Always Aiming Higher
Sitting Down With… Boris Malyugin, Professor of Ophthalmology and Deputy Director General at the S. Fyodorov Eye Microsurgery State Institution, Moscow, Russia
Aleksandra Jones | | Interview
What inspired you to become an ophthalmologist?
I come from a medical family; my grandparents and parents were doctors. From early in my life, I knew I wanted to practice medicine, but I wasn’t sure which specialty to choose. Every summer, I stayed at my grandmother’s house in the countryside. She lost her eye when she was just 15 years old and my strongest memory of staying there is of her removing her glass eye. She would store it in a glass of liquid every evening and it obviously made a strong impression on a young mind. Perhaps this was part of my motivation to work with eyes. Surgery was an obvious choice for me – I like to work with my hands and see clear results in my work.
What was it like to be mentored by refractive surgery pioneer Svyatoslav Fyodorov?
When I first started in the cataract and corneal surgery department as a young doctor, I didn’t have much contact with Fyodorov. He was like a god to us – unattainable; far in the distance. I trained under Zinaida Moroz (famous in Russia for her corneal work, including transplants) and I enthusiastically observed and took part in complicated surgeries. At the time, there were many opportunities for young ophthalmologists. Our teachers removed cataracts with ECCE, implanted IOLs, and left the patients for us to do suturing. We did 15 of those cases a day so, after a couple of weeks, we were quite skilled. This helped me progress surgically in a very short time. Of course, this is no longer the case – there is a lot more regulation and residents are much more restricted. My younger colleagues have to put in much more time to get to that point.
As my surgical skills developed, Fyodorov noticed me and asked me to work with him. I started assisting with his surgeries and helping look after his patients. He was enthusiastic about his work and full of ideas that he was willing to share with his younger colleagues. It was a very interesting time, with great advancements in IOLs, refractive surgery, glaucoma, cataract surgery, corneal transplants… New materials, such as silicone and hydrogel, were starting to be used. We didn’t know a lot of things about the anterior segment that we do now, but it was truly exciting work.
What do you need most to progress in your career – is it innate ability, hard work, or the right training?
It’s a combination of these things, but the right mentor can motivate you and serve as a role model. Encouragement from them to explore the profession in depth is invaluable to a young person at the start of their career. A lot of clinical and specifically surgical practice helps to gain clinical experience fast and to grow the hand skills.
The clinic’s environment is also crucial – motivation to do research, ask questions, and challenge senior colleagues helps to grow great doctors. Clinics that consider younger physicians inferior are not conducive to such growth.
Young ophthalmologists often have interesting views, and it’s important for them to feel like they can express those views freely. Experienced physicians should not take their junior colleagues for granted. As doctors, we must challenge the reality around us and strive to be better and do better.
You have designed surgical devices. How did you become an inventor?
A great thing about working at my clinic is that I have had access to manufacturing facilities. With the boom in new devices, lenses, and materials at the start of my career, it was easy to implement new ideas I had into my clinical practice. There was less regulation, so it was much easier then than it is now. The creative, innovative atmosphere at the clinic really helped me try different things, share ideas, and develop new devices.
Persistence is crucial; there are so many great ideas in every area of ophthalmology, but only one or two might become widely used in clinical practice. Many areas still need improving, from diagnostics through surgery to postoperative care. You have to explore the unmet need in depth, try different approaches, and become an expert in your chosen subject matter. Then, choose your best idea, focus on it, and keep going.
What do you find inspiring these days?
When surgeons get really good results, they get great emotional feedback from the patient. It results in a huge endorphin rush that you want to repeat. You get “addicted” to it and you crave these positive emotions. This feeling drives most surgeons to keep going, getting better, and doing a great job every time.
These days, I’m not only a surgeon; I also supervise scientific research in the clinic. I try to identify potential areas for improvement and gaps in care and available solutions – whether it is a new IOL, a new suturing or surgery technique, or a new diagnostic. I encourage younger colleagues to work on addressing these unmet needs. It’s a very important part of my current activities – identifying existing solutions that we haven’t implemented yet.
A leadership position in ophthalmology – what has that been like for you?
Every good surgeon will, at some point, be offered an administrative position. It’s not always good; sometimes you might lose a great doctor and gain an average administrator. It really depends on the person – some people revel in it. It’s not easy to combine clinical and administrative work; it has been a challenge for me and the latter takes a lot of time out of my day.
How do you see your subspecialty changing in the future?
There are exciting frontiers on the horizon of refractive surgery, such as changing the refractive index of the cornea using lasers. Modifying the IOL after implantation is a great way to fine-tune the refractive result we can achieve. In the future, a lot of our work will be done by computers, so the physician’s role will be very different. In diagnostics, there will be no need for physical contact between an ophthalmologist and a patient during an exam – it will all be done by machines. They can visualize subtle defects so much better than the human eye can! Robotics and semi-automatic systems are coming into surgery so, at some point, the role of the surgeon will also look very different. It has already happened to a large extent in other surgical specialties and it’s coming to ophthalmology, too. An ophthalmologist’s reality will be very different in a decade or two – but no less interesting! Knowing more about genetics will give us an even better understanding of many diseases. It will result in better outcomes for patients and for doctors, which makes me very excited.
What excites you outside of ophthalmology?
I love travel, although opportunities to do it these days are obviously very limited. I’m hoping to begin again this summer. I also enjoy physical activity. As a young boy, I was part of a swimming team; these days, summers are for swimming and winters are for skiing!