Hard Work Pays Off

What first piqued your interest about ophthalmology?

When I graduated from medical school, I interviewed for specializations in three subjects: otolaryngology, obstetrics and gynecology, and ophthalmology. The hospital’s new chief of ophthalmology, Ildikó Süveges, seemed the most promising mentor. She was a good lecturer and a great surgeon, and she wanted me in her department – so I accepted, and it was one of the best decisions of my life. I’m glad I chose ophthalmology because it’s always changing and improving. I think it has developed more in the last two decades than any other medical profession. We moved from intracapsular cataract extraction to microsurgery in that short time, and can even compensate for astigmatism and presbyopia in the same procedure. So a 70-year-old person with no other ophthalmic pathologies can gain back the visual acuity he or she had as a 20-year-old.

How did your career path lead you to cataract and refractive surgery?

The world’s first excimer laser procedure was performed in the United States in 1987 by Marguerite McDonald in the USA. It was 1992 before the first excimer laser arrived in Hungary, and I began to use it right away. I enjoyed it so much that I used it for all of my procedures, a total of about 30,000 cases to date. Around the same time, I published an Ophthalmology article – still one of my most cited works – about avascular corneal wound healing following refractive surface procedures and found out that UV-B light might be harmful in the first six months following PRK. Living in Europe without the oversight of the FDA, we could experiment more than our American colleagues, so they came to us to study our excimer laser methods and learn about wound healing.

Cataract surgery was part of my ophthalmic training, so I worked on cataract cases from the beginning. First, I learned to perform intracapsular cataract extraction, then extracapsular techniques, and then in the 1990s I began to use phacoemulsification. I knew phaco was going to be the future, and even then, I expected refractive and cataract surgery to merge, because all cataract surgeries are refractive procedures as well. So cataract surgery was always an important part of my ophthalmic activity.

What was it like to perform the world’s first femtosecond laser surgery?

In 2008, I had the chance to perform the first-ever human femtosecond laser-assisted cataract surgery. Many Hungarian scientists and IT professionals helped develop this equipment. I knew Tibor Juhasz and Ron Kurtz beforehand, so they approached me to ask if I would be willing to perform the surgery on a patient. I felt the same excitement as I did when I started refractive surgery; I immediately knew that it was going to be an important part of my life, and possibly many others’ lives. I also knew that I had to be very thorough and cautious, because if I made a mistake, a patient might be harmed and the whole method condemned. So I approached it very humbly, and did no harm. Of course, we introduced the new procedures gradually: first the capsulotomy, then lens fragmentation and liquefaction, and last but not least wound creation and arcuate keratotomy to control preoperative astigmatism.

The first femtolaser patients did all well, and I’m sure they benefited from the new method. There was some conjunctival redness at first, but all of the corneas stayed clear and IOPs were normal. The only issue was that the corneal wound was always more central than we predicted using the old patient interface. We had to redesign the interface to achieve our original goal: nice, smooth corneal wounds near the limbus, exactly as planned. We still check up on the original patients, and all of them are doing well. I’ve even edited a book on femtosecond cataract surgery, which I hope will help many surgeons just beginning to use the laser. So I’ve fulfilled my responsibility to femtolaser surgery – and now, millions of patients benefit from the technology.

What is your advice for trainees just embarking on their ophthalmology careers?

Choose ophthalmology and you enter a wonderful world where you don’t feel the passage of time. Confucius said: Choose a profession you like and you will feel like you aren’t working at all. I feel the same; I enjoy every moment of being an ophthalmologist.

I always advise that hard work will eventually bring rewards, and as a young person, one should do everything possible to get the best knowledge from the best places. Choose a good chief who can help you develop, and who is a team player. Then you can reach the stars. There are more opportunities for young ophthalmologists now than ever, but that’s a great thing. I feel sure that ophthalmology is one of the best among the medical professions.