Crossing (Corneal) Borders
Sitting Down With… Audrey Talley Rostov, Director of Cornea, Cataract and Refractive Surgery, Northwest Eye Surgeons and Global Medical Director, SightLife, Seattle, USA
What inspired you to become an ophthalmologist?
I don’t think there was a single reason – it’s more a combination of factors. In medical school, I had the opportunity to do a research fellowship. I started in one lab but funding changed, so I needed to find an additional research opportunity. I ended up doing a research fellowship in ophthalmology at the Massachusetts Eye and Ear Infirmary, where I studied endophthalmitis.
Initially, I was coming at it from more of an infectious disease/molecular biology standpoint, but then, as I started to learn more about ophthalmology, I simply fell in love with it. I enjoyed the combination of outpatient medicine and having the opportunity to do surgery – I’m very surgically orientated – and I didn’t really enjoy inpatient medicine very much. But mostly, it was realizing what a difference you can make to someone’s quality of life. I would say that’s what really drew me to ophthalmology.
What would you be doing if you weren’t an ophthalmologist?
I guess if I wasn’t in ophthalmology but still in medicine, I would either be in dermatology or plastic/reconstructive surgery. But if I wasn’t in medicine at all, maybe I would be a yoga instructor! Every day, first thing in the morning, I do some sort of workout, whether it’s running or cycling or spinning. And then in the evenings I do yoga. Sometimes we do mini yoga sessions in the operating room between cases! I think I’d enjoy being a yoga instructor: I love to work out and I like the opportunity to try and motivate people.
Where did you train – and who are your mentors?
I did my residency at Washington University in St Louis, Missouri. The person who really kindled my love of cornea – my sub-specialty being cornea, cataract and refractive surgery – was Jay Pepose. He’s an amazing teacher and a great researcher; he’s also extremely ethical and has a great sense of humor. I really credit him with sparking my interest in cornea.
I then did a fellowship with Dick Lindstrom at Minnesota Eye Consultants. Dick has been a mentor to me ever since, he is just an amazing individual. He taught me about combining clinical practice with clinical research, being innovative, the importance of involvement with industry for innovation – and incorporating that into clinical practice, as well as further honing my surgical skills and teaching me how to come up with original solutions.
What are your career highlights so far?
One of my highlights from early on in my career was the opportunity to train where I did – and to have Dick as a fellowship director and mentor. Aside from that, it is the global work that I do. I work with SightLife – a global health organization committed to eliminating corneal blindness worldwide – where I have served as Associate Global Medical Director for the last few years. I’m now on the board of SightLife and I also serve as the Global Medical Lead between the Global Medical Director and the board. In this role, I’ve been very involved with surgeon training and curriculum development worldwide. In particular, I’ve developed a curriculum for training surgeons in certain techniques, such as endothelial keratoplasty, DMEK, DSEK, as well as other corneal transplant techniques.
We’ve trained hundreds of fellows across the world – and now many of these people are training others. We really go for sustainability in our program. It is not just about mission trips where people go and do surgery and then leave; it is really more about teaching and training. Going back to India and seeing people that I’ve trained participate in workshops where they train other surgeons has been incredibly rewarding.
Tell us more about the humanitarian work you have been involved in.
About 10 years ago, I was invited to give a keynote speech in Mumbai but, shortly before I left, terrorist bombs went off, and the event was cancelled. I had already purchased airline tickets, booked the time off, and my husband was going with me as well, so we decided that we would go anyway and just change our itinerary.
At that point, SightLife was just branching out into global work, so I asked if there was any way I could add some value. I ended up training a surgeon in PK and DSEK, back when endothelial keratoplasty was only just being adopted. She was the only surgeon for a catchment area of a couple of million people and it was clear that she just didn’t have the means to go and get training. It made me realize that although there were some amazing surgeons in India, there weren’t enough resources to train enough of them to serve the entire population. After that, we started looking at the whole cornea ecosystem – not just training surgeons, but also making sure there are enough corneas available, ensuring quality of tissue, distribution, and building capacity. We have been working on that for the last decade.
Over the last couple of years, SightLife has also embarked on a prevention program following a proof-of-concept study done by the Proctor Foundation. The study looked at using female community healthcare volunteers in rural Nepal to diagnose and treat early corneal injuries; a lot of blindness in developing countries is caused by secondary infection from a relatively minor injury that is not treated. Even as we’re trying to treat the 12 million corneal blindness cases that exist, about a million people are becoming blind every year, so it makes it hard to catch up. The prevention program looks to train additional community healthcare volunteers and, so far, it has been incredibly successful. These women are able to treat and resolve 96 percent of the injuries that they are faced with, helping eliminate corneal blindness.
Has access to eye care in developing countries improved over the last decade?
It’s definitely looking better, especially in terms of additional surgeon training. Another important factor is policy, and that’s why at SightLife we work with governments in India and Nepal, to help with the implementation of healthcare policy.
It’s great to see that the landscape is really improving and more patients are able to get access to care. But there is still so much more work to be done.
What main projects are you working on right now?
I’m helping with additional curriculum development, not just for corneal surgeons, but also for general ophthalmologists, as well as optometrists. There are always new techniques to learn, so we want to make further changes to the DMEK curriculum in developing countries, as well as creating a keratoconus curriculum.
On the home front, I do a lot of work with femtosecond lasers and femtosecond laser keratoplasty techniques – it’s a big research interest of mine. I’ve also been doing a lot of work on cross-linking for keratoconus.
How do you see the field of ophthalmology changing in the future?
Techniques are obviously becoming less and less invasive. And corneal treatments are becoming much more bespoke and focused on specific problems, compared with 10 years ago, when we used to perform full thickness keratoplasty for all diseases. For example, in endothelial keratoplasty, if there is a problem with endothelial layer, we can now just replace that layer.
Within corneal surgery, I think we should be looking to cataract surgery and aiming to provide not just functional vision, but take it to a more refractive level. Years ago, cataract surgery was just about restoring functional vision. Now, with modern IOLs, we can provide patients with a better range of vision and, therefore, a better quality of life. I find it really exciting to correct someone’s astigmatism and restore their vision to unprecedented levels. There is still a lot of work to be done, but I think one of the most exciting things that you can do in ophthalmology is to help people go beyond simply functional vision, and perform a truly refractive procedure. My hope is to take corneal transplant surgery to that level as well.
What advice do you have for ophthalmologists at the beginning of their career?
You’ve made a good choice! It’s an extremely rewarding profession and my advice would be to find something you really like to do and get very good at it. Don’t forget that our end goal is to take care of patients and what we’re doing is really a privilege. I think it’s also important to remember about self-care. You can only be a good doctor if you also care for yourself. Try to avoid burnout by doing daily exercise, knowing your limits, and remembering to find balance in your life.
I think I’d also remind new ophthalmologists that it is OK not to love everything that you’re trained in, but it is important to keep learning. I was recently at an institute in Bangalore, India, where they had a quote above the doors to their study and research area, which read: “The most dangerous phrase is ‘because we’ve always done it that way.’” I love that. It is extremely important to be a life-long learner.