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One To Watch | Nov/Dec '21

One to Watch: David Felsted, DO

Dr. Felsted is a cataract, refractive, and MIGS surgeon at Barnet Dulaney Perkins Eye Center in Flagstaff, Arizona.

Please share with us your background.

I consider myself a Westerner, although I spent most of my childhood in South Bend, Indiana. My dad worked in the finance sector of health care, and when our family had the chance to leave the Midwest for the Wasatch Front in Utah, we jumped at it. As a teenager, when I wasn’t working my job at a local tire shop, I was up in the mountains crushing Brighton Ski Resort.

After graduating high school, I attended Brigham Young University for a year before serving a mission for my faith in Cape Town, South Africa. When I returned home, I worked hard to get into the rigorous Brigham Young accounting program and then quickly realized I didn’t want to work on spreadsheets and tax law for the rest of my life. With The Great Recession of 2008 in full swing, I began to question my potential future at a big accounting firm. Around that same time, my parents went golfing at a local course and were randomly paired up with Robert Cionni, MD. He was kind enough to invite me to watch him in surgery for a day. You could say the rest was history—the ophtho-bug bit me hard. I completed the rest of my accounting degree while simultaneously jumping through all the necessary premed hoops.

I met my wife Jenny that same year. She was the girl all the guys wanted to date, and I was somehow the lucky one who married her. She became my greatest motivator for getting into medical school and residency. While finishing up our undergraduate degrees, we managed student apartment units and tried to enjoy our last few simple days before I started my journey into medicine.

I then started medical school in Phoenix, where we somehow survived the 118° heat with a newborn before moving to Northern Arizona to complete clinical rotations. I made daily commutes on my road bike starting as an MS-1 and carried this habit all the way through PGY-4 of residency—rain, sun, snow (studded tires, of course), and swamp.

As an osteopathic student, I had no choice but to hit the road and rotate across the country in order to secure a match. The summer of 2015 felt like a “So, You Think You Can Match” season finale (at least that’s how it seemed at the time). I did get the chance to rub shoulders with some world-class surgeons before ultimately matching at my top choice: The Medical College of Georgia. I have always put my wife and kids at the top of the totem pole of priorities. I chose this program because they celebrated my family choices and promised to give me excellent training without making me sacrifice my role as a dad.

Surviving medical school and residency with a brood of children and a wife who stays at home was an expensive endeavor. Like many others, I did not have a rich uncle or a state school to rely on, so it was up to me to find creative ways to make things work before those attending paychecks came in. I spent many late nights on call both as a surgeon and as a dad. At one point, we had four kids under 4 years old, and I was taking Q3 primary call at the veterans’, children’s, and adult medical centers. Although this was a true test of our relationship, we grew from it and celebrate making it through this time in our lives.

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

The cliché is that we all like working with our hands and using technology, right? I’m no different. At age 23, I became dissatisfied with the prospect of not being able to make an impact on people. I grew up using my hands to tinker with Legos, build remote-controlled airplanes, fix things, and work on my car, so naturally I began asking myself, “Why should I settle for a desk job?” I wanted to use my manual dexterity and next-generation technology to help people see better. I truly believe ophthalmology self-selects candidates, and when I watched Dr. Cionni perform some of the first laser cataract cases, I felt like I had found my golden ticket.

Please describe your current position.

I am a high-volume cataract, refractive, and MIGS surgeon in a very large practice in Northern Arizona. Originally, I thought I would pursue a fellowship and start a solo boutique practice, but the events of 2020 didn’t go as planned for anyone. We had an unfortunate turn of events within our immediate family. My brother-in-law was diagnosed with glioblastoma halfway through my PGY-4, and we made some last-minute decisions to be closer to him before he ultimately passed away in 2020. My whole outlook on life changed at that point, and I suddenly realized that life is too short. I now enjoy operating twice a week, helping people from all walks of life see their best.

Who are your mentors?

It takes a village—or, in my case, maybe multiple. Dr. Cionni is ultimately responsible for opening the door for me and getting the flames going. As a premed student, I spent so many days in the OR with him and his partner Darcy Wolsey, MD, asking tons of questions. They were incredibly patient. During medical school, Craig Cassidy, DO, a local refractive surgeon in Phoenix, became a mentor of mine. I sent him many emails asking for advice, and in the moments when I didn’t think a match was in the making, he would send snippets of motivation to keep me going.

Adam Kaufman, MD, FACS of the Cincinnati Eye Institute has also been pivotal in the development of my career. One day he sat down with me and pored over my personal statement, application, and CV to help me nail everything down and match. I am still in contact with Dr. Kaufman and find his insight incredibly valuable.

During residency, I was drawn to the attendings who believed in me despite the weight I carried as a dad and sole provider for my family. Lane Ulrich, MD, spent many days in the OR teaching me how to horizontal chop a nucleus and work in the angle to implant my first MIGS device. David Bogorad, MD; Stephanie Goei, MD; Dilip Thomas, MD; Amy Estes, MD; Zack Lukowski, MD; and Kathryn Bollinger, MD, were all instrumental in my development as a resident and, more important, as a person.

I must give a big shout-out to the team at MillennialEYE and BMC, especially Tamara Bogetti, MBA. This group has connected me time and time again, supported me, and lifted me during residency when I really needed it. BMC continues to inspire and direct me as a young ophthalmologist in my first few years in practice. Attending the MillennialEYE Live meetings has been a way to network and develop instant connections, and now the virtual platform YoungMD Connect enables me to do the same from the comfort of my home.

Of course, I must also mention Gary Wörtz, MD. I still remember a phone call with him where, at the end, he said “Dave, this doesn’t have to be a one-time conversation. You can call me anytime, and we can keep chatting as your career progresses.” A true mentor makes time and invests in your future with it. In addition, spending a year on a podcast (Ophthalmology off the Grid: Survive & Thrive) with Gary taught me a lot of career and life lessons and ultimately made me realize the true value of helping the next generation.

Finally, my current mentor is my partner at Barnet Dulaney Perkins, David McGarey, MD—a family man with a big heart. He is an excellent surgeon and helped me transition into private practice, teaching me multiple MIGS surgeries, LASIK and PRK, multifocal and advanced technology lenses, and implantable collamer lens implants. Dave has invested so much into my development this past year and is a true example of a mentor who is willing to lead the next generation to success. I have a ton more to learn from him!

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

I have the opportunity every day to work with patients from the wonderful and vibrant Southwest Native American community. I get to take care of silversmiths, painters, artists, jewelers, and local historians. I will never forget when I had the opportunity to work with a patient who had served our country during World War II, assisting in Navajo translation—it was a true honor to shake his hand and thank him for what he did.

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

This past year was an incredible learning opportunity for me, as I adopted a lot of new surgical techniques, tripled my daily case volume and began implanting new devices. As MIGS continues to expand and evolve, I am embracing it with open arms. I want to continue to be able to offer my patients as many options as possible to address their disease progression.

Techniques and devices that I currently use include trabecular microbypass shunts (eg, iStent InjectW [Glaukos]), viscocanaloplasty, ab interno trabeculotomy, and the Omni Surgical System (Sight Sciences). I am in the process of adopting the Hydrus Microstent (Ivantis) and the Kahook Dual Blade (New World Medical). Implantable glaucoma depot medications will continue to transform the treatment paradigm, and I am excited to begin using them this year as well.

For refractive patients, I currently offer laser cataract surgery, PRK/LASIK, the Optiwave Refractive Analysis System (Alcon), Vivity and PanOptix IOLs (Alcon), toric IOLs, the Tecnis Symfony IOL (Johnson & Johnson Vision), and dropless steroid depots, both intracanalicular and intracameral.

What is the focus of some of your research?

Although I admire the work of my colleagues who dedicate time to scientific research, I have never been that type. My current focus is on the practical aspects of microsurgery that assist the patient and/or the surgeon. In the future, I also hope to work more closely with industry to develop new technologies. I am currently working on a project with several different intraoperative steroid depots for cataract surgery to evaluate their efficacy, placement, and outcomes. I am also involved in the development of a new direct micro-camera to assist with MIGS device placement and visualization, which can be challenging for busy surgeons. With the help of this technology, maybe in the future we will all stop breaking tape and rotating heads/scopes.

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

My day typically starts at 6:00 am with a run or bike ride, followed by studying and eating breakfast with the kids. I then either drive or bike to my office, which is about 6 miles from home. I spend 2 days a week in the OR and 3 days in clinic. Lunch is spent charting or visiting Jenny and the kids for whatever activity they have going on that day—last week it was a violin concert, next week it will be swimming lessons. Afternoon clinic usually ends by 4:30 pm, and then it’s off to a Little League game or a mountain bike ride with everyone (even the 4-year-old rides the trails). If I’m on call, sometimes I need to see a consult or help someone out in the ER. On nights where kids aren’t the main event, I try to catch up on house projects, work events, finances, or future career planning. I also really enjoy helping med students out on the trail to match, and I spend a lot of time on phone calls, coaching them on their next steps.

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

I’m right there with you, figuring things out as I go. Something I learned early during residency was to make a brand for myself and invest in it regularly. With rising demands for our services, the future is bright and optimistic in our profession. For those who are the sole bread winners of the home, diversify your income streams and ensure that your employment contracts are flexible enough to do so. It is possible to be a good parent, spouse, and surgeon. Spend time building the life you want to live right around you so that you don’t feel like you need a vacation to escape it. Make intentional efforts to balance your family, hobbies, and career.

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

My interest in innovative technology sparked my love of eye surgery, and I continue to embrace the future of premium extended depth of focus/trifocal lens implants, MIGS devices, depot medications, laser platforms, and advanced surgical viewing systems. Although portions of my practice are spent implanting premium IOLs (eg Vivity, PanOptix, Symfony, and torics), another is spent serving the Native American patients who come from the reservation. This population is truly unique and special and, at the same time, very vulnerable.

Each week presents a new set of complex cases with super dense nuclei, pseudoexfolation, white cataracts, or traumatic zonules. Sometimes my only chances to see these patients are at their preoperative assessment and on the day of their surgery. For some patients, travel time can be 4 hours or more. I have adopted many ways to help them, despite our short interactions. Dexycu (EyePoint Pharmaceuticals) and Dextenza (dexamethasone ophthalmic insert 0.4 mg, Ocular Therapeutix), along with MIGS procedures, have been remarkable options to ensure steroid delivery. In an area of the United States where eye care is desperately underrepresented, anything to help stave off an incisional glaucoma procedure or postoperative complication is welcomed with open arms.

Neda Shamie, MD | Section Editor