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One To Watch | Nov/Dec '20

One to Watch:
Erin Sieck, MD

Dr. Sieck is an Assistant Professor of Ophthalmology and Visual Sciences at Washington University in St. Louis, Missouri.

Please share with us your background.

I am fortunate to be the middle of five children, so growing up our house was always loud. In my early childhood, we lived in Denver, Colorado, where my dad served in the US Army Medical Corps as a cornea-trained ophthalmologist. I was pushed down a mountain with skis on for the first time at age 2, and I still ski as often as I can. When I was in the third grade, my father separated from the Army as a Major, and our family relocated to Quincy, Illinois.

After graduating high school, I attended a 6-year combined bachelor’s and medical degree program at the University of Missouri-Kansas City, where I spent most weekends studying and eating BBQ. I completed my ophthalmology residency at the University of Colorado surrounded by dedicated and energetic mentors who confirmed for me that I had chosen the correct field. I recently finished an advanced anterior segment and glaucoma fellowship at Washington University in St. Louis (WashU). During my last year, I was able to convince WashU to hire me as faculty, and I started full time in August.

A few years ago, I married my medical school sweetheart, Iftiar. On the weekends, we can be found sitting in the park, reading books, and enjoying St. Louis’ excellent international cuisine.

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

I was drawn to ophthalmology from a young age. At that time, the AAO would send surgical videos on VHS; I enjoyed watching these tapes with my dad and was the only kid who could stomach them. My dad showed me how much he loved his work, and his patients showed me how much they appreciated him by offering us free pie at the grocery store. Because I had an early interest in eye care, I was able to become involved with the Kansas City Free Eye Clinic during medical school, which sealed my fate.

In residency, I truly liked all aspects of ophthalmology. I loved the quick but effective procedures, and I knew I wanted to enhance my surgical skills with a fellowship. I ultimately chose glaucoma due to the pathophysiology of the disease and its multiple surgical treatment options and because of my mentors. I developed a deep respect for the relationships that are developed with patients over decades of glaucoma care.

Please describe your current position.

This year, I became the newest addition to an incredible glaucoma service at WashU. I have an emphasis on complex and uveitic glaucoma, and I work closely with our uveitis specialist in a joint clinic. In addition to treating all varieties of glaucoma, I do complex anterior segment and IOL work. The best part of my job is teaching residents phacoemulsification and teaching fellows complex glaucoma procedures.

Who are your mentors?

Is there a limit to the number of people I can list? I have been blessed with kind, thoughtful, and patient mentors in both residency and fellowship. On the second week of my glaucoma rotation in residency, Malik Kahook, MD, asked me “So, you are doing glaucoma, right?” He, in addition to Leonard Seibold, MD; Jeffrey SooHoo, MD; and Mina Pantcheva, MD, showed me that glaucoma can be challenging but that is what makes it fun. These mentors gave me research projects and encouraged me long after I left their rotation. Rebecca Epstein, MD, and Cara Capitena Young, MD, were my glaucoma fellows when I was a resident. They were both recruited to join the University of Colorado’s faculty, and they sat by me during my first tube shunt, trabeculectomy, and MIGS procedures. They are not only some of my favorite teachers but also my close friends.

The legacies of my mentors in fellowship do not need to be outlined. Michael Kass, MD, taught me about the history of glaucoma and the beauty of seeing the same patients for more than 30 years. Carla Siegfried, MD, showed me that nothing beats a perfect trabeculectomy. Anjali Bhorade, MD, taught me compassion for patients struggling with a chronic disease. Finally, Arsham Sheybani, MD, taught me to be the master of the OR. I am so grateful for everyone listed above.

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

During fellowship, I was awarded the Young Eye Surgeon International Service Grant from the ASCRS. This is a new initiative for young ophthalmologists in their first 5 years of practice, designed to support them in incorporating global ophthalmology into their careers. I was honored to be selected for this grant by the global ophthalmology giants in our field.

With my grant, I will be traveling to Sierra Leone to work with a local comprehensive ophthalmologist. She wants to improve her surgical glaucoma skills, and I will work on my manual small-incision cataract surgery skills in return. Unfortunately, the trip is currently on hold due to COVID-19, but in the meantime the ASCRS International Committee has been hosting seminars on the current advances and programs they support. It has been an honor to be in the virtual presence of so many who have dedicated their life’s work to international ophthalmology.

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

I find all of the MIGS devices and the new data on their outcomes exciting. We are starting to treat patients into their 90s and 100s. Having the capability to perform smaller, angle-based procedures as a first step into incisional glaucoma treatment not only buys us time but leaves the conjunctiva untouched for subsequent procedures that may be required. With each new MIGS device, our options broaden. I look forward to seeing head-to-head trials among the devices and their long-term outcomes.

What is the focus of some of your research?

Currently, my research is focused on uveitic glaucoma outcomes. I am fortunate to work closely with our uveitis specialist to provide individualized care for each patient. As they stand, uveitic glaucoma studies enroll very few patients. We hope to develop a cohort and present our outcomes based on medication changes and surgical choices.

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

I enjoy staying busy. I like to be high volume both in the clinic and in the OR. I try to fit teaching into both spaces as well with my medical students, residents, and fellows. The relationships I make with my patients keep me going. I know that every ophthalmologist agrees that nothing beats a postoperative cataract patient, and every glaucoma specialist agrees that nothing beats an IOP of 8 to 10 mm Hg after trabeculectomy. These outcomes and my patients’ reactions keep me fulfilled.

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

My best advice is to surround yourself with people whom you respect and trust. These individuals don’t necessarily need be within your practice, but having senior ophthalmologists as mentors is vital to staying on track. I formally invited a few mentors to meet with me biannually to review my progress.

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

During fellowship, I implanted many Xen Gel Stents (Allergan) with Dr. Sheybani. Throughout the year, we tweaked the procedure to try to improve outcomes and increase efficiency in the OR. I had great results with this procedure and look forward to continuing to place this device. I prefer an ab externo, open-conjunctiva technique for patients who are younger or African American, whereas I prefer an ab interno, closed- conjunctiva approach for elderly patients with poor tissue. Making this distinction in the OR has improved my outcomes.

Neda Shamie, MD| Section Editor