Please share your background with us.

I grew up in Flintridge, California, and received a parochial education through high school. My high school track team used to run practices on the all-weather track at the nearby California Institute of Technology (Caltech), and I ended up applying and getting accepted there with a proposed aerospace engineering major. My dad was an internal medicine specialist but encouraged me to pursue my engineering interests in college. After the first year, I was drawn more to the biological sciences and ended up majoring in biology with a minor in chemistry. I married my high school girlfriend, Peggy. I was uncertain about graduate versus medical school after the rigorous basic science years at Caltech and after a year of postgraduate research. I opted to do both through the Medical Scientist Training Program at the University of Colorado School of Medicine. I completed my residency at the University of California, Irvine, during which time Peggy and I had our two sons. I stayed on 1 more year at Irvine to do a cornea and refractive surgery fellowship. I was fortunate to be offered a job as an Assistant Professor of Ophthalmology at the Casey Eye Institute in Portland, Oregon, right out of fellowship.

What drew you to ophthalmology and, specifically, to your field of interest?

When I was doing my graduate research work in medical school, I was very much headed in the direction of infectious disease, but the bench work drove home how much I loved working with my hands. My father, the internist, discouraged my interest in the internal medicine pathway and encouraged me to check out ophthalmology in medical school after he had been impressed with a lecture he heard by a retina surgeon. The first time I got a glimpse of the eye through a slit lamp and indirect ophthalmoscope, I was compelled by the views and diagnostic power of “the living histology” that ophthalmologists had at their fingertips. Cornea was the obvious choice to me because this subspecialty has the best surgical outcomes (in my opinion). Over my first 10 years in ophthalmology training and practice, the cornea subspecialty has developed into the most exciting and diverse surgical and medical subspecialty in ophthalmology.

Please describe your current position.

I am an Associate Professor and Chief of the Division of Cornea and Refractive Surgery at the Casey Eye Institute, Oregon Health & Science University, in Portland, Oregon. I have a busy clinical cornea service both in Portland and Vancouver, Washington. I perform surgeries to address iris and lens pathology and IOL complications as well as simple and complex corneal surgeries, including refractive procedures, PKP, DALK, DSEK, DMEK, limbal stem cell transplants, KPro implantation, and ocular surface tumor treatment. I direct our AUPO-approved Cornea Fellowship and the Casey Ophthalmology Residency cornea clinical and didactic curriculum. I am involved in a number of clinically oriented research projects and national and local clinical trials both at the Casey Eye Institute and at the Portland Lions VisionGift eye bank, where I serve on the medical advisory board as Co-Medical Director. I also currently serve on the FDA Ophthalmic Devices Panel and am an accreditation board member for the Eye Bank Association of America.

Who are/were your mentors?

I am grateful to Roger Steinert, MD, who took an interest in me as a resident at UC Irvine and then allowed me to stay and train under him for my cornea fellowship. His techniques and personal interactions with me definitely gave my career momentum. There are many others in our field who have inspired and taught me directly and indirectly, including Mark Terry, MD, and Ed Holland, MD. Our current chair at the Casey Eye Institute, David Wilson, MD, is a continued example to me of someone who can direct with a gentle and sincere manner and foster an environment of collegiality, creativity, and innovation.

To what do you attribute your success?

Hard work and enthusiasm have definitely played a role, but we all must admit that where we are and where we end up in life has a lot to do with circumstances we can’t control. In my opinion, I have been given opportunities that others have not had, from the beginning. I remind myself that I could have been born 1,000 years ago, and my ability to do slit-lamp exams and microsurgery may not have served me so well in a different historical setting. Wherever we find ourselves, we must utilize the chances we have to improve our communities and our world. I am trying to do this, but I could do better.

What has been the most memorable experience of your career thus far?

I have one patient with a history of Stevens Johnson Syndrome in my practice whose vision I helped restore from hand motion to 20/25 through a series of ocular surface reconstructions. He is someone on whom all previous doctors had given up. His eyes are an ongoing battle, but it is a good fight. This magnitude of success is what keeps me trying for less fortunate patients.

What are some new technological advances that you have found particularly exciting? Which advances in the pipeline are you most enthusiastic or curious about?

Advancements in cell programming and tissue engineering will undoubtedly affect my field considerably in the near future. Chemical signalers like ROCK inhibitors will likely change our surgical approaches to corneal endothelial disease. Corneal bioengineering of all five layers through use of synthetic collagen matrices and culture and reprogramming of human stem cells may change the landscape of corneal surgery. We may be able to grow a new cornea from the patient’s own cells to replace a damaged or diseased cornea. I am also excited about the up-and-coming availability of corneal collagen crosslinking and topography-guided ablation to address ectatic deformation of the cornea and corneal scarring.

What is the focus of some of your research?

My practice is currently involved in multiple local and national clinical trials including UV crosslinking, DMEK versus DSAEK surgery, assessment of Fuchs dystrophy patients for pharmaceutical interaction, and newer techniques in femtosecond laser-assisted keratoplasty. We will be joining the Zoster Eye Disease Study (ZEDS) multicenter trial as it begins to enroll patients. I also have a number of studies in collaboration with our local eye bank looking at success rates of femtosecond laser preparation of corneal tissue and DMEK tissue preparation.

What is a typical day in your life? What keeps you busy,fulfilled, and passionate?

I love teaching and do it on a daily basis with my fellows and residents. They keep me sharp by consistently asking me questions that I have to surreptitiously look up at the end of clinic. The medical and surgical complexity of my corneal clinic is a daily if not hourly challenge, but it is a good fight. I operate 1.5 days per week (and sometimes at night), see patients in clinic 2.5 days per week, and spend the rest of the time collaborating on studies.

What advice can you offer to individuals who are just now choosing their career paths after finishing residency or fellowship?

First, don’t lose your enthusiasm and ideals. They will transform your career and our field, and they will help you maintain stamina when other things drive discouragement.

First, don’t lose your enthusiasm and ideals. They will transform your career and our field, and they will help you maintain stamina when other things drive discouragement.

Third, engage in public policy in relation to medical practice. The new generation of doctors is going to have to take back some control of our profession. We have given up too much of our autonomy as physicians and surgeons to other elements in the business of medicine that do not value our patients’ best interests or the doctors’ skill sets. Our profession is under trial right now, and the responsiveness of this generation of doctors will have lasting implications on the quality of medicine delivered.