Ophthalmology off the Grid
Episode 33

The Ultimate Teacher

Sumit (Sam) Garg, MD, and James Mazzo sit down with Gary Wörtz, MD, to honor the legacy of Roger Steinert, MD. Discover the valuable role that Dr. Steinert played in the careers of Dr. Garg and Mr. Mazzo and gain an understanding of just how beloved he was as a mentor, colleague, and friend.

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

Gary Wörtz, MD: A great clinician. A family man. A special guy to all of us. A great leader. A pioneer of cornea, cataract, and refractive surgery. A friend to many. A true gentleman. The ultimate teacher for our profession

Most of us would be proud to have just one of these accolades. Well, Dr. Roger Steinert holds all of them, and then some. On June 6, Roger passed away after a 2.5-year battle with glioblastoma. He was 66 years old. His legacy, however, is sure to live on forever.

In this episode of Ophthalmology off the Grid, we pay tribute to Roger by speaking with two individuals who knew him well: Dr. Sam Garg and Jim Mazzo. As they and many others can attest, Roger’s impact is immeasurable. But today, we’ll try to capture the essence of this truly outstanding ophthalmologist, mentor, colleague, friend, and above all, human being, and give thanks to the many ways in which our field was made brighter, having been touched by Roger Steinert.

First up is Dr. Sam Garg.

Gary Wörtz, MD: Well, welcome to Ophthalmology off the Grid. This is Dr. Gary Wörtz, and today we have a really special episode. I think we all know Roger Steinert was a fantastic ophthalmologist, friend, mentor, colleague to all of us, and unfortunately we recently learned of his passing. What we wanted to do, and we actually had this lined up before we learned of that, but nevertheless, we wanted to get some people that Roger really impacted.

He was really special to all of us, but wanted to have a few people tell us a little bit about Roger: what Roger meant to them, how Roger impacted them personally and professionally. Today, I have on the call Dr. Sam Garg. Sam and I have been friends for quite a while, but Sam, thank you for taking a little bit of time out of your busy schedule to talk to me today.

What I'd love to do is just get a little perspective on who Roger was to you, maybe even starting with how you met, and how Roger impacted your career during the past number of years.

Sam Garg, MD: Sure. Thanks Gary. I met Roger when I came to UCI in 2006. He had already been here for a year or 2 at that point. I was a resident. We always hear of the big stature of Roger Steinert, but one thing I was sort of impressed with was you would never know that by meeting the guy.

I actually started out my career really focused on retina, and I thought I was going to do retina, and had applied in retina, and during the application process and doing some soul searching, I realized that retina wasn't really what I really felt passionate about. I really enjoyed cataract surgery, and I thought I would really enjoy corneal surgery.

At that point, I made an appointment to sit down with Roger and sort of just let him know my feelings about what I thought about my career. At that point, the SF match was already closed for cornea applications, so either I was going to take a year off, or he offered to allow me to interview for the cornea position at UCI the following year, and I happily accepted. We did sort of a makeshift interview at that time.

I met with the other faculty as well, who also know me, and was lucky enough to match here. Really, during my fellowship years when our friendship really blossomed. I found that I had a lot in common with the guy. Really respected his approach to basically everything. He was a great clinician. He was a great person to the staff. He was a great person with respect to his relationships to industry. He was a great family man.

I got a chance to really get close with him that year. Then, at the end of my fellowship year, he offered me a job. It was really a privilege to be able to stay on here at UCI, and learn from him, and work with him side by side. After about a year in the practice, he asked me to be medical director, and then we started on our building project.

I worked countless hours with him sort of from the very beginning. Not so much on the fundraising side, but from the operation side, and the actual building side to put together plans on the building and help sort of make sure we balance our clinical needs with research needs and whatnot. Finally, that culminated into the building that we are in now, which is the Gavin Herbert Eye Institute. Then just continued to work with him. It's really been a privilege.

Gary: You know, it's very interesting. Here you are, you sort of have a late-stage residency epiphany that retina is not going to be your thing, and Roger, it sounds like, really became your champion and was willing to sort of champion your efforts to transition into cornea and cataract. Then, not only that, but take you on as a partner and a co-faculty member. Really it sounds like he sort of took you under his wing. There's an old saying that I love. The saying is, "As hire As, and Bs hire Cs."

Roger was obviously an A, an A+, and obviously he saw something really special in you and was willing to, as you mentioned earlier, not ever let the ego get in the way, but really champion you to become your best self. It sounds like that was a trait that he shared with lots of people, but specifically with you. Is that a fair assessment?

Sam: Yeah, I mean, I wouldn't call myself an A, but I think Roger really brought out the best in many people. We're seeing that more and more now, as people from all parts of the practice come up to me and say, "You know, Roger meant so much to me, and he was so supportive and was so open." He really did bring out the best in people. It was one of those people that you just felt good working hard for.

I think that has really done well for me in the sense that because I worked so hard for Roger, it's opened a lot of doors for me. I think those doors wouldn't have been there had I not had his support. It's not really the work ethic. I think the work ethic was there before, but really the dedication to something bigger than just practice. What we've built here at the Gavin Herbert Eye Institute is really more than that.

It's more than just treating patients, but it's about doing great surgery, being teachers, being liaisons to the community ophthalmologists, being somewhere for the people of the community to look to for specialty care. We really built this together, and it's not just me, it's all of our faculty. He was a special guy to all of us.

Gary: What is sounds like is he sort of established a really special culture of working hard, but also figuring out the why behind the hard work, which is having an impact, both professionally, but also in the community and with other patients. I never had a chance to see him in surgery, but one of my attendings was a fellow of his.

I remember as a resident, she had just amazing surgical skills, and she said, "The best person I ever saw operate was Roger Steinert, because every movement was perfect. There was no wasted energy. It was like symphony inside the eye that was going on." That stuck out to me before I ever knew who Roger Steinert was. I heard of this mythical man, who was sort of this surgical artist.

I love hearing stories about people who just seemed to sort of pursue excellence, not only just surgically or clinically, but as you mentioned, he's a great family man. One other thing I'll mention is, I think we had spoken off line about some special patients that he had impacted. Any stories or anything that comes to mind about patients that you saw him interact with that he really made a lasting impression on?

Sam: Yeah, I get reminded of that on a daily basis because a lot of my practice is his old patients that he transitioned to me during my sort of beginning years, so then they've stuck with me since. Then, once he became ill, they had no other choice really. Patients love him. It's daily that patients ask, "How's he doing?" Up until recently, I've been saying he's been doing just fine. He really has done really well over the last several years, and just recently was he taking a change for the worse.

His patients adore him. Back to his surgical skills, he really was quite gifted in the OR. If you looked at the size of his hands, and the stature of the guy, you would never think he could be so nimble inside the eye. Really, he always was looking for ways to make a particular technique more efficient, better outcomes. He really strived to be the best surgeon he could, at the same time giving his trainees a lot of autonomy. I think the reason a lot of us, from a surgical perspective, do pretty well after training with him is because he gave us so much autonomy.

The other thing is, he's one of the only surgeons I've ever met who would operate on-axis every single time. Operating with his right hand sometimes and his left hand sometimes, depending on where the patient's astigmatism was, to really give the patients the best outcome possible. He was equally comfortable both ways, but for most of us, we're so dominant with one of our hands that it becomes awkward to do phaco with your nondominant hand. But he was just really, really gifted in that regard.

Gary: Wow. That is just really impressive. I only know one other surgeon who is ambidextrous. I just think that is ... it's one thing to be ambidextrous, it's another thing to be surgically ambidextrous, so that is really impressive. Tell me a little bit about the transition point when he realized it was time for him to step away. I'm assuming that was a pretty hard decision for him. Just walk me through that a little bit.

Sam: Yeah. This was in December of 2015. He had a pretty dramatic event, where we realized the diagnosis, and he had to actually go to emergency surgery within the next couple days. Unfortunately, after surgery, he came out with a little bit of a weakness on the right side of his hand. He was right-hand dominant, so he, at that point, stepped away from clinical care, but was still very involved in the actual ... at that point, he was actually interim dean of the medical school.

Just a couple days after surgery, after neurosurgery, he was back in the office, back to running the business of the medical school. He'd already stepped back a little bit at that point because of that position, but at that point he had to cease completely his clinical care. Unfortunately, he never made it back to seeing patients, but he would always still have rounds with the residents and the fellows and always be available for questions from the faculty regarding clinical care. Up until the very end, he was always very passionate about patients.

Gary: Yeah, patient care, absolutely. One other question I'll ask, and this just has to do with fellowship training. Sometimes these questions get to the heart of people. Clearly, you said that he gave you enough autonomy as a fellow to really stretch your skills and develop into the surgeon that you are today. Any memorable mistakes that you made as a resident, or as a fellow that he had to correct, and, if so, if one comes to mind, how did he approach correcting people because that's a delicate skill?

Sam: Right. I made plenty of mistakes. He was always, early on in the year, he would sort of say either during the case or after, he was one of those guys that even during surgery, patients knew who was operating, they knew if he was operating or his fellow was operating because to this day there's patients that know that I did their surgery, but he was there overseeing me, and that's why that had a good outcome versus a lot of times patients aren't really sure who did their surgery.

He had a way of sort of breaking things down to a very granular level, and he knew everything about microsurgery. So, really, one of the highlights of my career thus far has been the ability to write a book with him. We wrote a teaching manual on microsurgery, and sort of the thought behind instrumentation and design, why we place certain sutures the way we do, why we approach surgery in a certain way. He brought that to the OR on a daily basis.

He really had a very analytical mind. At UCI, he had a dual appointment in ophthalmology and biomedical engineering, so he really was inquisitive as to the why and how things happen. I think that made him a much better surgeon because he didn't just take things at face value, he wanted to know why do we place things the way we do, and how can we make that better? That then led to sort of becoming that way and trying to figure out not just how to do things, but what's the rationale for why we use a particular phaco technique, and can we optimize that?

There was one time where he generally did not turn over his cataracts unless it was a triple as part of a corneal case. I remember the one time just seeing the look of disappointment on his face, it was a DSAEK triple, and I broke bag. He wasn't disappointed in me often, thank god, but that was one of the times that you could just see the look of disappointment on his face, and he's saying, "Come on, guy. This is something I wouldn't have done." That sticks with me just because to this day, I have a hard time passing down my cataracts for the same reason. I think there's such little room for error compared to a corneal surgery that, you know, it's one of those things that stuck with me.

Gary: Got you. What do you think Roger will be remembered for? When we're at the twilight at our careers, and hopefully that's a long time from now, we surely will look back on and will continue to share stories about the people who influenced us, the shoulders of the giants that we have stood on to take ophthalmology where it's going, and he's clearly one of those giants. What do you think his lasting legacy is going to be, if there is one, or if you could put that into some words? Not an easy question, but what do you think?

Sam: No, not an easy question at all, thanks for that. I think Roger is going to be remembered as many things. He's going to be remembered as the guy who went from a very successful private practice to an academic institution and helped raise the stature of that institution, raising $40 million to build a clinical building. The first time it's ever been done at UC Irvine. He's going to be known as a great leader, not only at the university, but at ASCRS. He's going to be known as a pioneer of cornea, cataract, and refractive surgery.

He's going to be known as a friend to many. Really a true gentleman, and I think on top of everything, he's going to be known as a good guy. He's one of those guys that just really is well revered by everyone. He had that personality about him, despite his greatness, he was just a normal guy. He liked to joke around, and he liked to just be normal. It wasn't all about work and being on all the time. Some of my favorite times with him were our personal times, just joking around, making fun of each other. Really, that's not something you can do with all of the greats.

Gary: Right. That's a very, very special quality. Someone who is humble, a luminary with a humble spirit. I think there's a lot of what you said that we all can aspire to be. If we can aspire to be half the man Roger Steinert was, we would count ourselves lucky. Sam, we're going to have some conversations with some of his other friends to sort of put this episode together. I really appreciate you being willing to come on. I know this is a little bit difficult given the proximity to his untimely passing. Sam, I just want to say thank you for your words. Thank you for carrying on his legacy because as long as the people he's trained are around taking care of patients, that's a little bit of Roger that lives on, I think, in you, so thank you very much.

Sam: Thanks so much, Gary.

Gary: It’s clear what a valuable role Roger played in the career and life of Sam. Next, I sat down with Jim Mazzo to discuss how he convinced this ultimate Red Sox fan to move to California and open the Gavin Herbert Eye Institute, Roger’s talent for ophthalmic surgery, and how to play The Steinert Challenge. Here’s Jim.

Gary: This is Ophthalmology off the Grid, and today I have the distinct pleasure of speaking with Jim Mazzo, who is currently the Global President for Ophthalmic Devices with Carl Zeiss Meditec. Jim was a dear friend of Roger Steinert. We are inviting a few guests to come on and talk about just what made Roger so special.

Roger had a dream career. He was head of Mass Eye and Ear Cornea Division. He was the founder of the Gavin Herbert Eye Institute. He was Chairman of Ophthalmology at UCI, President and Program Chair of the ASCRS, and while that's just a crazy amount of things to pack into one career, but what's interesting is as I've talked to folks, those accolades really don't even begin to describe what Roger meant personally to people. Today, Jim, I'd just like to get a little bit of a flavor of what Roger meant to you, and maybe you can just start at the beginning. Where and how did you start interfacing with Roger, and let's just kind of start there.

Jim Mazzo: Well, thank you, Gary, and thank you very much for doing this. This is quite an honor of many people to be able to talk about our dear friend Roger. I have the unique experience of really helping bring Roger from Boston to California, as we had this vision here to start the Gavin Herbert Eye Institute, and at that time we didn't even have the name Gavin Herbert. It was the Startup Premiere Eye Institute in Southern California, to compliment what we had at Jules Stein, Doheny up north and UC San Diego down south.

As several of the leaders, and Peter McDonnell was just leaving us to go to Hopkins, we met and we said, "You know we're really going to need the top to create an eye institute and to have people provide the resources, we're going to need one of the best, if not the best." Remarkably, Roger's name was always at the top of the list.

You know me, I reached out and said, "Roger, can we meet and get a chance to talk about this?" That's how it started, and that was in the year of 2003.

Gary: Okay, so you said, "We need the best." Roger's name, obviously, kept rising to the top, and that's when you guys first started. Was it an easy sell to get Roger out to California? I know that there's a lot of stories of him loving his Boston Red Sox, so talk about that a little bit. Was it a hard sell getting him to come to Irvine?

Jim: He and April loved Boston. Beyond just the Boston environment, you hit the nail on the head, his passion for his Red Sox. He actually talked about how many times did the Red Sox come out to see the Angels, and play the Angels. I actually remember that, thinking he was kidding me, but he wasn't.

Gary: That's hilarious.

Jim: I don't believe it was a hard sell because Roger realized that one of his greatest passions was teaching. Probably was his largest passion if you really boiled it down to what he wanted to do in ophthalmology. He saw this as an opportunity to be the first to create a teaching institution, and to really leave a legacy there of the young and up-and-comers who are going to replace him. I think after that initial sale, and of course, I brought him out in February.

Gary: Very strategic.

Jim: Very strategic. Although I'm Italian, I'm not that dumb. I understand that you need to take advantage of the opportunity. The blue skies over the gray skies was a big plus. It wasn't a hard sell, but of course there's always emotion when you move, but he realized that this was his opportunity, and it was a win-win.

Gary: A lot of words get thrown around, and we've kind of talked, I've talked to other folks, about his leadership style, and starting something from nothing, or really from the ground up. That takes a really special leader. What do you think made him such a special leader?

Jim: I think there's a couple factors. One, humility. Roger, by far, was one of the more humble individuals I've ever met, especially with how many accolades he already had, and obviously incurred post him coming to California. I think to get the type of young physician, the people like yourself, to want to come here, and the people that were here to stay, they saw humility as such a great point that Roger had. They really said, "This is the type of individual I want to be with."

He didn't come in with arrogance. He didn't come in and say, "I'm Roger Steinert, why wouldn't you want to be here? I'm Roger Steinert, why wouldn't you want to give me money to help start this institute?" Then to compliment that was the other partner in this whole idea was Gavin Herbert, who both financially and emotionally needed to understand who was going to be the leader. He fell in love with Roger as well. That leadership style of humility was probably the greatest strength we had, and Roger's greatest strength through his tremendous life.

Gary: It's interesting, as I've interacted with some of the fellows he's trained who've become dear friends of mine, there's sort of this culture of quiet confidence, humility, but excellent skill. Maybe in some way that's a little piece of Roger that he has sort of ingrained that. I look at Sam Garg, I see a quiet confidence, humility, but just in same skill set. Do you agree with that sentiment?

Jim: You know, Gary, I will tell you being in this business now 38 years, I've seen hundreds of thousands of surgeries. I have to say, across the globe, Roger had some of the best hands that I've ever watched surgery. You know, obviously, the intricacies of the surgical procedures that you all do, and corneal transplants being one of those, it was like his hands were part of the eye.

I remember telling my friends, "I've never seen a surgeon where their hands and the eye were almost one unit working together." I think that, obviously, is another characteristic. You know when you want to go to a program, you not only want to be able to learn from somebody because of their leadership skills, but you want to obviously learn their surgical prowess. His ability to do corneal surgery was extraordinary.

Again, he never touted it. He never said I was the best at this. He always would talk to the residents and say, "Here's what you can do." They looked at him like he was Michael Jordan going, "You know what, I don't think I could shoot a basketball or do surgery like that." He made them relaxed.

Gary: Right.

Jim: Again, another reason people came to the Eye Institute, another reason people followed Roger.

Gary: It's really interesting, I think you see this play out, not just in our field, but really in any field that people who are good and are confident, they really don't need to tell everyone about it. Their skill set and what they do speaks volumes. Every time I talk to someone about Roger, without exception, his surgical skill comes out, and his humility, and his love for teaching.

It's so neat to see how someone of some excellence can really kind of keep it all together, and leverage that, that humility, and skill, and confidence to make something that outlasts him, obviously kind of live indefinitely with the Gavin Herbert Eye Institute. Do you feel like that's one of his most proud accomplishments would be creating the Gavin Herbert Eye Institute?

Jim: You know, most definitely. Roger and I had many, many discussions at the Eye Institute, at our homes, and he would always talk about this as his legacy. To create something and be the first is always somebody's dream. We literally, the three of us, Roger, Gavin, and myself, literally did this fundraising effort, and every dollar was raised from independent sources. Not one came from the state. Not one came from the university. We worked it hard.

The other thing too, to build on that legacy, what is something, you kind of stirred my thought process is, a lot of strong people are always great when things are going well, but when things aren't going well, to me that's a strength. We've all have bumps in the road, but after Roger was diagnosed, and Kelly and I were there that evening, I never saw him, or heard him ever complain. Never.

Gary: Really?

Jim: Never.

Gary: That's incredible.

Jim: That, to me, is unbelievable. Never did he say, "Why me?" Never did he say, "Well, I'm going to stop now. I'm going to go enjoy." He went right back. In fact, I saw him that evening after the surgery, and obviously he was somewhat lucid, but we talked, and the next couple days, he kept saying, "Okay, when am I going to ... I'm going to get back. I'm going to get to the office."

It wasn't just words. He actually did. Until almost his last days, April was driving him to the office because he loved it. You talk about that this was his legacy, is because it was his passion, and I think we all look for our passion, and he found this to be his passion.

Gary: You know, this may go a little bit of a sideways direction, but you know, as you're saying this, it's sort of stirring my thoughts as well about it just seems like they don't make them like they used to. That's maybe a little cliché, but we kind of have these cultural conversations about the generation that is up-and-coming, the millennial generation, and sort of the desire for instant gratification, and for things to happen now, and sort of becoming disenchanted with work fairly easily.

Listen, I know lots of millennials where that stereotype does not apply, so I don't necessarily buy into that 100%, but it just seems like what Roger was about was doing it the right way, not necessarily instant gratification, but really spending his time building a foundation that could last, and last, and last.

There's so many life lessons we can apply to approaching a project, your family, your career, just in that same way. What are your thoughts about that? Would you agree?

Jim: You know, I would agree because I think today all of us, I'm by far not a millennial, all of us are always so much moving forward. We've got to get going. We've got to do the next thing. I don't think we enjoy the moment. Roger always enjoyed the moment.

Gary: That's awesome.

Jim: Even during his struggles, he enjoyed the moment. I think that's the point we miss. We're always ... "You're now going to do this, and then we're going to jump to our next meeting."

Gary: Right.

Jim: Wouldn't it be nice just to hang up and reflect on what we just talked about?

Gary: Yeah, absolutely. Absolutely. I'm going to switch gears a little bit and talk about The Steinert and The Steinert Challenge. I know that this is something that you had a little bit of a part in. Could you just kind of explain what is The Steinert, how to order it perhaps, and what The Steinert Challenge has done and is continuing to do?

Jim: You know, this is one of the great mysteries of life. We've even asked April, "How did The Steinert come about?" The Steinert is half gin, half vodka, or martini there with stuffed olives. That was his drink, and, all of a sudden, it became his persona. We're still trying to figure out the day it was the origin, but I can tell you that when Roger would be at meetings, academies, ASCRS, ESCRS, whatever the meetings are, at the end of the evening, you'd always see that my buddy's smiling, and he'd be sitting at the bar, usually with a drink and/or a cigar, just smiling, and having the tables and chairs around.

As people would walk in, he would tell you to come sit down and have a drink. More often than not, The Steinert was in his hand. Unfortunately, as we know, Roger was failing. The Lewis', Rick and Robin, Kelly, my wife, and myself decided to do The Steinert Challenge. That goes back to that ice bucket challenge that occurred several years ago. The concept is you make a Steinert, you toast, and then you donate to the Gavin Herbert Eye Institute in Roger's name.

We leverage a passion of his. We used that word earlier today. One of his passions was to enjoy life, so by enjoying life through The Steinert, we can keep his name going in contributions to his passion, The Gavin Herbert Eye Institute.

Gary: I'm just going to throw this challenge out to everyone who is listening. Roger meant the world to our profession, and I would really love to see this take off in an even bigger way, so if you're listening to this podcast, and Roger has ever impacted you, or even peripherally impacted you just though his contributions to our field, I would really encourage you to take The Steinert Challenge.

Videotape yourself, say a kind word, and give at least $100 to the Gavin Herbert Eye Institute. If you can do more, do more, but I think that's a great way to toast Roger Steinert for his vision, his impact, and his legacy for ophthalmology. Jim, any parting words that you might have about Roger before we wrap this up?

Jim: You know, I just would continue to say that Roger was a teacher. That was his life was to teach. He did it through his residents. He did it through his skill set. He did it through his humor. Many of us think we teach, but in order to be a real teacher, you have to take the time to ensure that what you've taught is understood. I think that's the difference between a teacher and someone who has actually impacted the people of the future. He would sit down with you and say, "Let's go through what we just did. Do you understand? How can I help you?"

I want to leave that besides his humility and his passion, he was the ultimate teacher for our profession. There's no greater gift than to keep his legacy going because he taught us to continue to teach others so that as years go on, this great profession, which has been very good to me, very good to you, continues through other remarkable people like Roger and yourself. I think I leave people with that he was the ultimate teacher, and something we need to always admire about Roger.

Gary: I’d like to close this episode with a quote from Roger’s eulogy, as I think it perfectly captures his impact and legacy.

“He was devoted to ophthalmology, to helping save sight. But more so, he was devoted people -- to helping others, to save vision, and to improve the quality of life -- and to teaching others in this quest.”

We are all so privileged to be students of Dr. Steinert. I’d like to thank those who contributed their fond memories of Roger so that we could honor this very special man. And thank you for listening. See you next time.

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

7/16/2017 | 36:59

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