5 Questions with Charlotta Zetterström, MD, PhD

1. Why did you choose a career in ophthalmology?
My career in ophthalmology occurred mostly by chance. The specialty was one of my first rotations, and I enjoyed it so much that I decided rather quickly to continue practicing.

I enjoy ophthalmology because it is a good mixture of medicine and surgical procedures. Additionally, the patients greatly benefit from their treatments. Their good vision is my greatest reward. I deal a lot with pediatric cataracts, and was drawn to this subspecialty because these children are especially helpless. They are, however, also the best patients to work with, as a successful surgery will grant them good postoperative vision—an extremely valuable gift for patients who have their whole lives ahead of them.

2. Do you feel like there are different hurdles you had to overcome being a woman in a male-dominated profession?
Although some female ophthalmologists feel they have faced challenges upon entering the field, I have been fortunate enough to avoid many prejudices.

My guess is that women might shy away from becoming ophthalmologists because the field is very prestigious, and it requires a lot of time and commitment. I think that some women might feel like it could jeopardize their family time. Where I am from in the northern part of Europe, however, it is much more common for women to be ophthalmologists. In countries like Norway and Sweden, I believe that the ratio of women to men ophthalmologists is almost half. Still, I will say that there is a need for more women in this field. Until then, we need to band together and offer each other support and encouragement in our endeavors.

3. What interests you about pediatric cataract surgery?
As an anterior segment surgeon, I perform phaco surgery on patients ranging from 2 weeks to 100 years old. Additionally, I perform corneal grafting and pediatric cataract procedures. Although I cover the entire span of possible cases, pediatric cases are the most rewarding and challenging; you never know what is going to happen in a child's eye. The pediatric eye is much more sensitive, especially in terms of inflammation. Additionally, they have much higher vitreous pressure, which makes surgery more demanding. There are also different techniques that may be used during pediatric cases, especially for patients younger than 2 months. As pediatric cases are relatively rare, I consider it a great opportunity to perform this type of surgery. And because I perform intraocular surgery on adults, I can often incorporate these surgical skills into my cataract pediatric surgeries as well.

4. What has been the greatest advance in surgery since you began 27 years ago?
I would have to say phacoemulsification, foldable IOLs, and ophthalmic viscoelastic devices are the greatest technologies. In general, it is amazing to see all of the changes that have occurred during my time in this field. When I started, we did not implant lenses in children. Now, we do this routinely in almost 100% of pediatric cases. Additionally, 30 years ago we did not perform treatments for congenital cataract in extremely young patients. We have since learned that you have to perform the operation before 2 months of age for the best outcomes.

5. What part of your research most interests you?
Decreasing the incidence of secondary glaucoma in early cataract surgery in pediatric cases is one of the main problems that we face; if that could be solved, many children could benefit. My current research focuses on this.

I think that if we could decrease the inflammation and the incidence of lens epithelial cell proliferation, we could decrease the patient's chances of developing secondary glaucoma; this might be achieved by washing the lens capsule and removing the lens epithelial cells. You can do this by using a Perfect Capsule (Milvella Ltd., North Sydney, Australia) with a substance—we have been using fluorouracil. We have found that when the lens capsular bag of rabbit eyes was completely clean, there was a lower rate of postoperative complications. Now that these studies have ended, we are looking into the possibility of beginning human trials.