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One To Watch | Jan/Feb '21

One to Watch: Cristos Ifantides, MD

Dr. Ifantides is the director for ophthalmic global outreach at the University of Colorado and the interim co-chief of ophthalmology at Denver Health in Denver, Colorado.

Please share with us your background.

I am a first-generation American, a child of Greek immigrants, and a grandchild of Greek refugees. I have two brothers with whom I am very close. I was born in New York, where I lived until the age of 12, when my family relocated to Florida. I am a firm believer in the American dream and like to think that I am proof that it is still alive and well. Hearing stories of the challenges my grandparents and parents faced in their lives, I felt a deep sense of gratitude for the safety and opportunities America afforded me. My dad often reminded me that the only reason my grandmother survived as a refugee was because of the kindness of strangers. I felt, and still feel, obligated to improve the lives of others.

I was fortunate to attend a fantastic state school that gave me opportunities to learn, grow, and do research. I received my bachelor’s degree, medical degree, and master’s degree from the University of Florida. (Go Gators!) Between college and medical school, I served in AmeriCorps as an elementary school reading teacher for children who were reading at well below their reading level. This experience opened my eyes to the educational and health disparities that exist in my own backyard.

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

I fell in love with medicine because it combines rational thinking, science, and an opportunity to improve patients’ lives. Within medicine, I wanted to choose a career path that would have the greatest impact on those most in need. This led me to ophthalmology. I completed an ophthalmology residency at Mount Sinai Hospital in New York City, followed by an Academic Global Ophthalmology fellowship at the Wills Eye Hospital in Philadelphia. During my fellowship, I learned advanced anterior segment surgery skills from some of the world’s best surgeons at Wills, LV Prasad Eye Institute, and many other institutions around the world. This experience completely changed how I viewed solving health care disparities. It helped me realize that we have been practicing health care relief rather than health care systems development. Without building strong health care services markets abroad, we will never achieve the goal of eliminating blindness. For this reason, I have continued my global ophthalmology work with the goal of creating stable markets for eye services similar to what patients in the United States enjoy.

Please describe your current position.

I currently serve as the director for ophthalmic global outreach at the University of Colorado in Denver, Colorado. I also serve as the interim co-chief of ophthalmology at Denver Health, our local safety net hospital. In these roles, I work with residents and fellows almost every day, and I love the teaching environment. We have developed a fantastic manual small-incision cataract surgery (MSICS) curriculum for our residents that includes lectures, wet labs, and operating as the primary surgeon on mature cataracts under my supervision. Because Denver Health is a level one trauma center, we see a tremendous amount of trauma. Although I am less than 4 years out of training, the surgical experience during my fellowship and now at Denver Health has accelerated my surgical skills development because of the complexity of the diseases that we see daily.

Who are your mentors?

Wow. Where do I start? I don’t believe anyone is truly self-made. Somewhere along the path to success, someone decided to give of their time or energy when there wasn’t anything in it for them. I try to remind myself of that, so my list is quite long. Early on when I was an attending, one of my mentors, Malik Kahook, MD, advised me to find mentors for different aspects of my life. Because I have multiple interests, this was sage advice, and it has really helped me to grow over the past 3 years.

Brad Feldman, MD, was my fellowship director and has continued to be a guiding force in my global work and life in general. I really value the global ophthalmology mentorship that I’ve received from Jeff Pettey, MD; Mitchell Brinks, MD, MPH; Matt Oliva, MD; Geoffrey Tabin, MD; Juan Batlle, MD; Cathy Schanzer, MD; and Suzanne Gilbert, PhD, MPH. They have shown me that helping strangers can and should be a way of life.

In the realm of innovation and entrepreneurship, Dr. Kahook; Anthony Vipin Das, MD, FRCS; Virender Sangwan, MD; Calvin Roberts, MD; and Naresh Mandava, MD, have been some of my biggest supporters and have provided continued guidance for my research. They have accelerated my understanding of product development and have provided me with the resources and know-how to develop ideas.

In terms of career development and personal advice, Mark Blecher, MD; Hunter Cherwek, MD; Alan Palestine, MD; William Trattler, MD; Rich Davidson, MD; Steven Yeh, MD; Stephen Petty, MD; Prem Subramanian, MD, PhD; and James Tsai, MD; have really helped me map out what I want to be when I grow up. Their guidance has often allowed me to reflect on this idea and has helped me to determine where I should focus my efforts (and, just as importantly, where I should not).

Of course, none of these individuals is siloed in the groups I laid out. All have provided me with mentorship on life and building relationships. I owe my current and future success to those who have invested in me.

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

It’s hard to say which single event is the most memorable. Overall, nothing compares to witnessing the overwhelming joy of a patient after removing the eye patch on postop day 1 after MSICS. I was able to see this joy many times during my fellowship, and I share the miracle at Denver Health with my residents. Some of these patients go from being blind to 20/20 UCVA on the very next day. To quote a book written about the Himalayan Cataract Project, Second Suns, “Witnessing so much unmitigated joy never loses its power.”

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

Not everyone can be Brandon Ayres, MD; Nicole Fram, MD; or Iqbal Ike K. Ahmed, MD, FRCC, so technology that allows “normal” surgeons to make complex surgeries routine and routine surgeries easy is something I highly value. I am a big proponent of the Zepto capsulotomy system (Centricity Vision) because it has allowed me to make complex cases (phacodonesis, pressurized white cataracts, etc.) much more routine. I also find that this device provides fantastic centration of the capsulotomy on the visual axis. The learning curve is short, especially considering how long it takes to master the use of devices such as a phaco machine.

In terms of pipeline technology, I am particularly interested in the pinhole IOL. Many of my patients have a significant amount of irregular astigmatism, so I’m excited to offer this lens when it becomes available. Lastly, I am very interested in the race to robotic cataract surgery, which is on the horizon. Automated robotic surgery will likely replace many of the routine cataract surgeries that we do, and robotic-assisted surgery will help make surgeons much safer and more exact, especially for complex cases. It is certainly a controversial topic with many downstream implications for the future of ophthalmology, so I like following along in its development.

What is the focus of some of your research?

My research focuses on big unmet needs in our field. This includes diseases such as dry eye disease that are undertreated and conditions such as intraoperative floppy iris syndrome that negatively affect surgical safety and outcomes. I also have great interest in creating affordable solutions for low- and middle-income regions where supply chains are spotty and resources are lacking.

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

I try to get an early start on the day when I encounter the fewest disruptions and can focus. Mindful meditation is typically the first thing on my agenda, followed by setting my goals for the day. I also schedule my international calls during the early morning hours because my global ophthalmology collaborators live in time zones that are typically many hours ahead of Denver’s.

I then make my way downtown to Denver Health. My days vary, but I am in clinic seeing my own patients, staffing resident clinic, or in the OR. My OR schedule is usually funky and includes a good amount of trauma and complex cases. When I’m staffing resident OR, my day is exciting and challenging, sometimes with as many as six MSICS cases. I love my team there. We share a special bond of working in the trenches at a safety net hospital. Every day is an adventure!

On my research days, I’m typically in our 3D printing lab, the wet lab, or the research lab. I’ve spent many more hours failing at something than being successful. I’ve (mostly) learned to enjoy the process of trial and error, so I continue to spend a large portion of my energy on drawing, building, and tinkering.

No matter how difficult the day is, things always improve as soon as I step through the door to my home. I have a very loving fiancée who is my biggest supporter. Together with our dog, Rocco, we try to stay as active as possible in order to fit in with the Colorado crowd.

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

Seek out mentorship. Many times, we wait for mentors to come to us or to be assigned to us through some sort of formal program. I recommend seeking out people whom you want to emulate and letting them know that you want to be like them. Technology makes it possible to receive mentorship from anywhere in the world. Don’t be shy. You are not a bother. Good mentors will make time for you, no matter how busy they are.

Don’t forget the most vulnerable people in your community. Our practice patterns have changed over the past few decades, and some practices don’t see anyone who cannot pay full price. If you decide that you want to share your talents with vulnerable patients, start by setting modest goals for yourself. Commit to one vulnerable patient per year, month, or week to start. I guarantee your life will be more full.

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

I was fortunate enough to learn MSICS at LV Prasad Eye Institute in Hyderabad, India. This is my favorite surgery to perform, and I love teaching it to residents. It is a safe way to remove a dense cataract, and it is the surgery of choice for people who are skilled in both phacoemulsification and MSICS. However, most high-income countries do not train their surgeons in MSICS, so many phaco-only surgeons inevitably encounter a dense cataract at home or on outreach abroad.

For this reason, I developed a technique to help improve the safety of phaco surgery on eyes with dense cataracts. I dubbed the technique rotary chop because the holes drilled into the lens with a phaco needle make the nucleus look like the dial of an old rotary phone (I am probably dating myself here). I find that trainees learn rotary chop much more quickly than traditional methods. I’ve received great feedback from surgeons all around the world who have tried the technique. For those who give it a shot, send me your videos!

Neda Shamie, MD | Section Editor