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Business & Profession Cornea / Ocular Surface, Professional Development, Education and Training

Patient to Pathfinder

Credit: Headshot supplied by Kendall Donaldson.

Was there a moment that piqued your interest in ophthalmology?

I was quite young when my vision began to falter – just third grade. In fact, it wasn’t until I was caught copying my classmates on multiple occasions before my parents were alerted. This incident led to my first eye examination, revealing a high prescription of around minus five diopters. Glasses today aren’t recognized as the “uncool” or unpopular accessory as they were when I was a child; back then, they were a one-way street to getting picked on or singled out. Picture a child with a pair of glasses that’s far too big for their face – that was me (at least for a little while).

For those who haven’t experienced poor vision (especially in a classroom setting), I can assure you it’s a hard thing to grasp. And looking back, it was this deficiency – alongside various social pressures – that inspired me to do everything I could to understand more about it. It seems natural that, when you’re exposed to a specific area of medicine from a young age, you develop a curiosity and desire to understand it better. Take my daughter, for example. She was born with a tumor that affected her hearing and has recently developed an interest in ear, nose, and throat medicine, with aspirations to one day become an otolaryngologist.

Because I wasn’t burdened with any other notable medical issues, I was solely exposed to optometry and ophthalmology. Naturally, I had come to admire my optometrist and even constructed a model eye for a science fair using household items. I also had the opportunity to take part in early studies, such as those testing bifocals to slow myopia progression and introducing hard contact lenses to young children for the same purpose. It was through these experiences that I began to grasp the fundamentals of optometry and ophthalmology – so much so that I saw it as a potential career path for the future. And despite some detours along the way, I always found my way back to ophthalmology.

Which mentors have influenced your career?

The more mentors one has across different aspects of life, the better. Personally, I’ve been fortunate to have several mentors who have left a lasting impact on me. For instance, Doug Koch, a prominent figure in ophthalmology, has been a superhero of sorts for me. His contributions to cataract and refractive surgery, along with his emphasis on continuous improvement, have been inspiring. He instilled in me the importance of not only understanding what we do but also why we do it – a valuable lesson across all industries.

Similarly, David Chang’s leadership in ophthalmology, particularly through organizations like the American Academy of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgery (ASCRS), has been invaluable. His dedication to advancing education and collaboration within the field has been exemplary.  Dick Lindstrom has been another remarkable mentor, teaching me the significance of collaboration with industry and offering insights into the future of ophthalmology. His ability to anticipate trends and innovations is truly remarkable. And finally, Vance Thompson’s emphasis on kindness and patient-centric care has deeply influenced my approach to the patient experience and staff interactions. Each mentor has contributed uniquely to different facets of my professional growth.

With each mentor, I was able to gain a different perspective and skill. All were great in their own right; I suppose I’m the product of their teachings combined into one collective philosophy. Today, I make it a priority to serve as a mentor whenever possible. Beyond my students, this also extends to my staff, including technicians and front-desk personnel. Encouraging their growth and development is just as rewarding as guiding fellow ophthalmologists.

How do you think teaching in ophthalmology is changing?

Digitalization is clearly paving the future of ophthalmology, but I do have reservations. Human interaction is almost becoming underrated; I think that live meetings and live interactions are essential to creating relationships. Of course, things like the metaverse, simulations, and virtual learning are helpful in many ways, but we shouldn’t lose sight of each other and our shared goals born through in-person collaboration.

What changes have you seen in cataract surgery and ocular surface disease management over your career?

It’s been 20 years since I completed my fellowship; one theme throughout this period has been the consistent evolution of cataract surgery. From improvements in our phacoemulsification machines to the emergence of premium intraocular lenses – including multifocal, extended depth of focus, light-adjustable, and toric lenses – these advancements not only help patients regain clear vision but also reduce dependence on glasses. The range and quality of vision continues to improve with each passing year as new lens models and types are introduced.

Ocular surface disease, on the other hand, wasn’t a significant focus across my residency and fellowship, as there were limited treatment options beyond artificial tears. In fact, it wasn’t until the introduction of Restasis (cyclosporine) in 2002 that the field paid more attention to ocular surface disease management. Subsequent treatments, such as Xiidra, soon followed and could offer patients more options. Particularly in the past decade, there has been an explosion of new treatment modalities, including various eye drops, procedural treatments – like thermal pulsation and intense pulsed light therapy – and lid cleaning procedures.

What motivates you in terms of your own research?

Currently, my primary focus revolves around the balance between visual acuity and visual quality – it’s not uncommon to encounter patients with 20/20 vision who are dissatisfied. Twenty years ago, it was normal to question why someone with “perfect” vision could be unhappy. Some even attributed it to a mental deficiency. But today, new instruments are providing us with a clearer understanding as to what’s going on. Optics of the lens can sometimes lead to compromises, manifesting as higher order aberrations or changes in lens optics affecting vision quality. Patients may also experience phenomena like ghosting or halos, even while achieving 20/20 vision. For instance, they might struggle with night driving or encounter ghost images when reading. Fortunately, we can now understand these various aberrations and pinpoint the source of the problem within the eye – whether it’s the lens, cornea, or retina. By switching to a lens with different optics, we can significantly improve a patient’s visual experience. And though both lenses may achieve 20/20 vision, the difference in quality is profound.

I’m also intrigued by the quality of vision versus range of vision. Often, in cataract surgery, we must find the balance between preserving vision and expanding the scope of a patient’s sight. Yet, no existing lens perfectly mimics the natural lens of, say, a 10-year-old. Hence, the plethora of lens options available. Generally, as we extend the range of vision, there’s a trade-off with quality – we want to develop a lens that offers both quality and range of vision, akin to the human lens. I’m particularly interested in the light-adjustable lens, which is the only lens in the world that can be adjusted postoperatively. This allows patients to trial their vision before locking them in when they’re happy with both noted areas.

What are the proudest moments in your career?

When I see my students receive recognition for their contribution to ophthalmology, it’s always touching. Whether it’s one of my high school students winning a state science fair award or a fellow going on to become national and international leaders, it makes me proud to know I’ve had a positive impact on their lives. Aside from that, making The Ophthalmologist’s Top 100 Power List, and also the Top 100 Women in Ophthalmology was a big deal. And though I’ve had many other career highlights, I’m a family oriented person, so my children sit above the accomplishments I’ve gained in academia and industry.

What advice would you give to the rising stars of ophthalmology?

In ophthalmology, we’re incredibly fortunate to have one of the highest satisfaction rates among medical professionals in any career. Maintaining enthusiasm for what you do is key. I’ve found involving my family in my work, whether through research projects or patient assistance, to be fulfilling. It’s essential to show them that you enjoy what you do.

Beyond this, collaborating with industry is another important step. Contributing to the development of technologies not only improves patient care but also allows us to deliver advancements faster. Within this, volunteering is another key aspect. Express interest in others’ work and get involved where you can. People are usually eager to have enthusiastic collaborators. For instance, if a resident or fellow shows interest in my work, I’m more than willing to involve them in some way.

What personal qualities have been key to your success in ophthalmology?

I would say a key personal quality is my commitment to being a role model. Whether it’s with my own children, my students, residents, fellows, or staff, I’ve always strived to set a positive example that encourages the people around me. This dedication to leadership extends beyond mere instruction; it prompts reflection and questioning of our practices.

In teaching, you are surrounded by inquisitive minds and nearly every day you find yourself challenging/reconsidering the status quo for an alternative method. Repetitive tasks, such as working up patients for cataract surgery, can easily become monotonous if approached with a static mindset. However, interacting with residents, fellows, and colleagues who question our practice forces us to reevaluate often. And by constantly questioning and seeking ways to enhance our practices, we not only elevate our performance but also keep our work engaging and fulfilling.

Another crucial attribute that has contributed to my success, both personally and professionally, is maintaining a positive attitude. We often interact with elderly patients and one common trait among the people who reach the remarkable age of 100 is a resilient and optimistic outlook on life. These centenarians approach each day with gratitude and positivity, finding joy in the simple pleasures and challenges of life. Their example serves as a reminder of the importance of maintaining a positive perspective, both in our work and in our daily lives.

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About the Author
Jamie Irvine

Associate Editor | The Ophthalmologist and The New Optometrist.

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