Gary Wörtz, MD: Finding mentors early on is important for so many reasons. A good mentor can help us carve out the right career path and teach us lessons that we can then carry forward into our own practices. Some of us are given the chance to give back by passing those lessons along to the next generation of ophthalmologists.
Dr. Sumitra Khandelwal counts herself lucky to have had what she calls “true mentors,” whose advice she still relies on to guide her today. She pays it forward with the residents she trains at Baylor College of Medicine at the Cullen Eye Institute.
Sumitra is here today to talk to us about those who have helped her along her journey, as well as the advice she gives to new residents seeking help from her. She also discusses how she originally dreamed of becoming a famous, international journalist before ultimately finding herself drawn to a career in medicine.
Coming up, on Off the Grid.
Speaker 1: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.
Gary: Welcome to another edition of Ophthalmology off the Grid. This is Dr. Gary Wörtz, and today I have the fantastic Dr. Sumitra Khandelwal with us from Baylor. Sumitra and I have known each other for quite a while. I think, Sumitra, didn't we meet in Austin, maybe at one of the first MillennialEYE meetings? If my memory serves me right, I think that's where we met. Is that right?
Sumitra Khandelwal, MD: That's actually when we first met. I know we had both seen each other's names on emails and on different programs, but that was actually our first meeting, at Austin.
Gary: MillennialEYE has held a near and dear place in my heart ever since then, and it's going to be a great meeting this year, but that aside, I'm really happy to welcome you on to Ophthalmology off the Grid. I want to talk a little bit about what makes Sumitra Khandelwal tick. With that being said, why don't you give us just a little bit of an overview of your practice, some of your passions, then we'll just dive in and maybe even start with some background stuff.
Sumitra: Sounds great. Well, thanks for having me, Gary. This is great to be part of this, Off the Grid. So, I'm in Houston, and I'm a Professor of Ophthalmology at Baylor College of Medicine at the Cullen Eye Institute. I'm also the Medical Director for Lions Eye Bank. That's a new role I picked up 2 years back. Always exciting to have new challenges ahead. I also staff the residents at the Michael E. DeBakey VA. Basically, I'm trying to be in two places at once, and I have decided that you can do that as long as it's the same zip code. But, once you start crossing town, it's a little bit more difficult.
But I love it because every half day is a little different. Every day presents its own challenges, and just when I get a little exhausted of a clinic filled with patients, then I can switch over to doing one of my other roles, like teaching the residents or serving as administrator at the Eye Bank. It's a lot of fun. I grew up in Houston, so it's also great to be back, actually. It's been a fantastic 5 years now.
Gary: That's awesome. It sounds like you have a lot of variety in your life. Going back, a little-known fact, I think, about you is that you did not start college thinking you were going to be in medicine. Actually, you had other passions. Talk to us a little about that. You were studying International Studies at WashU, maybe thinking journalism. Is that right?
Sumitra: Yeah, it was funny because I actually grew up with two parents who are physicians, and I admired them incredibly. They're wonderful people, wonderful mentors, but just seeing the way that they approach—the nightly conversations that were all about patients and stories and such—it's funny, it drew my brother and I away from medicine. He succeeded in that; he's in politics and a lawyer.
Me, on the other hand, I'm here, so as you can see, I went in a different direction. When I was in high school, I wanted to be a famous international journalist. I kept looking at all these great feature, news-type articles. Back then, I think the news was a lot happier. I wanted to do something like that, and so when I went to WashU, I majored in International Studies. My priority was to do at least two abroad programs. [I] did communications classes, obviously. I was editor of my newspaper in high school, and so [I] went in really being excited about that.
It is exciting. It's really fun. It's just that I found that I still was drawn back to the steadiness that could be some sort of medicine or something like that, and so, my second semester, I decided to go ahead and take some of the pre-reqs, and the one that really caught me was, I think a lot of people would agree, physiology really caught me in college. I ended up going down and at least doing a biology minor and then going into applying for med school.
My thought was, though, I could somehow integrate the two. When I did my study abroad, I did it in Spain. One of my focuses was health care issues there. I also did my thesis when I was in college on two cities, El Paso and Ciudad Juárez. They're just a bridge away from each other, but they have very different structures, and one of my projects in college was actually how different political events changed the health care in two neighboring cities when they're a first-world country meeting a third-world country.
It was really exciting to bring all these interests together. Ultimately, I went into medicine, and I fell into ophthalmology because that's what I was exposed to my first year during a research project. So, I'm not really quite the international journalist I thought I would be. I'm still getting to write tons of articles for great publications, like MillennialEYE, and maybe getting to travel to great meetings too. So, maybe, indirectly, I'm getting to check off some of those boxes.
Gary: I think it is interesting because, I think if you have passion at your core for helping people, that can express itself in various ways. It can be through shedding light on issues, political or geopolitical issues. We can also be much more tactile in terms of helping patients, or it can even be somewhere in the middle, like teaching residents, where you're giving back.
I know your background. I've read through your CV and just know your story a little bit. You have really had some of the best minds in ophthalmology invest in you, and now you get to take that and pay that forward to the residents who are at Baylor. Talk to me a little bit about what those mentors had meant to you along the way, both at Emory and Minnesota Eye and maybe even beyond that, and maybe some of the lessons that they taught you that you're able to carry forward as you train residents now at Baylor.
Sumitra: I think I've been so lucky to have just, each step of the way, have not just attendings who teach you surgery, not just people who say, "Here's your evaluation," but really, true mentors. Mentors who not only pat you on the back and say, "Good job” and hope the best for you, and write you good letters, but also those who are a little bit realistic and make you humble as well.
Certainly, when I was in residency, Emory has a great residents’ program. It's a pretty casual group, the attendings are always willing to help out the residents. It seems a lot less hierarchal, I think, than other programs, and I had some great mentors there. Brad Mandolin was my research and clinical mentor. I think we all, as we operate, have a little person on our shoulder that we imagine criticizing us. “Why are you doing that?”
Sumitra: “Stop doing that.” “Come on,” and my last name back then was Serita. “Come on, Serita, you can do better than that.” So, that's Brad. I'm not sure what he would think about the fact that I hear his voice still, this many years later. I think he may appreciate that, but he was always very realistic too about what are the realities out there.
It's not just a golden brick road. There's always going to be some challenges, and I think, also, the honesty that attendings can provide for you, their struggles, their ups and downs—it really sets the scene for going into practice and going into your subspecialty with your eyes wide open. I certainly try to do that as well. I certainly don't want to burden my residents with all the negatives, but I want them to be realistic about, if you go into this subspecialty, here are the good and the bad.
Pick it based on the bad because, if you could do that every day, if you can see a dry eye patient, 20 of them in a half day, then you're okay, you're doing pretty good. If you can't stand the idea of glaucoma suspects all day, then don't do glaucoma, for example. He taught me that, he told me to take the most boring thing in the subspecialty and imagine it all day long, and that's how I ended up with the anterior segment because I still think that everything about is just so exciting.
Then, I went to Minnesota Eye Consultants in Minneapolis, and all those attendings are so [passionate about] hands-on training. I think they really take such pride in the fellowship that they have. It's a private practice, but like other private practice fellowships, they invest so much in their fellow, it's almost an extension of their practice, and they're so excited to see us go on to do other things afterward. Even now, I get emails saying, "Hey, I saw you in that. So proud to see you out there."
It was a great group, a group that I still reach out to whenever I have questions, and it's always fun when you have multiple attendings. There are definitely great fellowships out there where you have one or two attendings working with you. The ones where you have multiple attendings, you can get a little multiple personality disorder. You operate with Dave Hardin one day, and you operate with Sherman Reeves the next day, and Liz Davis the next day, and Tom Samuelson, they all have their perks and their tips and the, “Hey, you forgot how I did it.”
That's what keeps it really exciting and also makes you a better surgeon because you're adapting. You're learning new techniques on a weekly basis. They're such a great group, too. They really embrace their fellows. They were one of the big reasons why I, actually, was looking at some private practices, and I was looking at academics, and they're so excited. They're a private practice, but they're so excited to have their fellows go on to continue research and teaching, and teaching peers as well as residents and fellows.
Dr. Lindstrom was a huge proponent of me looking at places like Baylor, and that's how I had ended up here. It's funny, the residents always ask, "How do I go about looking for jobs?" I say that you start reaching out to physicians in the area early on. I remember asking Doug Koch if I could maybe just chat with him about opportunities, and he said, "Sure, but there are none out here in our practice." I was like, "Well, you know what. Let me just come by anyway." He was like, "Okay." I kept letting him know that I was very interested in Baylor.
He still jokes around about how he was thinking about the restraining order, but he wasn't quite sure how to file it because I definitely was very persuasive. But I think, for the residents, I always tell them, "If you have an idea of what you want, and you have an idea of location or multiple locations, reaching out early is really helpful because it takes a little while to have somebody really create a position for someone's practice." It's not a 6-month thing. It's not like applications, where you apply at the end of your year and see what match ends up happening.
It's all about word of mouth, and opportunities as they arise, and being flexible. That's also very important as you join a practice. I think, though, if that had been where it all stopped, that would have been an amazing list of mentors. I'm just so lucky here. My colleagues are my mentors. Having Doug Koch and Marshall Bowes Hamill, Steve Pflugfelder, Mitch Weikert—they're some great people and great teachers, and we are always teaching each other. It's so fantastic, if not a little bothersome to them, the fact that whenever I have crazy cornea in front of me I say, "Hey Steve, can you come take a look?"
And then I try to disperse it. If I asked Steve for every single case, then he may get a little tired. So, I go to Mitch, and I say, "Hey Mitch, what about this case?" and alternate between them. But, the most amazing day was the day when Mitch came up to me and said, "Hey Sumitra, what do you think?" And I'm like, "I don't know if I have a lot of thoughts. I don't know if I can contribute to you." But, really, we all help each other. That's the great thing about being side by side with such great minds.
There's one case where three of us were discussing it, and our technicians are like, "Hey, why don't you present at a cornea conference and start seeing patients, guys."
Gary: Right, right.
Sumitra: That’s the kind of stuff that comes in. And, you know, Zaina Al-Mohtaseb joined the year after me, but she and I just have a blast and we learn from each other in so many ways, and that just shows that your peers, your comradery the same year as you, can be the best mentors in some way because they can really teach you about yourself as well as what they have learned, their experiences. Although, she and I are still a little bit suspicious of the fact that we're here at Baylor and they refuse to put us in clinic at the same time on the same day.
Gary: I can see both sides of that coin. You guys love to have a good time, and you're both hilarious. I always laugh when I'm with either one of you, so I can't imagine if you're both in the same clinic. I think that it would be really, really fun. I know that would be a fact. One thing you said, actually, struck me as very interesting, and it reminds a little bit of my story. You said that you really wanted to be at Baylor. You were told time and time again there's no opportunity here. You kept asking, and eventually, magically, an opportunity presented itself.
I had a similar situation in the place I'm working now. I, for 6 years, was persistent about, thinking about having an opportunity to work at Commonwealth. It's interesting that, I think, a lot of times the jobs—this is not to say that there are not good jobs that are out there that are desperately looking for ophthalmologists—I do think good ophthalmologists are in short supply. So, there is a demand for good ophthalmologists, but sometimes I think the best positions are the ones that you find and they really aren't looking for someone.
By the time they're looking for someone, generally those positions have been filled, just like you said, by word of mouth. What are your thoughts on that? As you talk to residents who are getting ready to leave and are looking for opportunities, walk me through that. What are your thoughts about finding the opportunity yourself rather than looking at a recruiting site or another traditional method?
Sumitra: Well, I think word of mouth is really helpful, and I think it does help to know someone who knows somebody who knows someone. So, whenever our residents are thinking about what they want to do, I always ask them location- wise, I always say, "Well, here’s a few practices here, and I know so-and-so. I'm happy to put you in touch." Just chatting with them about the market and the area, that may not be a job interview, that may just be me setting up one of the residents or fellows with a friend of mine [who] happens to live in, name a city, and then they can talk from there and then decide what are the other options out there. Maybe they end up interviewing with that group.
I think, for a lot of groups, there's almost this idea of, when do I add my next person, when do I expand? And I think that, you'd be surprised how many times it's in the back of the practice's mind, but they're not sure quite how to go with it. A lot of smart practices, smart academic centers would rather take a really good talented person who's looking to join and wants to be there as opposed to waiting until they really need somebody.
Sumitra: And, as we all know, when you start a practice, it's a gray zone. I mean, it's great when you end up in a situation where you're taking over someone who's retired or someone who’s left, but a lot of times you're building parts of the practice, and so you have to figure out what you're going to do with your time. And I think residents and fellows are not, they're very good at selling themselves on a personal statement or in an interview, but I think one thing is to take some of the things that you can bring to a practice and make sure that people are aware.
For example, if you're a cataract/cornea person and you're also doing MIGS, great, you're more of a fit in half the practices out there. Or, if you're somebody who is comprehensive, but you're willing to do a little medical retina. There's so many comprehensive physicians out there who have thought about opening up a medical retina part of their practice, but they haven't quite done it because they don't want to do it themselves, and you could be that person who fills the role. I think there's something to say about what your, not just what your skill set is, but what it is that you could add to a practice that can actually build a pro forma for you, in a way.
For academics, the way that it ended up is, they heard about my excitement for resident teaching, my research in outcomes, and they created some extra FTEs, some extra funding from the public hospitals, from the county, as well as the VA, in order to fund me, and then we ended up having a situation where Zaina came on the year after, and then we split all of the public time just because suddenly we were so busy. It's surprising how you get busy. In the beginning, it's very quiet in your practice, and you've got X number of patients, and you're twiddling your thumbs a little bit. That's the time where you should be really excited and start planning stuff because you're never going to get a breath of fresh air like that again.
Gary: Right. That's right. So, I do want to switch gears a little bit and talk about one of your main responsibilities, [and] I think, one of your main passions, and that's really about looking at optimizing outcomes at the VA with your residents. I read a paper of yours about femtosecond laser-assisted cataract surgery, really comparing outcomes for resident surgery, and you actually did show a decrease in posterior capsule rupture rate by using the laser. I think that's maybe a little bit controversial. We can say, well, maybe in the resident population, it's a little a different. They're still in that learning curve, but talking about your philosophical approach to introducing technology to residents and how you go about evaluating technologies to say, "Hey, does this actually drive outcomes?” whether that's refractive outcomes or safety for patients.
Sumitra: Yeah, well, I think one of the great things about this residency curriculum is that, you know, all the attendings are very dedicated toward optimizing their outcomes. At the VA, we're very lucky in that we've got some access to equipment, and the thoughts are, can we utilize and view technology as being not just something to improve outcomes because there is some discussion out there about femtosecond, but how can we add this as a way to expose the residents and fellows to new technology.
That's one of the things that we don't want to see. We don't want to see residents and fellows go out, and they've never been exposed to a certain aspect out there, and they go out into a practice and they're re-learning a bunch of stuff. We want them to be, in our program, exposed to all the new technology, even if they don't take it with them. Even if they don't go and buy a femtosecond, at least they've been exposed to it. They can make their decisions on it. Hey, they can even go out there and make themselves marketable to a practice. Hey, you just bought a femtosecond. Wow, here’s a resident who's already done 30 cases on it. This is going to be a great person to add to our practice. I think that's one of the reasons.
The other thing, though, is there's a curiosity. In order to do a study looking at resident technology and resident outcomes, you have to have the technology. It's tough to get a study going, otherwise. We're very lucky in that our Chief of Service at the VA, Sylvia Hysong, is very supportive of newer technologies. We've looked at, what are the ways that we can improve, so, we have that femtosecond study that was really great. It showed, at least took away the fear, and then the residents do very well with Femto. Granted, these were senior residents. Initially, we bought the technology, thinking maybe we could use it as a stepwise approach for first and second years, but then we found the docking's a little bit difficult, as well as the view and the height of the section to be a little bit more gentle. So, we now incorporate in the third years.
There's a learning curve in just “How do you implement technology in a residency program?” Then, with the senior residents, we compared the two, and senior residents still know how to break bag pretty well. It was pretty good. What we wanted to show was that there [were] not increased complications, but it was great that there was a decrease in it. What we do with this technology now, now we publish that, is we let the residents do it based on what they feel like they want.
We have one resident this year who's going to go join a practice that has this particular technology that we have, the femtosecond, there, and is excited to do all the cases, try different LRIs or intrastromal arcuate incisions or instrastromal arcuate incisions, try all different things. Then, [there are] others that are going to go out to practice and they're not going to use it and they don't mind pulling out the old phaco machine because that's what they're going to use.
Definitely the femtosecond's been exciting. We also have multiple different platforms for phacoemulsification technology. Not just one brand, but multiple types, both vacuum-based, as well as peristaltic, just in case the residents are going out, but also because residents go out there. They read the BCSC book about this is vacuum-based versus peristaltic, but how do you really understand the difference unless you've actually used the equipment?
Sumitra: That's one great thing that we have that we were a big proponent of, making sure we had access to that technology at our VA. Then also, we've got [Verion], as well. We're working on a study right now, we can get those outcomes, and then looking forward to more technology in the future. I think it's really great. Some of the things that we've focused on for the outcomes besides just the complication rates though, [are] things like operative time and how do you plan your day. We do a ton of cases at the VA; we run two rooms, seven to 10 cases per room. But some residents can do more than that, so how do we plan our days?
We've got some studies on operative times, on routine cases and complex cases, so, that's just really exciting to me. One would consider it to be administrative because you're looking at data and you're trying to figure out how to make things more efficient, but I look at it as research. Some of those things can be published, especially if you've got a good med student or resident. So, it's very exciting to me to look at that.
Gary: I also want to talk to you about what excites you about the future. I know being around residents is always exciting because they're coming up with cool ideas. You're also at an academic center that has access to, I'm sure, a lot of technologies that we would all be jealous of. But what excites you about the future? Where do you think we're going with, you can take this in any direction you like, whether it's refractive cataract surgery, or laser refractive surgery, or even otherwise? Where do you feel like, if you had to place some bets, where do you feel like we're going to be making some major advancements, maybe, in the next 10 to 20 years?
Sumitra: I think there's going to be a lot of advancements in refractive cataract surgery. I think we're still looking for that holy grail of how we can conquer presbyopia, in one way or another, whether it's early on, someone's 40s, or when it's time for cataract surgery. I think that's going to be really exciting. I think we're going to figure that one out in the next decade.
I think there's some exciting stuff in cornea. It's all the exciting stuff we don't even think about right now. But, it's funny, we were talking the other day about things like endothelial cell injection. My fellow was like, "Well, I hope it's not anytime soon because I just figured out how to do edema." I mean, it's exciting, right. How many careers do people have where they say to themselves, "I'm looking forward to something exciting that's going to actually take my skill set and throw it out the window because it's going to be so disruptive."
I think that's the exciting thing about it. It's a little scary too because, as technology improves, it's more expensive. We hope that the path for getting all this great technology comes with the ability to still maintain that excitement and grow and obtain them in your practice. But, I think that's going to be really fun, not just devices and machines, but also just techniques, and what we know now, hopefully, will not be what we do 15 to 20 years from now.
I was at a party the other day, and this retired ophthalmologist was giving me the whole story of his extracap and intracap days, and I was, "Oh no, that's going to be me one day at one of those parties, talking about the days of ‘I did phacoemulsification and stuck a monofocal in the bag.’”
Gary: Right, yeah. That's funny to think about that. It's like someone said, "Someday Snoop Dog is going to be on the oldies channel." I heard that and I thought, no, that can't be, but, you know, that at some point, that's going to be old. That's going to be old music. I think that it's like a shocking fact that the things that we think are fun and relevant and new are going to someday be old and boring. One thing I am interested in, and I'd like to get your take on this is, I'm just processing this question also, I just feel like machine learning and what artificial intelligence may do for refractive cataract surgery could be really exciting.
It seems the machine learning has really taken off in the last year or so. There's even some AI for diabetic retinal screening, which is pretty cool. And just approved by the FDA, and something I'm interested in is, maybe, even more advanced formulas where we're looking at hundreds of factors and figuring out the right lens/surgical incision approach for each patient based on this normative or AI platform. With your background in research and outcomes, is that something you guys have looked at, at all or are thinking about?
Sumitra: Well, yeah. I mean, I think there's definitely some. Well, first of all, we've got to be honest. We spend a lot of time on our IOL calculations and there's still no perfect way—of course there's gray zones about effective lens position and stuff. I think that's where some of the formulas are going. Some of the newer-generation formulas. They haven't quite gotten there yet, but you're right. It would be nice to know, to have the outcome be predestined.
There's always going to be outliers, as one can know, but, one thing I've learned with this administration rule of doing the outcomes is that it is very much a pattern, and you see patterns over and over again, and I think because we're more excited about things like producing papers from this, and the literature that goes with this, and how to create our day. But, I bet you there would be a way, even from scheduling your OR day to scheduling your clinic for some metric, to go in there to make you more efficient. Not just your scheduler, but really, I mean, the numbers are there.
For example, our schedulers now are finding this is how long it's taking me to see this patient, well, let's re-process her schedule. But I bet you there'd be a way for a machine to do that for you and be much more accurate. Right now, we're putting manpower into it. Manpower to calculate IOLs. Manpower to figure out where to put your LRI. Manpower to figure out how your schedule should be. How many cases you can do in a day. It's very interesting to see the little assembly line like, but as long as there's checks and balances to make sure the outcomes are still just as good, I think it's a pretty exciting idea.
Gary: Yeah, I've actually thought about this. Efficiency is the ultimate in sophistication in my operating room. I preach efficiency so much that my techs and nurses roll their eyes every time I say the word, but I'm like the efficiency hound and I actually said something very similar the other day. I said, "You know, if we can put in the age of the patient, the grade of the lens, the clarity of the cornea, and the maximal dilated pupil, I would bet you that we could probably, if we had those four factors, we could probably with pretty tight tolerances, predict how long the case is going to take and we could actually find ways to schedule patients more efficiently."
Because we know that some cataracts are going to take [two] to three times as long as another one, but our schedules generally don't know that unless we somehow tell them that. So, yeah, I totally agree with you. I think there are ways that we are going to utilize artificial intelligence to make our schedules flow better, to make our outcomes more predictable, and, I think, one other thing is, we're going to be able to sit down with a patient and know if they are a potential outlier before we do surgery and give them some relative parameters just like the weatherman would say, "60% chance of rain."
Well, what does that mean? It means, maybe, take an umbrella but maybe it's going to be sunny. It'd be nice to sit down with a patient to say, "Based on the way your eye is built, we have about a 40% chance of hitting our target." At least we can set our expectations ahead of time with that patient based on some factors, rather than just saying, "We'll fix it with LASIK later if it's not the way we want to be." So, anyways, I'm excited about artificial intelligence, and it sounds like you have some interest there as well for the future.
Sumitra: I think also, I mean, I think as our patient population changes—it's a different demographic, it's a different generation—I think we're going to see more interest in patients knowing those kinds of numbers, [and] having more efficiency in the clinic. I mean, we're already seeing that now. I mean, it's not that common to get a patient who expects that long time with the surgeon in the room discussing all this. They want to hear outcomes and numbers. I go to a satellite clinic out in Clear Lake, out in Houston, which is near NASA, and half my patients are retired engineers.
Gary: Oh, wow.
Sumitra: They used to be part of the Department of Defense. I mean, you should just hear it. They chat with me about, they're like, "Really. That's how you do your IOL calculations?" They're like, "I would have thought this, this, and that." I'm like, "Wow.” They're interested in the numbers, like, "Hey, you have a long eye so, your chances of having a hyperopic outcome or a myopic outcome are a little bit different compared to the regular population."
I think we're going to see that more and more. Obviously, that's a unique population. They want all numbers. They want to wipe my landing pad.
Gary: That's right. You should actually gather those old engineers and put them to work for you because I bet they would come up with some amazing things, and they probably have a lot of gas left in the tank, so, just a thought. So, anyways, well, Sumitra, I'm so happy that we got a chance to catch up and that you got a chance to come on and give us some of your insights, and, as I've said to some other guests in the past, anytime you have something you'd like to share with us, you have an open invitation to come back on. We always love hearing what's going on with you and look forward to seeing all the things you're going to do in the future for our profession. So, thanks again for being on tonight.
Sumitra: Awesome, thanks for having me here.
Gary: Awesome, this has been Ophthalmology off the Grid with Dr. Gary Wörtz and Dr. Sumitra Khandelwal. Catch you next time.
Gary: Residents often seek advice that will help them with their job search, and they can benefit from a mentor whose guidance is honest and realistic. Those just starting out in their career can benefit from following Sumitra’s example.
Reach out to the people you want to work with and start forming connections early on. If possible, gain exposure to a range of equipment before you go out into practice. Be able to sell yourself on your strengths. Even if a practice isn’t actively looking for someone new, you might find out that you have just the skills and experience it needs.
This has been Ophthalmology off the Grid. Thanks for listening.
Speaker 1: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.