A SPECIAL SUPPLEMENT TO

TIMES$Q2τFLDO3XEOLFDWLRQRIWKH$PHULFDQ6RFLHW\RI5HWLQD6SHFLDOLVWV WinR Women in Retina 10TH ANNIVERSARY

Enriching the World of Retina Presented by the ASRS Women in Retina Section

SUMMER 2018 2007

2018 WinR BOARD 2008 Chair Nancy Holekamp, MD

Vice Chair Judy Kim, MD 2009 Treasurer Mina Chung, MD

Secretary Camille Palma, MD

Communications Chair 2010 Jessica Randolph, MD

Members at Large Caroline Baumal, MD Zélia Corrêa, MD, PhD 2011 Diana Do, MD Fellow-in-Training Chair Elizabeth Atchison, MD

Chair Emerita and ASRS Board Representative 2012 Jennifer Lim, MD

Founding Members Julia Haller, MD Alice Lyon, MD 2013 Pauline Merrill, MD

2014

20 North Wacker Drive, Suite 2030 Chicago, IL 60606 2015 phone: 312-578-8760 www.asrs.org

© 2018 American Society of Retina Specialists. All rights reserved. No part of this publication may be reproduced or transmitted, in any form, without the prior written permission of 2016 the American Society of Retina Specialists.

2017 FROM THE WinR CHAIR >>

Nancy M. Holekamp, MD Chair, ASRS Women in Retina Section Director of Retina Services Center for Pepose Vision Institute Chesterfield, Missouri ASRS Women in Retina Section Celebrates 10th Anniversary

As the Women in Retina Section marks its 10th anniversary, we honor an occasion nearly 60 years in the making. Author Cathleen Schine once said, “Women are in positions of power the most radical of activists could only have dreamed of in 1960.”

Fortunately, Alice McPherson, MD, dared to dream big. In 1960, she became the world’s first full-time woman vitreoretinal specialist and founded the retina service at Baylor College of Medicine in Houston, Texas. CONTENTS

Alice McPherson led the way for other women Why form an organization for women ASRS Women in Retina retina specialists, including my own mentor, retina specialists? Section Celebrates Dr. Neva Arribas, who was a practicing retina This question became the focus of a Women 10th Anniversary 1 surgeon in St. Louis in the 1960s. in Retina Roundtable meeting on March 31, In 1984, nearly a quarter-century after she 2007 at the Hotel Sofitel in Chicago. ASRS In the Beginning— began her retina practice, Dr. McPherson, members Pauline Merrill, Jenny Lim, A Conversation With along with her mentee, Judith Feigon, MD, Alice Lyon, Julia Haller, and I met with 3 the WinR Founders 4 became the first women members of representatives of —Carol Hoang, the Vitreous Society (now the ASRS)— Anne Fields, and Leeana Carleton. Our representing 1.5% of the 1-year-old moderator was Linda Szyper, president of Women Retina Leaders— Society’s membership. Publicis Medical Education Group. Pearls From Our Pioneers 7 Fast-forward another 23 years to 2007. By Carol Hoang introduced the meeting objec- that time, 11% of ASRS members who tive: “To gain insight into the educational and identified a gender in their member profiles professional needs of female physicians in the Managing the Issues Facing were women—and an organization for area of retinal medicine and develop an Women Retina Specialists 14 women retina specialists was an idea whose ongoing forum for discussion and actions time had come. related to the stated needs.” Medical Retina Fellowships: A Growing Career Option 16

WinR congratulates all women retina specialists for their professional achievements. The time line below includes some memorable highlights, but is not a comprehensive listing.

WinR ASRS WinR ASRS Women Fluorescein Founders’ in Retina Pyron Award Conference Award 2006 2007 2008 2008 2009 2009 Julia Haller Women in Retina Susan Bressler First Annual Emily Chew is the Catherine Cukras becomes first Founded co-recipient of the WinR Fluorescein first woman to win receives the woman president ASRS Pyron Award Conference at the the ASRS Founders’ Retina Society of ASRS ASRS meeting Award Raymond R. in Maui Margherio Award

| retina times Women In Retina SUPPLEMENT | Summer 2018 | 1 FROM THE WinR CHAIR >>

WinR Founders Alice Lyon, MD; Pauline Merrill, MD; Nancy Holekamp, MD; Julia Haller, MD; and Jennifer Lim, MD, enjoy the 2007 ASRS Annual Meeting in Palm Springs.

Pauline Merrill provided the rationale for The new organization was dubbed Alice McPherson, MD creating a female-specific organization for Women in Retina, and Dr. Julia Haller—the Founder, Retina Research Foundation Founder, McPherson Eye Research women retina specialists: first, and still the only woman ASRS president— Institute at the University of soon gave us our nickname, WinR. Our group Wisconsin-Madison • The retina community is historically Professor of brainstormed on when and how WinR would Baylor College of Medicine male dominant. Houston, Texas meet, and we developed some practical ideas: • The number of women in retina • The venue should be easy to get to, with was increasing. Charles L. Schepens, MD little to no impact on families. Hence, Opens the Door • More women were in leadership WinR would “tag-along” to meetings positions, but they were still an exception women retina specialists already attend. Dr. Alice McPherson rather than the norm. credits the legendary • Smaller meetings and group dynamics Charles L. Schepens, • No current organized group met the would be significant “draws” for women MD—known as the specific needs of female retina specialists. retina specialists. father of modern retinal surgery—for giving her • Polled female physicians thought a • The setting should be more intimate, with an unprecedented career opportunity. women’s retina organization would open, less-formal discussions. be valuable. “Dr. Schepens accepted me into his • Networking during WinR forums must be retina surgery program at a time The discussion then centered on current a top priority. when no other women had been issues—both clinical and professional—facing offered this type of fellowship training,” The roundtable unanimously agreed on an women in retina: Dr. McPherson recalls. “He gave me his inclusive membership policy: If you are a full support and allowed me to learn • Involvement in key woman in the ASRS, you are automatically a from his expertise. professional associations member of Women in Retina. Others inter- “Without his training, I would have ested in the group are welcome to participate. spent the rest of my life doing • Networking Thus, in a small hotel conference room in refractions,” she adds. “But instead, • Mentoring I have been fortunate enough to have Chicago on a cold, grey day in March more had an extensive vitreoretinal surgery • Career advancement than 10 years ago, Women in Retina was born. practice and to have founded the The excitement and energy of that first meet- • Clinical trial involvement successful Retina Research Foundation.” ing are captured on page 4 as WinR Secretary • Practice establishment Camille Palma, MD, interviews the 5 founders.

ASRS ASRS The Pyron Founders’ Macula Award Award WOMEN in RETINA Society 2009 2010 2010 2010 2010 2011 Sandra Rocio Julia Haller Joan Miller Ursula WinR Logo Emily Chew Montezuma receives receives the receives the Schmidt-Erfurth is created is first woman the Retina Society ASRS Pyron Award ASRS first woman to give president of the Fellowship Research Founders’ Award the Retina Society Macula Society Award J. Donald Gass Lecture

2 | retina times Women In Retina SUPPLEMENT | Summer 2018 | That discussion led to a new term—“WinR-gy” And a 2017 online Doximity survey showed —the unique, positive vibe that comes that female doctors earn up to 27% less than when smart, accomplished, and creative male doctors in the same specialty.3 Thus, women gather. WinR will continue to have a purpose and a Mark S. Humayun, MD, PhD mission. WinR is eager and ready for the next ‘ The roundtable President, ASRS 10 years and beyond. Congratulations, WinR unanimously agreed References

On behalf of the American Society 1. Wallis CJ, Ravi B, Coburn N, Nam RK, Detsky AS, Sat- on an inclusive kunasivam R. Comparison of postoperative outcomes of Retina Specialists, I am honored among patients treated by male and female surgeons: a population based matched cohort study. Br Med J. membership policy: to congratulate the ASRS Women in 2017;359:j4366. doi:10.1136/bmj.j4366. Retina Section on 10 years of success If you are a woman 2. Sarsons H. Interpreting signals in the labor market: through collaboration. Your talent and evidence from medical referrals [job market paper]. Working paper. November 28, 2017. https://scholar. in the ASRS, you are dedication are an inspiration to all harvard.edu/fi les/sarsons/fi les/sarsons_jmp.pdf. Accessed May 7, 2018. automatically a member Society members, and your mentoring program is helping to shape the next 3. The First Annual Doximity Physician Compensation Report. Doximity, Inc, San Francisco, CA. April 2017. of Women in Retina. generation of women retina specialists. https://blog.doximity.com/articles/the-fi rst-annual- doximity-physician-compensation-report. Accessed Others interested in the May 7, 2018. On page 16, Rukhsana Mirza, MD, and her Financial Disclosures group are welcome Dr. Holekamp – ALIMERA SCIENCES, INC: Consultant, medical retina fellow, Ria Desai, MD, explore Investigator, Speaker, Grants, Honoraria; ALLERGAN, medical-only retina fellowships as a growing INC: Consultant, Investigator, Speaker, Grants, Honoraria; to participate.’ GENENTECH, INC: Consultant, Investigator, Speaker, Grants, career option. They highlight their male Honoraria; KATALYST SURGICAL, LLC: Stockholder, Other Financial Benefi t; PHARMACEUTICALS CORPO- mentor, Lee Jampol, MD, who created the RATION: Consultant, Honoraria; OHR PHARMACEUTICAL, What was it like for the trailblazers? INC: Investigator, Grants; OPHTHOTECH CORPORATION: medical retina fellowship at Northwestern Investigator, Grants; REGENERON PHARMACEUTICALS, On page 7, WinR Board Members Jenny Lim University—one of the fi rst of its kind in the INC: Consultant, Speaker, Honoraria. and Alice Lyon talk with several women retina . leaders for their perspectives on careers at a There will always be changing, contemporary, time when few women were in our fi eld, as and even controversial issues pertinent to well as the unique challenges and opportuni- women in medicine—and more specifi cally, ties for women in retina. women in retina. In fall 2017, the British Medical Journal published an article suggesting Sunir J. Garg, MD, FACS What’s ahead? Editor in Chief Retina Times that patients treated by women surgeons may Since WinR’s founding in 2007, the percentage have better outcomes.1 One month later, Thank you, Women in Retina of women members who identifi ed a gender a highly publicized working paper by a in their ASRS member profi les has increased Harvard researcher found that referring Happy 10th anniversary! from 11% to 17%—and the proportion of doctors judge female surgeons more harshly It’s no surprise why we women fellow-in-training members is nearly than male surgeons when patients die.2 call you WinRs. double that, at 33%. Given that 50% of today’s ophthalmology residents are women, Your energy, teamwork, and spirit these percentages will certainly continue to ‘ WinR will be here to shine through on every page of this increase. 10-year anniversary tribute by Women for WinR will be here to support the growing support the growing in Retina, Women in Retina. number of women retina specialists through- number of women out their careers, focusing on key topics of At Retina Times, we look forward to interest. On page 14, Manjot Gill, MD, leads a retina specialists featuring more news about WinR’s discussion with several of her women mentors throughout their mentorship program and events, as and peers on issues facing women in retina. well as your perspectives on issues careers ...’ facing women retina specialists.

The Our Mission Macula is Mentoring Society 2011 2011 2012 2012 2012 2013 Janet Sunness Joan Miller Usha Chakravarthy Lejla Vajzovic receives Joan Miller WinR starts the receives the gives the gives the the Retina Society gives the AAO Mentoring Program, Macula Society Macula Society Macula Society Fellowship Research Jackson Memorial Our Mission J. Donald Gass Medal Paul Henkind Paul Henkind Award Lecture is Mentoring Memorial Lecture Memorial Lecture

| retina times Women In Retina SUPPLEMENT | Summer 2018 | 3 WinR FOUNDERS REFLECT >>

Camille V. Palma, MD Secretary, ASRS WinR Section Retina Services of Illinois, LLC Chicago, Illinois In the Beginning—A Conversation With the WinR Founders

As Women in Retina celebrates its 10th anniversary, the 5 founding members refl ect on the early days of WinR and how it has grown into the vibrant organization it is today.

Panelists Camille Palma: What inspired you to I thought to myself, “There’s a chemistry among Julia A. Haller, MD create Women in Retina? women that is different—it’s important, and ASRS Past President it’s feeding so many other things.” Funny, Ophthalmologist in Chief Jennifer Lim: A couple of years before William Tasman, MD, sometimes from the horizon, you can see the WinR was offi cially formed, several industry Endowed Chair landscape, and I was blown away by it. Wills Eye Hospital partners had broached the idea of getting Philadelphia, Pennsylvania women retina specialists together. I remember an early event at the Association for Research ‘ There’s a chemistry Nancy M. Holekamp, MD in Vision and Ophthalmology (ARVO) where ASRS WinR Chair among women that is Director of Retina Services I was surprised not just by the number of Center for Macular Degeneration women who attended, but by the range of topics Pepose Vision Institute diff erent—it’s important, Chesterfi eld, Missouri discussed— from having kids to job promo- tions and salary disparities. I don’t think those and it’s feeding so many topics were ever openly discussed in a meeting Jennifer I. Lim, MD like that before. other things.’ ASRS WinR Chair Emerita and ASRS Board Representative Director, Retina Service Nancy Holekamp: On several occasions, —Julia A. Haller, MD University of Illinois at Chicago women in industry, specifi cally from Genen- Chicago, Illinois tech, said, “We have support for our professional Jennifer Lim: We have similar passions and women colleagues from within our company.” ideas. When we gathered everybody in the same Alice T. Lyon, MD There were a lot of women in powerful roles room, the group dynamic created something Director, Vitreoretinal Service at Genentech at the time, and they saw our and Vitreoretinal Fellowships bigger than what any one of us alone could have Northwestern University potential, encouraged us, and inspired us. Feinberg School of Medicine imagined. It took the collective effort of all the Chicago, Illinois Pauline Merrill: I remember a dinner founders to combine with Genentech support meeting in Chicago. We had already had some to recognize and form Women in Retina. discussions about starting a Women in Retina Pauline T. Merrill, MD Then, of course, Julia Haller made the great Assistant Professor group, and our Genentech representative said Department of Ophthalmology suggestion to have it come under the umbrella she would be happy to facilitate an organiza- Rush University Medical Center of the ASRS, and that made it take off for all Partner, Illinois Retina Associates tional meeting. That meeting was the beginning. Chicago, Illinois of us. It’s been really exciting. We have accom- Julia Haller: I was unable to attend the plished a lot of things through the partnership original meeting in person, so I listened in via of ASRS and WinR. phone while all the other women were together Pauline Merrill: While we are giving credit, in Chicago. I kept listening during the breaks, we have to remember that at that fi rst meeting and was surprised to hear such energy and when we decided we would call ourselves excitement—something I had never heard on another conference call.

The Macula Society 2013 2013 2014 2014 2015 Cynthia Toth receives the Retina Society Dimitra Skondra Alice McPherson Anita Agarwal Anat Loewenstein Award of Merit, and delivers the receives the is the fi rst woman receives the receives the Charles L. Schepens Lecture Retina Society to receive the Macula Society Macula Society Raymond R. Margherio International Council J. Donald Gass Medal Arnall Patz Medal Award of Ophthalmology Gonin Medal 4 | retina times Women In Retina SUPPLEMENT | Summer 2018 | WinR founders and members gathered at a luncheon at the 2015 ASRS Annual Meeting in Vienna, Austria. (l-r) Mina Chung, MD; Pauline Merrill, MD; Nancy Holekamp, MD; Alice Lyon, MD; Alexandra Kautzky-Willer, MD; Marion Munk, MD, PhD; Barbara Blodi, MD; Jennifer Lim, MD. Not pictured: Julia Haller, MD.

Women in Retina, Julia said, “Of course, we are fellows to go to Subspecialty Day with a mentor insight into how much having a female-only all winners, W-I-N-R.” and sit through 2 days with a senior person opportunity can make a difference. who puts it all in perspective for them. Camille Palma: Mentoring is a huge Pauline Merrill: I had wonderful mentors, part of Women in Retina’s mission Alice Lyon: Another important part of most of whom were male, from and strength. How did you decide to mentoring is supporting one another intellectu- through fellowship with Mike Lambert. There incorporate mentoring as a key focus ally as retina specialists and bouncing ideas off of were a few women mentors along the way, too. of WinR? Who were your mentors? one another. The surgical and clinical discussions Cindy Toth had just arrived at Duke, and of during these conferences were incredible. I course I looked up to Julia Haller, Jenny Lim, Nancy Holekamp: In the early days, think until we had WinR, we felt like we often and Alice Lyon, even if they were only a little bit our main industry sponsors were women at weren’t called on for our expertise, so this gave ahead of me. Genentech and Regeneron who were so excited us a platform and a voice for us to support one that we had started WinR and enjoyed seeing Jennifer Lim: In the beginning of my career, another intellectually. our growth and development. They loved the most of my mentors were male. Once I got into involvement of professional women at our Julia Haller: Our fi rst Fluorescein Conference , however, I was fortunate to have great functions, such as the ASRS Annual Meeting was at ASRS in Hawaii in 2008. The women who female role models. My residency class was half luncheon and our Fluorescein Conference. presented were so excited and interested, and I women, and I had the mentorship of Dr. Eve After these meetings, they would say, “Let’s found that extremely rewarding. It also gave me Higginbotham. do more.” During fellowship, I was blessed to have Julia At one point, we pulled out a napkin and Haller teach me how to operate, along with started writing down ideas about a mentoring ‘ At one point, we pulled Drs. Peter Campochiaro, Susan Bressler, and program that would have 4 touchpoints over out a napkin and Janet Sunness. I saw how they balanced work, the year with 4 specifi c missions. That napkin life, and family issues. conversation has evolved into a multifaceted started writing down Not until I was done with my training did I feel mentoring experience. ideas about a mentoring more isolated being female, because everywhere The Winter Brunch has a mentoring mission I went, I was surrounded by males. For me, of helping fellows understand ethical and program ... That mentoring became an important issue because responsible interactions with industry. The napkin conversation a lot of younger women would come up to me ARVO case conference is a chance for WinRs and ask, “How did you balance your work with to present their science and their research to a has evolved into a your family?” friendly crowd. multifaceted mentoring Camille Palma: How have your careers The Women in Ophthalmology (WIO) been aff ected by the relationships travel grants include women in the broader experience.’ you’ve formed through WinR? picture of WIO. The American Academy of —Nancy M. Holekamp, MD Ophthalmology (AAO) travel grants allow

2015 2016 2016 2016 2017 2017 Joan Miller Jennifer Lim Carol Shields receives Mary Elizabeth Johanna M. Seddon Irene H. Maumenee receives the is fi rst WinR the ASRS Founders’ Hartnett gives the receives the receives the ARVO Weisenfeld representative Award Macula Society ARVO Weisenfeld AAO Laureate Award voted onto the Paul Henkind Award Recognition Award ASRS Board Memorial Lecture

| retina times Women In Retina SUPPLEMENT | Summer 2018 | 5 WinR FOUNDERS REFLECT >>

Pauline Merrill: These relationships make know we were missing that, but looking back, we hardest residencies in which to get a place in all the scientifi c meetings even more enjoyable and can see and appreciate the benefi ts. of medicine—and then gotten a fellowship in they facilitate exchange of ideas. Now that I’ve retina, so she’s unbelievably accomplished, and Camille Palma: What advice do you met groups of people I hadn’t spent a lot of time she needs to give herself credit for that. have for young WinRs who are just with before, including international WinRs, big joining the organization? Camille Palma: The interview meetings feel smaller and more collegial. concluded with an energy, or shall we Nancy Holekamp: Jump in with both feet! Alice Lyon: WinR has opened up the door for say WinR-gy (thank you, Julia), that Have fun, enjoy your profession, your colleagues, all of us to meet younger ASRS members. We have I can only guess was similar to the meetings, and helping others. grown bigger than our own circle of professional fi rst meeting of this incredible group women to include trainees and younger women Jennifer Lim: Reach forward to the people of women. Their enthusiasm and in practice, and it has been wonderful getting ahead of you. Reach back to the people following passion are palpable, and the future together at meetings. you. Network with everybody and offer all you of Women in Retina will continue to have. honor those intentions. Julia Haller: For me, it’s almost like getting new sisters. WinR has given me an extra group of Pauline Merrill: Take advantage of all Financial Disclosures people with whom I have a special connection. networking opportunities that come your way. Dr. Haller – CELGENE CORPORATION: Board of Directors, Stock, Stock Options; JANSSEN PHARMACEUTICALS, INC: No matter how infrequently we see one another, WinR should be one of many—there are other Advisory Board, Consultant, Honoraria; KALVISTA PHARMA- CEUTICALS LTD: Consultant, Honoraria; LOWY MEDICAL there’s an instant rapport because we know we’re ASRS member sections as well as opportunities RESEARCH INSTITUTE: Consultant, Honoraria; MERCK & CO, INC: Consultant, Honoraria; NOVARTIS PHARMACEUTICALS passionate about the same things and we’re in in practice, during training, and in academics. CORPORATION: Consultant, Honoraria; SPARK THERAPEU- sync about our commitment to patient care, Don’t miss a chance to network and connect. TICS INC: Consultant, Honoraria; THROMBOGENICS, INC: Investigator, Grants. research, and education. Dr. Holekamp – ALIMERA SCIENCES, INC: Consultant, Alice Lyon: Our profession, our personal Investigator, Speaker, Grants, Honoraria; ALLERGAN, We are committed to pulling our sisters along relationships, and the communities we have INC: Consultant, Investigator, Speaker, Grants, Honoraria; GENENTECH, INC: Consultant, Investigator, Speaker, Grants, with us, and I’m so grateful. I got involved in created have brought us together. We’re lucky to Honoraria; KATALYST SURGICAL, LLC: Stockholder, Other Financial Benefi t; NOVARTIS PHARMACEUTICALS CORPO- WinR by luck, and no matter where I go, have multifaceted lives; we’ve made a lot of hard RATION: Consultant, Honoraria; OHR PHARMACEUTICAL, INC: Investigator, Grants; OPHTHOTECH CORPORATION: when I see another WinR, it brightens my day. choices for the right reasons, and now we get to Investigator, Grants; REGENERON PHARMACEUTICALS, INC: enjoy the fruits of what we’ve done and pass that Consultant, Speaker, Honoraria. Nancy Holekamp: It’s hard to appreciate Dr. Lim – ALCON LABORATORIES, INC: Consultant, on to everybody else. Honoraria; ALIMERA SCIENCES: Investigator, Grants; what you’re missing. I think we started WinR ALLERGAN, INC: Investigator, Grants; GENENTECH, INC: not to solve any problems, but because we were Julia Haller: Be intentional and deliberate Advisory Board, Investigator, Speaker, Grants, Honoraria; JANSSEN PHARMACEUTICALS, INC: Investigator, Grants; encouraged to, and it was going to be about looking at the accumulating evidence about QUARK PHARMACEUTICALS, INC: Consultant, Honoraria; OHR PHARMACEUTICAL, INC: Investigator, Grants; OPTHEA an adventure. where women fall behind. Realize that you need LIMITED: Consultant, Honoraria; REGENERON PHARMA- a seat at the table. You need to raise your hand, to CEUTICALS, INC: Investigator, Grants, Honoraria; SANTEN Now, looking back after 10 years, I think we all INC: Consultant, Honoraria; SECOND SIGHT MEDICAL be aware you’re up against societal barriers. PRODUCTS, INC: Investigator, Grants; VINDICO MEDICAL appreciate how much we’ve gained—collegiality, EDUCATION: Other, Honoraria. support, sisterhood, the ability to make very large Push yourself, make changes, and get beyond Dr. Lyon – None. Dr. Merrill – ABBVIE INC: Consultant, Investigator, Grants, meetings smaller—and I think we’ve all personally your comfort zone. We as women tend to Honoraria; ALIMERA SCIENCES: Consultant, Investigator, Grants, Honoraria; ALLERGAN, INC: Consultant, Honoraria; and professionally benefi tted from it. underestimate ourselves, to undervalue our COVALENT MEDICAL, LLC: Stockholder, Stock; EYEGATE accomplishments. Any woman in retina is PHARMACEUTICALS INC: Investigator, Grants; SANTEN, INC: We WinRs all help one another, and because we Consultant, Investigator, Grants, Honoraria incredible. She’s gotten into college, into are familiar and have a shared mission, we readily Dr. Palma – None. medical school, into ophthalmology—one of the reach out and support one another. We didn’t

The American Society DIAMOND PLATINUM of Retina Specialists CORPORATE MEMBER CORPORATE MEMBER Women in Retina Section Regeneron Pharmaceuticals, Inc Allergan, Inc gratefully acknowledges the following Corporate Members EMERALD GOLD who have committed CORPORATE MEMBER CORPORATE MEMBER generous support for 2018. Genentech, a member of Alimera Sciences, Inc the Roche Group

The Macula Society 2018 2018 2018 2018 2018 2018 Joan Miller receives the Ursula Cynthia Toth Anat Loewenstein Mary Elizabeth Joan Miller receives Charles L. Schepens/ Schmidt-Erfurth gives the receives the Hartnett receives the ASRS Pyron American Academy of receives the Macula Society Michaelson Macula the ARVO Award Ophthalmology Award Macula Society Paul Henkind Society Award Weisenfeld Award J. Donald Gass Medal Memorial Lecture

6 | retina times Women In Retina SUPPLEMENT | Summer 2018 | WOMEN RETINA PIONEERS >>

Alice T. Lyon, MD Jennifer I. Lim, MD ASRS WinR Co-founder ASRS WinR Chair Emerita Director, Vitreoretinal Service and ASRS Board Representative and Vitreoretinal Fellowships Director, Retina Service Northwestern University University of Illinois at Chicago Feinberg School of Medicine Chicago, Illinois Chicago, Illinois Women Retina Leaders— Pearls From Our Pioneers

“ None of us can know what we are capable of until we are tested,” said Elizabeth Blackwell, MD, who in 1849 became the fi rst woman in the United States to graduate from medical school. Her words no doubt resonate with every retina specialist—but none more so than the women pioneers in our subspecialty.

We owe these women homage; they blazed the Panelists trail for all of us. When the fi rst woman in retina, Susanne Binder, MD Alice McPherson, MD, completed her retina Professor of Ophthalmology Sigmund Freud University fellowship in 1958, she set high standards. Vienna, Austria How did she and other women retina pioneers Adjunct Professor of Ophthalmology Weill Cornell Medical College Judith T. Feigon, MD, PA achieve success? New York, New York Houston, Texas We asked 10 of today’s leading women retina specialists—5 from the United States and 5 from other countries around the world—about Susan B. Bressler, MD Julia G. Levy, PhD, Professor Anat Loewenstein, MD the challenges and rewards of entering a male- of Ophthalmology Director, Division of Ophthalmology dominated specialty, the mentors who helped Wilmer Eye Institute Tel Aviv Medical Center Johns Hopkins University Vice Dean, Sackler Faculty of Medicine guide their careers, and their advice for women School of Medicine Tel Aviv University today. Here’s what they said. Baltimore, Maryland Tel Aviv, Israel Why retina?

The common denominator is curiosity: these Usha Chakravarthy, MD, PhD, CBE Joan W. Miller, MD Professor of Ophthalmology and David Glendenning Cogan Professor women retina pioneers, like many of us, were— Vision Sciences and Chair of Ophthalmology and are— drawn to the challenges, intricacy, and Queen’s University Belfast Ophthalmology Consultant Chief of Ophthalmology the ever-changing nature of retinal diseases and Belfast Health and Social Care Trust Massachusetts Eye and Ear surgery. These women are intensely inquisitive, Belfast, United Kingdom and Massachusetts General Hospital Boston, Massachusetts self-motivated, energetic, and driven by variability and differences.

Ursula Schmidt-Erfurth, MD Some of the international women chose US retina Emily Y. Chew, MD Professor and Chair training when their own countries did not offer Director, Division of Epidemiology Department of Ophthalmology and Clinical Applications Director women opportunities. Deputy Clinical Director Christian Doppler Laboratory for Ophthalmic Image Analysis (OPTIMA) Susanne Binder: I decided on retina Bethesda, Maryland Scientifi c Director Vienna Reading Center because it is most interesting—the brain-tissue Medical University Vienna of the eye. My kind mentor, Professor Wolfgang Vienna, Austria Funder at the First University Eye Clinic in Janet L. Davis, MD Leach Chair in Ophthalmology Vienna, was the father of 4 daughters; he sup- Professor of Ophthalmology Young Hee Yoon, MD, PhD ported me when I wanted to learn microsurgery. Bascom Palmer Eye Institute Professor of Ophthalmology University of Miami Asan Medical Center But in 1974, women were not allowed to do Miller School of Medicine University of Ulsan surgery on their own in Vienna; they could only Miami, Florida Seoul, South Korea assist the surgery of their male colleagues. Later, I went to Johns Hopkins and Duke Eye ‘ In 1974, women were not allowed to do Center, where Drs. Ron Michels and Robert Machemer taught me everything about vitreous surgery on their own in Vienna; they could only surgery. Coming back to Austria, I had less assist the surgery of their male colleagues.’ resistance at the clinic. —Susanne Binder, MD

| retina times Women In Retina SUPPLEMENT | Summer 2018 | 7 WOMEN RETINA PIONEERS >>

WinR Chair Nancy Holekamp, MD, and Susan Bressler, MD Joan Miller, MD Anat Loewenstein, MD

Young Hee Yoon: When I became an the operating room. surgery seemed Dr. Bob Butner taught me how to examine and ophthalmology resident at Seoul National to demand precise, consistent, repetitive steps; draw as a second-year resident. He has University Hospital in South Korea in 1982, it retina surgery, by contrast, seemed more been an inspiring mentor and a good friend was very diffi cult for a woman to get selected. creative and demanding in the moment. since I started my fellowship. In 1980, they offi cially announced they would Janet Davis: When I convinced Dr. David accept 1 woman out of 3 physicians every other Parke I was committed to retina, he told me year. So, we had 2 women out of 12 residents in ‘ Some leaders are I should train in uveitis, too and become a the program. born women.’ specialist in posterior-segment infl ammations There were no fellowship-trained retina special- and infections. He and Dr. Danny Jones then ists in Korea; I think that frustration was the key —Geraldine Ferraro worked to set up my 2 fellowships, one at driver in my decision to go abroad to pursue First female US vice presidential candidate Bascom Palmer and the other at National Eye formal training. Institute with Dr. Bob Nussenblatt. These are And retina offered the greatest opportunity my true mentors; without their help, I don’t My most infl uential mentor was Dr. Stephen to develop therapies for diseases that cause believe I would have had this career trajectory. Ryan at Doheny Eye Institute during my clinical devastating vision loss and lacked good fellowship in 1992-1993, and afterward. I was Joan Miller: I have had wonderful mentors, options: AMD, , and his fi rst international clinical fellow. He taught including Drs. Evan Gragoudas, Ephraim retinal degenerations. me how to become a leader in the fi eld. Friedman, and , who welcomed Thanks to these pioneers, medical retina fl ourishes me as a professional colleague and expected In the US, a growing number of women were today and offers many treatments. Indeed, the same hard work and dedication, regardless attracted to retina by the many opportunities neovascular AMD patients often recover vision of gender. They gave me great advice about it offered. with treatment. Anat Loewenstein was prescient, believing in myself, pursuing my dreams, and Susan Bressler: I chose to work on stating, “I fi gured retina is the fi eld that would building a robust network of colleagues, friends, age-related macular degeneration (AMD), a have most of the innovations in the coming years.” and family. I couldn’t be more grateful. disease for which nobody could do anything for Who were your mentors? Others credit women scientists as mentors. patients at the time—and which therefore had a wealth of opportunity. I was inspired by my All of the women interviewed credit wonderful, Emily Chew: My mentor was a dynamic ophthalmology mentor, Dr. Stuart Fine, to enter kind people with mentoring them. These were woman who was conducting retinoblastoma the exciting fi eld of clinical trials. In those days, men initially, who welcomed them as students, research. She impressed upon me the impor- medical retina was the “forgotten child” of and then as colleagues and collaborators. Female tance of research, and she made the retina look our subspecialty. retina mentors did not exist for Alice McPherson like the most important organ in the body. Most in the 1950s, and were few even in the 1990s. of all, she loved her work. ‘There were no Still, many shared fond memories of their train- When I was a resident, the retina appealed most ing. Alice McPherson expressed heartfelt gratitude to me; I like chronic diseases such as diabetic fellowship-trained retina to Dr. Charles Schepens—the fi rst retina specialist retinopathy, as I came from an internal medical ever to accept a woman trainee. Dr. McPherson background. I also liked that fact that we could specialists in Korea …’ became the fi rst of many women in retina whom treat these patients for a long time and develop relationships with them. My mentors during my —Young Hee Yoon, MD Dr. Schepens specifi cally selected—and she went on to become a mentor to many others. fellowship cemented my love for retinal work and for the importance of research. Judith Feigon: I went to see Dr. McPherson Joan Miller: I was attracted to ophthalmol- in 1980 and asked if she’d accept me for the Ursula Schmidt-Erfurth: Mentors for ogy because of the opportunity to provide retina fellowship. She agreed, with the stipula- young female professionals were sparse 20 years both medical and surgical care, and to treat tion that I would be the fi rst 2-year rather than ago. There was, however, a role model—a friend patients of all ages. Retina surgery appealed to 18-month fellow. Dr. McPherson also said I was of our family—who personifi ed intelligence, me because you often have to problem-solve in the fi rst woman she had accepted!

8 | retina times Women In Retina SUPPLEMENT | Summer 2018 | integrity, and independence, and she happened passionate about retina, including women now my retina division has 4 professors and 4 to be an eye doctor. and men, who “followed” them well before fellows. I served as chairman for 6 years—the Instagram! Our WinR trainees today are maximum term. And sometimes, mentorship begins at home. fortunate to have female retina role models In the Korean Retina Society (KRS), on the Anat Loewenstein: My fi rst mentor was and mentors. other hand, I was treated differently. I became my mother, Dr. Esther Shapira, who was a Joan Miller: The percentage of women retina the fi rst female member of KRS in 1993; now cardiologist and worked until the day she passed specialists has climbed steadily since I joined the we have 65 women out of 340 members. I am at the age of 89. She taught me that practicing fi eld. When I was a young attending, I asked Dr. very proud of being able to encourage many medicine and making a change for patients is Alice McPherson what it was like to be the fi rst smart female residents to choose retina as their the most important thing, and the thing that woman in retina, and even though Alice was subspecialty. Most of them kindly told me that I gives the best fulfi llment. I still think about my often the only woman in any group—whether was their role model. mother every day. it was the Retina Society, the Club Jules Gonin, My second mentor was Dr. Susan Bressler, who or a board meeting—she was very clear that she taught me meticulousness in treating retina paid it absolutely NO attention. ‘ The maximum bonus of patients, and that there is a possibility for I believe we can learn a great deal from Alice. approximately $19,000 wonderful balance between career and family. My generation of female retina specialists coped was given to the men My third mentor was Dr. Julia Haller, who with potential bias and exclusivity by expecting taught me vitreoretinal surgery, and that it is to be treated as “one of the boys,” but I never felt immediately at their possible to treat patients in the best possible way that an opportunity was withheld, or a different and in the most diffi cult situations, while main- standard was used in my professional journey. hiring, while we women taining a sense of humor and being friendly. What career challenges have you were given less My fourth mentor was Dr. Eugene de Juan, encountered? who taught me to keep an open mind, to think than $2000.’ Emily Chew: We were aware that certain outside the box, and to think “big” with vision. bonuses were given to the physicians as part of —Emily Chew, MD their pay as federal employees in the late 1980s. The maximum bonus of approximately $19,000 Ursula Schmidt-Erfurth: There is less ‘ My fi rst mentor was was given to the men immediately at their bias in research and more bias on the surgical hiring, while we women were given less than side. My fi rst chairman told me there was my mother, Dr. Esther $2000. We discovered this years later, thanks to “no need” for me to do a fellowship in the Shapira, who was a an institute-wide investigation subsequently United States, as I “was already married.” The published in Science, noting the huge disparity German Research Foundation withdrew 50% cardiologist and worked in our salaries. Since then, there have been of my fellowship funding, as my partner also changes in these bonuses. However, there are had an independent grant. until the day she passed still gender-based salary differences that need to Has the attitude changed over the years? In be addressed. at the age of 89.’ some groups and professional societies, very —Anat Loewenstein, MD We also have to be aware that resource alloca- much, such as the Macula Society. Surprisingly, tion may differ by gender. Nancy Hopkins the young generation appears not to keep up from MIT did an extensive study that found with the evolution, as seen in the recent intro- signifi cant differences not only in the salaries, duction of an international imaging society Throughout our careers, we will meet mentors, but resources given to women vs men in with an extensively male board. whether we connect personally or we admire them research. We need to continue to be vigilant in from afar. Our women retina pioneers expressed assessing the equality of the playing fi eld of the their gratitude for kind mentors who offered work environment for men and women. ‘My fi rst chairman told guidance and opened doors for them. Young Hee Yoon: When I returned to Susan Bressler: I credit Risa Mann, MD, me there was “no need” Korea in 1993, I faced a gender-based barrier one of very few female professors at Johns to becoming a faculty member in an academic for me to do a fellowship Hopkins University Medical School when I was institution. Seoul National University Hospital a medical student; I was fortunate to have her in the United States, as I had almost all male faculty members, except a assigned as my advisor throughout medical few in pathology and pediatrics. I was fortunate “was already married.”’ school. She demonstrated to me how a woman to be recruited by Asan Medical Center, affi li- could become a successful academic physician ated with Ulsan University Medical School. —Ursula Schmidt-Erfurth, MD and attempt to “have it all.” Although she was a Although Ulsan University is a new private pathologist, her lessons crossed all disciplines. university, Asan Medical Center is now the Janet Davis: There is gender bias every- Half of our panelists had no female mentors; they biggest and best medical center in Korea. where. Some of it is convenient, such as my not stuck to their convictions and goals, and forged needing to wear a name badge for the fi rst 5 In my institution, I got full support from my ahead in their careers. These women in retina, years at national retina meetings because so few hospital president in many ways. Although I in turn, have created opportunities for learning women attended. Now there are so many that was the fi rst and only retina specialist in 1993, and contributing as mentors for students even the women need to identify each other

| retina times Women In Retina SUPPLEMENT | Summer 2018 | 9 with name badges. I was amazed by the last we are making real progress in creating more ‘Early on, there were WinR luncheon I attended. supportive environments and opportunities for growth and equality in medicine. no set maternity or Gender bias and workplace inequality were common in the early days; women retina Our common desire to be successful, both family medical leave specialists found that lower pay and lack of professionally and personally, demands constant inclusion in many facets of their careers, particu- attention and commitment to family for women policies. I recall how larly in leadership positions, were ubiquitous. in retina—defi nitely more than in other fi elds Dr. Claes Dohlman in ophthalmology. These personal relationships Fortunately, the tide has turned and women now also bring the most vital personal sense of comprise almost half of the retina fellowship helped forge these accomplishment and happiness. Mentors have trainees. Women are also holding more leadership been instrumental in helping women retina new paths ... ’ positions in our fi eld. As these issues clearly exist specialists navigate the work aspect of key personal in 2018, some were more egregious in these earlier —Susan B. Bressler, MD issues we face. days of women in retina. Susan Bressler: Early on, there were no Balancing family life and career demands also nities also play a role. I had immense support set maternity or family medical leave policies. fi gured prominently—as explored in greater depth from my colleagues, male and female, and I was I recall how Dr. Claes Dohlman helped forge on page 14. given protected time to undertake my research. these new paths for me, my spouse (who was simultaneously affected), and others who fol- Obtaining grant funding, leading projects, ‘Some [gender bias] is lowed us. We will all face hurdles, such as being and publishing outputs in the 1990s were unprepared for dealing with family illnesses, particularly challenging. However, I was held convenient, such as my deaths, and other adversities. to the same standards as men; there was no discrimination. Professional standards should not needing to wear a The woman who worked hard, in everything, be applied uniformly, and this is indeed the case name badge for the fi rst and who shared her talents in the research lab in the United Kingdom. as well as the operating room, all while juggling 5 years at national retina her professional career and her family life, proved Judith Feigon: I feel I’ve always been she could succeed. She fl ourished and earned held to a higher standard than men. My older meetings because so few the respect and “ultimate rewards”—depart- brother is a retired psychiatrist who was fi rst women attended.’ ment chair, partner, section director—plus the in his class in med school. My father came to adventures of motherhood and partnership along the United States as a child, and my mother’s —Janet Davis, MD the way. This is true for many of us as women in parents were immigrants; after family and retina, and is one of the most important bonds we community, education was key. My father share. This is how WinR started, and it will be always said he’d educate his children “to the max.” Joan Miller: The biggest challenge to me our legacy. as a woman retina surgeon was in balancing Anat Loewenstein: I attribute my success the demands on my time: emergency surgery, To what do you attribute your success? mainly to perseverance and hard work, to not clinical care, supervising research and clinical giving up, to striving always to become the best. Janet Davis: I’ve been a member of the “We trainees, writing, raising a family, and being a Never Guess, We Look It Up Club” since age 9. Emily Chew: Success is not always defi ned supportive wife to a husband who also had a Also, if no one else will do a task, then I will. uniformly. I believe we all hope to achieve our demanding professional career. I am not sure that club has a name—I would own personal goals and meet the expectations Peers or mentors who did not have children— propose “The Little Red Hen Club.” There are of our institution or practice. Obviously, this or who had spouses who provided the real advantages to taking control over both your will be different for everyone. “in-home” support—may not have had the knowledge and your actions. I have had wonderful colleagues and my same demands I experienced. But I tried to Usha Chakravarthy: Professional success mentors have played important roles in guiding stay focused on what I was trying to do rather is built on hard work and perseverance, but and supporting me for a satisfying, enjoyable, than worry about whether it was tougher for me networking and being presented with opportu- rewarding, journey. I have a great family who than it may have been for others. keeps me grounded. I have since come to realize that one never truly ‘I have … come to Women in general are required to work much comprehends the struggles that another person harder to be recognized for their efforts. My faces, and that comparing oneself to others is realize that one never friends in other fi elds have the same opinion. not helpful. But I am very optimistic that the future truly comprehends the I have become more aware of gender issues generations are changing because of the very experienced by others since moving into a struggles that another forward-looking young men and women who leadership role as chief and chair of a large oph- have much fewer gender biases. thalmology department with an accompanying person faces, and that Joan Miller: I attribute my success to curios- hospital management role. As a leader and—I comparing oneself to ity, hard work, and persistence. Working as a hope— role model, I am more sensitive to the health care provider is still a wonderful career; challenges and stresses on young people in others is not helpful.’ you can go to work and actually help other academic medicine. However, I fi rmly believe —Joan Miller, MD people and be paid for it. Ophthalmology, and

10 | retina times Women In Retina SUPPLEMENT | Summer 2018 | Many women faculty and fellows participated in the 2018 Duke Fellows Advanced Ursula Schmidt-Erfurth, MD Young Hee Yoon, MD Vitreous Surgery Meeting. seemed to respect me more, assuming that I had you are probably going to make less money ‘Professional success spent more time and effort to reach this level doing it. This is okay if you are not looking for than my male colleagues. an easy job that is overpaid. is built on hard work Ursula Schmidt-Erfruth: I attribute my Also, if you going to wear scrubs outside the and perseverance, success to a genuine interest in understanding OR, make sure they are really nice scrubs. You the retina and retinal disease, and the motiva- can look like a surgeon without being a slob. Tie but networking and tion and endurance that emanate from this your hair back. This is a procedural specialty. impulse. I like to believe that this is the source being presented with Anat Lowenstein: Establish goals and of all true personal and professional success and negotiate to achieve them, both with bosses opportunities also the value of investing life energy and lifetime and families. into any task. play a role.’ Joan Miller: Be conscious about your choices There are no fair standards that apply to and make value judgments on how you spend —Usha Chakravarthy, MD everyone in the overall society, nor for men or your time. Time, in the end, is the only resource woman, different social classes etc. Individuals we control. retina in particular, is a spectacular profession who are more driven than the average person because one gets to practice medicine and will fi nd competitiveness, and will have to Ursula Schmidt-Erfurth: Identify your surgery on the same organ. handle it appropriately. individual interests and talents and set your personal priorities. If you want to succeed, you As Donald D’Amico, MD, liked to point out ‘I feel I’ve always been will need a lot of motivation and endurance, when we met with neurosurgeons, vitreoretinal which you will be able to mobilize only if you surgery is the most diffi cult and demanding held to a higher feel great satisfaction in what you do. surgery in the human body. Where else do you manipulate tissue that most people can’t even standard than men.’ Susan Bressler: Partnership is essential. My see! How cool is it to show a show a resident partner happens to be my husband, Neil, but I —Judith Feigon, MD the reattachment of a giant retina tear with don’t think a partner and a collaborator need perfl uoro-N-octane and draw them away from to be one and the same. My advice is to form a the cornea subspecialty to retina fellowship! What advice would you give to young close, symbiotic work relationship with some- (Sorry, Dr. Dohlman.) women in retina? body to develop ideas and programs, to critique one another in an honest, open way, and to keep Susanne Binder: If you know what you Lastly, the clinician-scientist track has been each other intellectually sharp. especially gratifying for me because I have been want, you can achieve it. Do not give up on your able to problem-solve and develop therapies for dreams, and learn to forgive yourself if you are You have to be able to communicate your patients I saw clinically and for whom, at the not 100% perfect. I think I fought too many ideas, and having a collaborative partnership beginning, there was very little to offer. unnecessary fi ghts when I was young. I am forces you to develop and enhance this skill. much more relaxed now, and I focus more on I also recommend surrounding yourself with Young Hee Yoon: I am fortunate to have things that matter. bright, hard-working people, including those received superb clinical retina fellowship train- who may be in other areas but still complement Usha Charkavarthy: Aim for the best and ing at Doheny Eye Institute under Drs. Richard your areas of interest. Keep an open mind to the highest regardless of your specialty interest. Ober and Larry Chong. With that background, continue learning from these opportunities. I was able to build my own retina division at the Emily Chew: Be prepared, be collaborative, biggest hospital in Korea. To my surprise, I did be fl exible, be curious. Stay strong, stand up for not experience any signifi cant resistance from your beliefs, and do not buckle under pressure. my patients because I was woman. Always follow through on projects. Take action; ‘Time, in the end, is don’t just talk. Be a good mentor; give gener- I have conducted over 12,000 vitreoretinal the only resource surgical procedures and trained over 50 fellows, ously of your time and your brain power. and I am still one of the busiest retina surgeons Janet Davis: You are probably going to have we control.’ in Korea. Sometimes I do benefi t from being a to do better work than a man to succeed, and woman. Patients and other hospital members —Joan Miller, MD

| retina times Women In Retina SUPPLEMENT | Summer 2018 | 11 WOMEN RETINA PIONEERS >>

In your personal life, fi gure out the things that can be managed by or delegated to someone else. Try to lighten your household manager role so you can maximize the time you spend with your family and on your work, and to permit that time to be devoted to high-quality, value- added activities. For today’s professional woman with a young family, it is very hard to “shut off.” A generation ago, we didn’t have certain challenges that are omnipresent today—cell phones, internet, email—and the workday didn’t necessarily oper- Susanne Binder, MD ate 24/7. It was easier back then to say to yourself, “I’m going to unplug; I’m going to go home Anat Loewenstein: My most memorable The overwhelming answer was “no.” Each woman and be dedicated to my family for several hours moment was when I became department chair; has made her choices and is living her dream. without distraction, and then if I want to start I was the fi rst woman in my hospital to chair a One person did regret that she did not stay in working a few hours later, that is my choice.” surgical department, and when I got my profes- academic practice. They all refl ected that it is Other factors young professionals are increas- sor’s degree at a relatively young age. important to recognize that not everything is perfect, and women in retina do need to embrace ingly faced with are the overscheduling of Joan Miller: I have had many enjoyable and this understanding. children, the growing tendency to live far away memorable moments as a woman in retina. from our extended families, and the trend It was very exciting to work with Dr. Evan These women in retina exude a positive, forward- toward starting families at an older age. Many Gragoudas and others to develop photodynamic looking, strong, and adventurous perspective that adults today are sandwiched between caring for therapy (PDT), the fi rst pharmacologic therapy serves them well. Through each individual’s intel- children and for their own aging parents. for neovascular AMD. We worked on PDT in lectual brilliance, curiosity, tenacity, cooperative nature and leadership, each has set the greatest What was your most memorable the laboratory from the fi rst patient treated goals and standards for herself and for future moment in retina? to successful clinical trials—and ultimately approval and adoption around the world. generation of women to succeed in our fi eld. Susanne Binder: My most memorable Financial Disclosures moment was when I became chair of a big eye Then it was even more fun to help lead the Dr. Binder – CARL ZEISS MEDITEC: Consultant, Honoraria team, with Drs. Tony Adamis, Pat D’Amore, Dr. Bressler – BAYER HEALTHCARE PHARMACEUTICALS: department in 1995. Now, 60% of my physician Investigator, Grants; BOEHRINGER INGELHEIM: Investigator, and Evan Gragoudas, that identifi ed the role Grants; GENENTECH-ROCHE: Investigator, Grants; MERCK staff is female, and they all do surgery! & CO, INC: Investigator, Grants; NOTAL VISION: Investigator, of VEGF in ocular , and Grants; NOVARTIS PHARMACEUTICALS CORPORATION: Usha Chakravarthy: It is hard to select a Investigator, Grants; SPARK THERAPEUTICS INC: Investigator, to work on developing therapies based on Grants. most memorable moment, but being honored VEGF inhibition to replace and improve on Dr. Chakravarthy – ALLERGAN, INC: Advisory Board, Hono- with a Commander of the Most Excellent raria; BAYER HEALTHCARE PHARMACEUTICALS: Advisory . Board, Grants, Honoraria; CARL ZEISS MEDITEC: Speaker, Order of the British Empire (CBE)—a national Honoraria; HEIDELBERG ENGINEERING: Speaker, Honoraria; Ursula Schmidt-Erfurth: I will always NOVARTIS PHARMACEUTICALS CORPORATION: Advisory award for the United Kingdom—in 2017 was a Board, Grants, Honoraria. defi ning moment, as this was a recognition of remember the support I received from brilliant Dr. Chew – None. experts in the fi eld for obtaining the Donald Dr. Davis – ABBVIE INC: Consultant, Other Financial Benefi t; my work in the fi eld of retina. ALLERGAN, INC: Other, Other Financial Benefi t. Gass Medal of the Macula Society as a European Dr. Feigon – None. Emily Chew: I have had many memorable female researcher. Dr. Lim – ALCON LABORATORIES, INC: Consultant, moments, but I especially enjoy seeing our Honoraria; ALIMERA SCIENCES: Investigator, Grants; Young Hee Yoon: A memorable moment ALLERGAN, INC: Investigator, Grants; GENENTECH, INC: young trainees achieve success. Advisory Board, Investigator, Speaker, Grants, Honoraria; was in 2007, when I fi rst joined WinR in JANSSEN PHARMACEUTICALS, INC: Investigator, Grants; Judith Feigon: QUARK PHARMACEUTICALS, INC: Consultant, Honoraria; What’s memorable? A man Palm Springs at the ASRS Annual Meeting. OHR PHARMACEUTICAL, INC: Investigator, Grants; OPTHEA who was fi nger counting when he fi rst came 2 LIMITED: Consultant, Honoraria; REGENERON PHARMA- I used to think that, unlike in Korea, there must CEUTICALS, INC: Investigator, Grants, Honoraria; SANTEN years ago came in the other day at 20/50 after INC: Consultant, Honoraria; SECOND SIGHT MEDICAL not be gender bias in the United States, but PRODUCTS, INC: Investigator, Grants; VINDICO MEDICAL Avastin and Eylea. That happens very often I could sense that it was there. And I was also EDUCATION: Other, Honoraria. in this work. And I remember when [Society Dr. Loewenstein – ALCON, LTD: Consultant, Honoraria; impressed that many male colleagues were ALLERGAN, INC: Consultant, Honoraria; BAYER HEALTH- co-founder] Roy Levit invited me to join the supporting WinR. CARE, INC: Consultant, Honoraria; NOTAL VISION, LTD: Vitreous Society in 1984. It was a very big deal! Consultant, Honoraria; TEVA, LTD: Consultant, Honoraria. Indeed, every pioneer we interviewed mentioned Dr. Lyon – None. Dr. Miller – BAUSCH+LOMB: Consultant, Honoraria; the importance of WinR. Dr. Davis feels WinR is GENENTECH/ROCHE: Consultant, Honoraria; KALVISTA PHARMACEUTICALS LTD: Consultant, Honoraria; LOWY ‘I have had many a great way for us to meet one another. She stated, MEDICAL RESEARCH INSTITUTE: Investigator, Grants; MASS. “There is a critical mass when a group stops being EYE AND EAR/VALEANT PHARMACEUTICALS: Other, memorable moments, Intellectual Property Rights, Royalty; ONL THERAPEUTICS: a minority.” Consultant, Advisory Board, Intellectual Property Rights, Royalty, Stock Options. but I especially enjoy Given the chance, is there anything Dr. Schmidt-Erfurth – BOEHRINGER INGELHEIM, GMBH: Consultant, Honoraria; NOVARTIS PHARMACEUTICALS in your retina career you would CORPORATION: Consultant, Honoraria; ROCHE HOLDING seeing our young AG: Consultant, Honoraria. do diff erently? Dr. Yoon – ALCON LABORATORIES, INC: Consultant, trainees achieve success.’ Speaker, Honoraria; ALLERGAN, INC: Advisory Board, Consultant, Investigator, Speaker, Grants, Honoraria; BAYER HEALTHCARE: Advisory Board, Consultant, Investigator, —Emily Y. Chew, MD Speaker, Grants, Honoraria.

12 | retina times Women In Retina SUPPLEMENT | Summer 2018 | Coming to the ASRS Annual Meeting in Vancouver, Canada?

Join us for these WinR events

WinR Luncheon Saturday, July 21, 2018 11:55 AM – 1:10 PM

WinR Case Conference Monday, July 23, 2018 5:15 PM – 7:15 PM

Visit asrs.org/annual-meeting

The Women in Retina (WinR) Section provides a network of peers for all female ASRS members. Automatic inclusion in the Section is provided for all female ASRS members; however, membership in WinR is open to all members. WOMEN’S ISSUES >>

Manjot K. Gill, MD Associate Professor of Ophthalmology Northwestern University Feinberg School of Medicine Chicago, Illinois Managing the Issues Facing Women Retina Specialists

In the past year, more focus than ever has been put on us as women: our rights, our voices, our ambitions and struggles. Female retina specialists often face unique issues—particularly in establish- ing ourselves in our careers while trying to achieve a balance in our professional and home lives.

Panelists Manjot Gill: Can you describe some expected, I try my best to make it work—but career hurdles you have had to I realize there are many other options that will overcome? work out great in the long term. Sophie J. Bakri, MD Professor of Ophthalmology Carol Shields: I’ve had to navigate a few Mayo Clinic challenges in medicine, and specifically retina, Rochester, Minnesota ‘ Looking through the centered mostly on the overwhelming predominance of males back in the 1980s when “retrospectoscope,” Susan B. Bressler, MD I entered. This did not frustrate or scare me; Julia G. Levy, PhD, Professor I don’t see the of Ophthalmology I had quite a bit of experience working with Wilmer Eye Institute males, having grown up with 5 brothers and challenges as hurdles. Johns Hopkins University School of Medicine later attending the University of Notre Dame when there was a male-to-female ratio of 5:1. They’re part of life.’ Carol L. Shields, MD —Sophie J. Bakri, MD Professor of Ophthalmology However, in medicine, it was a bit more chal- Thomas Jefferson University lenging, as there were skills to be gained and Director, Ocular trust to be earned. I simply focused on topic Oncology Service Manjot Gill: Managing work/home Wills Eye Hospital and gave it my best. Now, with more women in balance is a constant struggle for Philadelphia, Pennsylvania retina, there is greater support for both female women in all fields. How have you and male newcomers. been able to navigate this through Susan Bressler: In my generation, there various stages in your professional were few role models, and I am grateful for and family life? those I had, most notably Gisele Soubranne, Carol Shields: I agree this is a major con- MD, in Paris. There were so few US women in cern for new parents in the field of medicine, retina that most organizations were unprepared especially with careers involving potential to understand the strengths that women could emergencies and long hours. My husband, Jerry, add to their programs and the best means of and I have always worked as a team. We initially dealing with the unique challenges that women used a daycare facility near the hospital, but face, such as child rearing. as our family grew, we employed 2 in-house In the last several decades, many more women nannies to run the home front. have been entering the field, providing greater One of us tried to do research work from home strength in numbers, but some trails need to each Tuesday and Friday whenever possible. be “blazed” over and over. Progress is slowly Our children entered formal half-day education being made. at a Montessori school at age 18 months; later, Sophie Bakri: Looking through the this was extended to full day. We also started “retrospectoscope,” I don’t see the challenges office hours very early while the children were as hurdles. They’re part of life. There are chal- asleep so we finished early and were often able lenges, and sometimes things don’t go according to pick them up from school. to plan. I expect that. We had dinner together as a family— When I look back and advise younger people, I every night. I believe this is important for tell them not to worry, because when one door family bonding. closes, another opens. I’ve learned to go with Susan Bressler: The greatest asset can be the flow, and if something doesn’t work out as your partner, provided it is a healthy union.

14 | retina times Women In Retina SUPPLEMENT | Summer 2018 | Equally sharing all responsibilities and bur- are “Doctor.” Enjoy every step of your from day 1 of motherhood and done everything dens—work, money, home, child care, and elder child’s development. to retain her, and been nicer to my mother care—is critical. But this is equally beneficial for and sister. the partner, who may derive the same pleasure Help at home, whether from other family in participating in home life as women are ‘Home time should be members or employees, is so important. Being thought to experience. for family; protect that able to delegate more mundane, but essential Few of us likely think we have found the bal- precious time.’ tasks—food shopping and preparation, laundry, ance. From day to day, one aspect of our lives banking, house repairs—lets us preserve our seems to be the winner—while the next day, —Carol L. Shields, MD elective time for highest-yield professional and it’s some completely different component and personal activities. There is also a lot to be said yesterday’s winner is back at the bottom again. about having emergency back-up and support. It is a never-ending juggle; you just pray that all Susan Bressler: Don’t let it all go by and the balls don’t crash down at once! forget to live and enjoy life. Our careers are ‘What often needs to be only one part of who we are, as is true for all Sophie Bakri: The first key is to know what our colleagues. you want in terms of work/home balance. The sacrificed is sleep, so be balance is different for each person; it depends Invest yourself wisely in those other aspects of glad that women seem on many factors and can change over time. life; apply the same discipline and commitment Once you have figured that out, the key is to be that you did to your education and training. to need less than men, organized to make that balance happen. What often needs to be sacrificed is sleep, so be especially as they glad that women seem to need less than men, For example, there are many child care especially as they grow older. options—always go for the most reliable and grow older.’ safe option where the children will be happy Sophie Bakri: When my children tell me “I —Susan B. Bressler, MD and stimulated. Peace of mind as a working can’t,” I tell them there’s no such thing—they parent is very important. When the children need to try, and keep trying. I believe in letting Sophie Bakri: I’m fortunate to be very happy are young, try to find the most-inclusive them work it out rather than intervening and where I am in life, work, and the “balance” options—for example, schools that offer before- doing it for them. I think teaching my children between them. I wouldn’t change anything! or after-school programs or clubs. stamina, persistence, and “grit” is important and will help them in the long term. Manjot Gill: I want to acknowledge our When your children are young, many extracur- esteemed panel for their thoughtful and honest ricular activities like sports can be done on When it comes to my younger colleagues, responses. We are fortunate to have these weekends, when you are available to take them I would advise them to have a plan, have a women as role models and to draw upon their to games or practices. Sometimes, our work schedule, and arrange for help. It requires a experience and wisdom to forge our own paths. involves travel and it is important to have a sup- lot of organization to have a successful work, portive network (eg, spouse, partner, family) to personal, and family life, but it can be done. Ultimately, the struggles facing women in be around for the children. It is also essential to retina are similar to those in other fields, Manjot Gill: Is there anything have a backup plan in case you have a sick child, both in and outside of medicine. However, you would have changed or especially during the winter months. Consider with a growing number of women pursuing done differently? outsourcing any domestic tasks that take away careers in retina, we hope that fewer barriers from your time with your children when you Carol Shields: I would not change anything; exist and that women have a chance to attain are home. I am satisfied with how my career has evolved. a rewarding work/life balance. Early on, I worked efficiently in the clinic and in Manjot Gill: What advice would you At times, this concept of work/life balance may surgery and participated in research activities— give to your younger colleagues or seem an elusive ideal, but by making deliberate but only during office time. My home time was your own daughters? choices about which opportunities to pursue busy with children, meals, cleaning, homework, and when to pursue them, our panelists have Carol Shields: Anything is possible. You school activities, birthday parties, and more. demonstrated that it is possible to engage mean- need to define your priorities, such as how When my children were young, I did not travel ingfully with work, family, and community. much time you want at work, at meetings, and much to meetings, as that involved too much at home. When you are working, you must time away from my family. As the children grew perform well and efficiently to earn your up, I traveled more and participated more in Financial Disclosures colleagues’ respect. leadership positions. Dr. Bakri – ALLERGAN, INC: Advisory Board, Honoraria; CARL ZEISS MEDITEC: Advisory Board, Honoraria; You will be happier if you keep your work and GENENTECH, INC: Advisory Board, Honoraria; NOVARTIS I thank all my retina colleagues who trusted home life simple and don’t try to do it all. PHARMACEUTICALS CORPORATION: Advisory Board, me with their patients, and I especially thank Honoraria. Do not overcommit to late-afternoon Dr. Bressler – BAYER HEALTHCARE PHARMACEUTICALS: my work colleagues who shared responsibilities Investigator, Grants; BOEHRINGER INGELHEIM: Investigator, committee meetings, evening conference calls, with me. Finally, I thank my partner, Jerry Grants; GENENTECH-ROCHE: Investigator, Grants; MERCK or weekend interviews. & CO, INC: Investigator, Grants; NOTAL VISION: Investigator, Shields, who supported my career and family Grants; NOVARTIS PHARMACEUTICALS CORPORATION: Investigator, Grants; SPARK THERAPEUTICS INC: Investiga- Home time should be for family; protect that choices along the way. tor, Grants. precious time. It is acceptable to say, “No thanks, Dr. Gill – None. Susan Bressler: Hard as it sounds, I would Dr. Shields – AURA BIOSCIENCES, INC: Advisory Board, I am with my children” at that time. When at have had another child, found Mary Poppins Honoraria. home, you are “Mom” and when at work, you

| retina times Women In Retina SUPPLEMENT | Summer 2018 | 15 MEDICAL RETINA >>

Lee M. Jampol, MD Rukhsana G. Mirza, MD Louis Feinberg, MD Ria Desai, MD Associate Professor of Ophthalmology Professor of Ophthalmology Medical Retina Fellow Associate Program Northwestern University Northwestern University Northwestern University Feinberg School of Medicine Feinberg School of Medicine Feinberg School of Medicine Chicago, Illinois Chicago, Illinois Chicago, Illinois Medical Retina Fellowships: A Growing Career Option

The last decade has seen many advances in medical retina. Widespread use of anti-VEGF alone has dramatically changed the way many ophthalmologists practice. However, medical retina is still relatively young. We spoke with one of its earliest pioneers, Lee Jampol, MD, on the history of the field.

While some women’s experience has been Why would today’s resident choose medical entirely positive, many physicians recognize retina as a career? “As a resident, I was immedi- that in prior decades, there were biases against ately drawn to medical retina,” recalls Ria Desai, training female physicians. At Northwestern MD, the medical retina fellow at Northwestern University, we recognize Dr. Jampol for not University. “Every medical retina patient is a only training numerous women in residencies puzzle you must decipher with your clinical and fellowships, but also for supporting the skills and your understanding of imaging results. creation of what is now an entirely female “Now that we have efficacious treatments retina service, with the exception of himself, for common retinal diseases such as diabetic at present. retinopathy and macular degeneration, the “I have always picked people by their abilities, next step will be to understand how and why not by gender,” Dr. Jampol explains. “In the common disease manifestation can vary 1980s, there was a strong bias against women among patients,” says Dr. Desai. “Future goals Northwestern University Medical Retina in medicine. By choosing candidates based will include further characterizing disease pro- Fellowship Program Fellow Ria Desai, MD; Professor Lee Jampol, MD; and Associate solely on their qualifications, I found that I got cesses and tailoring discussions and treatments Professor Rukhsana Mirza, MD. better-quality trainees.” to individual presentations and patients.”

Dr. Jampol began his career, like many of Rukhsana Mirza, MD, associate professor of Medical retina is constantly evolving—tele- the early medical retina specialists, as a retinal ophthalmology and associate program director medicine, machine learning, gene therapy, and surgeon who discovered that his greatest inter- of the vitreoretinal fellowships at Northwestern artificial intelligence are promising advances. ests were in clinic, rather than in the operating University, reflects on the climate of medical “There is no doubt that machines will replace a room. He credits Drs. Donald Gass, Morton retina a decade ago. “I was motivated to pursue lot of what we do,” says Dr. Jampol. “However, Goldberg, Lawrence Yannuzzi, Howard Schatz, medical retina due to the rapid change in ocular this is positive … It will free up time for physi- Lloyd Paul Aiello, and Matthew Davis, as key imaging and potential treatments,” she recalls. cians to think more about diseases and develop research ideas. Many of our advances in the physicians who developed the field. “Early anti-VEGF agents became available next 5 years will be focused on imaging … and during my final year of residency. Knowing this Dr. Jampol cites the concept of , machine learning will play a vital role.” the development of novel imaging modalities, would revolutionize the way we treated macular and the creation of large multicenter clinical degeneration, I pursued my fellowship in 2005,” The 2017 ASRS Preferences and Trends (PAT) trials as major influences that have further says Dr. Mirza. “Many questioned my pursuit Survey shows that 10.3% of US respondents transformed the field in recent years. of a field charged with managing patients with and 8.2% of international respondents identify ‘bad vision.’ However, in 2006, the MARINA as medical retina specialists.1 These statistics, He also created one of the first US medical trial showed the effect of an anti-VEGF agent combined with an ever-increasing interest in retina fellowships. What prompted Dr. on exudative AMD—setting a new standard the field, show that the future remains bright Jampol to start a fellowship at Northwestern and giving a far different prognosis for a disease for medical retina specialists. University in the early 1980s? “As imaging and process previously thought to be hopeless and Reference diagnostic capabilities improved, I developed unfulfilling to treat. a large medical retina practice,” he recalls. “I 1. Stone TW, ed. ASRS 2017 Preferences and Trends had all of these great patients to teach with, “Since my training, new trials and imaging Membership Survey: Chicago, IL. American Society of Retina Specialists; 2017. so I started a medical fellowship … almost modalities have furthered our understanding and treatment of retinal disease,” Dr. Mirza Financial Disclosures simultaneously with our surgical fellowship.” Dr. Desai – None. adds. “Now, more than ever, medical retina has Dr. Jampol – NATIONAL EYE INSTITUTE: Investigator, According to Tim Losch of SF Match, the transformed into a career where physicians can Grants; QUINTILES/JANSSEN PHARMACEUTICALS: Other, number of medical retina fellowships has Honoraria. maintain functional vision in many patients Dr. Mirza – None. more than doubled, from 13 to 27, in the past who once were told vision loss was inevitable.” 5 years alone.

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