Supported by Allergan
Dr. Finklea is a cornea attending surgeon and Director of the Wills Eye Center for Academic Global Ophthalmology at Wills Eye Hospital in Philadelphia.
Please share with us your background.
I grew up in the small town of Lutz, Florida, on the far outskirts of Tampa. Despite this Florida heritage, my childhood was filled with far less alligator wrestling and airboat-based travel than one might expect. Nonetheless, I was lucky to spend my early years catching panfish in local ponds and riding bikes to the park. Around age 10, music took over my life for the better part of the next decade. My very loving and understanding parents endured every new instrument I brought into the household until, much to their surprise, a university agreed to let me make noise there instead. I spent the next 4 years at the University of Florida in Gainesville, Florida, studying music performance and biological engineering before moving north to the University of Virginia in Charlottesville, Virginia, for medical school.
Upon graduating from medical school, I went on to residency at the Wills Eye Hospital in Philadelphia, where I met the mentors who would shape my career and my life for years to come. During my residency, the global health program at Wills Eye was developed, and I was afforded the opportunity to begin exploring projects and partnerships that would later become a major part of my career. I went on to complete the Wills Eye Fellowship in Academic Global Ophthalmology, which allowed me to take a deeper dive into public health systems and learn from some truly brilliant minds from around the globe. Being a slow learner, 1 more year of fellowship was in order, so I was spent a year at the Duke Eye Center in Durham, North Carolina, where I studied the finer points of cornea and anterior segment surgery. At last, I completed my training and returned to Philadelphia to join a wonderful practice full of dedicated eye surgeons where I continue to work today.
What drew you to ophthalmology and, specifically, to your field of interest?
In so many ways, life is all about timing. In my first few weeks of medical school, I was randomly paired with a pediatric ophthalmologist for a community service project. With his mentorship and my interest in international health, I was able to participate in public health projects overseas, which solidified my resolve to pursue this profession. An additional aspect of ophthalmology that I found particularly enticing was the opportunity to truly repair something that had been broken. The ability to replace a cornea, suture in a lens, implant an iris prosthesis—overhauling a poorly functioning organ back to good working condition is something that few other fields have the ability to do. The joy that visual rehabilitation can bring to a patient has very few parallels. This ability is truly a gift that we are given on a daily basis as surgeons.
Please describe your current position.
I was drawn to my position in Philadelphia by the opportunity to work within the elusive “hybrid model” of medicine. I work in a multispecialty private practice that is closely involved with the residency and fellowship programs at Wills Eye and has a focus on complex anterior segment surgery. The cornea fellows rotate through our private clinic and join my partners and me in the OR. There is no better way to push yourself as a surgeon and clinician than to dedicate time to teaching. There are few opportunities to consider the finest nuances of a procedure as you do when describing and instructing a trainee on the individual steps of a surgery. It is truly a win-win.
On the academic side, I direct the Center for Academic Global Ophthalmology (CAGO) at Wills Eye, where we host a fellowship in global health and run several domestic and international public health projects. One of the greatest joys of my job is the chance to work with growing programs at our partner sites in places like Rwanda, Peru, and Haiti.
Who are your mentors?
I cannot overstate how fortunate I feel to have been led into the orbit of some phenomenal mentors. A few who went out of their way to give me insight and direction when I needed it the most include Brandon Ayres, MD; Irv Raber, MD; and Sadeer Hannush, MD, of Wills Eye Hospital; Terry Kim, MD; Melissa Daluvoy, MD; and Victor Perez, MD, of Duke Eye Center; Sayan Basu, MD, and Prashant Garg, MD, of the LV Prasad Eye Institute in India; and Ciku Mathenge, MD, of the Rwanda International Institute of Ophthalmology in Kigali, Rwanda. In the area of global health, Brad Feldman, MD, is not only a standout fellowship director but also a model for selflessness and prioritizing those in greatest need.
Mentors aren’t always those in positions of seniority to a mentee. Some of my most influential mentors have been my coresidents and cofellows during training. In addition to these individuals, every one of my nine practice partners has offered perspective, insight, and direction that have been fundamental in jumpstarting my career in ophthalmology.
What has been the most memorable experience of your career thus far?
Working in global health has provided me the opportunity to create a network of friendships and a tapestry of experiences that would have been unimaginable only a few years ago. While on a project in Sierra Leone as a fellow, I remember a local gentleman walking up to me at the end of a long OR day. He recognized the logo on my scrub hat and came to tell me that he used to live in Philadelphia. Unfortunately, he had been forced to return home to Sierra Leone before he could obtain necessary eye care and cataract surgery in the United States. His vision had steadily declined over the years due to the severely limited eye care services in western Africa. Now, years later, he was overjoyed by the opportunity to have his vision restored by the clinicians and surgeons in the Sierra Leonean clinic that we were supporting. This experience drove home for me how interconnected we all are, no matter what corner of the globe we hail from.
The experiences I had as a student working at the goliath ophthalmic systems of LV Prasad and the Aravind Eye Hospital in India will forever shape how I view the field of medicine and what may be possible with a paradigm shift in health care delivery. Learning manual small-incision cataract surgery from surgical fellows at the Lahan Eye Hospital in Lahan, Nepal, taught me what it means to be a world-class surgeon. Surgeons only 1 or 2 years my senior would perform more than 80 surgeries per day with effortless precision, while taking time to provide insightful tips for my cases.
An even more memorable experience was, after the OR, getting crushed in games of badminton, not by the surgeons, but by the young children of the staff members who would show absolutely no mercy.
What are some new technological advances that you have found particularly exciting? Which advances in the pipeline are you most enthusiastic or curious about?
The advances that I get most excited about tend to not be the most overengineered technology, but rather the technology that allows for the most elegant, effective, and low-cost ways to obtain the highest-quality outcomes. It has been exciting to work on innovations in secondary lens fixation to create safe and reproducible ways to obtain the desired refractive results. The steady improvements and modifications in manual small-incision cataract surgery have enormous implications for low- and middle-income countries.
In my private clinic, I am eagerly awaiting the opportunity to take the next step forward in endothelial rejuvenation through injectable cell lines. The possibilities for expanding autologous or allogenic cell lines and using them in minimally invasive endothelial keratoplasty would be field-changing and would open many new doors in the treatment of corneal endothelial dysfunction. These treatments would have far-reaching effects, particularly in regions where corneal tissue is in short supply.
What is the focus of some of your research?
Health care disparities, barriers to care, and implementation of academic programs in low-resource settings are my main areas of interest in global health research. We are fortunate to have passionate global fellows and alumni who engage heavily in their partnerships abroad, and the needs of the partners drive our in-country research.
At home, my passion lies in technique- and device-development for anterior segment reconstruction. Microinstrumentation has made possible many delicate procedures previously unattainable by manual surgery. It is exciting to be learning from the brilliant minds who have pioneered this field while also finding new ways to advance our profession’s abilities in the OR.
What is a typical day in your life? What keeps you busy, fulfilled, and passionate?
My mornings are a well-orchestrated exercise in organized chaos, punctuated by the barks of our urban dog pack. My commutes are an opportunity to learn about something outside the world of medicine and to catch up on world affairs via podcasts, books on tape, and audio classes. The bulk of my workday is spent in the clinic and the OR, where I’m lucky to often be joined by our cornea and global fellows. The time is intermixed with administrative work for our global health department, wet labs for residents and fellows, and work on the Wills indigent-care clinic. Evenings offer an opportunity to spend time outdoors, sneaking in a bike ride before dusk with my partner, fishing in the Pennsylvania trout streams, or taking our dogs for a run in the woods.
I stay passionate by following a path that is need-driven. In every community there will be gaps in the delivery of and access to care, and if you dedicate your time to addressing these needs, you will never find your career unfulfilled.
What advice can you offer to individuals who are just now choosing their career paths after finishing residency or fellowship?
For so many highly motivated and overachieving residents and fellows, medical training is a chute that you tumble down in a semicontrolled fashion. As you emerge into the professional world of medicine, you have the opportunity (possibly for the first time) to truly choose the path that will help you create a fulfilling career and life for the next several decades. It’s important that you take time to think about the values that led you to medicine and how you would choose to practice if finances were no object. Think about those populations that may not have access to high-quality health care in your own community and how you can be an advocate for them in your practice and daily life.
Once you settle into your practice, it is the perfect time to take on challenging cases and push yourself as a surgeon. Residency will give you a basic set of skills, but it is up to you to take those skills and develop them into your full surgical tool kit. Taking on difficult cases and succeeding at them will build your confidence and propel your career forward. I was told that you learn more in your first 5 years in practice than you do in all your years of formal training, and I can attest that this is 100% true. Challenge yourself. You can do it.
Tell us about an innovative procedure you are performing or a new imaging/diagnostic tool that has improved your practice.
The most useful tool I’ve added to my practice in the past 2 years has been the diagnostic analysis software Veracity Surgical (Carl Zeiss Meditec). This platform, and the similar Smart Solutions (Alcon), provides the ability to combine all of your diagnostic data from clinic-based devices into the software where it can be manipulated. I find it exceptionally helpful to be able to pull information from each of my preferred diagnostic devices into a single platform where the outcomes can be compared in a variety of combinations. Additionally, the automated analysis of postoperative outcomes helps to identify consistencies in refractive misses, information that enables practical changes in practice patterns.
In addition, I have been excited about the knowledge being gained from Descemet stripping only (DSO) procedures. This has been an excellent opportunity for several of my patients with visually significant Fuchs dystrophy to improve the clarity of their vision without undergoing complete endothelial keratoplasty. Although the procedure has several limitations and the eligible patient pool is currently small, the surgical technique development and research going into Rho kinase inhibitors will pave the way for the next generation of treatments for corneal endothelial dysfunction.