October 2018


EyeWorld reports from the 2018 Women in
Ophthalmology Summer Symposium

EyeWorld reports
from the 2018 Women
in Ophthalmology (WIO) Summer Symposium, August 16–19,
Ponte Vedra Beach, Florida

View videos from WIO 2018: EWrePlay.org

Cynthia Matossian, MD, discusses her presentation on beauty-related procedures that can impact
the ocular surface.

View videos from WIO 2018: EWrePlay.org

Lisa Nijm, MD, discusses ocular surface disease management, the prevalence of dry eye, and how it affects patients.

Challenges and opportunities for women in ophthalmology

While women have made great strides in ophthalmology, many challenges and opportunities remain, according to Sonal Tuli, MD, Gainesville, Florida. For example, although more than 50% of medical school students now are women, the number of women in ophthalmology begins lagging behind men in terms of reaching the higher leadership roles, data presented by Dr. Tuli showed. 
This could be due to various factors including culture, a lack of female role models in the field, explicit and implicit bias, and impostor syndrome, Dr. Tuli said. Kathryn Colby, MD, Chicago, gave more details on impostor syndrome, including her own experiences with it. Impostor syndrome, she explained, is when high-achieving individuals question their abilities and fear that others might discover them to be frauds. This is more likely to be experienced by women, but it can be experienced by men as well. At least 70% of people will experience impostor syndrome, Dr. Colby said, which can be associated with anxiety, stress, and depression. 
Dr. Colby, for example, was invited at a recent meeting to give a talk on ocular surface tumors in children. When she reached the podium, she saw in the audience four experts in that specific field, which caused her to ask, “Why am I giving this talk?” Within those few moments, Dr. Colby recognized this impostor syndrome in herself, internally laughed about it, and ended up giving a successful presentation. 
In terms of monitoring impostor syndrome, you need to pay attention to your inner voice, Dr. Colby said. Sharing your experiences with impostor syndrome is also helpful in showing others (and yourself) that you’re not alone in experiencing those feelings. Learn to recognize when those feelings arise in yourself, visualize your success, step out of your comfort zone, and make friends with failure, which Dr. Colby said is the only way we learn and grow. 
Ashvini Reddy, MD, Oklahoma City, addressed specific statistics on women in ophthalmology, especially from an earnings standpoint. There is a disparity in earnings between men and women, for various reasons, that should be addressed and explored because the “expense” of neglecting this topic is great. Dr. Reddy pointed out that a woman earning $50,000 less annually faces a loss of $1.5 million over her 30-year career. If you added that up among all U.S. female ophthalmologists, that’s more than $6.7 billion during their working lifetime. 
Michelle Cabrera, MD, Seattle, spoke about sexual harassment in ophthalmology in the context of the #MeToo movement. WIO conducted a survey earlier this year of its membership on the topic of sexual harassment, finding that 59% of survey participants (who were mostly female) experienced sexual harassment, 47% of which reported it happening within the last 5 years. Most reported sexual harassment occurring while they were in medical school or residency, but it happened at later career stages as well. 
In terms of strategies to combat sexual harassment, Dr. Cabrera offered several. These included bystander interventions—when those witnessing it offer the victim support and/or confront the harasser—increasing partnership with an institution’s Title IX office, having sexual harassment education programs, and creating zero-tolerance policies.

Editors’ note: The speakers have no financial interests related to their

Tips for better patient-healing and better self-healing

Several speakers during this session gave strategies to better heal patients and also take better care of oneself as a physician. Kelly Muir, MD, Durham, North Carolina, addressed the common topic of patient compliance issues with eye drops. There are a variety of reasons why patients may be noncompliant with drop regimens, but Dr. Muir gave three ways to “help us help our patients take care of themselves.” 
The first was to provide clear communication materials, developed with an active voice, limited dense text, and clear graphics. Her second tip was to ask patients about any problems they might be having with their drops and take the time to address each of them. If the patient is having trouble remembering their drops, for example, suggest pairing drop time with another routine activity, such as brushing one’s teeth. The third tip Dr. Muir offered is having patients bring in their drops and show the physician or technician how they are administering them. This can help identify any issues the patient might be having with administration, and counseling or devices that could help them with proper administration could be suggested. 
Jullia Rosdahl, MD, Durham, North Carolina, offered her five “practical resilience hacks” to help prevent burnout, a syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment.
Her first hack is performing “micro-mindfulness,” that is taking a moment in everyday actions to be present, such as when you touch a doorknob before going in to see a new patient. Feel that doorknob, be present in that moment and use it as a way to transition from whatever you were thinking before to go in and be fully present for that patient, Dr. Rosdahl said. 
Her second hack included trying to achieve the 3:1 positivity ratio. Write down three things that make you feel good and think about how you can incorporate more of those things into your daily life, she said. Third, create boundaries with your patients and colleagues by coming up with a boundary speech (what you plan to say when you need to say no to someone). 
Dr. Rosdahl’s fourth hack is when you find yourself catastrophizing an event, create an “and” statement. For example, when you’re thinking about how much you have to do, add something like “and I have such a fulfilling job and am so thorough.” This, Dr. Rosdahl said, “opens up possibility and gives you space to feel a positive direction instead of a spiral down into catastrophe.”
Finally, Dr. Rosdahl’s fifth hack was to “take your pulse,” figure out where you feel frustration in your body and figure out what you need to do to cool down.

Editors’ note: The physicians have no financial interests related to their comments.

Practice management

Jane Shuman, Ashland, Massachusetts, described what it takes to attract and retain quality support personnel. Most offices only recruit when they need staff, leaving them little time to advertise, interview, and hire the type of employees they might want. Quality support personnel might not necessarily have ophthalmic experience, but they will have experience dealing with people in sometimes unpleasant situations, such as those in the hospitality industry. Students can be great resources for externships as well. 
Getting the attention of these types in a job could mean engaging them in conversations when you meet with them, posting a more nontraditional ad on job sites and on a career page on your website, and/or creating bonus incentives for employees who recruit new hires. Once a person is hired, retention can be helped by providing employees with the tools they need to do their job in addition to having a formal orientation program, setting specific expectations, and establishing a mentor, Ms. Shuman said. Having open communication, access to managers, and regular thank yous can go a long way, she added. 
Ransomware and cyberattacks are now considered common in the healthcare field. Renee Bovelle, MD, Glenn Dale, Maryland, cited statistics that found 45% of ransomware attacks in 2017 were within the healthcare industry, and healthcare has the highest financial burden to remedy these situations as well. There is not only the financial issue of getting the data back but fines that might be issued from a legal standpoint as well.
What do you do if you find you are the victim of a cyberattack? First, Dr. Bovelle said to close down the machine and unplug it. Then notify a compliance officer and conduct a forensic audit, which will tell you if the data breach should be reported to the Department of Health and Human Services. Ransomware attack risk can be decreased by having secure, up-to-date file backups, using reputable antivirus software and a firewall, personalizing anti-spam settings, avoiding public, wireless internet sources, educating employees, and having privileged account management.

Editors’ note: Ms. Shuman has financial interests related to her comments. Dr. Bovelle has no financial interests related to her comments.

Best abstracts of the meeting

A few abstracts were selected, from the dozens of accepted posters, for presentation at the meeting. One covered research by Cristina Lopez-Beauchamp, MD, Washington, D.C., and coinvestigators on the impact of surgical simulator training. Ultimately, the research found that implementing a virtual simulator training course for cataract surgery prior to and during training for residents resulted in a significant decrease in surgical time and complication rates. The virtual simulator, Dr. Lopez-Beauchamp said, can give the resident the opportunity to develop fine motor skills, control hand tremor, and practice on all the steps of cataract surgery, as well as allow them to identify and concentrate on weak points from their past surgical cases. 
Xuemin Zhang, MD, College Park, Maryland, described research that evaluated the variability in retinal vessels using OCT-angiography (OCT-A). Dr. Zhang and her colleagues found that there is (1) low intrasession variability in vessel caliber for OCT-A en face images; (2) the coefficient variation for vessel caliber is similar for OCT-A and ICG-A; and (3) the variability appeared to be higher in patients with glaucoma, supporting the theory that there is altered blood flow in glaucoma.

Editors’ note: The physicians have no financial interests related to their comments.

Learning to love medicine again

In “Learning to Love Medicine Again,” Starla Fitch, MD, Atlanta, said that to her, practicing in today’s medical atmosphere can feel like being on a teeter totter where one end is weighted with negatives—many of which cannot be controlled by the physician—and the other end is weighted with positives.
Dr. Fitch related how she had experienced feelings of burnout and ultimately reached a breaking point. She also shared what she started to do to move forward from that burnout, change, and to help others in a similar position. 
Finding someone who can accurately mirror you is so important, she said. This person is a sounding board who can reflect your situation and offer insights. Second, she said having a positive attitude is important. How does one cultivate that? By finding and making regular reminders that emphasize what we love about medicine and why we went into this field in the first place, Dr. Fitch said. Finally, recognize what you are grateful for in your life and share your gratitude with others. 
Dr. Fitch said a few years ago she started sending short notes of thanks and gratitude to one person each morning. She also incorporated an exercise of sharing three things that each member of her OR team are grateful for each day. 
Before concluding, Dr. Fitch left attendees with three challenges. First, do no harm—not just to patients, but also by not losing sight of yourself or your staff and colleagues. Second, find what makes you remember why you went into medicine in the first place. Third, raise your hand—don’t be afraid to show that you’ve experienced burnout or another situation that you and your colleagues might also need support in.

Editors’ note: Dr. Fitch has no financial interests related to her comments.

Women in leadership in a new era of medicine

Barbara McAneny, MD, Albuquerque, New Mexico, said that while developing one’s resilience in the field of medicine is important, she doesn’t want women in ophthalmology to learn how to be resilient but complacent in a system that needs to change. 
While there are now a significant number of women in medicine and even more when looking at the number entering medical school and residency, only 20% of women in healthcare are in what Dr. McAneny called the “C suite,” those in CEO, CFO, and similar positions. Even fewer women of color hold those positions, she added. There is also a significant pay gap between male and female ophthalmologists. 
“We need to learn that we have to step forward and demonstrate our value, speak up, raise our hand for what we deserve to have,” Dr. McAneny said, adding later that the pathways toward leadership roles might need to be redrawn in ways that don’t inherently seem to exclude women. 
The changes that women might want in medicine will be less likely to come to fruition if women are not putting themselves out there and standing up for their needs and value, she said. In addition, women who are in leadership roles need to avoid pulling up the ladders they climbed behind them. 

Editors’ note: Dr. McAneny has no financial interests related to her comments.

Leading with less ego

Alice Epitropoulos, MD, Columbus, Ohio, took on the topic of ego in leadership. “Ego is obvious and sits right out in the open. It’s one of the biggest barriers to people working together effectively,” Dr. Epitropoulos said, before explaining the symptoms of ego as those that give you a “distorted image of your own importance, resulting in an inability to see what’s around you.” 
These symptoms include ignoring feedback, only surrounding yourself with like-minded people, being blind to how your actions affect others, underestimating how much you are being watched, losing touch with the frontline experience, and not letting go of control. 
Preventative pearls, Dr. Epitropoulos said, include practicing humility, understanding that work is not all about you; it’s about the people you serve and what they needed. She said leaders should find truth tellers in their life, people they know well who can give them the “straight scoop.” Non-egotistical leaders are tough but fair; they lead with compassion and empathy; and they are learners. They rely on teamwork, capitalizing on the cooperation and talents of other individuals. Dr. Epitropoulos also said that leaders should pass that leadership onto others at times. Allowing others to take the wheel gives them the opportunity to showcase their talents. Doing this, she said, inspires the whole team to bring their best.

Editors’ note: Dr. Epitropoulos has no financial interests related to her comments.

Game changers in technology and innovation

Several new technologies and innovations were covered in the last session of the meeting. Lejla Vajzovic, MD, Durham, North Carolina, discussed her experience with the Argus II retinal prosthesis (Second Sight, Sylmar, California). This prosthetic, which consists of external glasses that have a video camera, external foil, and video processing unit that sends signals of what an image looks like to an electrode array on a surgically placed epiretinal implant, is indicated for patients with severe retinitis pigmentosa who have a previous history of useful vision. As the patient with the prosthetic scans the room, an image is projected onto the array in the shape of what the camera sees. 
Overall, Dr. Vajzovic said patient expectations with this prosthetic are often much higher than what the device can deliver in terms of image quality, at least at this point. The patient has to learn how to interpret the images that it does convey, so a discussion of patient expectations is key. The implant has shown to improve patients’ ability to identify large letters, their ability to locate an object, and their performance on direct motion tasks. More than 25% of patients using the implant regained measurable visual acuity, Dr. Vajzovic said. 
Going forward, improvements are being made to the implant’s aesthetics and sizing, and the possibility of integrating assistive technologies (such as eye tracking, a stereo sensor, and thermal imaging) is being explored. 
Perhaps not a technology or innovation that’s benefiting ocular medicine but one that is beginning to impact it are newer procedures and regimens meant to enhance one’s looks, such as lash extensions, lash embellishments, lash perming, lash lifting, eyeliner tattooing, and conjunctival jewelry and tattooing, said Cynthia Matossian, MD, Doylestown, Pennsylvania. 
Dr. Matossian shared how these procedures can exacerbate ocular surface issues by interfering with the functions of natural lashes themselves and how the various adhesives and very nature of the procedures can impart potentially harmful substances onto the eye and damage some of the eye’s structures that are vital to maintaining healthy function. 
Overall, Dr. Matossian’s message is to “keep beauty procedures in mind as one of the causes or exacerbators of ocular surface disease.”

Editors’ note: Dr. Vajzovic has financial interests related to her comments. Dr. Matossian has no financial interests related to her comments.

EyeWorld reports from the 2018 Women in Ophthalmology Summer Symposium EyeWorld reports from the 2018 Women in Ophthalmology Summer Symposium
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