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One To Watch | Mar/Apr '16

One to Watch: Christina Rapp Prescott, MD, PhD

In case there was ever any doubt, the future of ophthalmology is in good hands! MillennialEYE 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.

Christina Rapp Prescott, MD, PhD

Christina Rapp Prescott, MD, PhD

Dr. Prescott is an Assistant Professor of Ophthalmology in the Division of Cornea, Cataract, and External Diseases at the Wilmer Eye Institute, Johns Hopkins School of Medicine, in Baltimore, Maryland.

Please share with us your background.

I began college as a physics major, but, after working with the scientists at Regeneron Laboratories, I decided to pursue a career in medical research and switched to biophysics. George Yancopoulos, MD, PhD, inspired me to apply to medical scientist training programs, and I went to the University of Colorado, where I earned my PhD in neuroscience as well as my MD. Although I initially planned to pursue a career primarily in research, during my third and fourth years of medical school, I fell in love with clinical medicine, especially the surgical fields.

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

Because I love fixing things, I enjoyed all of the surgical specialties. However, ophthalmic surgeries were by far the most elegant (apologies to my general surgeon husband). The combination of elegant surgeries and tangible benefits of visual improvement was irresistible, and, after the first day of my rotation, I knew I had found the right fit for me. For the same reasons, I chose to focus on anterior segment surgery.

Please describe your current position.

I am blessed to work with many leaders in ophthalmology at the Wilmer Eye Institute, where I am an Assistant Professor in the Division of Cornea. I perform a mix of cataract, refractive, and corneal surgeries. One thing that is unique about my practice is that I specialize in pediatric corneal pathology. Together with my colleagues in the pediatric ophthalmology division, I manage children with congenital or acquired corneal pathology from all over the world.

Who are/were your mentors? 

During my fellowship at the Massachusetts Eye and Ear Infirmary (MEEI), I had the opportunity to work with many wonderful teachers and mentors. I learned about the Boston Keratoprosthesis from Claes Dohlman, MD, PhD, and James Chodosh, MD, MPH, and about refractive surgery from Roberto Pineda, MD. Now, I am fortunate to work with Albert Jun, MD, PhD, and Esen Akpek, MD, who continue to provide me with support and guidance.

Of all the people I have been blessed to work with, my primary mentor has always been Kathryn Colby, MD, PhD. She was my mentor even before she knew who I was! I met her at a Women in Ophthalmology (WIO) meeting during my first year of residency and was impressed not only by her personal success but also by her dedication to helping other women succeed. Dr. Colby was the reason I chose to pursue fellowship at MEEI, and she has been an even better mentor than I thought she would be.

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

A baby that I performed a corneal transplant on at 3 months of age just turned 1. I have grown close with the family and just went to her first birthday party. Seeing how well she is doing makes me know I made the right career choice. I know we have challenges ahead, but I am blessed to be a part of her journey.

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

Corneal transplants continue to advance at an astounding rate. We are in the middle of a paradigm shift toward more selective transplants. I am most excited about incorporating these new techniques into pediatric cornea patients, especially because their success rate with traditional transplantation is so low compared with adult patients.

What is the focus of some of your research?

In addition to optimizing newer partial corneal transplantation techniques in pediatric patients, I am working with one of our pediatric ophthalmologists to develop protocols to optimize the long-term management of pediatric corneal transplant patients. Right now, we are collecting data on current practice patterns of pediatric cornea specialists around the world. We are also working to develop a voluntary pediatric corneal transplant registry.

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

Every day is different, which keeps me both busy and interested. Mondays and Tuesdays are surgery days, and Wednesdays and Fridays are clinic days. On Thursdays, I do research in the morning and refractive surgery in the afternoon. I work with medical students, residents, and fellows and enjoy learning from them as well as teaching them.

Most days, I drop my children off early in the morning and then get to work between 7:30 am and 8:00 am. I like to start my days early so that I can be done by 5:00 pm and spend the evening with my family. Once I pick my children up, my cell phone gets put away (unless I am on call) until they are asleep.

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

The best part of my job is the people that I work with. I would encourage young ophthalmologists to try to meet as many people as they can—colleagues, staff, and even patients—before making any career decisions. Ophthalmology is a great field with elegant surgeries and great outcomes, but there will be tough days. On those days especially you need to be around people you care about and respect.

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

One pediatric corneal transplant technique that I learned from Dr. Colby in fellowship, and have since taught the Wilmer fellows, is what I call the magic carpet technique.

With this technique, as the host cornea is excised, it is sutured back to itself (at intervals 45° away from the planned cardinal sutures). The host cornea is completely excised but held in place by four sutures to avoid exposure of intraocular contents. The corneal surface and the donor cornea endothelium are then coated with viscoelastic, and the donor is placed on top of the host. After three of the four cardinal sutures are placed, the initial host sutures are cut and the host cornea is pulled through the open area (usually the 9 o’clock position, as I am right-handed). The corneal transplant then proceeds as usual.

I have some concerns about the contact between the two surfaces, but the bed of viscoelastic will help protect the donor endothelium. Additionally, I think the risk of some endothelial cell loss is lower than the risk of an open eye in babies or other high-risk transplants.