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One To Watch | Nov/Dec '15

One to Watch: Bruna Ventura, MD

In case there was ever any doubt, the future of ophthalmology is in good hands! Millennial EYE presents a series highlighting the One to Watch. In each issue, we will profile a rising star, one who may not be advanced in years but has already made great advances in our field.

Bruna Ventura, MD

Bruna Ventura, MD

Dr. Ventura is an ophthalmologist at the Altino Ventura Foundation and the HOPE Eye Hospital in Recife, Brazil.

1.Please share with us your background.

I was born and grew up in a city in the Northeast of Brazil called Recife. My parents, Liana and Marcelo; my siblings, Camila and Marcelo Jr; and I are very close. All our lives, we have treasured our family and nurtured it. It is very clear to us the true value of having best friends in our close relatives.

Growing up, I went to an American school, where I learned English and, thus, was introduced to a world of opportunities. My parents always valued education and exposure to new cultures, so since the age of 14 I have been living abroad on and off. I started with a summer course in France with my sister. It was the first time we traveled alone, and it was a fun and memorable month. When I was 15, I went as an exchange student to Welland, Canada, where I lived for a year with one of the most amazing families I have met: the Murrays. At the age of 18, I spent 5 months in Mexico, where I did a Spanish course at the University of Torreon and discovered two new families with which my heart felt at home: the Cornus and the Claros.

I went to medical school in Recife at the University of Pernambuco. Midway through medical school, I spent a summer month with Camila, at the age of 18, and Marcelo Jr, at the age of 13, in Salamanca, Spain. This was the first trip the three of us did alone, and it was an amazing experience to explore the beautiful country of Spain, with its rich culture and cuisine. My last rotation in medical school was done at McGill University in Montreal, Canada, with Miguel Burnier, MD, PhD. Before residency, I spent a couple of months in California, where I had the pleasure to rotate with Mark Mannis, MD, at the University of California, Davis.

I did my residency in ophthalmology at the Altino Ventura Foundation in Recife. The Foundation carries the name of my grandfather and was founded 29 years ago by my grandparents, Altino and Lourdes Ventura; their partners, Inacio and Auristela Cavalcanti; my parents, Marcelo and Liana Ventura; and their partners, Ronald and Elani Cavalcanti. Throughout the years, the Foundation has become an important tertiary referral center in ophthalmology for the low-income population, providing care for approximately 35,000 patients per month. Also, it has the biggest residency program in the country, with 24 new residents per year. Every year, we have a total of 88 doctors in training, counting the residents and the fellows.

During residency, I earned my master’s degree at the Federal University of Alagoas, and I am currently working on my PhD at the Federal University of São Paulo.

After residency, I spent 1 year doing a postdoctoral research fellowship in cataract and refractive surgery at Baylor College of Medicine in Houston, Texas, under the supervision of Douglas Koch, MD; Mitchell Weikert, MD; and Li Wang, MD, PhD; from these individuals, I learned not only about cataract, refractive surgery, and research but also valuable tips on doctor-patient and doctor-staff interaction. After my year in Houston, I returned to Recife and started to practice at the Altino Ventura Foundation and the HOPE Eye Hospital. The HOPE Eye Hospital is a private hospital that was founded in 1986 by the same cofounders of the Altino Ventura Foundation. In the past 29 years, it has been an important ophthalmology referral center in Brazil, helping 25,000 private patients per month.

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

I come from a family of ophthalmologists. My grandfather, Altino, was from the time when ophthalmologists solved everything, from glasses to cataract and strabismus surgery. In 1953, he and his partner, Inacio Cavalcanti, founded a clinic with a dedicated OR, infirmary, and central air conditioner, revolutionizing ophthalmic care in Northeastern Brazil. My parents are also ophthalmologists. My mother is a pediatric ophthalmologist, while my father dedicates himself to cataract and retina surgery.

When I was a child, my parents took my siblings and I to outreach cataract projects of the Altino Ventura Foundation in the interior of our state. As children, we helped patients to and from the OR, and we were always amazed with the patients’ reactions on postoperative day 1 when their patches were removed and they noticed they could see. During my teenage years, I went with my father to the OR on my vacations to watch him operate. With all of these positive experiences in ophthalmology, it was only natural that we chose to pursue the same profession as our parents when the time came: Camila and I became ophthalmologists, and my brother is finishing medical school.

During residency, I enjoyed and was interested in many different fields, especially in the anterior segment. At the Altino Ventura Foundation, we have a high volume of cataract surgeries, and since the beginning of my training I have loved the procedure, its challenges, and outcomes. Throughout these 3 years of training, I went to several scientific meetings with my parents, watched them present on different topics, and would frequently sit with my father, discussing what was being presented in the cataract sessions. In between sessions, we would meet up with some of their friends, most of them anterior segment surgeons who I have known my entire life, and have interesting conversations. It always amazed me how technology and techniques in cataract surgery evolve so rapidly.

I would go back from meetings and apply my newly acquired knowledge, seeing the benefits in my own patients. This started making me focus more and more on adult cataract surgery. In my second year of residency, I participated in my father’s PhD thesis on congenital cataracts and fell in love with the children and with research. In my third year of residency, my father started teaching me how to operate on congenital cataracts, and I realized that operating on these children was a big challenge and gave me enormous satisfaction. At the end of my third year, I had also been exposed to refractive surgery through some good friends and decided it was another field that I wanted to pursue.

3.Please describe your current position.

I am currently the Head of the Cataract Department of the Altino Ventura Foundation and Vice-Mentor of the Specialization Course in Ophthalmology. At the HOPE Eye Hospital, I work as an ophthalmologist and the Medical Coordinator of the OR.

4.Who are/were your mentors?

My mentors since childhood are my parents and their friend William de la Peña, MD. They have not only inspired me and helped me shape my career but have also influenced all aspects of my life. Howard Fine, MD, a good family friend I have know since my teenage years, has also had a key role in my decisions concerning my career and has always been so caring and considerate. Another great family friend who has had a huge impact on my life and served as a mentor is Rubens Belfort Jr, MD, who is always eager to help and gives the best advice. Also, Dr. Koch, whom my father met as a fellow at Baylor College of Medicine in 1982, inspired me before I met him in person and has only continued to amaze me as I have had the opportunity to learn from him and hear his advice. He has become a dear friend and has given me guidance through the years.

Throughout my training, many other ophthalmologists served as role models and mentors to me, and I will always be grateful to them. For the sake of space, I will not mention them all, but I truly hope they have taken my thank-you notes seriously, as they have been so important to me.

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

The Altino Ventura Foundation has a mobile surgical unit that has been routinely performing cataract surgery in the countryside of my state for 15 years. To date, more than 25,000 surgeries have been performed through this specific project. There is always a third-year resident accompanying the attending who is responsible for the surgeries. One of the most memorable experiences of my career so far was a week that I spent in the surgical unit as a resident. It was amazing to operate on 20 to 25 patients every day and see the huge impact we were having on their lives. These patients are from the low-income population, and most of them would not have the means to go to the capital city of Recife to undergo surgery. All of the effort to maintain the surgical unit and to leave the capital to go to the small cities in the countryside becomes very small when compared with the huge pleasure of restoring sight in the most remote areas.

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

One recent advance that I have found particularly exciting is the use of the femtosecond laser in cataract surgery. The evolution of the laser platforms in recent years has resulted in a safer and more precise procedure, decreasing the incidence of complications and increasing its reproducibility. Over the past 2 years, I have been very involved with femtosecond laser cataract surgery, and it has been interesting to see how the technology can benefit patients, from those with mild cataracts to those with challenging conditions.

Another exciting advance concerns multifocality. So many of our patients want to be independent from glasses after phacoemulsification. Recently, we received approval in Brazil to use trifocal lenses and extended depth of focus lenses in addition to some new multifocal IOLs.

With regard to advances in the pipeline, I am very interested in the intracameral devices that have been developed to make automatic capsulotomies even faster than the femtosecond laser. Although the intracameral devices do not perform corneal incisions and phaco fragmentation, I believe there is surgical utility for both the femtosecond laser and these new technologies, as they can easily be used in patients who do not dilate well.

7.What is the focus of some of your research?

Currently, the focus of my research is laser cataract surgery, congenital cataracts, and new imaging devices that are used in the preoperative planning of cataract surgery.

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

A typical day in my life starts with my alarm clock going off at 5:50 AM. By 7 AM, I am at the hospital, ready to start operating. Surgeries last the entire morning, and I have lunch at the hospital, usually discussing administrative issues with my father and our team. In the afternoon, I have clinic, which ends around 6:30 or 7 PM. I exercise for an hour and then go home. After dinner, I usually take some time to prepare lectures or work on papers and my research projects.

Sharing my time between ophthalmology and administrative matters of the Altino Ventura Foundation and the HOPE Eye Hospital; surgery, clinic, and research; and adult cataract patients, congenital cataract patients, and refractive surgery patients keep me busy. The dynamism of the activities in which I am involved and the results I see in my patients make me passionate about what I do.

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

My advice would be: Shape your careers so that you can achieve your definition of success. This definition will and should be very personal. Thus, you must first determine exactly what scenario in your future would make you feel successful and then focus on making the choices throughout your career that will enable you to achieve that.

10.Tell us about an innovative procedure you are performing or a new imaging/diagnostic tool that has improved your practice.

The femtosecond laser in cataract surgery has improved my practice. The HOPE Eye Hospital was one of the first hospitals in Brazil to implement laser cataract surgery, so I have been using the LenSx laser (Alcon) since I returned from Houston. I use it routinely to perform relaxing incisions in patients with corneal astigmatism that is not significant enough for toric or multifocal toric IOLs but that would negatively affect vision if left untouched. I am always amazed at how efficient the laser is in fragmenting even brunescent nuclei, significantly decreasing the ultrasound energy spent in their emulsification and transforming these potentially harder cases into a routine scenario.

In one recent case of a brunescent cataract, the nucleus was so dense that the retinal OCT was unable to image the patient’s macula. Intraoperatively, the laser’s OCT was able to image the nucleus, and the laser effectively fragmentated it. Furthermore, in patients with lens subluxation or posterior polar cataracts, the laser’s real-time intraoperative OCT imaging enables a personalized approach for capsulotomy creation and phaco fragmentation.