One To Watch | July/Aug '17

One to Watch: Andrew A. Kao, MD

Dr. Kao practices at Empire Eye and Laser Center in Bakersfield, California.

 

Please share with us your background.

I was born in West Virginia, where my obstetrician uncle delivered me, and I grew up in Bakersfield, California. My parents are of Chinese descent, from Cambodia and Korea, and they immigrated to the United States via Taiwan, giving me a pan-Asian cultural background. I graduated from Stockdale High School, where my participation in the Medical Academy, with its job-shadowing opportunities, helped me decide early on to become a physician.

I graduated with honors from UC Berkeley, where I majored in molecular and cell biology, and I next went across the Bay for medical school at UC San Francisco (UCSF). I spent an extra year there performing research in the glaucoma division after I decided to specialize in ophthalmology. I then completed a preresidency ocular pathology fellowship at the Bascom Palmer Eye Institute, followed by residency at the New York Eye and Ear Infirmary and a fellowship in ocular oncology back at UCSF. I joined Empire Eye and Laser a year ago.

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

At UCSF, I was required to do a 2-week-long rotation in a surgical subspecialty. Thinking I was going to be an internist, I picked ophthalmology so that I could learn to use a direct ophthalmoscope. As I became immersed in the rotation, I learned how to use a 90.00 D lens and perform optical coherence tomography (OCT), and I got to watch cataract and pterygium surgeries as well as a ruptured globe repair. I quickly fell in love with the mix of longitudinal patient care, microsurgery, and cutting-edge diagnostic technology.

I fell into my ocular pathology fellowship serendipitously, but I ended up loving that subspecialty for numerous reasons. I gained an in-depth understanding of the eye’s anatomy and a clinicopathologic understanding of disease processes from reading cases every day and teaching residents weekly. I also attended the residents’ daily morning lectures, which gave me a strong foundation in basic ophthalmic knowledge even before starting residency. As many of the cases we saw were conjunctival biopsies, corneal buttons, and globes with intraocular tumors, I developed an affinity for the anterior segment and ocular oncology. This led me to pursue my ocular oncology fellowship after residency and fueled my interest in treating anterior segment tumors.

Please describe your current position.

I am a comprehensive ophthalmologist and ocular oncologist in private practice in Bakersfield, California. I also volunteer a half-day a week, providing medical and surgical care at the Advanced Center for Eyecare, which is a nonprofit eye clinic for the uninsured and underinsured population of Kern County. Students from my high school’s Medical Academy shadow me throughout the year, allowing me to give back to my community. We also have optometry students rotate through our office during their externships; I enjoy interacting with and teaching these individuals.

 

Who are your mentors?

In all stages of my training, I was fortunate to have many excellent mentors who helped to further my career. If I named all of them, the list would fill multiple pages, so I will attempt to just name a few (in chronological order).

First, all the residents and fellows I have worked with in my various stages of training were welcoming and great teachers in their own ways, and they helped to stimulate my interest in ophthalmology.

In medical school at UCSF, Shan Lin, MD, got me started in clinical research and helped me through the nuances of conducting a prospective study looking at anterior segment imaging in patients with glaucoma.

I cannot overstate the role that my ocular pathology fellowship director at Bascom Palmer Eye Institute—Sander Dubovy, MD—played in advancing my career in ophthalmology. He taught me all I know about ocular pathology and also provided tremendous support and encouragement as I was applying for ophthalmology residency.

New York Eye and Ear shaped me into the ophthalmologist I am today. My most influential mentors there were Joseph Walsh, MD; Paul Sidoti, MD; Anita Gupta, MD; Glenn Silbert, MD; John Flanagan, MD; and Harsha Reddy, MD. They each provided guidance during my residency and beyond, and they showed me by example what it means to be a great ophthalmologist.

Back at UCSF, Bertil Damato, MD, PhD, and Armin Afshar, MD, MBA, not only taught me about diagnosis and treatment of ocular tumors but also showed me another level of compassion and devotion to their patients and families. They forced me to think critically and outside the box, which prepared me to be able to empathically treat these often-vulnerable patients in my current practice.

Last, Daniel Chang, MD, has supported me wholeheartedly as I have started my career with him. He has shown me what is necessary to be a successful ophthalmologist in private practice while continuing to perform research and volunteer care for the underserved in our community.

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

One weekend on trauma call in fellowship stands out for me. On Friday, I performed a few cataract surgeries on my own for the first time at the county hospital. I was then called back for a ruptured globe repair with the resident; I had never repaired such a large defect, but the case went well. I then did an emergency anterior chamber washout the next day, which was the first time I had done that. This series of cases forced me to get out of my comfort zone and try new things, which boosted my confidence and made me realize that I might actually make it as a surgeon!

I have also had a few especially memorable patients. I removed bilateral white cataracts from several developmentally delayed patients in residency. On postoperative day 1, the immediate change in personality was striking and moving. One patient became quite talkative, when she had previously been quiet and withdrawn. Another could not stop enthusiastically mimicking my hand gestures once he was finally able to see them!

During my fellowship, a young Hmong child presented with unilateral group E retinoblastoma. We recommended enucleation, but his parents and grandparents refused due to their cultural beliefs; they wanted to treat him with traditional medicine. The situation was very similar to that discussed in The Spirit Catches You and You Fall Down, which I had read in medical school. After weeks of discussion and compromise, the patient’s family agreed to enucleation and were relieved to see that their child had no ill effects from the surgery and would grow up living a normal life.

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

The realm of microinvasive glaucoma surgery (MIGS) has potential to help a large number of glaucoma patients, especially in a city like Bakersfield, where access to a glaucoma surgeon is limited. I look forward to new microinvasive procedures that are effective and safe for treating our many glaucoma patients.

What is the focus of some of your research?

I am currently a subinvestigator in a clinical trial of next-generation extended depth of focus IOLs.

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

I love being a comprehensive ophthalmologist because I never know what pathology I am going to see on a given day. It keeps me on my toes and looking forward to the next patient. Outside of work, I enjoy cooking new recipes with my new sous vide immersion circulator and electric pressure cooker. I try to go on long bike rides on the weekends (although this is tough when it is consistently over 100° in the summer!) and hang out with my friends and family. I am also a strings coach (I play the violin) for Stockdale High’s orchestra during the school year.

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

The most important objective for me was keeping an open mind. To be honest, I never thought I would be in private practice in Bakersfield, but not limiting myself geographically led me to a great opportunity and a welcoming community that was glad to have me back. Also, do not be afraid to try new technologies and surgical techniques. Having more tools in your toolbox only makes you more comfortable in the OR and more prepared to handle any unexpected events (which will definitely happen!).

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

While not new, I have found anterior segment OCT to be immensely valuable in helping diagnose conjunctival and corneal tumors. This technology can often distinguish which layer a lesion is in and help with patient counseling and surgical planning. It almost acts as an optical biopsy, although, of course, it does not replace a tissue diagnosis. Regarding excision biopsies of ocular surface tumors, I prefer a minimalistic approach. If a lesion is shown to be neoplastic, I prescribe topical chemotherapy drops as adjuvant therapy (5-fluorouracil for squamous tumors and mitomycin C for melanocytic tumors). If there is deep invasion, I refer the patient for radiotherapy (proton beam or plaque).

author
 
Neda Shamie, MD | Section Editor
  • Associate Professor of Ophthalmology, Doheny Eye Institute, University of Southern California Keck School of Medicine
  • Medical Director at the University of Southern California Doheny Eye Center-Beverly Hills
  • nshamie@doheny.org

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