Professor Doctor Manfred Zierhut – Devoted Clinician, Researcher, and Educator (1953 to 2022)

Professor Doctor Manfred Zierhut

Loch Ness, Scotland – 2019

The Anglo-Irish poet and philosopher David Whyte wrote that “the death of anyone close to us is always a form of salutation, a simultaneous good-bye to their physical presence and a deep hello to a more intimate imaginal relationship now beginning to form in their absence.”¹ So it was and so it will be for those of us who knew, respected and loved Manfred Zierhut, a dear friend and colleague who left us on August 22^nd of this year following a long illness, far too young at age 68, in his home town of Tübingen, Germany. This journey was made all the more poignant as Manfred, in an act of characteristic openness and courage, invited many of us to accompany him on what would become a year-long traverse of the terrifying terrain the essayist Christopher Hitchens labeled “the land of malady.”^2,3 Always the generous friend and mentor, Manfred shared many lessons along this journey, mostly unspoken and yet all crystal-clear reflections of a rich life lived, or rather consumed, on his own unique terms.

Manfred was born on December 28, 1953, in Schwabach/Franconia, in northern Bavaria, but grew up in the Rhineland region of Germany. Following high school and military service, Manfred studied chemistry in Duisburg and Cologne, Germany. He then pursued medicine in Antwerp, Belgium, from 1976 to 1982, after which he took a clinical and teaching position at the University Eye Clinic in Hanover, Germany, from 1983 to 1984 under the then director Professor Doctor Heinrich Honegger (1925–1985). In 1984, Manfred moved to the University Eye Clinic in Tübingen, where he developed an interest in inflammatory eye disease under the guidance of Professor Doctor Hans-Jürgen Thiel (1934–2020). In 1987, Manfred received specialist certification for ophthalmology and from 1989–1990 he worked with Professor C. Stephen Foster at the Massachusetts Eye and Ear Infirmary of the Harvard Medical School in Boston, USA. Manfred returned to Tübingen in 1990 as a senior physician, was appointed “Extraordinary Professor” in 1997, and following Professor Doctor Thiel’s retirement in 1999, became head of University Department I, where he remained until his retirement in 2019.

Over nearly forty years as a full-time academic ophthalmologist, Manfred had what can only be characterized as an extraordinary career as a clinician, researcher and educator, writing more than 300 papers, reviews, and chapters; authoring or editing more than two dozen textbooks – including his ‘labor of love’ and magnum opus - Intraocular Inflammation;⁴ delivering more than a thousand invited lectures; organizing numerous international congresses, workshops, and meetings; and training generations of ophthalmologists – including many from the developing world in his very special IUSG-ICO Venice Course and for whom such specialized education would have been otherwise unavailable. Rachel Caspi commented, “Manfred considered spreading knowledge and training the next generation of physicians as a goal of utmost importance, and always emphasized bringing together science and ophthalmology. He was always thinking of his next project, and he and I often discussed his various ideas when we met at conferences that he was forever organizing or attending. I will truly miss him and his inexhaustible drive and energy.” Carlos Pavesio recalled, “Manfred and I had many phone calls, late into the night, to discuss chapter submissions for Intraocular Inflammation. His insights, comments, and suggestions were a testament to his deep understanding of the subject. I cherish these memories.” Justine Smith shared, “Manfred was addicted to uveitis. He lived it 24/7, year after year. He was interested in every aspect of our subspecialty: every patient and every colleague; every institution and every region; the past, the present and the future; the laboratory, the clinic, and the community.” Nawfel Ferrand, Manfred’s last clinical fellow, added, “Manfred was a remarkable and unique person who was always full of ideas and life. He had the gift of connecting people and ideas in the most straightforward way. I admired his passion for knowledge and his patience to share it. He will always remain my role model and mentor.”

Such incredible clinical and academic productivity was punctuated by several internationally recognized leadership positions, including head of the German Uveitis Patient Interest Group (1996–2017), member of the General Executive Committee of the German Ophthalmological Society (DOG; 2006–2018), two terms as President of the International Uveitis Study Group (IUSG; 2009–2013; 2018–2022), and nearly fourteen years as Editor-in-Chief of Ocular Immunology and Inflammation (OII; 2009–2022) – a period distinguished by an impressive increase in the number of submitted manuscripts, total published pages, and, most importantly, overall impact factor as measured by peer-reviewed citations. Aize Kijlstra, who was founding Editor-in-Chief of OII in 1992,⁵ commented, “As the founding Editor of OII, then published by Æolus Press, I am so proud of Manfred Zierhut, who took over the editorship from Hank Kaplan in 2009 and turned my seedling into a full-grown tree in the forest of ophthalmology journals. Under his reign, the number of articles increased nearly four-fold. Manfred introduced the very popular ‘Disease of the Year’ section and saw OII as an important ‘teaching’ platform. His social engagement was apparent as he helped many scientists from developing countries to publish their work in the journal. He was truly a great ambassador for OII!” Hank Kaplan, who was Editor-in Chief from 1999 to 2008,⁶ noted, “The passage of the Editor-in-Chief position to Manfred Zierhut was a momentous milestone for OII. Through his enthusiasm, intellect, and energy he transformed it into a leading international publication in our field. He markedly improved its quality and expanded its authorship and readership across the globe.” Derrick Smit, interim Editor-in-Chief of OII, added, “It was a privilege to call Manfred my mentor and friend. I will remember fondly his encyclopedic knowledge of music and his adventurous spirit.” Manfred was honored with many recognitions and awards throughout his career, but was particularly proud of the David Ben Ezra Award (2021), which he received from the International Ocular Inflammation Society (IOIS) at Thessaloniki, Greece, and the Ted F. Schlaegel - G. Richard O’Connor Medal (2022), which was officially presented by the IUSG in Utrecht, Holland. Jim Rosenbaum shared, “Manfred’s zeal and determination created a lasting-legacy. He transformed OII, left a mark forever on the IUSG, fathered interferon therapy for uveitis, and perhaps most importantly, embraced every corner of the world as he shared his quest to elucidate uveitis.”

Beyond medicine and ophthalmology, Manfred had deep, life-long interests in travel, photography, music, and, of course, friends and family. Manfred meticulously mapped each new country he visited, an impressive list of over 130 by his own count, and had plans to visit ten new countries each year until he achieved his goal visiting all, or nearly 200. He could read or converse in at least seven languages, including Latin, Greek, English, Spanish, Portuguese, Dutch, and, of course, German. Manfred often shared photographs from these travels – most of nature scenes or those with whom he travelled or met along the way, and many of which were both moving and memorable. One of his favorite destinations was Iguaçu Falls on the border of the Argentine province of Misiones and the Brazilian state of Paraná, a site he visited nearly a dozen times and which he called “the most beautiful place on earth.” Rubens Belfort recalled, “Manfred was much more than a physician and lived immersed in the cosmos always looking for the universal harmony and happiness of humans. His journey represented a balance between science, medicine, travel, music and philosophy. He will be with us forever.” Manfred’s music collection was legendary – filling his house from floor to ceiling. Phil Murray recalled, “Manfred loved all types of music, and he had an encyclopedic knowledge of rock, jazz and jazz fusion. At every opportunity he would listen to live music and would travel across continents to go to gigs. Even when attending international conferences, he would make trips to see the artists he loved. His last gig was this Summer when his doctors allowed him to see The Rolling Stones, a group he enjoyed greatly.” Ron Neuman added, “Manfred was to me a friend, a ‘go-to’ person to unload frustrations, and beyond all a ‘Music Man’ with vast knowledge of 1960s, 70s, and 80s rock and roll. He had sparks in his eyes whenever he talked about concerts and the aging rock stars he loved so much. His admiration for Milton Nascimento, the well-known Brazilian singer, was especially deep.” These musical memories provided the primary source for the regular, thematic playlists that Manfred constructed and shared as he approached each new round of therapy over the past year. Manfred called the last playlist, circulated as he prepared for experimental CAR-T therapy, ‘Hope’ – something he never lost, even in the face of what he most assuredly knew were challenging odds. Many of us can still hear Manfred’s signature, upbeat refrain when seeing a compelling case, hearing an interesting lecture, or returning from a concert or newly discovered destination – “It was simply amaaaazing!” Thank you, Manfred, for being such an amazing colleague, mentor, and friend, and for reminding all of us what a gift it is to be present in the moment. Manfred is survived by his wife Marina, his daughters Sarah and Chantal, and his grandchildren Jonah, Nina, and Lina. Sarah and Chantal shared, “Despite our father’s demanding work and travel schedule, and many outside interests, he was always there for us. He supported and loved us unconditionally. We will carry his memory in our hearts forever.”

The Well of Grief ⁷

Those who will not slip beneath

the still surface on the well of grief,

turning down through its black water

to the place we cannot breathe,

will never know the source from which we drink,

the secret water, cold and clear,

nor find in the darkness glimmering,

the small round coins,

 thrown by those who wished for something else.

By David WhyteCopyright © 2007, David Whyte. Reprinted with permission from Many Rivers Press, Langley, WA. www.davidwhyte.com

Acknowledgments

The authors have no relevant financial conflicts. We thank David Whyte for allowing us to reproduce his original poem entitled, “The Well of Grief” (River Flow: New and Selected Poems - Copyright 2012 by David Whyte) and a passage from “Crossing the Unknown Sea” (Copyright 2001, by David Whyte).