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One To Watch | May/June '19

One to Watch:
Brandon Baartman, MD

Dr. Baartman practices at Vance Thompson Vision in Omaha, Nebraska, focusing primarily on cataract and refractive surgeries, corneal surface and transplant surgeries, and microinvasive glaucoma surgery.

1. Please share with us your background.

I am a Midwesterner, originally from Rochester, Minnesota, and I’ve since settled in Omaha, Nebraska, with my wife, Nicole, and our daughter, Sophia. Nicole and I met while in medical school together at Wake Forest University, and we both trained at the Cleveland Clinic, she at the Fairview Center for Family Medicine and I at the Cole Eye Institute. We both loved our training programs and, to our surprise, enjoyed living in Cleveland as well. I went on to complete a fellowship with Vance Thompson Vision (VTV) in Sioux Falls, South Dakota.

Being a doctor was never really on my radar growing up, and I always thought I’d be a teacher or work with computers like my parents did. In college, on a whim, I took an introductory course to the field of neurosciences, and it was one of the best decisions I’ve ever made. The professor of this particular course could have made entomology sound fascinating (I took that course as well), but the way he presented retinal signal transduction and axonal transport was amazing. It was then that I decided to change paths and pursue a career in science and medicine, and I haven’t looked back since.

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

Ophthalmology is the best field of medicine for many reasons, but none greater than the simple fact that we can do the greatest good for the greatest number of people. The skills and efficiencies developed by those who have come before us have paved the way for us to care for more people in shorter periods time, with better results to boot. Each eye we touch is a life altered, and the feeling I get when I connect with patients who benefit from our work is special. As an anterior segment surgeon, my goal is to deliver the best surgical outcomes to as many patients as possible. The global burden of blindness and its trajectory presents a significant task for us in the coming years, and I feel a sense of responsibility to help carry the torch and continue to push forward the advancement of technology and patient care.

3. Please describe your current position.

I work with VTV in Omaha. With the help of our organization, I opened our clinic here shortly after completing my fellowship. Being in a new clinic location, my days have a lot of variety, but I focus primarily on cataract and refractive surgeries, corneal surface and transplant surgeries, and microinvasive glaucoma surgery. We have been working hard to create a world-class clinical research center in Omaha as well, and I look forward to bringing new studies to the region.

4. Who are your mentors?

So many people have influenced the way I practice medicine, but I’ll try to narrow down the list. The people I most frequently call on for guidance are those I lock arms with every day at VTV. Vance Thompson, MD, and John Berdahl, MD, were hugely influential in shaping how I practice, and I look up to the other VTV doctors including Mike Greenwood, MD; Russell Swan, MD; and Debby Ristvedt, DO, and all of the remarkable optometrists who work with us there. I spent my formative years with Jeff Goshe, MD; B.J. Dupps, MD; Ron Krueger, MD; and Tim Steinemann, MD, at the Cleveland Clinic. They guided me through my first steps as an eye surgeon, and their teachings continue to be a source of support for me—I hope they realize how much of my success is theirs to share.

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

This one’s easy. Early in my fellowship year, a patient came in from out of state with a pretty tough cataract. He had a history of trauma and was left with traumatic mydriasis and a progressive cataract, and he came to see us with hand-motion vision. What’s more, he was a retired engineer with high expectations, hoping not for just functional vision but for some spectacle freedom. I knew it would be a challenging case, and, to help get the job done, I used a variety of tools like the femtosecond laser, intraoperative aberrometry, and a capsular tension ring. Fortunately for the patient, everything went smoothly, and we got an EDOF lens well centered in the bag. Fortunately for me, he continues to do well and reminds me of this every time I visit him back home in Rochester. It was my dad’s cataract, and it was one of the most meaningful days of my life to earn his trust and take care of his eye.

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?

When I hear about new technologies, I try to envision how their implementation would affect my daily practice 5 years from now. Considering what I do most frequently—cataract and refractive cataract surgery—I would say that office-based adjustment of implants is the advance I am most excited about. Beyond the refinement of residual refractive error, I see this technology allowing us to “trial” presbyopia correction or monovision, adding a level of customization that our patients truly desire.

A couple of different technologies in this space are currently available, including the Light Adjustable Lens (RxSight) and the Perfect Lens (Perfect Lens), which uses a femtosecond laser to adjust the optic’s power and characteristics. I think we’ll see continued advancement on this front in the coming years. I am most curious about where this will lead us and whether we will one day have a surgery or lens option that maintains the anterior capsule (think, microcapsular incision and more efficient emulsification of the lens) and replaces the lens material with a substance that more closely mimics the crystalline lens of a 20-year-old. That’s the holy grail of lens replacement surgery.

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

Although I’m still determining the right niche of ophthalmic research to pour my time into, I’ve had some great opportunities to explore a few different areas. As a fellow, I was able to work on projects for a medical device company that uses negative pressure goggles to manipulate IOP (Equinox). This project has blossomed into work investigating how manipulation of IOP might change retinal blood flow and perhaps help us to noninvasively measure cerebrospinal fluid pressure.

One of the most readily accessible ways to contribute to medical science is through retrospective review, and I’ve done a couple of recent studies looking at how we use advanced-technology lenses in eyes with pathology, such as post-RK eyes and glaucomatous eyes. Our clinic in Omaha has recently been greenlit as a clinical study site for a couple of exciting technologies in refractive surgery and glaucoma, so I’m looking forward to continuing to build that aspect of my career.

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

I would describe a typical day as crazy but wonderful in so many ways. I get up early and try to get about an hour of work, research, or reading in before it’s time to get Sophia ready for school.

Once I make it to work, my days consist of clinic, surgery, or laser blocks in half-day segments. I think the most rewarding part of what I do every day is interacting with my team and navigating the challenges of starting a new clinic together. I work with a wonderful group of people, and I draw a lot of energy from them and how much they care about each other. We try to cultivate the work family environment by spending time together outside of the clinic every month, and I think that adds a special element of connection to our daily work. I’m also fortunate to be a part of a larger group of clinics with other surgeons and clinic managers who have the same team-first attitude; connecting with and learning from them is a regular part of my work flow as well.

As much reward as I get from time spent at work, nothing is better than picking up my daughter from daycare, where I get the biggest hugs. The best days for me end with dinner and a walk around the neighborhood with Nicole and Sophia, which refreshes me and helps keep family number one in my life.

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

Find your “why.” This seems simple, multiple books have been written on the subject (even one with that exact title by Simon Sinek), and I think there’s good evidence that it benefits your life and business to be intimately familiar with your own motivators. For advancing trainees, this means that they should identify what it is that gives them genuine satisfaction and relentlessly pursue it.

For example, my “why” is to bring joy to those who are vulnerable, and the way in which I practice medicine reflects that. I have found some of the most satisfying patient encounters to be with those who are most anxious about their eye health. Helping to ease a patient’s tension through education and even humor brings a lot of satisfaction to my work. With the ever-improving safety and efficacy of common ocular procedures and patients who often feel vulnerable about their vision and surgery, an anterior segment practice lends itself well to satisfying my particular “why.” It can be tempting to focus only on the bread-and-butter procedures or on the surgeries you like to perform most, but I think the lasting satisfaction of holding a job that fulfills your personal “why” is much more significant. Find a subspecialty and a practice that add fuel to your fire.

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

I try to stay up on the latest technologies aimed at improving patient care and outcomes, and I think it’s one of the things that makes our field so remarkable.

In the clinic, I’ve been trying to improve on patient needs for in-office dry eye treatment. There are a lot of new tools in this space, and my team has been using TearCare (SightSciences). This device delivers a heating sequence to the eyelids before I clear the lids at a slit-lamp camera, allowing me to document and show the patients what I’m doing. I think taking the time to show patients what’s going on with their eyelids provides valuable positive reinforcement and helps with compliance to at-home therapies.

On the surgical side, I’ve recently been using the Zepto capsulotomy system (Mynosys) for cases with advanced-optic lenses in order to help center the optic on the visual axis. It’s a small but often-overlooked part of refractive cataract surgery, and it’s nice to have access to a device designed to make this step more efficient and accurate.

Neda Shamie, MD | Section Editor