Show Summary

Jorge Fortun, MD, of Bascom Palmer Eye Institute joins John Kitchens, MD, and Scott Krzywonos for a wide-ranging conversation on the art of retina practice, from the unique challenges of seeing highly educated, high-expectation patients in Palm Beach Gardens, to the patient communication strategies he relies on every day. He shares the analogies he uses to explain DME, GA, and AREDS vitamins, discusses the realities of seeing celebrities and titans of industry, and reflects on how to have honest conversations when medicine has nothing more to offer.

The episode also covers the ongoing threat of unregulated stem cell clinics in Florida, how patients are arriving more prepared — and sometimes better informed about clinical trials than the physicians themselves — and what Jorge is most excited about in the retina pipeline, with a specific focus on TKIs. He closes with a preview of his role at ASRS 2026.

Hosts: John Kitchens, MD, Scott Krzywonos

Topics Covered

Practicing Retina in Palm Beach Gardens

• Patient demographics: wealthy, highly educated, internationally diverse; often arriving for a fourth, fifth, or sixth opinion

• Discretion and VIP accommodations for high-profile patients; privacy protocols in place for political figures and celebrities

• Managing expectations: Jorge's core principle is that disappointment comes from expectations and reality not aligning — and his job is to be thorough and honest without inspiring false hope

• When medicine runs out of answers: the importance of acknowledging the human being beyond the OCT, including referrals for low vision and mental health support

Patient Communication: Analogies & Metaphors

• DME and dialysis: explaining lifelong treatment burden to diabetic patients by comparing intravitreal injections to dialysis — "dialysis for your retina, but much better"

• GA and complement inhibitors: the car and the cliff — pressing the brakes matters most when you're far from the edge; if the car is moving slowly, the calculus changes

• AREDS vitamins: explaining why a well-studied, clinical trial-backed formula is meaningfully different from the supplements his Palm Beach patients are already taking

• The risk of "retina speak": even physician colleagues outside ophthalmology often don't understand what retina specialists are talking about; plain language and analogies are essential

Stem Cell Clinics in Florida

• Jorge’s colleague Tom Albini, MD, has documented and testified before Congress on unregulated "stem cell" clinics in Florida that caused serious complications in multiple patients

• Florida's concentration of elderly, wealthy patients seeking solutions makes it a particularly fertile environment for these clinics

The Retina Pipeline: TKIs & GA

• Jorge's near-term excitement: TKIs as sustained-release agents offering dual mechanistic VEGF inhibition — intracellular and extracellular — for wet AMD, DME, and diabetic retinopathy

• GA therapies: two FDA-approved complement inhibitors are available but generate significant chair time; oral and subcutaneous agents in the pipeline are promising; stem cell approaches remain supportive, not restorative

• Clinical trial conversations: wealthy, internationally connected patients often arrive with knowledge of trials Jorge hasn't heard of; honesty about what he doesn't know is his default

ASRS 2026 Preview

• Jorge helped organize Retina Surgery Around the Globe at the opening of ASRS 2026 — Wednesday session, first day of the meeting

• Concept: four teams of early-career retina surgeons from around the world present surgical videos, mentored by Aleksandra Rachitskaya, MD; Nina Berrocal, MD; Paul Chan, MD, MBA; and Jorge himself

• Mission: promote young surgeons and showcase international surgical technique and innovation; inspired by the belief that US retina surgeons learn disproportionately little from their international peers

Key Takeaways

• Patient communication in a high-expectation, highly educated practice demands clear analogies, radical honesty, and the humility to say "I don't know" — without losing the patient's trust.

• TKIs represent the most tangible near-term advance in treatment burden reduction; GA management remains largely a counseling and expectation-management challenge.

• Retina Surgery Around the Globe at ASRS 2026 is a must-see for anyone interested in international surgical technique and supporting the next generation of retina surgeons.

Sponsors

This episode is sponsored by Genentech. Watch their Purple Chair Series at Vabysmo-hcp.com. 

This episode is sponsored by Ocular Therapeutix, a biopharmaceutical company working to redefine the retina experience across drug development, treatment, and outcomes. Learn more at OCUTX.com.