A Vision for Ophthalmic Pathology
Sitting Down With… Sarah Coupland, Professor and George Holt Chair of Pathology at the University of Liverpool, leader of the Liverpool Ocular Oncology Research Group, and Honorary Consultant Histopathologist at Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
What inspired you to the ophthalmic field?
My father was a medical oncologist and my mother was a nurse, so I grew up with “medical speak” over the dinner table – it became second nature to me. After graduating from medicine in Sydney, Australia, I moved to Berlin, Germany, and began a PhD in ophthalmology. I examined the immune mechanisms involved in corneal rejection, which meant performing corneal transplants in rats followed by histological and immunohistological examination of their eyes. And that’s how I rediscovered my enthusiasm for the morphological understanding of disease mechanisms.
After completing my PhD, I did a three-month elective with William Lee in Glasgow, UK – a period during which I finally made the decision to specialize in histopathology. I then spent seven years training in general pathology with Harald Stein at the Charité Benjamin Franklin in Berlin – at that time a referral center for lymphomas, head and neck surgery and ophthalmic tumors – and emerged with a number of pathology subspecialties under my belt.
You make it sound straightforward, but there were a few “bumps in the road…”
I’ve not encountered what I would consider true adversity, but I have experienced a number of challenges along the way. Learning German in my mid-twenties to a sufficient standard to work as a pathologist, write complicated medical reports, and teach students was particularly demanding. To complicate things further, human anatomy in the German medical system is still described in Latin, so I had to learn that as well!
The most dramatic (and literal) bump in the road was my pregnancy with triplets near the end of my pathology training. Unfortunately, my contract was due to end during my maternity leave, and there was concern that I would have a job to return to, in order to complete my training! Luckily, I was able to organize a phased return to work and I completed my training, two years after the children’s birth (despite the complication of HELLP syndrome (severe pre-eclampsia), which put all four of us in intensive care for a few weeks). After my final exams, I went on to submit my Associate Professor thesis, becoming the first female “Privat Dozent” from the Stein lab.
What is unique about ophthalmic pathology?
As an ophthalmic pathologist concentrating on ocular oncology, I interact closely with clinical teams. Ophthalmological diagnoses are very reliant on morphology and images. The beauty of the eye – and the surrounding structures – is the ability to see many pathologies in situ in the patient, which can allow for easier interpretation of the samples. That being said, many cases are difficult because the eye samples can be tiny! For example, intraocular biopsies of the choroid or vitreous can be very demanding; one is expected to ‘squeeze out’ as much information as possible: morphology, immunophenotype, and genotype.
My favorite aspect of the work is making a difficult diagnosis in a timely manner to improve a patient’s outcome. The typical scenario would be a vitreous biopsy for suspected vitreoretinal lymphoma. These are notorious for the fragility of the tumor cells and the relatively high rate of non-diagnostic samples. By working closely with the vitreoretinal surgeons, we have been able to make recommendations with respect to how the sample is taken, transported, and processed in the lab to improve the diagnostic yield. And that is essential because vitreoretinal lymphomas are high-grade tumors where diagnostic delays must be avoided.
If you could change one aspect of your field, what would it be?
I was taught that the pillars in the understanding of medicine are the “three Ps”: pathology, physiology and pharmacology. If we are to make progress in the understanding of the pathogenesis, prevention and treatment of disease, we have to invest in these cornerstones of scientific medicine. Academic pathology is one of the most fragile subspecialties in medicine at present, and we have to increase awareness of its importance and create initiatives to make it attractive and prevent its complete disappearance.
What can be done to make the ophthalmic field more diverse?
Surgical specialties all suffer from a male/female imbalance. This may be due unconscious bias within the individual, society, and within institutions. The issue must be addressed head-on, with women of all backgrounds being encouraged to enter ophthalmology and associated specialties, to take this career into consideration even when they are at secondary school before progressing into medicine at university. Through programs such as Women in Vision UK and ARVO’s Women’s Leadership Development Program, women can be supported through their entire clinical and research careers. Mentorship programs or networks should also be available, acting as a buddying system, so that women can tap into these whenever problems arise. Finally, male colleagues should be made aware of what obstacles are still present for progression of female ophthalmologists, and should be enlisted to help overcome these.
What is your proudest professional achievement?
Receiving the ICO’s Award for Ophthalmic Pathology in 2018 at the World Ophthalmological Congress in Barcelona. This award is given out only every four years to someone who has consistently supported training and research in Eye Pathology. It was instigated by the late Gottfried (Fritz) and his wife, Lieselotte Naumann, of Erlangen, Germany, and involves an international competitive selection process. Together with William Lee from Glasgow, Naumann was one of my mentors during my training as an eye pathologist. To be chosen amongst the previous awardees was a great honour for me.
How has your life changed during the COVID-19 pandemic?
The pandemic has actually brought me closer to my research team. I used to rush between buildings, cities, and countries – but a lot of time can be saved through virtual platforms. I see my students and post-docs significantly more regularly than before.
If you could go back in time to give yourself some advice, what would you say?
Pick your battles. Don’t waste time on things that take you away from science. And don’t spend too much time writing long emails!
Outside of work, what makes you happy?
My three children make me very happy and proud, and beyond them, I very much enjoy cycling, walking, photography, music, and delicious seafood (cooked by my husband)!