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Refractive Surgery | Jul/Aug 2009

5 Questions With Damien Gatinel, MD, PhD

Dr. Gatinel is the Assistant Professor and Head of the Anterior Segment & Refractive Surgery Department, Rothschild Ophthalmology Foundation, Paris.

1. What is the most challenging aspect of being a surgeon?

Being a surgeon is a daily challenge. We have to continually reach for and maintain excellence to give our patients what they expect and deserve. The pre- or postoperative complications we deal with stay on our minds—even after we close the office door and leave the hospital. Remaining on the cutting edge of a constantly evolving surgical specialty, such as ophthalmology, is a challenge in and of itself. I am indebted to the training that I received from my mentors, and it is important to me that I return the favor by transferring my skills to younger colleagues.

2. How has refractive surgery changed in the last decade?

I started practicing refractive surgery at the end of the 90s. For me, the most gigantic leap in the history of refractive surgery was the introduction of the excimer laser, which enables the development of nonempirical algorithms and sophisticated ablation designs.

Precision in design has not been fully translated into precision of obtained results; anticipating the reaction of living tissue is still difficult. When I started practicing refractive surgery, I found a need to better understand the cause of unexpected outcomes after surgery, such as the mechanism of induced higher-order aberrations. Building better models will improve our understanding of the constraints of particular treatments. This is an area of research on which I am still working.

3. How have recent studies influenced your surgical technique or the technology that you use?
Currently, I am interested in better IOL power prediction in atypical aphakic eyes. This topic is at the crossroads of refractive and cataract surgery and will become more important with time. I am also quite interested in the evaluation of new diagnostic technologies that help us confirm or repudiate the responsibility of a young cataract in the genesis of visual symptoms (ie, double-pass aberrometry).

Another field I am interested in is post-LASIK ectasia prevention. I believe that the use of anterior and posterior elevation topography and optic pachymetry increases sensitivity of detecting keratoconus as early as possible. Double-applanation tonometry is another tool that we use routinely to measure corneal biomechanical properties such as corneal hysteresis and resistance factor. Beyond the quantitative data, we are investigating the shape characteristics of the waveform applanation signals.

4. What motivated you to get a PhD, and how has your degree made a difference in your career?
I believe pursuing some research activity is integral to an academic career. I decided to become an ophthalmologist early in my life. As a teenager, I enjoyed studying math and physics, and, more particularly, topics dealing with optics and image formation. I always had a dream of being a doctor who relieved suffering patients. Ophthalmology rapidly revealed itself as the profession that would allow me to combine the therapeutic and technical aspects I was seeking for in my professional life.

I think that pluridisciplinary study is exciting and efficient, especially in the field of ocular optics correction. Some of my research led me to collaborate with a mathematician on the design of a customized mutifocal wavefront correction method. Also, I was recently involved in the design of a multifocal diffractive IOL; I interacted with physicists and scientists during this project. Through my research, I have met chemists, mathematicians, optical scientists, and astronomers. Consulting and establishing partnerships with different ophthalmic companies has allowed me to learn about the intricacies of the ophthalmic industry. All these experiences are enriching and have broadened my horizons.

5. What inspired your love of photography?
Vision and photography share the process of capturing an image, but the quality of a photographic picture does not depend (only) on technique.

Through my professional activity, I have many occasions to travel and wander in nice places—from foreign cities to wild landscapes. I live in Paris, which is also scenic, and I often take my reflex camera when I go out. My favorite themes to capture through photographs are architecture, lifestyle, and landscapes. To me, composition and color design are the key elements. I am quite interested in the impact of color on our emotions. As a self-taught amateur, I have not been exposed to the teaching of any particular photographic method or technique. However, I noticed that I like the use of lines, which often are obliquely oriented in my pictures. Lines are standard artistic tools, but they can provide intense artistic tensions, especially when both natural and manmade lines are present in the same image.

The rapid shift from film-based photography to digital has made the image workflow computer-based. I enjoy digital postproduction, as it provides incredible liberty to reframe (ie, crop) and to adjust brightness, contrast, exposure, and color. Interestingly, postproduction can also change the paradigm of photography by eliminating defaults inherent to cameras and lenses, such as flare or light halos, with dedicated imaging software. I wish we could do this as easily to improve the vision of our patients who complain of visual disturbances. However, flare can be made evocative and attractive when it gives the impression of flooding light in the image. A similar philosophy applies to blur, haze, or limited depth of focus, all of which can add expressiveness to a photograph, but are usually considered optical defects or imperfections when present in a human eye. Hence, vision and photographic vision may diverge, be it from an artistic, technical, or medical point of view. Finally, creative photography requires not only mastering the principles of content and organization of the composed image frame, but also how the viewer perceives images, which leads us back to ophthalmology and vision.