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One To Watch | Sept/Oct '22

One To Watch: Zeba A. Syed, MD

Dr. Syed is a cornea, cataract, and refractive surgery specialist at Wills Eye Hospital in Philadelphia.

1. Please share with us your background.

My parents are immigrants from India who moved to New York in the 1970s. I was born and raised in Westchester, New York, and my favorite childhood memories include managing a house full of pets, globetrotting with my family, and spending summers filled with backyard barbecues. I have been blessed with incredible parents who supported every random obsession that emerged during my childhood, ranging from chess tournaments to Rubik’s Cubes. I also grew up in a clan of physicians; my mother is a psychiatrist, my sister is a radiologist, and my father and brother practice internal medicine. My extended family includes aunts, uncles, and cousins in various medical specialties as well (imagine how captivating the conversations were at family reunions).

As a youngest child, I naturally gravitated toward rebellion and tried to fall in love with a career outside of medicine. As an undergrad at Harvard College, I majored in religious studies and spent a summer teaching abroad. I recall taking a course in positive psychology during college, and one of the lessons addressed how to select a career path. The professor’s approach involved creating a Venn diagram with three categories: (1) your strengths, (2) what you find meaningful, and (3) what you find fun. Despite my efforts to find a calling outside of medicine, it became increasingly clear that medicine was the perfect fit for me. It combines my strengths in science, my desire to make meaningful contributions to those in need, and my enjoyment of working with my hands.

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

During my first year at Harvard Medical School, I had a hunch that I would ultimately enter a surgical field. I enjoyed my anatomy courses and always liked tinkering with gadgets as a child. However, ophthalmology was nowhere on my radar until the summer after my first year of medical school, while spending time with my family in New York. I decided to identify voluntary research opportunities and emailed a handful of physicians across various specialties at academic institutions in New York. One of the few who responded to my email was Nathan M. Radcliffe, MD, who was then a glaucoma specialist at Cornell University. I spent a summer working on several projects under his mentorship and shadowing in his clinic.

My experience that summer piqued a serious interest in ophthalmology. I found the surgeries to be anatomically fascinating, the patient-doctor interactions to be meaningful, and the potential to impact patients’ quality of life to be extraordinarily rewarding. I was excited to be part of a research community in whichever field I entered, and the scholarly opportunities within ophthalmology were immense. By the end of that research summer with Dr. Radcliffe, I had chosen my future medical field. I enrolled in two ophthalmology rotations at Massachusetts Eye and Ear Infirmary (MEEI), my home institution at that time, and this was followed by ophthalmology residency at MEEI.

During residency, my favorite clinics and surgeries were those involving corneal pathology. I found the anterior segment examination to be the most enjoyable part of patient evaluations, I thought that the surgeries were delicate and innovative, and I found corneal suturing to be somewhat relaxing. In the field of cornea, I saw patients having their vision restored in ways I did not witness in other subspecialties. I worked on a few cornea research projects during my residency and found the academic opportunities to also be promising. My residency at MEEI was followed by a cornea fellowship at Bascom Palmer Eye Institute.

3. Please describe your current position.

I work at Wills Eye Hospital as a cornea, cataract, and refractive surgery specialist, and I am an Assistant Professor of Ophthalmology at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia. I have been at Wills for the past 4 years since graduating from cornea fellowship. I am also codirector of the cornea fellowship program at Wills. I spend essentially 100% of my time in Center City, Philadelphia, where Wills is located.

My practice mix is approximately 50% cornea, 40% cataract, and 10% refractive. Working at a tertiary care referral center, I am typically referred advanced cornea pathology from community physicians. A large proportion of the cataracts in my practice are complex or coexist with corneal disease (eg, keratoconus or Fuchs). The cornea department at Wills has been an amazing source of clinical and surgical growth for me, as I often run difficult cases by my colleagues and bounce ideas off of them when approaching challenging conditions.

4. Who are your mentors?

I am incredibly grateful to countless mentors who have supported my journey. As mentioned earlier, Dr. Radcliffe was my earliest mentor and the reason I went into ophthalmology, and I do not hesitate to remind him when we bump into each other at meetings. At MEEI, Matthew Gardiner, MD; Ula Jurkunas, MD; Samir Melki, MD, PhD; and Carolyn Kloek, MD, were mentors who inspired my career trajectory. In the MEEI cornea department, James Chodosh, MD, MPH, was instrumental during my fellowship application process and helped me identify the best fit in a cornea program. Roberto Pineda, MD, was also a surgical and research mentor to me in my residency years.

During my cornea fellowship at Bascom Palmer, I received immense support from Carol Karp, MD. Dr. Karp is someone I continue to try to emulate in many ways. To me, she exemplifies the highest level of dedication to her patients, academic prowess, clinical acumen, and commitment to mentorship of future generations. My fellowship program directors were Anat Galor, MD, MSPH, and Kendall Donaldson, MD, MS, and I was so grateful to work under their tutelage. I also gained valuable clinical and surgical training from faculty members in the department, including Guillermo Amescua, MD; William Culbertson, MD; Sonia Yoo, MD; and Mohamed Abou Shousha, MD, PhD.

A primary mentor of mine at Wills Eye Hospital has been Christopher Rapuano, MD, the director of our cornea service. When embarking on a new research endeavor, I always enjoy running ideas by Dr. Rapuano. He challenges me to elevate projects to their highest potential and guides me to rethink problems in innovative ways. Jose Pulido, MD, has also been a mentor at Wills, and he encourages me to think outside the box and to collaborate with companies that are interested in introducing new technological advances to our field (such as vibrational OCT, described in more detail below). Over the past 4 years at Wills, I have also learned that friends and colleagues could be mentors in their own unique way. Aakriti Garg Shukla, MD, is a fantastic friend who has been a source of academic inspiration over the past 3 years, and I have enjoyed lunch breaks spent generating research ideas, which have led to memorable collaborations.

In recent years, I have become increasingly engaged in Cornea Society and its various efforts. I am grateful to Kathryn Colby, MD, PhD, for involving me in several Cornea Society projects, including Descemet membrane endothelial keratoplasty wet labs and virtual journal clubs.

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

I have treasured many moments since embarking on this rewarding journey in ophthalmology. One recent memory involves a 38-year-old woman with aniridia, limbal stem cell deficiency, and corneal scarring who was referred to me with counting fingers vision in both eyes. She had just given birth, and I remember her describing the challenges of motherhood with her disability. After reviewing all options, we decided to implant a Type 1 Boston Keratoprosthesis in one eye, and, within a few visits, she was able to read the 20/80 line. At her postoperative week 1 visit, she told me she had seen her baby for the first time and eagerly showed me photos of her child from her phone. Moments like these make me feel incredibly grateful to work in a field with potential for such great impact on the lives of patients and their families.

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?

Since starting at Wills, once technological advancement that I have had the opportunity to explore and that I am excited about is vibrational OCT. Vibrational OCT utilizes optical coherence tomography to measure the resonant frequency of tissue components that are excited by a spectrum of audible sound frequencies. Vibrational OCT has previously been employed in dermatology, and we are now learning about its applications in the field of cornea.

Another pipeline technology that I am enthusiastic about is a device that measures blood oxygen saturation in ocular vasculature and is thus able to detect abnormal oxygen metabolism. We are just starting to collaborate with the research team that has designed this technology, and I look forward to learning about its prognostic utility in anterior segment diseases.

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

Several of my recent projects have addressed corneal transplantation outcomes. When I started working at Wills, one of my dreams was to build a risk calculator or nomogram to predict graft outcomes. I noticed that patients often asked about the probability of their transplant surviving after any given number of years, and clinicians could only provide round estimates. Given the number of corneal transplants performed annually at Wills, I suspected that we should be able to provide patients with more data-driven statistics. I worked with Eric Shiuey, a Jefferson medical student, to review 37 preoperative variables and graft outcomes in more than 1,000 penetrating keratoplasties (PKPs), and we developed and published a nomogram that predicted PKP prognosis with high accuracy.

Since then, our team has completed several related projects. We recently created and published a similar Descemet stripping endothelial keratoplasty (DSEK) survival nomogram. Both PKP and DSEK nomograms are currently being validated by collaborators at other institutions. We have evaluated additional predictors of graft survival, including contralateral graft status and socioeconomic factors. Ultimately, I hope that the results from these studies enhance patient counseling prior to corneal transplantation.

I am also presently collaborating with a researcher at Thomas Jefferson University to study the use of antifibrotic antibodies to reduce corneal scarring after injury. We have completed our first trials and look forward to sharing these results with the cornea community.

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

My average week consists of 2 days of clinic, 1 day of surgery, 1 day of procedures or lasers, and 1 day of administrative tasks or research. I love the diversity that working at an academic institution offers, and when asked which of these days (clinical, surgical, procedural, administrative, or academic) I find most enjoyable, I genuinely do not know the answer. I feel incredibly blessed to be able to wake up every day excited for whatever the workday holds, and I find each of these components of my career to be deeply fulfilling.

Outside of work, I especially cherish quality time spent with loved ones. I feel lucky to live a drive away from most of my family members, and many of my closest friends reside in the northeast. Together, we enjoy traveling (especially long road trips!), anything involving the outdoors, exploring the culinary delights that Philadelphia has to offer, and Bollywood. I love trying new activities, and one of the many great things about Philly is its dynamic cultural scene; there is always a new festival, concert, or exhibit that is worth checking out!

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

My single most important tidbit of advice is to seek out solid mentors and role models with whom you share values and career ambitions. It is not necessary for us to pinpoint one person to serve as a mentor in all facets of our careers. For instance, the person you consider your academic mentor may be different from the person you consider a surgical mentor. When we finish training, we are extremely impressionable, and it is crucial to receive guidance from individuals with whom we share values and who therefore appreciate our principles and long-term vision.

By the time training is complete, most of us have a pretty solid idea of what excites us. Some may find fulfillment in research, others in clinical care, others in industry collaborations, others in teaching, and so forth. Although it may be hard to find the “perfect” job right off the bat, we can certainly find a position that fulfills as many of our passions as feasible. It is also important to keep in mind that job positions evolve over time, and, as we grow in a role, we can gain leverage and potentially reshape our career in ways that increase gratification.

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

As mentioned above, our team at Wills Eye Hospital has begun investigating the use of vibrational OCT to identify various features of the cornea. A recently completed pilot study on normal corneas was just published, and we are now working on additional projects evaluating corneas with keratoconus and other pathology using vibrational OCT. I am excited that this technology may have the ability to detect ectasia earlier than existing diagnostic technology (including clinical evaluation, topography, and tomography), as it measures subtle biomechanical properties of corneal layers instead of larger anatomic changes.