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One To Watch | Sept/Oct '21

One to Watch:
Nandini Venkateswaran, MD

Dr. Venkateswaran is a cornea, cataract, and refractive surgeon at the Massachusetts Eye and Ear Infirmary in Waltham, Massachusetts, and an instructor of clinical ophthalmology at Harvard Medical School in Boston.

Please share with us your background.

I am a born-and-raised New Yorker and am blessed with an incredibly supportive and loving clan made up of family, close friends, and mentors who have always believed in me and helped me to fulfill my dreams.

I knew from a very young age that I wanted to pursue a career in medicine, and I was accepted into the competitive, combined 8-year BA/MD Rochester Early Medical Scholars program at the University of Rochester School of Medicine and Dentistry in Rochester, New York. My experiences in college and medical school sparked my passion for ophthalmology, and I went on to complete my ophthalmology residency at the Bascom Palmer Eye Institute at the University of Miami in sunny Miami, Florida. I am indebted to that program; those amazing 3 years provided me with an unparalleled foundation in medical and surgical ophthalmology. I then completed a cornea, external disease, and refractive surgery fellowship at the Duke Eye Center at Duke University in Durham, North Carolina, where I fell in love with the elegance and intricacy of corneal, anterior segment, and refractive surgery.

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

My introduction to ophthalmology was truly fortuitous. I had earned enough credits to graduate a semester early from college and was in search of a productive yet enjoyable way to spend the 8 months I had free prior to matriculating into medical school. My family ophthalmologist, Kenneth Rosenthal, MD, offered me a position as an ophthalmic technician, surgical coordinator, and research coordinator at his high-volume cataract and refractive surgery practice in Great Neck, New York. I immediately seized the opportunity, perceiving it as a wonderful way to engage in patient care prior to medical school; however, I never anticipated that these 8 months would ignite my love for the field of ophthalmology and microsurgery.

In my short time at Dr. Rosenthal’s practice, I learned how to evaluate patients with a multitude of anterior segment conditions, perform diagnostic imaging, counsel patients on premium IOL options, and book them for complex cataract and anterior segment surgeries. I helped author compassionate-use device exemptions to implant some of the first artificial iris implants (HumanOptics) in patients with congenital and acquired iris defects prior to the device’s FDA approval, and I helped oversee clinical trials that Dr. Rosenthal was running on the artificial iris devices from Ophtec and Morcher. I began to learn the art of scientific writing by authoring case reports and surgical technique papers on fascinating cases that I encountered in clinic. Time flew by, and I entered medical school knowing in my heart that I was meant to pursue a career in ophthalmology.

In medical school, I had the privilege of working with Holly Hindman, MD, a clinician-scientist specializing in cornea and external disease as well as cataract and refractive surgery. She provided me with unique opportunities to prepare and present cases at the University of Rochester Flaum Eye Institute’s grand rounds as a first-year medical student (the only medical student presenting among all residents)! While working in her research laboratory, I also had the opportunity to conduct basic science research on the mechanisms of corneal neovascularization and to write numerous papers. Time spent in Dr. Hindman’s clinic, OR, and lab instilled in me a passion for corneal disease.

Throughout ophthalmology residency at the Bascom Palmer Eye Institute, I continued to nurture my passion for corneal and ocular surface pathology as well as cataract and refractive surgery. I worked alongside leaders in the field and had opportunities to perform full-thickness and lamellar corneal transplants, ocular surface tumor excisions, complex cataract surgeries, and even laser vision correction procedures. After these rich experiences in corneal and anterior segment surgery, it was only natural for me to pursue a fellowship in cornea, external disease, and refractive surgery at Duke University.

Please describe your current position.

I am currently a cornea, cataract, and refractive surgery specialist at the Massachusetts Eye and Ear Infirmary in Boston, and I primarily work at our satellite practice in Waltham, Massachusetts. I am also an instructor of clinical ophthalmology at the Harvard Medical School in Boston.

My practice has been steadily expanding, and by being at a large academic institution and tertiary care referral center, I am able to treat patients with an expansive breadth of medical and surgical pathology. My daily patient mix ranges from cataract and refractive surgery evaluations to complex dislocated IOL consultations that require lens exchanges or secondary lens implantation; unstable keratoconus that requires crosslinking; secondary corneal edema or corneal scars that require lamellar corneal transplantation; refractory dry eye disease; corneal ulcers, dystrophies, or degenerations; and ocular surface tumors that require medical and/or surgical intervention. At this juncture of my career, I embrace the wide variety of patients who walk through my clinic doors, and I love offering each of them a customized plan to improve their vision and eye health.

I also teach ophthalmology residents in the Massachusetts Eye and Ear Infirmary Emergency Department and work in the clinic and OR with cornea and anterior segment fellows.

Who are your mentors?

I would not be who I am or where I am today without the selfless dedication, commitment, and support of my many mentors. By training in many of the top ophthalmic institutions in the country, I have been fortunate to form an extensive national and international network of mentors and sponsors whom I turn to frequently for advice.

I am forever indebted to Dr. Rosenthal for believing in me as a young college graduate; training me from the ground up as a technician, surgical coordinator, and research coordinator in his practice; and entrusting me with the care of his patients. My experiences in his office opened my eyes to the dynamic and innovative nature of ophthalmology. Dr. Hindman at the University of Rochester introduced me to the subspecialty of cornea and external disease. Time spent with her helped me realize prior to residency that I had an affinity for treating patients with corneal disease.

During ophthalmology residency at the Bascom Palmer Eye Institute, I had the privilege and honor to work with many trailblazers in our field. Carol Karp, MD, took me under her wing from my first month of residency and trained me in the art of diagnosing and caring for patients with complex ocular surface tumors. She and Anat Galor, MD, MSPH, helped me transform into a confident presenter, researcher, and scientific writer. Sonia Yoo, MD, and William Culbertson, MD, empowered me to perform LASIK and PRK cases solo as a third-year resident and exemplified how fulfilling a career in refractive surgery can be. Harry Flynn, MD, and Audina Berrocal, MD, instilled in me a respect for the retina that I uphold today, even as a cornea specialist, every time I examine patients or perform surgery.

Cornea fellowship at Duke University was one of the most formative years of my career. My mentors there shaped how I operate and how I think about and approach refractive and cataract surgery patients and complex anterior segment pathology. To this day, I constantly hear Terry Kim, MD; Melissa Daluvoy, MD; Preeya Gupta, MD; Victor Perez, MD; and Lloyd Williams, MD, PhD, in my head as I examine and counsel patients in clinic or think through maneuvers in the laser suite or OR. Their generosity and passion for teaching enabled me to see and care for many diverse patients, and the skills I gained from those experiences will be useful throughout my career.

In the realm of career development and advancement, Tamara Bogetti, MBA; William Trattler, MD; Kendall Donaldson, MD, MS; Bonnie Henderson, MD; Janice Law, MD; and Darby Miller, MD, MPH, have been incredibly generous advocates and sponsors, always identifying opportunities for me to teach and speak at national conferences and become involved in national ophthalmology societies. Jai Parekh, MD, MBA, my mentor through the Ophthalmic World Leaders fellowship program, has been invaluable in offering pearls of wisdom to help me succeed in my first few years of clinical practice and as I begin to collaborate with industry. At the Massachusetts Eye and Ear Infirmary, Kathryn Hatch, MD, and Christian Song, MD, have become wonderful mentors and resources to turn to, and spending time with them in the OR and laser suite has helped me immensely when implementing new techniques for my patients.

My family of mentors inspires me daily to be a more consummate clinician, surgeon, collaborator, and researcher.

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

It is hard to pinpoint the most memorable experience of my career, as there have been so many! To this day, however, I still vividly remember the first patient I met as a young ophthalmic technician: a 16-year-old high school student and skilled pianist who had congenital aniridia and cataracts and was debilitated by his photophobia and decreased vision. Cataract extraction with IOL implantation along with insertion of the HumanOptics artificial iris prosthesis brought this young man to 20/30 vision OU, enabling him to obtain his driver’s license and continue studying piano in college! His story was one of the main forces that inspired me to pursue a career in ophthalmology.

During fellowship, I cared for a gentleman throughout the COVID-19 pandemic who had developed fungal interface keratitis after a combined Descemet membrane endothelial keratoplasty (DMEK) and cataract surgery. The patient required a rebubbling procedure for a detached graft. For 8 weeks during the pandemic, we saw each other weekly for cornea checks, intrastromal injections of antifungal agents, and serial ultrasonograms to ensure that there was no posterior extension of the infection. We were both pleasantly surprised to observe a potentially devastating infection melt away and leave just a small stromal scar. In my last month of fellowship, he had recovered his vision, with 20/30 visual acuity in the affected eye. We gave each other a high-five that day, relieved that we had preserved his transplant and his vision.

In my first year of practice, I have taken care of some very sick eyes, and my patients and I have shared many hugs and tears throughout our journeys together. Memorable yet challenging cases from this past year include operating on two patients with white, hypermature cataracts that ensued after complicated intravitreal injections, performing complex cataract surgeries on two monocular patients with brunescent cataracts and extremely shallow anterior chambers, inserting secondary IOLs in multiple patients with aphakia or dislocated IOLs/capsular bag complexes, and draining and excising a recurrent iris implantation cyst. Seeing my patients regain vision after months of being in darkness is incredibly rewarding, and my heart melts with gratitude knowing that I was able to change their lives in such a profound way.

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

In my first year of practice, I have been able to offer and implant five new IOL technologies for my cataract surgery patients: the PanOptix trifocal IOL (Alcon), the Vivity extended depth of focus (EDOF) IOL (Alcon), and the Tecnis Eyhance monofocal and toric IOLs, as well as the Synergy IOL (Johnson & Johnson Vision). It energizes me in clinic to have engaging conversations with my patients about their lifestyle and vision goals, to educate them on the growing armamentarium of IOL choices, and to match them with the IOL platform best suited for their needs. The surge of new IOL technologies is simultaneously thrilling and overwhelming, and I embrace the challenge of critically evaluating and effectively implementing each new technology into my clinical practice. In the future, I hope to have access to the Light Adjustable Lens (RxSight), which can provide customizable and titratable visual options for patients.

I also strive to reduce my patients’ postoperative drop burden in my surgical practice. For many of my patients, placing Dextenza (Ocular Therapeutix), a preservative-free dexamethasone-eluting intracanalicular implant, at the conclusion of cataract surgery has markedly improved their postoperative healing experience and medication compliance. It has also reduced callbacks about postoperative medications. I look forward to exploring the potential use of Dextenza in an office setting for the treatment of ocular surface conditions such as dry eye disease and allergic conjunctivitis.

Lastly, I am excited by the future trajectories of corneal transplantation. Incorporating DMEK into my cornea practice has been incredibly rewarding, and I celebrate with each of my patients as they recover their vision expediently after surgery. The concept of injecting endothelial cells into the anterior chamber as an alternative to endothelial keratoplasty is exciting, and I hope to one day offer this treatment modality to my patients with corneal disease.

What is the focus of some of your research?

Research is an aspect of medicine that I have always thoroughly enjoyed. During residency and fellowship, I authored many peer-reviewed articles and book chapters on the outcomes and learning points from challenging clinical cases, the use of advanced imaging technologies for the diagnosis and management of ocular surface lesions and tumors and meibomian gland dysfunction, the efficacy of various therapeutics for the treatment of ocular surface tumors, and the results of novel surgical techniques in visual outcomes for patients with complex anterior segment pathology. I am gearing my current research toward assessing patients’ visual outcomes after refractive cataract surgery, particularly with the use of EDOF IOL platforms.

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

A typical day during my work week involves waking up, going to either clinic or the OR, and caring for my patients. Operating days are my favorite, and I love the intensity, precision, and focus that I need when performing microsurgery and refractive surgery. Outside of work, I enjoy spending my free time with my family and close friends. At the onset of the COVID-19 pandemic, I developed a love of the outdoors and hiking. Riding my Peloton bike, dancing, and practicing yoga have been wonderful ways to relieve stress and exercise indoors, especially during the cold Boston winters! Whenever I can, I love to travel either for conferences or for vacation, and I always find an opportunity to try new restaurants and cuisines in the cities that I am visiting.

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

For trainees, it is incredibly exciting to see the light at the end of the tunnel after numerous years of training. For the first time, as you start looking for your first job after residency or fellowship, you finally get to craft your narrative: where you work (geographic location), what practice setup you seek (private practice vs academics), what your schedule will look like (clinical responsibilities, research, and free time), and in what areas you want to specialize. Find mentors and/or sponsors whose careers you aspire to emulate and reach out to them for advice—they have been in your shoes before and can advise you on the next steps to take at this stage. Express your passions and interests to those around you so that, if opportunities arise, people will think of you. Expand your outreach by getting involved with committees on the national level. Ultimately, choose to do the things you love, but also take solace in the fact that your career path can change with time. Be open to new possibilities, embrace opportunities, and say yes to tasks that challenge you and help you grow!

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

In the past year, I have incorporated topography-guided LASIK into my refractive surgery practice with the help of my colleagues and industry representatives. The Phorcides Analytic Engine (Phorcides) has streamlined the process of incorporating this technology into my practice. It has enabled me to identify appropriate surgical candidates, better understand and treat each patient’s topographic aberrations and refractive errors, generate highly customized surgical plans, and produce fantastic visual outcomes for my patients.

To expand my skillsets in refractive surgery, I have also begun performing SMILE, which has expanded the laser vision correction procedures that I can now offer to my patients. Didactic sessions, wet labs, and conversations with colleagues have helped me learn the nuances of SMILE, and I have been thrilled at the visual outcomes of my patients. We are fortunate to have access to the VisuMax femtosecond laser (Carl Zeiss Meditec) at the Massachusetts Eye and Ear Infirmary, and I look forward to offering this novel technology to more of my refractive surgery patients.

Neda Shamie, MD | Section Editor