twice. We had a 3quarter inch Sony broadcast tape. We filmed all the cases for each course. Harvard doesn’t like you inviting guest speakers because they were not going to provide a fee. SW: Again, I was fortunate because Hubel and Wiesel were there and liked to teach. Initially they taught together. After that, I alternated them. Wiesel said, “Well, that’s terrible, Shirley because I liked that wine you sent me.” What I had done with Hubel and Wiesel, because I couldn’t pay them, was at the end of the course I gave them wine. Hubel liked red wine and Wiesel liked white wine, so each of them got a case of 6 even in the alternate years because they continued to help with a lot of basic things. Wiesel was very happy. He didn’t teach but he got the wine. And then of course, he left and went to New York. I had a phenomenal faculty, and it was I think a very good course. KD: That was in Boston, right? SW: Yes, here in Boston. Nearly all the cases on my website came from that course collection. Cogan’s cases were on the same 16-mm film, which amazingly stood the test of time. The advantage of the equipment was the film. It lasted a long time for us to use it again. As Nancy [Lombardo] will tell you, it was quite a job to edit all of them. KD: Exactly, yep, that was a lot. So how do you spend your time now? You’re kind of retired, but you’re not really retired, and tell us all the stuff you’ve been doing. You’re a pretty active woman still in neuro-ophthalmology. SW: First of all, I closed my clinic and didn’t take any more fellows—I think I took just one research fellow after that. I had always kept a lab going.First off, I got funded from NIH on a study that was called “Demyelination and the Optic Nerve,” and again, those of you who are going to be staying in academia and research, try to choose a title Digre et al: J Neuro-Ophthalmol 2021; 41: e767-e773 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations that can go both ways—in this case either research on the optic nerve or research on demyelination. I was funded by NIH as a single primary investigator for 15 years. This would not happen now. Now you would have to be a member of a lab. SW: I developed an in vivo rabbit eye model and used a transparent tadpole for injection of spinal fluid into the very visible optic nerve sheath. This work I did in collaboration with Harry Webster, an electron microscopist. When NIH funding stopped, my lab changed. We studied the visual evoked response (VER). The head of the EEG lab was very upset, but I advised him that I was only doing VERs in my own optic nerve cases. When the VER test was established, I closed my lab. At this time, the NOVEL Library was just being launched in Utah by you, Nancy Lombardo, and others. KD: The Neuro-Ophthalmology Virtual Educational Library, correct! SW: When Novel went out into the world as it has, I would get these wonderful requests, particularly from Japan, “Dear Honorable lady. Can I download ID number so and so?” They were very polite. I got them from France, Australia, and many others. And now NOVEL is a famous digital library. It can’t be beaten. It’s just terrific. KD: Yeah, absolutely. Tell us that story that you even made a diagnosis for a patient, didn’t you? A mother contacted you about one of your patients. I think it was your opsoclonus case. SW: Right. KD: Do you remember that story at all? SW: Was the child having opsoclonus? KD: She contacted you and said I saw this on your website, and I think this is what my child has. And you got her some help. SW: Yes, that’s true. That is true. I’m trying to think of whether the child was in America. KD: Yeah, right. Someplace else. SW: Yes, in Turkey. I think this was a child that was in Turkey with opsoclonus. And she got better. She clearly had an encephalitic process. And she presented with opsoclonus. She did not have a neuroblastoma. KD: Yeah, so are you working all the time, Shirley, in your free time or do you do some things for fun? SW: Well, when I stopped the clinic, I continued to teach on the service, and so on, and then I went back into research. This surprised everybody. “Shirley, why don’t you retire?” And I said, “Well, because I like what I do. And I’m not someone who can sit and read 3 books a day and remember them.” It was then that I’d become aware of the discovery of a second visual pathway. The melanopsin pathway was only discovered in 2012. And we know now that it’s the visual pathway that drives the pupil light reflex. I wanted to study retinal ganglion cells and thinning of the retinal nerve fiber layer. The OCT shows the degenerative process of the nerve fibers and shrinkage of the macular area. Digre et al: J Neuro-Ophthalmol 2021; 41: e767-e773 SW: The pathway doesn’t do anything with regard to imaging. It’s a straightforward visual pathway that runs from a specialized group of retinal ganglion cells that contain melanopsin. And it goes all the way, just like the other visual pathway, along the optic nerve back into the brain, where it divides. One branch goes to the suprachiasmatic nucleus, which is the pacemaker for circadian rhythm, and the other goes to the midbrain to synapse with the pretectal olivary nuclei and then on to the third nerve oculomotor complex. SW: I decided that it would be interesting to test the pupil light reflex and I went to borrow the handheld monocular pupillometer that nurses use. I asked my friend John, who was in charge of the ICU and he said, “Shirley, you can’t have one, you know, the nurses are using them.” So, I went to the company that makes them and said what I wanted. I took it up to Agnes Wong in Toronto, because Agnes had a Fellow in her lab working on the melanopsin visual pathway (a pediatrician). Agnes has always been a remarkable friend and supporter of my more unusual ideas. Her Fellow said, “Shirley, this isn’t going to work.” He had done pioneer work showing that the melanopsin pathway is sensitive to blue light of a particular wavelength. So, I went back to the company and said, “How about making me a monocular blue light?” They said, “No, it would be too expensive.” I said in that case, then will you lend me your chromatic pupillometer? And they said, “Yes.” Well, it took 6 months to get MGH to agree to let me borrow an expensive device, but we got it—and that has enabled us to test rods with pale blue light, cones with red light, and melanopsin with deep blue light to make sure that the final common pathway through the midbrain to the brainstem works normally for rods and cones but doesn’t work for melanopsin. And so, we started there. I chose to study PSP because it is a tauopathy like Alzheimer’s and patients who were participating in a Biogen drug trial were available. We studied 25 subjects and age-matched controls. SW: Then came the virus, and we were told we all had to leave and go and work at home. I grabbed the research files and took them with me. I contacted my research team and scheduled a regular conference call on alternate Thursdays which allowed us to analyze the data and start to write papers. One manuscript has already been submitted to JNO. KD: That’s great! You’re just going and making new discoveries even now. That’s awesome! Even during this time of COVID. What advice would you have for those who are early in their careers and that are thinking about neuro-ophthalmology, what advice would you have to give those people? SW: You may not know whether you like it or not at the beginning, so my advice is don’t give up. It’s a new experience, and it’s a very valuable experience really, because you’re seeing many patients at a point when you can cure them. For example, you can pick up a case with a pituitary tumor. I think it’s a very positive field to be in. You will find you have a spectrum of challenging cases. e771 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations KD: And do you have any other advice for young people, just about careers or going forward and that kind of thing? SW: Yes, I’ve been a mentor here for over 50 years. In fact, this time last week, I joined several other doctors who have been at the MGH for over 50 years. We attended an Ether Day event held to celebrate and honor our record and contribution. KD: And that was for 50 years, right? KD: If you had other advice for people just in general, about your career and advancement, and because you’ve been a mentor to all these residents and fellows and everything else, besides encouraging them to go into neuroophthalmology, do you have any other advice you’d like to give them? SW: I think you need to like the job that you’re doing, and unfortunately, too many people, or too many academics that I’ve met, have landed in jobs that they wish they hadn’t got, sometimes because they were moving as a couple, and it’s very difficult for the wife to find a job or the husband to find a job, and both of them be equal. It’s tough to sign on for a job that you may actually occupy for many years. I would recommend that if your fellow has a PhD, that they keep that alive and well, or if they do research, relate it to their PhD. My PhD was actually physiology really, and so was VER and so in a way, is pupillometry. I have a true line that way, although it’s a different question to answer. Look at your career and build on it that way. Don’t leave your PhD or your MD or any other degree you have behind just because you’ve now got it. KD: That’s great. So, Rachel and Meagan, do you have some questions for Shirley that you would like to ask? Rachel Calix (RC): I have one follow-up question, just because you’ve trained so many fellows. Do you feel like over the years your approach to training fellows has changed over the years in any way? Or things that you found were more important to stress or things that you wanted to expect from your fellows over time, has that changed? SW: Some things have changed. Now, when somebody is looking for a fellowship they really are going to take a lot of time to investigate whether the person they want to join is going to train them. I had the situation where I applied to Cogan and he said no. I also applied to Bill Hoyt but an ophthalmologist at Queens Square, a good friend of mine, Michael Saunders, got to Bill Hoyt first. Subsequently I spent time with Bill at a small group that he met with annually at Aspen. Figure 4: Dr. Marjorie Seybold, Dr. Bill Hoyt, and Dr. Shirley Wray. It’s still very important to make contacts. You need to feel that you don’t have to stay somewhere where you don’t like it, that it’s relatively easy to move elsewhere. For example, I made contact with David Robinson at Hopkins. I used to go to his computer course on a Friday. I’d do a day trip to Baltimore and back to learn how to use computer models to control eye movements. And of course, e772 FIG. 4. Dr. Marjorie Seybold, Dr. Bill Hoyt, and Dr. Shirley Wray. David Zee was there, and he has been a source of immeasurable help and support over the years. I’ve gone a long way round, Rachel to try to answer your question and it is probably not a good answer. KD: There’s not a correct answer. But would you say the advice you gave your recent trainees and your recent fellows is different from what you started to give them at the beginning of your career? SW: Oh yes, exactly. The beginning of my career, I was basically responsible for training somebody who could run a clinic and see patient after patient and look after them. As time went by, I think maybe it’s because I got more senior fellows as well, and I got fellows with PhDs, and so, I got fellows that wanted a foot in another door at the same time. And maybe that is... If they are doing pediatrics, for example, I don’t know if you do pediatrics, but I had to do pediatrics when I was at Queen Square because women were thought to do pediatrics especially well! I got loaned FIG. 5. Keeping up with her colleagues: Dr. David Kaufman, now Chair Neurology Michigan State University, Dr. Shirley Wray, Dr. Kathleen Digre University of Utah, and the late Dr. Henry Schutte (a colleague of Shirley Wrays from Queen Square and former Chair of Neurology at University of Wisconsin. Digre et al: J Neuro-Ophthalmol 2021; 41: e767-e773 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations out to Great Ormond Street to do outpatient clinics. Now, I consult on children with abnormal eye movements, and I am asked, “How did you do this, Shirley?” and I reply, there was an opportunity to see children and I took it. I have taken notice of many opportunities in my career. I put my name down 15 years ahead of the Wang Building at MGH and I got space to move my clinical unit from The Eye and Ear Infirmary to the Wang Outpatient Center at MGH. My goal was to bring neuro-ophthalmology into the department of neurology and I called my unit “Neuro-visual Disorders.” Since then, I think at least 6 neurology residents have chosen a career in neuro-ophthalmology and gone on to different centers for fellowship training. KD: Shirley, do you have any last words of wisdom you want to impart to the whole world? SW: Well, we all set up networks as we go through our careers, and of course, one network is our Fellows. The other network is when we go to meetings and meet unexpected people. At one meeting someone came up to me and showed me a video of his cat, D’Artagnan, who had head thrusts from side to side. I said, “He’s got oculomotor apraxia.” Well, I’m still in contact with him. In other words, you will meet people at meetings; stay in touch with them. I’m in touch with a lot of people who literally work worldwide. I have colleagues in Australia, New Zealand, Hong Kong, Canada, many countries in Europe. I trained a Fellow from the Philippines, Butch Tamesis, and after several years met up with him again at a meeting in Japan. He said, “Are you staying for the neuro- Digre et al: J Neuro-Ophthalmol 2021; 41: e767-e773 ophthalmology meeting on Saturday?” I said I didn’t know there was one. He said, “Well, one of my fellows is going to present a paper. Would you hear him present it to you before then?” I said I would. He himself had already trained 6 ophthalmologists in neuro-ophthalmology in Manila. His fellow presented his paper that Saturday. Neil Miller was there and asked the young man “Who trained you?” He said, “Well, I’m Shirley Wray’s grandfellow!” Butch and I have kept in touch over the years, and on my recommendation, a US team investigating familial genetic dystonia contacted him to examine the eyes in their patients. KD: That’s great. SW: So, keep in touch. It’s fun. KD: Shirley, thank you, thank you, thank you. This was a wonderful conversation, and we really appreciate your time and putting your time into this, and telling us your stories and how you started and everything else. It’s a wonderful... It was really a great conversation. SW: Well, thank you, thank you very much for the invitation. Thank you all very much. And good luck. ACKNOWLEDGMENTS Drs. Seay and 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. e773 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.