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Cover Focus | July/August 2017

20 Questions: Audrey Talley Rostov, MD

Getting to Know You

Currently, what book are you reading, what TV series are you binge-watching, what app do you use the most, and where do you get your daily news?

Book: I am reading The Gene: An Intimate History, by Siddhartha Mukherjee, and Hillbilly Elegy: A Memoir of a Family and Culture in Crisis, by J.D. Vance. I just finished Nutshell, a novel by Ian McEwan.

TV series: I do not watch much TV, except for Modern Family and Blackish, which I DVR and binge-watch to de-stress. I also just binge-watched Stranger Things on Netflix.

App: WhatsApp, Jetsetter, TripAdvisor, Kayak, Uber and UberEATS, Postmates, The Weather app, Google maps, Instagram, Facebook, Snapchat, beGlammed, and the Eye Handbook.

Daily news: The online versions of the New York Times, Daily Beast, and The Skimm; the BBC Twitter feed; and NPR on the radio at home and in the car.

What is something in your life you would happily do again, and what is something you would never do again?

Happily do again: I would happily marry my husband again (one of my life’s best decisions) and create our family again.

Never do again: It is hard to say what I would never do again. Often, bad decisions did not appear to be so at the time, and they ultimately led to other opportunities and eventually good experiences or outcomes. Many times in life you make the best strategic guesses with less-than-perfect information.

What are three places at the top of your bucket list?

No. 1: Safari in South Africa or Tanzania.

No. 2: Exploring and hiking in the Amazon in Brazil.

No. 3: Cycling in Italy on the Amalfi Coast or in Tuscany and Sicily.

If you had to donate half your income tomorrow, to whom would you give it?

I would donate it to SightLife, a global health organization whose mission is to eliminate corneal blindness. I am a global medical director with the organization, and I am proud of the work we do with surgeon training and eye bank development in developing countries such as India.

If there is one high-risk thing that you have not done but remain curious about, what is it?

I went heli-snowboarding 2 years ago and kayaking in Patagonia this past year. I would like to go sandboarding in Dubai or elsewhere in a desert. I missed out on doing this while traveling both in Dubai and in the Atacama desert in Northern Chile.

Your Thoughts on Ophthalmology

What is the health care landscape like in your country?

The health care landscape in the United States at present is complicated, at best. We are sadly in a political quagmire, with those in top government positions practicing partisan politics and demonstrating a crisis of conscience. It is increasingly difficult to comply with the ever-growing regulation of our profession while still attempting to serve the health care needs of our patients.

How enthusiastic are you about the future of ophthalmology?

Despite what I just said in that previous reply, I remain enthusiastic about the future of ophthalmology. We are in a time of great innovation, and we are able to treat and manage eye diseases better and less invasively than ever before.

What products in the pipeline excite you the most?

Products in the pipeline that excite me most are newer refractive IOLs that can provide more precise vision, especially those with the potential to be modified in real time during surgery, and accommodating IOL technology that provides an increased range of vision without sacrificing vision quality. I am also excited about additional applications of femtosecond laser technology in both cataract and cornea and about stem-cell technology that may decrease or eliminate the need for some types of corneal transplants.

What was your most memorable moment in surgery?

One of my most memorable moments in surgery was performing a PKP for Peters anomaly on a 6-week-old infant boy while I was 9 months pregnant with my son. I performed PKPs on both his eyes a few weeks apart, and I delivered my own healthy baby boy 5 days after the second PKP. Two weeks after surgery, I had to do an examination under anesthesia and remove sutures from the baby, and the mother of the infant held my son while I went into the operating room to take care of her son. That baby with Peters anomaly is now 21 years old and has BCVA of 20/40 OD and 20/200 OS.

What recent studies or technologies have influenced your surgical technique?

Recent technologies that I have incorporated into my practice include Descemet membrane endothelial keratoplasty (DMEK), glued IOLs, and femtosecond laser–assisted deep anterior lamellar keratoplasty (DALK).

What was the toughest decision you have had to make as an ophthalmologist?

The toughest decisions that I make in ophthalmology involve resource management for patients with limited financial and/or social support systems. Sometimes it is better to perform limited intervention in patients who may not be able to receive or comply with postoperative care.

How has ophthalmology changed since you started practicing?

Ophthalmology has changed with the introduction of better, less-invasive surgical techniques that provide enhanced outcomes and decreased need for postoperative care. Examples include Descemet-stripping endothelial keratoplasty (DSEK), DMEK, and DALK, techniques that provide patients with faster healing, less-invasive approaches to corneal transplantation, and decreased risk of rejection. Femtosecond laser assistance for cataract surgery, LASIK, and cornea transplantation increases the accuracy and safety of all of these procedures. New-technology IOLs provide astigmatism management and aid in presbyopic correction.

What advice can you offer the new generation of ophthalmologists?

Continue to challenge yourself throughout your career. Embrace changes in innovation and technology rather than fearing them. Push outside of your comfort zone in the continued pursuit of excellence. Be humble, and respect your patients and colleagues. Be mindful of ergonomics in clinic and during surgery: You only have one body, so take care of your neck and your back. Do not always sacrifice your family life for your career. Exercise regularly, and make time for yourself, your family, and your friends to reduce the risk of burnout.

If you could trade lives with a fellow ophthalmologist for 1 day, who would it be and why?

I do not know whether I would trade lives with anyone, even for a day, because I feel fortunate and I like my life. I have had the opportunity to practice in different countries and communities and to observe many different environments.

If you were forced to limit your practice of ophthalmology to one procedure, what procedure would you choose and why?

My one procedure would be corneal transplantation.

Your Thoughts on Business

What differentiates your practice from those of your competitors?

Our practice provides the greatest number and range of innovative techniques, as well as consultations and surgery on complex cases, of any practice in our region. We are also leaders in comanagment and integrated care. We offer laser-assisted cataract surgery; all US FDA–approved refractive IOLs; femtosecond laser–assisted corneal transplants, including DALK and PKP; microinvasive glaucoma surgery, CXL, LASIK, and phakic IOLs. We also provide pediatric ophthalmology and retina services.

How do you feel about private equity, and is there a place for it in ophthalmology?

Private equity can help to provide revenue and resource management to both expand and consolidate ophthalmology and eye care services. Hopefully it will not decrease opportunities for innovation.

How do you approach marketing your practice and specific procedures you offer?

We mostly approach marketing our practice through providing education and relationship management to those in our optometric referral network. We have traditionally not done any direct-to-consumer marketing, although that may change.

How do you or your practice keep staff members happy?

We try to encourage a respectful environment and to value and show appreciation for our staff. We have undertaken some management changes that have improved our team leadership. We try to stay current and competitive with salaries. I make sure to thank all team members who I work with directly on a daily basis and to commend staff members for jobs well done.

What is your end game?

My end game is to increase my global health work while maintaining a role in my private practice.