It is with great sorrow that we announce the passing of Lloyd M. Aiello, M.D., a pioneer in the treatment of diabetic retinopathy. Dr. Aiello died peacefully at age 87 at home on December 30, 2019, surrounded by his family.
Dr. Aiello was the second of three generations of ophthalmologists, all focused on diabetic eye disease and all working at the premier site for diabetes research and care, the Joslin Diabetes Center in Boston. Dr. Aiello joined Joslin in 1962 after receiving his medical degree from Boston University, and completing his postgraduate work at Harvard Medical School and the Massachusetts Eye and Ear Infirmary. At that time, almost all patients with type 1 diabetes and 60% of those with type 2 diabetes developed some form of retinopathy (abnormalities of blood vessels in the retina) over the course of their disease, and in many of these individuals, this led to blindness. As a result, diabetic retinopathy was the most common cause of blindness in working-age adults in the US.
In 1967, working with his father-in-law, William P. Beetham, M.D., Dr. Aiello revolutionized the treatment of diabetic retinopathy by pioneering the use of laser photocoagulation to treat this disease. The treatment was based on their clinical observation that proliferative diabetic retinopathy (the most severe form of the disease) was often less active when patients had another eye disease, such as retinitis pigmentosa, trauma or chorioretinitis which produced scarring in the retina or other parts of the eye. Their novel and radical approach was to consider whether they could intentionally create similar scars and induce a similar regression of disease. The boldness of this was extraordinary since the procedure meant destroying some normal areas of the retina in eyes where the underlying diabetic eye disease was already destroying other areas of the retina. Almost miraculously, this approach ultimately reduced the risk of blindness in these patients from 75-80 percent to less than four percent. As a result, waiting rooms at specialty centers like Joslin’s Beetham Eye Institute that were once filled by patients with seeing-eye dogs, had rarely a service dog in sight.
Over the next 20 years, Dr. Aiello served as a leader in two of medicine’s first and most successful multicenter, randomized clinical trials - the Diabetic Retinopathy Study (DRS) and the Early Treatment Diabetic Retinopathy Study (ETDRS). These were based on a novel clinical design in which one eye of the patient served as the treated eye and the other eye as the control, and both proved the effectiveness of laser photocoagulation therapy when applied in a standardized way. Indeed, until the recent introduction of new antibody therapies, retinal photocoagulation remained the undisputed standard-of-care for this condition for almost 50 years. Dr. Aiello also served on leadership committees for the National Eye Institute and National Institutes of Health (NIH)-sponsored Diabetic Retinopathy Vitrectomy Study and Diabetes Control and Complications Trial, which established the importance of good glucose control in reducing the risk of diabetic complications, like retinopathy, thus setting the standard of care for diabetes used today.
With all of the improvements in therapy, Dr. Aiello began to realize that a major limitation in the field was the late diagnosis of diabetic eye disease in many patients who did not have access to specialist care. So in 1990, he began working with Sven-Erik Bursell, Ph.D. to develop a telemedicine system using advanced video technology for the remote early detection of abnormal blood-vessel growth in the retina, as well as other vessel changes causing fluid leakage and retinal damage. They named this the Joslin Vision Network (JVN). Refinements of this approach have subsequently been used by Joslin and other institutions to allow for early diagnosis for those who might not otherwise have access to sophisticated diagnostic techniques for diabetic retinopathy, including patients who live far from medical specialists. This telemedicine approach has now been applied to many other medical conditions throughout the United States and the world.
In addition to his role as a premier clinical researcher, Dr. Aiello also served as Director of Joslin’s Beetham Eye Institute from 1971 to 2005 and from 1990 to 2001, he also headed the Section on Eye Research at Joslin, both positions now held by his son, Lloyd Paul Aiello, M.D., the third generation in the family to serve these roles. Dr. Aiello was also Clinical Professor of Ophthalmology at Harvard Medical School; a member of the Executive Committee of the Department of Ophthalmology at Harvard Medical School; President of the New England Ophthalmological Society; and for a number of years, a member of the Board of Trustees of Joslin Diabetes Center.
Dr. Aiello’s many honors include: the David Rumbough Scientific Award of the Juvenile Diabetes Foundation International; the Lighthouse Pisart Vision Award; the Leo R. Breitman Excellence in Research Award from the Juvenile Diabetes Foundation Massachusetts Affiliate; the Massachusetts Society of Eye Physicians & Surgeons Man of the Year; the American Diabetes Association Outstanding Physician Clinician in Diabetes Award; the 2003 American Telemedicine Association President’s Award in recognition of his contributions in the development of telemedicine and its advancement worldwide; and the 2003 Gertrude D. Pyron Award for Outstanding Achievement in Retina Research in recognition of his lifelong contribution to the understanding and treatment of diabetic retinopathy. In 2008-2009, Dr. Aiello also received the prestigious Warren Alpert Prize, an award given by Harvard Medical School, which is presented annually to a scientist or scientists whose scientific and/or medical achievements have led to the prevention, cure or treatment of human diseases or disorders. Both Lloyd M. Aiello and his son Lloyd Paul Aiello also were selected to give the Paul Henkind Memorial Lecture of the Macula Society (the only father and son pair to ever win this honor).
During his career, Dr. Aiello authored more than 100 original articles and 40 book chapters, review articles, and editorials. He trained many clinical researchers in ophthalmology and built Joslin’s Beetham Eye Institute into a powerhouse for clinical research.
Dr. Lloyd M. Aiello, who also served in the United States Navy as a Line Officer from 1954-1956, is survived by Nancy, his wife of 61 years, his son Lloyd P. Aiello, M.D., Ph.D. his daughter Robin Aiello, an accomplished marine biologist, and two grandchildren. There will be a service celebrating Dr. Aiello’s life in the spring of 2020. Details regarding the service, as well as memorial donations, will be provided at a later date.