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One To Watch | Nov/Dec '19

One to Watch: Lorraine Provencher, MD

Lorraine Provencher, MD is a glaucoma specialist and cataract surgeon at the Cincinnati Eye Institute in Cincinnati, Ohio.

1. Please share with us your background.

I grew up in a small town in rural southern Indiana and am a Midwesterner to my core. What many often find interesting, however, is that both of my parents were archeologists. Family vacations always ended up in ruins (literally), and I had my fill of fossil hunting along road cuts. Although I failed to fully appreciate it at the time, their adventurous spirit, intellect, and love of learning, combined with a humble Midwest upbringing, instilled in me an appreciation for hard work, a love of people from all walks of life, and an intense curiosity for science and humanity. A career in medicine was a natural fit.

I fulfilled my childhood dream when I was accepted into the Indiana University School of Medicine. It was during medical school that I discovered and fell in love with ophthalmology. I feel like my “big break” came when I matched into residency at the University of Iowa, one of the best teaching residencies in the country. I then went on to complete a glaucoma fellowship at the University of Michigan. After fellowship, I moved closer to my family and joined the Cincinnati Eye Institute Glaucoma Service.

On a personal level, I am married to the world’s most amazing man, John Provencher, who supports me in all that I do and is my biggest cheerleader. We are working on building a family, starting with our rambunctious new Labrador puppy.

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

It was actually neuro-ophthalmology that first caught my interest during medical school and inspired me to do a clinical rotation. I was quickly drawn to the short, precise, effective nature of ophthalmic surgery, balanced by meaningful clinical interactions. I was encouraged to see that vision really matters to patients. Both patient and provider seemed aligned with a common goal to save vision. It is harder to find such alignment in other specialties.

I went into glaucoma, specifically, for the lifelong relationships I am able to form with my patients. I enjoy getting to know people, hearing their stories, and meeting their families. Although it fascinates me, I despise glaucoma as a disease. I hate that it is irreversible, and I hate that sometimes it worsens no matter what we do. But I am grateful for the ability to take care of patients with glaucoma, appreciative of the therapies we currently have, and excited about what we will likely have in the future. It is never a good time to be a glaucoma patient, but it is certainly better than it used to be.

3. Please describe your current position.

I am a glaucoma specialist and cataract surgeon at the Cincinnati Eye Institute in Cincinnati, Ohio. My focus is on the surgical management of complex glaucoma, with a particular interest in providing microinvasive glaucoma surgery (MIGS), but I still very much enjoy the satisfaction of routine cataract surgery.

4. Who are your mentors?

That is a tough question, as so many people have made an impact on me along my journey. Having someone believe in you is incredibly powerful, and I would not be where I am without the support of great mentors. At the University of Iowa, I was fortunate to train with one of the greatest cataract teachers of all time, Thomas Oetting, MD, MS, and I am proud to say I emulate him daily. Lee Alward, MD, whose voice plays frequently in my head, introduced me to the glaucoma subspecialty and showed me how special and rewarding a lifetime of caring for patients with glaucoma can be. Both of these individuals instilled in me a love of teaching and a desire to give back to the field. I rounded out my glaucoma training with giants at the University of Michigan, including Paul Lee, MD, JD; Sayoko Moroi, MD, PhD; Josh Stein, MD, MS; Jennifer Weizer, MD; Shivani Kamat, MD; and Manjool Shah, MD.

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

I cannot choose one event, but I would say that individual patients are the most memorable to me. It is truly special to go through difficult situations with people and to earn their trust. Some of my most challenging cases have turned out to be my most meaningful experiences. Glaucoma care is tough, but the relationships formed make it worthwhile.

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?

Overall, I am most excited by a shift in glaucoma care toward treatment options that improve patients’ quality of life and take the burden of treatment out of their hands. These options may come in the form of new drug products, new devices, or new evidence from studies such as the LiGHT trial, which showed the benefits of selective laser trabeculoplasty as the first line of treatment for patients with open-angle glaucoma or ocular hypertension. In my practice, I ask all of my patients how our treatment plan is affecting their daily life. I strive to find a regimen that works to control their glaucoma without controlling their lives. This may involve switching to preservative-free or compounded drop options, proceeding with selective laser trabeculoplasty, or moving on to MIGS. As you might guess, I am very excited about extended implantable drug elution.

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

Most recently, my research has focused on patient-reported outcomes, an area that aligns with my passion for improving quality of life in glaucoma care. In this project, I used an abbreviated, practical version of the National Eye Institute Visual Function Questionnaire to determine associations between traditional clinical parameters of visual function (eg, visual acuity and visual field data) and patient-reported outcomes.

I also have an ongoing project with rheumatologists at the University of Iowa, in which we are reviewing patients seen in the rheumatology clinic with ocular inflammatory disease in order to identify volume, determine trends, and guide future therapy. At one point, I considered a fellowship in uveitis, and I have always enjoyed collaborating with other subspecialists.

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

I love to wake up early and hit the ground running. My days and weeks vary considerably, and thankfully I have a great team to help me keep it all straight. In general, my week consists of a mix of clinic, surgery, and laser time. I split my time between our main office, or The Mother Ship, and a satellite clinic. In the evening, I am usually working on a research project, fulfilling a committee obligation, or editing surgical videos. Outside of ophthalmology, I enjoy spending time with family, getting outdoors with my husband and our dog, traveling, trying new restaurants, and doing Pilates.

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

I would encourage all young ophthalmologists to identify the simple, routine things that leave a smile on their faces at the end of the day. This could be teaching residents, interacting with colleagues from another subspecialty, running an efficient clinic, or spending time with patients in their most vulnerable moments. Most often, we live in between the highs and lows, in a state of routine, so we must choose a status quo that is satisfying. It is important to try to put aside pride, money, accolades, and titles, as those are shiny objects that will come and go. Instead, we must find the frequent, little moments that sustain us and choose a career path that allows us to pursue these simple joys.

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

My practice has been improved by a combination of innovative therapies, including compounded, less frequent glaucoma medications; laser trabeculoplasty; and/or earlier surgical interventions, specifically MIGS. More importantly, these therapies are making a difference in the lives of my patients. By acknowledging and intentionally lessening the burden of our patients’ treatment, we can improve quality of life, boost compliance, and maximize outcomes.

Neda Shamie, MD | Section Editor
  • Cornea, Cataract, and Refractive Surgeon, Maloney-Shamie Vision Institute, Los Angeles
  • drshamie@maloneyvision.com; Twitter @nedashamie; Instagram @nedashamiemd