Off the Beaten Path

Ike Ahmed, MD, recently joined Gary Wörtz, MD, for an on-stage interview at the ME Live meeting in Nashville. In this live recording, Dr. Ahmed explains how being different enabled him to think differently about glaucoma treatment. The two surgeons also share thoughts on life, MIGS, and more while fielding questions from the audience.

Gary Wörtz, MD: Open, outspoken. It’s Ophthalmology off the Grid—an honest look at controversial topics in the field. I’m Gary Wörtz.

Gary: For many individuals, youth is a challenging time. With insecurities abound, pressures mount to look like everyone else, think like everyone else, and act like everyone else. In short, we choose fitting in over standing out. But for some, that choice is not so simple.

Ike K. Ahmed, MD: Quite frankly, being a brown guy, being very different living in Northern Saskatchewan, you know you're different. And when your name is Syed Iqbal Kareem Ahmed…

Gary: Yep, that’s Dr. Ike Ahmed. We recently sat down at the 2017 ME Live meeting in Nashville for a live episode of Off the Grid. In our conversation, Ike weighed in on how being different helped him think differently and how this revolutionized the way he thought about the treatment of glaucoma. Here we go…

Speaker 2: Ophthalmology off the Grid is an independent podcast supporting with advertising by Alcon.

Gary: Alright, yes. Let's do this. Yes. Awesome. They got the music going, too.

Ike: Wow, are we gonna fight?

Gary: I know, exactly. Mayweather. Alright. Hot mic is right. Thank you. I'm not sure, are we good here?

Ike, I just want to say this is such a pleasure. There are so many things that you have done in your career. To try and distill out some of the habits in some of the ways you've approached your life in 30 minutes, it's gonna be tough. I want to really just start by looking at the past, talking about how you grew up in Canada. We talked a little bit about this. Maybe what it was like feeling a little bit different growing up. Maybe how that has impacted your willingness to have a different approach to your medical career and glaucoma. So, with that being said, let's kick it off by giving us a little bit of background on what was it like growing up in Canada as Ike Ahmed.

Ike: That's interesting. That's a long story. First of all, thanks, Gary, for having me up here. I'm a big fan of yours and everything you're doing and the work you're doing. I think you could have interviewed anybody up here, and I appreciate being up here. As you can tell, I'm pretty big conformer…

Gary: Yeah, very conformer.

Ike: But, as we were talking earlier, Gary, we've all had our own experiences at it. And we've shaped that experience from our childhood. And when I look back, not that I'm an analyst of my childhood, but you know. Quite frankly, being a brown guy, being very different living in Northern Saskatchewan you know you're different. And when your name is Syed Iqbal Kareem Ahmed…

Gary: There's not a lot of those in Saskatchewan.

Ike: There is not a lot of them out there, exactly. And when you are the first brown guy playing ice hockey…

Gary: Ever.

Ike: I have to say, though, people treated me pretty well for the most part. But, you can't help but know you're different. And, I have to be honest with you, I actually resented that.

Gary: Sure.

Ike: I wanted to be Gary. I wanted to be John. What kid doesn't want to be part of the cool club?

Gary: If you only knew.

Ike: Maybe not this Gary, but you know.

Gary: Yeah, different Gary.

Ike: Not this Gary.

Gary: There're a lot of other Garys you could have picked.

Ike: I picked you, because you're here. So, that kind of grilled me a little bit, and I did resent it a little bit. And every kid wants to be part of the cool group and look like everybody else.

Gary: Well, look at us now.

Ike: Well that's true. We're hippies out here. But, everybody out here. I mean, you may not be brown ... we all, I think, are different in our own way and we feel that way as well. So, I think what happened over my life, I think I took that and said, "You know what, I cannot change who I am; I'll be different." And I looked at things differently. Honestly, I look at this event, probably different than maybe other people do. That helped me be different. So being different actually helped me to think different.

Gary: Well, maybe even feeling like: It's okay to have your own ideas about things. The problem I feel we have sometimes in any profession is getting stuck in a rut. At some point, you decided that ... and we can get into this ... you were going into glaucoma. You finished training in 2002?

Ike: Yeah.

Gary: Right when LASIK was the most miraculous computer-driven advance surgery to ever hit the world, you decided to go into the equivalent of being an intracapsular cataract surgeon. Right?

Ike: That's right, pretty well.

Gary: You decided to cut holes in eyes with big instruments, instead of doing what everyone else is doing, which was going and pursuing being a LASIK cutter. Why? What about glaucoma was interesting?

Ike: I think, again, it goes back to the way I looked at life. I did not like to follow. I became somebody who wasn't able to follow or be part of what the norm was. So, by being like that, I chose opportunities that were not the norm. Everybody obviously refractive corneal was growing. But, glaucoma's very dominant. I thought, "Here's where no one is looking."

Gary: So, it was really intentional?

Ike: It was, absolutely. For me, it was something that was not sexy, was not talked about, wouldn't be at a meeting like this. I thought, "Everybody's going this way, well I've been going my whole life this way, why not keep on going?" It was fortuitous that way, and I thought, "Here is the field that should be a surgical field and isn't. Maybe there's something that's going to happen down the line." That's how it started for me in glaucoma.

Gary: What are the questions we got? We threw out some questions with the hashtag #HotMicWithIke. They are like PG-13.

Ike: Okay, good. It's okay if they're not, though.

Gary: But, one of the questions was, when did you first get the concept or ... when did your mental stirrings occur about MIGS? When did you first start thinking like, "Can we do this differently?" Was that even before you went into glaucoma?

Ike: Yeah, that was before. And that's why I chose my fellowship in a place, which was in Utah, that was already doing things a little differently. Like nonpenetrating surgery and other non-trab procedures. And then we go into microinvasive, micro devices, stent and things like this, and it dawned on me when I walked into one of our hospitals and you see the general surgeons have minimally invasive sweet. That differentiates what they do. From typical open cases. And I thought, "This is exactly what we're doing." We are going from what would be open case, like an open happy microscopic procedure, and doing it minimally invasive.

Gary: Why can’t you do it with glaucoma?

Ike: That is kind of simple. Let's bring it to glaucoma. That's how MIGS started, and I remember back, it was 2009, and I presented at the American Glaucoma Society, which, by the way, is a very open society, we're very inclusive. Everyone hugs, Kumbaya, everything. It's amazing. Fireworks and everything. No, it's the exact opposite, right?

Gary: Right.

Ike: I basically had the stare-downs and a lot of negativity. Like, what's this guy talking about?

Gary: Right. Who's this guy? Why is he here? What's going on?

Ike: Well, I get that a lot anyways, but yeah. Particularly there. It's full circle now, seems like everybody wants to be in MIGS now. I laugh at that a little bit.

Gary: I think that is just a life lesson of when you have an idea, when you have a hunch. When something makes sense to you in your gut. Don't worry about what other people are doing. If everyone else is going the same way ... the definition of insanity is doing the same thing and expecting different results. So, we have to have people who are willing to say, "I know people are going to think I'm crazy. I know that I'm going to challenge tradition. But, this is worth it. It doesn't matter."

Ike: Yeah, and I think, a lot of residents are here and everyone is here to expand. I think that's the big lesson. You can follow and you can basically try to grow and do things a way everyone else does it. But, a bit of courage and little bit of challenging the norm, you can make big things happen. I think everybody can. But, it’s getting your head out of that mold, and even at meeting like this. We all tend to want to do things the certain way, we say this is what we do. Whatever I say right now, I would tell you, you should be thinking about something opposite, honestly. Because that's how you are going to make a difference.

And the second thing is that, thinking about making a difference, for me in my life is very important about doing things for the first time. For example, I'm a big Travis Rice fan. You know Travis Rice is one of the best snowboarders in the world. And the reason why he loves what he does is because he will board where no one has ever boarded before. Take slopes and just go crazy stuff. People know what I'm talking about, right?

It's the same thing for me. I got a thrill doing cases that nobody has done before, not to show off, [but] because it's that adrenaline rush. It's the same thing with challenging and doing something different and that rush is basically to be the first. To do something different. To change the norm. That's an innate desire to do something different.

Gary: Walk me through [this]. Let's say patient comes in, and they have some crazy anterior segment that has just been ... it's trauma, a surgery that went bad. Multiple retinal surgeries, multiple glaucoma surgeries. You have a situation that is going to require combining techniques and maybe doing things that have never been done in that way. Break that down for me. How do you compartmentalize? "Okay, we're going to take care of the cornea. We're going to take care of the iris. We're going to lens, the tube, the trab." How do you process and how do you dissect out the steps that you going to [take]? Do you map it out mentally? Do you go through the procedure in your mind? What is you prep for that "mission to Mars case" that no one has ever done before?

Ike: I think that the best tool we have is our imagination, right?

Gary: Right.

Ike: And we are only limited by that. And tap into that imagination and tapping into your life experience. But also your approach to how you deal with issues is, I think, helpful in dealing with challenging problems. And I agree with you. I think I've said complexity or complex cases are simplicity multiplied. So, really, complex cases are just doing simple steps in a logical coherent order. Well planned ahead and executed in a refine fashion. That's all complicated things are in life and in medicine. So, anything complicated you can break it down into different steps. And it's partly having a little bit of confidence, maybe a little bit recklessness, a little bit. But, also having a bit of the experience to do that and take in the challenge to do that. I think those kind of things helped me move forward into those difficult cases.

Gary: Alright. So, we know a lot about your successes, but we all know that in a career filled with multiple experiences, there are going to be ups and there are going to be downs. So, does any case or, maybe it wasn't even a specific case but a period of your life, where you said, I'm investing in either this technology, this project, or a case that just didn't go the way you thought it would go? And what did you learn from that? Is there any?

Ike: There's always failure, and there's always cases—I have to say, I am good at forgetting those.

Gary: Me too.

Ike: But, I think having a bit of faulty memory, I mean seriously…

Gary: Do you feel like that makes you resilient?

Ike: Absolutely.

Gary: It's okay.

Ike: You have to be obviously honest about it. But also be able to move forward on it. And we all every day make mistakes and make errors. And I think it's about learning from that and getting back up and doing it. It helped getting punished a few times as a kid. Falling down and getting back up again, right?

Gary: That's right.

Ike: Again, going back to those. So, that really helps you to be resilient. I'll be honest with you. I do feel almost uncomfortable being here, because I don't deserve being here to tell people my story. Everybody has a great story. And my story should be, if I chose to be up here, that anybody can be up here, anybody could do it. If I did anything that was positive in my professional life, anyone can do it. Beause if I could do it, anyone can do it.

Gary: I hear that, but I would say that everyone in this room looks to you. And you earned your spot. You earned your spot, because you were excellent and you just did it the old-fashioned way of being a very, very good surgeon. I'm not just trying to blow smoke here. You earned your spot.

That's another question I have for you, that I really wanted to dig into. When did you feel like you've earned the right? Or was this something you've always felt that you always had, sort of, just the right to speak up. Is that something that ... this may be even outside of ophthalmology, because we've talked about social media. Social media is, sort of, this new small town that we form in our own communities of people across vast spaces. But, they are in our infinite lives by the things we post, the things we share. And you live your life fairly ... I would say, kind of like: "Hey, this is me. This is Ike. I love people." This is what I get from your social media posts. You live your life out there.

Ike: It's a big facade.

Gary: Okay, well maybe it is. But, talk about that. What do you feel like when you have a voice in ophthalmology, and you're a leader in ophthalmology? That can extend outside. And you can use that for maybe moving people in a direction of like, "Hey, we can look at each other with maybe a little bit more open [and with] honesty.

Ike: I think there are a couple of things I will add to that. One is, I think, in this day and age—and I am big about digital and social media and technology—but, sometimes it’s hard to know what's real. Look, I'm serious. And what's authentic and what's organic. I think we get thrills with all this other stuff going on here, but biggest enjoyment sometime we get is that organic successes. So, I encourage all of us to think about that in terms of making it real. Speaking of that, we have also to remember that, as much as I love all this stuff, we're human beings, we're in medicine. We took the Hippocratic Oath, not to help your vision, not to see 20/15, but to make you whole as a person, right?

Gary: Right.

Ike: I never forget that. That extends beyond of what we do with our hands and in our examination lanes. And for me, I think medicine is about, again, humanity. So, yeah, I have strong feelings on social justice issues and humanity issues. And trying to bring people together in today's world just seems to be a bit challenging. I have to say, I guess being someone who is, for example in 2017, being a Muslim. A lot of bad shit happened that the Muslims are doing and the name that comes around that. You feel compelled to be able to speak to that. Not necessarily as a Muslim, but as a human being who is associated with something like that. That's one example, right?

Gary: Right.

Ike: And being in society where, of course, we are inclusive, but yet we see major divisions in societies. So, that's for us beyond ophthalmology, but I think it really encompasses who we are as MDs. I think anybody who's got those initials, or is in health care, has a responsibility. And I think I've talked with many of us, of course, for many of you here. But, don't be afraid to have that courage to speak up for what's right. You'll be fulfilled of what you're doing in your practice and in your life. But sooner than later, you'll be going through the emotions and you'll be, perhaps, not as content. And when you see of impacted life, but whatever small thing to do. And we're privileged Gary. We have a voice. We have a position, no matter what we like, we're role models to our patients, to our families, to our communities. And we, like it or not, and I am a Charles Barkley fan, but even despite that, we are role models. And I think we should actually try to live up to that.

I'm not saying if you don't do it, it's wrong. But, I think it's a responsibility we have. I know you do the same thing in your community, right?

Gary: Right.

Ike: And it's a wonderful responsibility to have, but I can tell you that probably my most fulfilling things I do is not taking somebody that's had 10 opinions and had five different surgeries. And has been told he'll never going to see again. And get him to see again. Or cutting-edge glaucoma surgery or interventions or getting awards. Or getting some of the things that have been privilege of doing, but it's when I have heart to heart discussion with someone like you, a brother like you, about human things, man. I remember those things much more than anything else.

Gary: Yeah, it's really interesting. So, you are Muslim, I'm a Christian from the South. Actually, sort of. I am, kind of, from Michigan but transplanted to the South.

Ike: We'll give you that one.

Gary: You'll figure that out. What's really interesting is, through some of your posts and through some of our conversations, I feel like I understand a little bit more. I've broadened my mind, I've opened my heart, and I see things differently. So, I want to encourage you that, through the risks that you've taken a little bit and putting yourself out there saying, "Hey, evaluate this little differently; don't paint everyone with this broad brush of good, or bad, or whatever,” it has impacted me and has really helped me personally. So, I want to say thank you for being courageous enough to let us in a little bit, and what it's like to be Ike Ahmed, and what it's like to be in your community. That being said, here is a new question that actually just came in through Twitter. "What is a typical day like for Ike?" What does it look like? What time do you wake up in the morning?

Ike: Yeah, it's great question. So, I'll tell you one thing. I don't drink coffee, I don't drink, or smoke, or any drugs I, kind of, leave out as well, for the most part.

Gary: Okay, alright. No drugs.

Ike: Adrenaline is my drug. So, I basically have adrenaline highs all the time and crashes, as well. I get up at about 4:35 in the morning. That's how early I get up. I will read at that time, I'll work out at least for an hour. I have a big 16' screen in my gym. I will watch my videos from before, I will go through emails, I'll answer stuff on my treadmill, even. Got a keyboard built in. I do that for the first hour.

Gary: So, you're running at 7 miles an hour, and you're typing emails?

Ike: Typing away, or responding. A lot of you will see sent in emails from that time in the morning.

Gary: That's interesting.

Ike: Yup, I do that. And then, I have four kids, so I will try to get the kids up and a wonderful wife, who's been very supportive of everything here. And then I go to work. And my work basically is surgery or clinic. And I have a very surgical practice. Our fellows are big part of our practice in teaching. And then I try to finish my day, honestly by about 3:30 to 4:00 in the afternoon. So, it's a very intense day. Lot of surgery patients, something else, and then I'm done. And then I wear my administrative hat, meetings and everything else. And then I like to go home, I like to go home and chill out in the couch, sometimes take a little nap and hang out with the family. My family is big to me. And catch up with some friends and then evening with my wife and kids. And then ... kind of boring, sorry guys. And then I do take work at home. So, I will do my editing and reviewing and writing papers and presentations and stuff like that. And then try to hit the bed by about 11:30 or so or 12:00.

I'm someone who sleeps very deeply. I need about 4, 5 hours of sleep. But I sleep very ... you couldn't wake me up. There is a fire alarm tonight at the Sheridan, I'm still sleeping in until 5:00 in the morning, 4:00 in the morning.

Gary: So, that's the interesting question that I think we all struggle with. I've got two kids, we had two kids in med school, and so they've been with us through this entire journey. Actually, not to make this about me, but part of the reason I chose ophthalmology is I was on a general surgery track and I realized that: man, I probably wasn't going to be around for my kids as much as I wanted to be. So, actually that's part of the reason I changed over to find ophthalmology was my kids, my wife, that is such a core of, everything else surrounds supporting them. So, work-life balance or having capacity to do the things you love professionally, but having enough time to make sure that your wife and your kids know that they're important. And that they are of priority. How do you? That's not easy.

Ike: It's not easy, but I can tell you now: "Happy life, happy wife, happy everything." Or the other way around, sorry. I learned to stop doing things that I don't like to do. So, I'll be at a meeting or a conference call, if it doesn't interest me…

Gary: You just click.

Ike: ... I'll hang up. I'm done.

Gary: Ike is over.

Ike: If this conversation isn't going much, I'm like ... well like you, you know. Grab the shoulder.

Gary: You can just grab the shoulder…

Ike: I think knowing when to move on is really important. And picking the right things to do, right?

Gary: Right.

Ike: You know, be successful at few things that you really enjoy, and don't worry about the rest of it. Let that ride, and don't try to accomplish everything. And that's probably the thing that helps. But, I think it would be hard for me to be comfortable in my career, if I wasn't comfortable at home, and vice versa. I think that would be very hard for me.

Gary: I say the same thing. You have to have that bedrock at home, where, basically you are anchored, and then it allows you to go out and do lot of fun things.

Let's switch gears a little bit. We've talked a lot about the past, about your journey and what you've learned. I want to get inside of your mind about where you feel like we're going. I can ask a lot of people and they would might have some answers. But, I want to know, in your opinion, with glaucoma specifically, but you can take this however you want—refractive cataract surgery, other unmet needs elsewhere—where do you feel like there are some major unmet needs in glaucoma? And where do you think we're going to be in 5, 10, and maybe even way down the future, towards the end of your career? Where are we going?

Ike: Well, I'd say overall—and I've had some experiences now in these areas—I think artificial intelligence is basically upon us right now and will be an extremely, extremely big part of medicine in life, honestly. And I think, we talk about social media and internet, that's like small potatoes compared to artificial intelligence, the power of artificial intelligence, and what the technology companies are working in this area on, not even in medicine but beyond medicine. I think that is going to be very powerful in accessing patients, treating patients, communicating with patients. Ultimately, you know, they're basically developing the algorithms for care plans and health care. So, I think that's an area that I think we need to really be paying attention to. And I think most of us in the room [aren’t] necessarily in that space. I’ve got buddies in tech space in Silicon Valley, and it's huge in that area. We see the surface happening now. So, I think that's an area I would say anybody who is going to be in practice for more than the next 10 years needs to be very in tune to. Because it's going to change the way you practice, the way you communicate with patients, the way you access everything.

Gary: Do you envision a model where a patient comes in, and you're basically identifying the risk factors? Or maybe even…

Ike: They haven't even come in yet. They are on their mobile phone.

Gary: Okay. So, Amazon Alexa is looking at their eye and…

Ike: She'll basically diagnose you, she'll basically suggest right treatment patter and if you need a script or anything done, it will be done for you. And if you need surgery, pick the right robot.

Gary: Wow.

Ike: Or us.

Gary: Or us.

Ike: For now. But, I think that's not too distant. I really believe that the way we're going with this stuff and the exponential growth in technology, and using the data ... there is so much we mine. And I am not talking about getting a history. I am not talking about getting a history from a typical entry. It's basically behavioral artificial intelligence [that] will be able to pick out whether you're going to get this or that, whether you're having a visual issue or not, and what the best course of action should be. That technology, in some way, is already kind of existing in some rudimentary ways. And I think it may sound futuristic in some ways, but it's going to be extremely disruptive; it already is some areas.

Gary: So, that sort of philosophical care shift from our fundamental approach of evaluating with our own algorithms and switching those over to more formalized algorithms. What do you feel like are some unmet needs that, maybe in next 5 years device-wise, or I'm thinking we've got some big unmet needs in presbyopia. We still have some unmet needs in glaucoma, where we don't know what someone’s pressure might be in between visits. Do you feel like these things could potentially move the needle for us as well?

Ike: Yeah, I mean, I think we're not going to be far away to basically we're, just like now, essentially everybody who's for cataract surgery, essentially we're going for ametropia. Anyone who's going to have cataract surgery or lens surgery is going to get a presbyopic lens. I think that is the future for us. So, anybody getting cataract surgery, they're going to get a presybopic lens. That's going to be the new norm in the future as technology changes.

Glaucoma, of course, is close to me. And, I think as we often heard about, is becoming very interventional. I mean, there is no such thing as a glaucoma follow-up. Basically, you're actively doing something for this disease. And, of course, stem cell neuronal protection on the rest of it extremely exciting as far reversing disease. So, in retina and glaucoma, these, of course, are big areas of need. And I think are going to probably be first in the eye, in term of their innovation and in terms of medicine.

Gary: Here's another, maybe little of topic. When you go to glaucoma meetings now and you see some of the AGS doubters or the haters, has your reception changed? Have people come up to you and said, "You know, I was wrong to doubt you?"

Ike: No, but they all want to be my friends now. I think, honestly, I don't mean this to just say this. But, I think you got to have humility with this stuff. Yeah, I mean, those are not easy. And I don't think it's anywhere compared to the folks that were before us in cataract…

Gary: The phaco.

Ike: The phaco and IOL hardships that folks underwent. That's something we should all read about, if we're not familiar with that. But, you basically move forward on. I always feel like you got to move forward to it. It's a bit gratifying when you see this kind of things happening, and people coming to you to get guidance and to lead things. But, it's a whole battle. I mean, still there are a lot of egos in our field. In any area. And that's one thing I always felt has been just really detrimental to progress. Check your ego at the door. Yes, be proud of what you do. But, there is no need to have an ego. And I think that's something that—and I am not just speaking on the AGS but in general—I stay away from.

Gary: Alright. Here is another question. This is from Sahar Bedrood. You've done probably every MIGS surgery, and then some we've never heard of and may not hear for a while. Probably, I'm guessing you don’t have a favorite one, because there is a lot of different categories. But, do you have a favorite? I mean, that you like, or in certain categories you feel like, "In this situation, this is just my go-to.”

Ike: Yeah, I mean. Honestly, I think it's going to be so much like saying your favorite IOL. I think, you going to have probably your workhorse one perhaps, but I find myself shifting and turning in many different ways. Obviously, when I'm doing something with cataract surgery I want something that is going to be really straightforward, quick recovery. And probably for someone that doesn't need very low pressure. In those scenarios, I want to go somewhere probably more toward natural outflow systems and internal drainage procedures. I have to say, I am probably more stenting in that sense. I think stenting has been what I've been doing more of than anything else as far as where to start. But, some of the other approaches: dilating, cutting, other thing like that are gaining some interest as well. And then I think you know, I know that the bleb is not popular in terms of a term. But, I think we are going back to the bleb.

Gary: What is a bleb?

Ike: Exactly.

But, we're able to find better ways to form these blebs, and I think they are going to be a place we are still moving toward to, in the future still for glaucoma for those who need it. I look at we're really in a good place to pick your product, but would say yeah. I think you want to, for those that are doing MIGS, pick a few places that you feel have your favorite canaloplasty procedure. You've got suprachoroidal and you've got subconjunctival. Figure a patient profile. But, I'll save that for tomorrow. Because tomorrow we have our master class for those who are going to be attending in the morning.

Gary: Alright. This is a question from Michael Paterson, "Would you change anything about the field of ophthalmology? And if so, what or why?" That's a very broad question.

Ike: It's a broad question. So, I don't think I would change much. But, I will say this. Again it has to go back to knowing what's real. I love working with industry. I love working with collaborators, but I always make sure that we come back to what's real and what the evidence is and what makes difference for our patients. And, its hard sometime to sieve through what is marketing and what isn't. And what's real and what isn't. And you get bombarded with all this information out there. And I think that going to a place where we know we're going to have is real, it’s important. We don't necessarily always get that, you know?

Gary: Right.

Ike: I know it may sound a bit old school, but I think its meaningful if something is real. Because, at the end of the day, that's part of what I think we do as physicians. But it's also something that we know cannot probably be sustainable in the future.

Gary: I just think that there is ... we only have so many hours in our day. Why don't we invest those hours in the things that make the highest impact, instead of just chasing things that may not work. Alright, I have to ask this question. This is from Priyanka Sood. "What's the secret to the hair? How do you get the awesome wave?”

Ike Just don't cut my hair. It’s pretty simple, actually that.

Gary: Just don't cut it, that's it?

Ike: It's basically Sheraton shampoo and conditioner. That's all it is, actually.

Gary: Priyanka, there it is. Sheraton shampoo and conditioner. You can have that wave as well. Alright. What is the most ... if you can talk about this, because I am sure there is a lot of skunk-works projects you're working on … at this time is there a particular project that you're working on, that you're most excited about? We'll just segment Omega out of this.

Ike: Okay, I was going to say Omega. Look up Omega, guys.

Gary: What is the coolest thing you're working on right now?

Ike: Okay, well I probably cannot disclose too much, but basically we are using neuro-stimulation to try to enhance aqueous outflow.

Gary: Is this with the gold contact lens from Purdue?

Ike: Yes, so you are familiar with that?

Gary: Yes.

Ike: That to me is one of the more exciting areas. We've seen some pretty cool animal in that early human data. Where very nonivasive and a very powerful way, and a very safe way to enhance aqueous outflow using basic neural stimulation. I'm involved in that project. I cannot say too much about it, but I think it's going to be very clever, and it can be applied in many different way actually.

Gary: It's one of the most novel ... If you haven't read about it, this is potential game changer on a whole another level.

Ike: Look up Bionode. So, I'm excited about that obviously. I have a bit of tilt in glaucoma, of course. And I think that's an area ... Again, some of the work they were trying off the ground in terms of stem cell and neurons. Those area, I think are super exciting. They are slow, of course. But, I see a lot of potential on that.

Gary: Okay. This is our last question. This comes from Neda Shamie. "How would your colleges describe you?", and then the follow up question is, "How do you think your wife and kids would describe you?" That's a hard question.

Ike: I don't know how my colleges would describe me because it's really hard to know. I think I look at myself very differently that perhaps other people think. I honestly am very simple person. I think maybe colleagues think like I am some super person who can do all this things, and I'm smart guy and really cool, good-looking person, or something like that. But, it's so opposite actually, you know. Seriously, it’s farther from the truth. I'm very much reflective, and I'm not necessary thinking I'm the best or the greatest. In fact, I think there are some reasons why I'm not. And why I think I learn from so much. Maybe that's what people think, I don't know. It's probably I think my facade. Probably the image is different than what the reality is, I think. As far about my wife and kids, I think ... I don't know, it's another good question as well. I think they just look at me as a 'dad' really. Look at me as a dad and husband.

Gary: They think you're fun?

Ike: I think they think I'm fun. I'm always the one who's pushing for family time. Seriously, I am like, "Family time, guys; we've got to get together for dinner." I push that a lot. They probably get annoyed by that the most probably. But, I cherish those times and try to remember.

Gary: Ike, you are a tremendous colleague, you're a brother, and I really appreciate what you've done for our profession, what you've done for me personally, just taking the phone call. I mean, I've called this guy, and he just picks up the phone and we talk about things and it's fantastic. So, just from me and from everybody from the bottom of our hearts: Thank you for what you've done for our profession. And we just feel lucky that we get to share this journey with you, man.

Ike: Thanks for listening, man.

Gary: I think we’d all like to go back and tell our younger selves that the status quo is not all it’s cracked up to be. Our differences help us develop new perspectives and innovative ideas that push the envelope (pause) and they just might help us change the world … or, at least, glaucoma. Above all, there is a powerful lesson here in embracing our own differences and accepting others’. MIGS aside, I think that is one of the greatest contributions Ike has made in our field.

So, thanks for tuning in to this special live recording of Ophthalmology off the Grid. For more episodes, visit eyetube-dot-net-slash-podcasts, and please take a moment to rate, review, and subscribe. And, as always, let’s continue to take our thinking off the grid.

Speaker 2: Ophthalmology off the Grid is an independent podcast supporting with advertising by Alcon.