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One To Watch | July/Aug '21

One to Watch: Shanika Esparaz, MD

Dr. Esparaz is a comprehensive ophthalmologist, cataract surgeon, and medical retina specialist in private practice at Northeast Ohio Eye Surgeons in Cleveland.

Please share with us your background.

I am a first-generation American, and my family is originally from Sri Lanka, a small island off the tip of India. My parents emigrated due to civil unrest in their country and a desire for greater safety and opportunity for their growing family. Their life in America began in Los Angeles, which is where I was born. My mother, although a physician in her home country, had to apply for residency when our family arrived in the United States. While she retrained, she worked several daycare jobs. My father worked hard as well, taking multiple jobs cleaning dishes while earning an MBA. My mother matched into a family medicine residency in Cleveland, which I now consider my hometown! My parents’ grit, hard work, and determination to follow through with their dreams, even after moving to a foreign country, was the foundation that allowed me and my younger sister to succeed.

Growing up, I enjoyed science and tennis. I played competitively in the United States Tennis Association on weekends while participating in school extracurriculars, science fair projects, and volunteer work during the week. Playing tennis taught me the value of healthy competition. I loved playing singles but also loved competing as part of a team. When I won, I felt pride in my individual contribution to the team. When I lost, it was a learning and growing experience.

I also watched my mother run her solo family practice. I spent many afternoons hiding out in various parts of her clinic, and, as I grew older, I helped with the practice where I could. I saw the relationships my mother built with her chronic care patients. The way she integrated her work life with her role as a mother has been the most profound influence on me as a physician and mother today. I know I can do it because I saw her do it with my own eyes.

After high school, I attended Northwestern University in Evanston, Illinois, where I majored in human biology anthropology. I met my husband on my first day of college. Our friendship and love grew over our time together—playing club tennis, working as partners in organic chemistry and as study buddies in the library, and sharing a dream to attend medical school one day. We maintained a long-distance relationship during medical school, as I attended Wright State University in Dayton, Ohio, and he stayed in Chicago. After our third year of medical school, he proposed! Thankfully, we were able to “couples match” into residency—he into interventional radiology at Beth Israel Deaconess and I into ophthalmology at Boston University. We were married shortly after our medical school graduations.

My time at Boston University was first class. I participated in a well-rounded, surgery-heavy training program. I saw a lot of pathology. Residency was tough, but, in hindsight, my training laid the foundation for my current clinical and surgical skills. There were moments in residency when I questioned whether ophthalmology was for me. At the start, I wasn’t the most gifted surgically, nor did I know much about the field of ophthalmology, as my medical school did not have a home program. But great mentors and experience helped me to become the surgeon I am today.

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

As a middle school and high school student, I was randomly placed into a lab working on diabetic retinopathy (DR). I worked there for several summers, studying how high-glucose environments cause apoptosis in retinal muller cells. Little did I know at the time, this would begin my interest in diabetes and, later, in diabetic eye disease.

As a third-year medical student, I chose to do my surgical rotation first, as I wanted to get it out of the way. I had long believed I would be a pediatric endocrinologist due to my love of working with children and my interest in diabetes. Through my surgical rotation, however, I realized how much I enjoy using my hands. I also knew that I wanted a lifestyle that enabled me to enjoy a family and become a mother and wife one day. I explored the surgical subspecialities and fell in love with ophthalmology.

After seeing my first cataract surgery, I knew that ophthalmology was the field for me. I loved how finessed, detail-oriented, and intricate intraocular structures were. I loved that ophthalmology could intersect with my passion for helping people with diabetes. I especially appreciated the almost-immediate postoperative results of improved vision and the ability to affect someone’s life so profoundly.

During my second year of residency, I knew it was time to choose to either begin comprehensive ophthalmology practice or pursue a fellowship. At that time, my husband had 1 year of training left in Boston. I decided to pursue a 1-year medical retinal fellowship at Boston University, as it worked out with the timing of our family (I had my first child right before the start of fellowship). Retina had interested me for some time. I always wanted to be able to see “ora to ora” with confidence. I also liked being able to perform several procedures, such as injections and lasers, in clinic. Moreover, my early passion for DR could come to fruition by my practicing as a retina specialist, with the ability to not only educate but also deliver vision-saving treatment. It’s interesting how life comes full circle and seemingly random opportunities end up changing your life.

Please describe your current position.

Currently, I’m in my third year as a comprehensive ophthalmologist, cataract surgeon, and medical retina specialist in private practice at Northeast Ohio Eye Surgeons. I have loved coming home and giving my children the opportunity to grow up near the same neighborhood where I grew up. Not to mention, my parents currently live in Cleveland as well and have been a huge help with our currently 2- and 4-year-old daughters.

I am the only retina specialist at our practice, so I had the opportunity to start the retina service. Much of my job has entailed not only mastering the learning curve of serving as a young attending but also bringing on a new line of service at a medical practice. I’ve been able to mold my clinic as my experience has grown, and I strive to continuously deliver safe, patient-focused, top-notch medical and surgical care.

I have enjoyed growing my cataract skills to include premium refractive cataract surgery as well. My residency provided a strong surgical foundation, but I recognize how important it is to continually read, watch surgical videos, and refine my skills as an attending physician.

Who are your mentors? 

Who is not my mentor? What I’ve learned since graduating from residency is that the learning never stops, hence the term practice of medicine.

From my residency, Nicole Siegel, MD, has been one of my longtime mentors. She is now the program director of the Boston University Ophthalmology residency program and, like me, is married to a physician with two children. During residency, I looked up to her and several other female attendings in our retina department. They showed me how to gracefully integrate clinical and surgical work with motherhood. I also appreciate Nicole’s support from a distance, as she regularly answers my texts about unusual patient cases.

In my current practice, I’ve had the opportunity to work with three experienced and skilled surgeons: Lawrence Lohman, MD, FACS; Marc Jones, MD, FACS; and Matthew Willett, MD. I’ve curbside-consulted them on my patients and have gone to the OR with them as well for complex cases. It is great as a young attending to be in a surgically supportive practice as you grow your skills.

Social media has always played a huge role in mentorship for me. I’ve enjoyed connecting with powerful surgeons such as Rupa Wong, MD; Neda Shamie, MD; Alison Early, MD; Andrea Tooley, MD; Dagny Zhu, MD; and Jesse Berry, MD, over social media and seeing how they manage the work-life pendulum. Additionally, I’ve learned a lot from connecting with folks on the virtual mentorship and educational platform YoungMD Connect.

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

This is a tough one! For me, it’s been a series of moments that have made my career memorable.

I recall one patient with very dense, hypermature cataracts who hugged me the day after her surgery. She told me that she never thought she would see again, let alone see better than she had in years. She said that I had given her her life back.

One of my long-term patients with diabetes whom I see every couple of months has become part of my work family. He knows about my family and my hobbies, and he even brings me funny eyeball stickers to mark my injection patients. When your patients become part of your work crew, you know you’ve built something truly amazing and meaningful.

Of course, implanting my first AcrySof IQ PanOptix Toric IOL (Alcon) was memorable. The immense satisfaction of not only removing my patient’s cataract but also correcting his myopia, presbyopia, and astigmatism at the same time felt truly remarkable. The joy he exudes at his postoperative appointments as he details everything he can do without glasses for the first time is incredibly rewarding to witness.

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’m excited about the advanced lens technologies I’ve been able to use in the past year. As mentioned above, I’ve had the opportunity to use the PanOptix lens, and I look forward to using the Vivity IOL (Alcon) soon as well.

In the world of retina, I am excited to see the potential treatments for dry age-related macular degeneration that will come out in the next 5 to 10 years. This disease currently lacks a designated treatment, so the current management strategy includes only methods of prevention.

I am also excited to witness the growing field of AI and imaging in retina. Within the next few years, we will have better methods of detecting choroidal neovascular membranes in the clinic and remotely through home-based OCT devices.

What is the focus of some of your research?

I have created two research projects focused on my interests outside of ophthalmology, both via student research groups I’ve formed through social media. One project is focused on time management skills among medical students, residents, fellows, and attendings. The other is focused on maternity leave in medicine. We will be exploring average maternity leave times, maternity leave experiences, and postpartum support in medicine among residents, fellows, and attendings.

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

I typically wake up around 5:30 am to meditate, stretch (especially my shoulders and neck area), and exercise. Working out has been a way for me to build confidence and practice self-care. This is a routine I have instilled since my first daughter was born during my residency.

I typically have a 45-minute commute to work, and I enjoy listening to podcasts during that time. I listen to a variety of entrepreneurial podcasts as well as podcasts related to ophthalmology and mindfulness.

On average, I have 2.5 clinic days and 1 surgery day every week. My clinic is 80% medical retina and is usually filled with injections, lasers, and surgical consultations. My OR days typically include standard and premium cataract surgery cases. I love working part-time, as on the days I’m not in the office, I’m able to work on my side projects and spend time with my toddlers.

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

Take time to explore different options for your first job out of training. Realize that every opportunity, whether it be an email or an interview, could lead to other opportunities in the future. It is also great to visit different practices to learn how they run and see which model fits you best: academic, private practice, or private equity.

It is important to remember that learning opportunities never cease to exist. It is perfectly acceptable to not know everything on your first day as an attending. This realization has become even more real to me as a third-year attending. I’ve learned that surgical and clinical acumen mature over time and that it is important to ask for help or for a second opinion when needed.

At the end of the day, if the patient is your number-one priority, you will always make the right decision.

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

From the surgical perspective, I’ve enjoyed continuing to implant PanOptix lenses. I look forward to using more presbyopia-correcting technologies in the future as they continue to evolve.

In my retina clinic, I’ve enjoyed using subthreshold lasers, specifically the PASCAL Endpoint Management system (Topcon), to offer to my typical injection patients an alternative or adjunctive treatment for macular edema in conditions such as DR, cystoid macular edema, retinal vein occlusion, and central serous retinopathy.

Last, I’ve been intervening earlier in patients with signs of severe nonproliferative DR. These patients have a 50% or greater risk of progression to end-stage diabetic disease with irreversible vision loss. Several valuable studies of aflibercept (Eylea, Regeneron), namely the Panorama trial, have shown that we can intervene early with anti-VEGF agents to possibly even reverse retinopathy. It’s been gratifying to be able to educate my patients on their chronic eye condition and witness their visual improvements with treatments I deliver in the clinic.

Neda Shamie, MD | Section Editor