Ophthalmology off the Grid
Episode 56

Fresh Perspectives

Audrey Talley Rostov, MD, talks to Gary Wörtz, MD, about her passion for working with organizations such as SightLife and Ophthalmic World Leaders. She also describes spending time as a child at her grandfather's dermatology practice and the strategic early career choices that helped her land in the right position.

Gary Wörtz: Projects that take us out of our typical day-to-day work environment can be extremely rewarding. Taking an active role in philanthropic efforts can introduce us to new populations with unique needs and provide us with a fresh perspective.

My guest today is someone whose work I greatly admire. Dr. Audrey Talley Rostov is a cornea, cataract, and refractive surgeon who is also heavily involved with SightLife, a global health organization with a mission to cure corneal blindness worldwide.

Audrey took time to speak to me about her experience traveling to India to work in an area with an overwhelming need for cornea care. She also talks about spending time as a child with her grandfather at his dermatology practice, and the strategic early-career choices that helped ensure she would end up right where she wanted.

Coming up, on Off the Grid.

Speaker 1: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.

Gary: Welcome back to another very special edition of Ophthalmology off the Grid, this is Dr. Gary Wörtz, and tonight we are talking to the one and only Dr. Audrey Talley Rostov. Audrey and I have known each other for quite a while. I think we've known each other digitally or virtually for a longer period of time, and have recently become acquainted through some projects and through some groups we've both participated in. Audrey is someone who I have just tremendously respected through the years for her body of work, both surgically and philanthropically, also, with her efforts in teaching. So, I think if there's an archetype of someone that we might all want to look up to and model our lives a little bit after, I think Audrey kind of represents a lot of those things. She's been kind enough to come on tonight and give us a little bit of an inside look into what makes her tick. So, Audrey, I hope that hasn't embarrassed you, all those things are very true, but thank you for carving out a little bit of time to spend talking with us tonight.

Audrey Talley Rostov: Great, thanks Gary, you're too kind.

Gary: Well no, I think that if anyone knows you, I think all the things that you do kind of amaze all of us, the fact that you're able to kind of keep a really healthy work life, and a family life, and a life that allows you to be active and engage in projects that are really important to you. So, before we dig into all that, I'd really like to just hear a little bit of your back story, what drew you to ophthalmology, what drew you to medicine in general. Most ophthalmologists I've met have some event or something that kind of steered them in that direction, so I would love to hear what it was for you.

Audrey: Sure. Well, growing up, I spent a lot of time with my grandparents, and my maternal grandfather was a dermatologist, kind of a dermatologist/family doctor, practiced out of his house, and I spent a lot of time basically in the waiting room and conversing with patients, having my stuffed animals come in for various and sundry maladies and things. He was a big factor, I'd say, in my life. It was interesting, this was way, way back in the day, my grandfather actually was French and got his medical degree at the Sorbonne, and I still have his medical textbooks which are in my office, and a lot of them are in French. When he got his degree in dermatology, it was before antibiotics. It was in dermatology and syphilology.

Gary: Wow.

Audrey: Yeah. So, basically, they treated things with heavy metals and such, and just fascinating to look at how medicine has changed over the last not-quite-century, but from the early 1930s onward. I'd say that would be my start in medicine, and was always of interest to me even from a very young age. Then, when I was in medical school, I actually ended up doing, a bunch of different things occurred, but I ended up doing a year research fellowship in ophthalmology. I was looking around, I had been working in a different lab, and the funding changed, and so I had a meeting with some friends of mine, and a friend of mine was telling me that he had another, there was a fellowship that was becoming available, and so I ended up working in the lab, and ended up working on a rabbit model of endophthalmitis, of all things. That just really turned me on to ophthalmology, and I just basically fell in love with the field, with how much you could make a difference in somebody's quality of life, and the very delicate microsurgical techniques combined with both outpatient medicine.

It just really felt like [to] me to be a home there. As well as being able to be innovative, and again to me it was really the difference you could make in someone's quality of life.

Gary: You know what, that reminds me so much of my own story. I've heard this time and time again, but ophthalmology is so special. I guess we're sort of preaching to the choir, we all believe that, but honestly it is a field that is really medicine in a nutshell, because you do have all the patient interaction that you could want, if you want to gear your practice that way, you have all the medical and rheumatologic conditions or infectious disease processes that need to be looked after, while at the same time you have all the surgical and insanely delicate microsurgery. Really, even within ophthalmology one can gear their practice all the way from peds to geriatrics as well. It is sort of this microcosm that we find ourselves in. I agree 100%, helping someone's quality of life, I don't save too many lives as an ophthalmologist, I did resuscitate a guy on a cruise ship one time, that's a whole other story, that was kind of rewarding, but I love helping people see, and it really never gets old.

Walk me through, I know that at some point after residency you did a fellowship with Dick Lindstrom, is that correct? Do I have my facts right?

Audrey: Yeah, exactly. I was really very honored, and had the privilege to be able to train with Dick Lindstrom for my cornea and anterior segment fellowship, which was really one of the highlights of my career. He is such an amazing man, it's like the man, the myth, the legend. He is an incredible legend in ophthalmology, but what a wonderful mentor. He was probably one of the most patient people I've ever met with, during the fellowship, millions of questions and spending the time, taking the time with me for training. Also, learning from him, in terms of innovation cycle, and learning that really seeing him model both being an amazing clinician and surgeon, taking the time to teach. Also, having time for a lot of different projects with industry and such, as well as with philanthropy.

Gary: I think that that is something that, it must be part of the culture of that fellowship, because I have so many friends and colleagues that we share who have gone through that fellowship, and every single one of them that I know has led this incredible professional life that does have those various facets of both the surgical, the innovation, philanthropy. That must be something that just is infectious when you are around Dick, and all the faculty at the Minnesota Eye Consultants. Is that a fair assessment?

Audrey: Absolutely. I can't think of really a better place to train, to have trained or to train, to really experience all those different facets of what can compose a really rewarding career.

Gary: I know at this point you're a partner at Northwest Eye Surgeons. Walk me through a little bit about your, if you don't mind, again I'm just sort of being nosy, but I'm curious as well.

Audrey: Sure.

Gary: Tell me a little bit about your early journey after fellowship, getting into practice, to where you are at this point in your practice.

Audrey: Sure. After fellowship, I have a lot of family here in Seattle, and so there was a very big pull, extremely strong pull I would say.

Gary: I gotcha. You were moving to Seattle one way or another, whether you wanted to or not…

Audrey: Exactly.

Gary: I gotcha. Okay.

Audrey: …To come to Seattle and settle. So, when I was looking for jobs initially out here, initially I was very involved with academics and a lot of publications. I had some different experiences, the great experience with Dick during my fellowship was amazing, but also made me rethink a little bit full-time academics. So, I decided to come out here to Seattle and to join an HMO at first, mostly because I didn't want to be tied into a practice. I was looking to set up my own practice, or to join an existing practice, but I was concerned about restrictive covenants. So, for a very brief time, I just joined a hospital-based practice that didn't have a restrictive covenant, so I could really take my time and look around and see the lay of the land. So, that's what I did. I was there for about a year. The great thing was, because it was a hospital-based practice and they didn't have a cornea surgeon there, they had kind of a small ophthalmology department, there was a ready-made practice for me to jump into.

So, I had complex cornea cases and sclerals, IOLs, I had all this complex stuff, which was great, just starting out of the gate. Then, I looked around and really had located a place where I thought I was going to have an office, and build a practice there. At the same time, one of my colleagues in town, a friend and colleague said, "Hey, the practice," his practice was looking for a cornea person. Essentially, I joined that practice with the understanding that if it didn't work that I would have this little office of mine, kind of south of Seattle, and a few years later, there were some ups and downs there, but a few years later, I became a partner. Then I became managing partner. Then we expanded the practice, and here I am.

Gary: Wow. So that's the origin story, you actually sort of just wanted to take your time, get your bearings in Seattle, figure out what the opportunities looked like, and make a strategic move.

Audrey: Exactly. I knew I needed to be very strategic, and because I knew I needed to be in Seattle, I didn't want to join the wrong practice, and knew I needed to kind of buy some time in a sense to look around a little bit and see what that looked like. Whether that was going to look like something that was my own, or joining an existing practice. I really wanted to again be strategic, mostly because I knew that this was where I wanted to be. Kind of like in real estate with the location, location, location, I didn't want to be fenced out of the place I knew that I wanted to remain.

Gary: That's funny, your whole meteoric pull to Seattle reminds me of my meteoric pull to Lexington, that's where my wife is from, her entire family is from here, it's where I trained. It's funny, I don't think I've told anyone this, but I actually took my first job an hour away from Lexington so that I could do the exact same thing. I could actually have a job that I could commute to, and wait and look for the right opportunity that presented itself in Lexington. So, I actually took the very same tack that you took, of a part-time or starter job, with the idea of looking for a more permanent job, without the problems of restrictive covenant.

Let's go on. I want to get in a little bit deeper with some of the things that you're really passionate about. You've talked a little bit already about complex corneas, you had fantastic training with Dr. Lindstrom. I know that you are deeply involved with Sight Life. I'd love to hear about how you got involved with SightLife, and also update us a little bit about what's going on with SightLife right now. It seems like they're just making some incredible strides, and we want to focus on that a little bit.

Audrey: Sure. Well, getting involved with SightLife, SightLife began as the Northwest Lion's Eye Bank, and so since starting in cornea practice, they were my eye bank, and as you know as a cornea surgeon, you're just basically intricately involved with your local eye bank. That's how the relationship began. Then there was a series of events that I call kind of a happy accident in a way. It was about 9 years ago, and I was actually invited to be a keynote speaker at a meeting in India. I had never been to India before. There were actually two meetings in fact, there was one in Ahmedabad, which is in Gujarat in the north, and then there was another one in Mumbai. So, my husband and I thought, well, wow, this is just a great opportunity, and so what we did is, I had planned to take the time off, I actually was able to manage 3 weeks off from practice, which never happens.

Gary: Wow. Yeah.

Audrey: My husband was taking, it was close to 3 weeks off. We had three kids, they were little then, and so we found places, appropriate childcare for our three children, which is nothing short of a miracle. I had plane tickets, and we planned things around the two meetings and some travel. Then a few weeks before the meeting was to occur, there were the tragic bombings, terrorist attacks in Mumbai, where I believe it was, maybe, the Taj Hotel and a Jewish community center. Just a horrible devastation. Also, a few weeks, I don't remember whether it was before or after, or within a couple of weeks, there were also bombings of several hospitals in Ahmedabad where healthcare workers were involved. So, the meetings actually ended up being canceled. This was a few weeks, maybe 6 weeks before we were supposed to go, or less. The meetings were canceled.

In the meantime, we had all of this infrastructure in place. My husband grew up in Brazil, and we are fairly intrepid travelers. We've taken our kids from young ages to more unusual destinations. We decided that, why not, let's go, there's probably never a safer time to go because everyone's on alert. We would just avoid some of the more major cities. We just restructured our trip and went to India. Before I went I asked SightLife, I said, "I have all this extra time now," and I was supposed to be at these meetings, and I had kind of heard that they were starting a global project affiliation in India. I asked if I could add some value while I was there. So, they said, "Well yeah, actually.” In Kochi, which is in South India in Kerala, there was a surgeon there who was the only cornea surgeon for, I don't remember how many millions of people.

She wanted to learn some DSAEK. So, basically, we arranged for me to go over there and to train her in DSAEK, and I had some pre-cut corneas available, and I sent over some tissue. Also, we used some of the tissue that they had available through their eye bank. When I got there, aside from just the DSAEK, we just did some more complex PKs, and PKs and IOLs. I was just amazed by the amount of pathology and the amount of need, that there was just so much need, it was overwhelming, the need for cornea care. They had their worst cases of bilateral corneal blindness, and I remember specifically there was this one older gentleman, a grandfather, who was being led in by his grandson. His grandson's sole job in life was to lead around his grandfather with bilateral cornea blindness. The man's daughter, the little grandson's mom, had to cook for her dad and had to care for him. So, it was basically this whole community caring for this older man, who was a very important man in the community. I ended up doing a cornea transplant and a cataract, an IOL.

The next day, he had ambulatory vision. When we took off the patch, he literally had ambulatory vision, and we realized that, not only could we make a difference and give him his life back, but it was also his grandson, and his daughter, and really the community. Taking a look at what a difference you could make not just for individuals, but for families and communities, and just how great the need is there in terms of corneal blindness. It's one of the highest prevalence of corneal blindness actually in the world, is in India. That just motivated me to figure out how I could become more involved and do more. So, I'd say that was the seminal event, if you will, that just made me realize how great the need is, and that this was basically something that I wanted to dedicate a lot of time and energy to helping.

Gary: Right. It reminds me of a story that Kevin Waltz, who I'm sure you're familiar with, told. He has done a lot in Honduras and El Salvador, and I've worked with him on some research. He said, "We think about cataracts surgery, and the corollary is really the same for corneal blindness, but the thing about cataracts surgery is just helping the patient to see." He said, "The real win is not just that the patient gets to see, but the grandchild who is taking care of the grandparent now is free to go to school and get an education. The daughter of the grandparent who is trying to make ends meet now is freed up to make more money and earn a living and provide some extra protein in the diet for everyone." It really becomes this bimodal distribution of effect where it's not just the older patient with the cataract or corneal blindness that you're helping, but you're really helping free up resources for the next generation to better their story and their family. It sounds like you're experiencing that same thing with your story.

Audrey: Absolutely. Yeah, so that moment I would say made me realize, as I said, just how great the need is there for treating corneal blindness. With SightLife, that's what happened about 9 years ago, and since then I've become a global medical director. I am actively involved in surgeon training, and curriculum development, and eye bank capacity building. The thing that I really enjoy about SightLife is that we really work on sustainability. So, it's training local surgeons in their local environments and their operating theaters, their ORs, and with what they have available. But, also making sure that there's all parts there, that there's eye bank capacity building. So, there are local eye banks that can get local tissue through eye donation counselors. In-hospital donation counselors to improve the amount of tissue that's available. Then, to have standardized protocols for screening of tissue, evaluation of tissue, processing of tissue, actually helped with having some pre-cut tissue over the last several years. Ramayamma Eye Bank at L.V. Prasad was the first in India to offer pre-cut dissect tissue.

Gary: Wow.

Audrey: Yeah. To really help with IT infrastructure, and so really helping with the whole cornea ecosystem. So, it's not just the type of group where you go and you do a bunch or surgery and leave, and then leave all problems that you sometimes created. But, it's really working on the entire cornea ecosystem. I think that that's one of the things that's so important when you're thinking about global health, is to think about all the different parts, the different components, because you can't just do one, especially in cornea care. If a surgeon doesn't have access to corneal tissue, then it's silly to train that person in corneal surgery if they're never going to doing it.

Gary: Right, no that's exactly right. The infrastructure becomes almost even more important than just the skill, because the skill is the tip of the spear. That's the last thing that needs to be there, and perhaps almost the easiest to train. All the other tackling and blocking that needs to occur, that does really require a lot of people thinking and strategizing. So, congrats on all your work with SightLife. Another group that I know that you're very active in, actually I just saw a tweet that you put out, I think yesterday or why day before with Michael Onuscheck, that is OWL, Ophthalmic World Leaders. So, tell me a little bit about your role in OWL, and what that group has meant to you over the years.

Audrey: Sure. OWL is an amazing group. It is a group of really dynamic people. The group Ophthalmic World Leaders, it started out as Ophthalmic Women Leaders.

Gary: Then Bill Trattler showed up at a meeting, right? So, you had to figure out…

Audrey: Then, we had to figure it all out. We just changed it up. So, we actually started out as Ophthalmic Women Leaders, and a few years back, Marsha Link, actually, Jaci Lindstrom, and then Marsha Link, convinced me to join the group. I didn't really know very much about it. At first it was mostly, I thought it was more for industry people. I joined and I realized that there was just this really dynamic group of individuals. The sharing, in terms of different issues, whether it was a practice management issue, or an issue of wanting to…ideas for innovation with industry, I realized that there's really such a nice amount of truly reaching across ophthalmology. It's a very interesting group. There's really no other group, I'd say, in ophthalmology like it, because it brings together people from practice management, surgeons, as well as leaders in industry. The amount of interactions, and network expansion, and opportunities are incredible.

I am sure that if it hadn't been for OWL, I wouldn't have Michael Onuscheck, president of Alcon, there in my OR with me to learn more. We had met at a meeting, at one of our OWL board meetings, and he said, "I really want to learn more about the cornea space. Can I come up and just spend some time with you in your OR?" We picked a date, and that was just the other day. He came up, and we had such a great discussion about how we can lead some different innovations that'll ultimately serve our patients. I'm sure that if it hadn't been for OWL, the two of us wouldn't have had the opportunity to have that interaction, and what's become a great friendship.

There’s many other people that I’ve had the pleasure and privilege to get to know through OWL, all different leaders in industry and practice management that have helped me when, say I've had an issue, an employee issue, and yet I was able to reach out to a colleague who had, say, a global salesforce of about 600 people or 800 people, and ask how they managed some different practice management issues that come up, employee issues, and then put that to work in my own practice. Those sorts of connections are really invaluable. It's such a nice place to be where there's not the same sort of feeling of competition, different industries against each other, it's really much more collaborative and almost like a safe space, if you will.

Gary: Right. Well I'll tell you, I've had the opportunity to have a few meetings with Micheal Onuscheck, a dinner etc., and I guess we shouldn't have favorites, but he's one of just the most incredible guys. It's always exciting when you have people in industry who are willing to come and spend some time learning and collaborating. Man, if OWL did nothing else for you than just that, and I know they’ve done a lot more, how wonderful of an opportunity I'm sure that was to have.

Audrey: Absolutely.

Gary: Yeah, it's fantastic. I've been a bystander in OWL, I've tried to support as best I could, and have tried to come to some of the meetings. But, I would actually like to be a little bit more involved, just like you mentioned, I think, sort of, in so many words, the quality of the people that are involved in OWL. I don't know that I've ever found a higher caliber of people, and that is across, it doesn't matter if you're a physician, or an industry, or in any of the fields, I found the quality and caliber of the people in OWL to be outstanding. I think one of the secrets of life, if I have a secret it's nothing that I've done, I've just found good people to surround myself with, and for some reason the goodness just rubs off. I've been very blessed and lucky to have good people that I've been able to surround myself with.

Audrey, before we wrap this up, while I have you here, I feel like this is such a cool opportunity to talk to a surgeon that I respect so deeply. I want to talk a little bit about your cataract practice. That's sort of my area of deep interest, and an area that I think we probably have a lot of overlap. I'd love to hear a little bit about your current cataract practice, and maybe just get a little bit of a flavor for what things are exciting about cataract surgery to you right now, whether that's laser technology or lenses, etc. What is exciting to you right now, and where do you think the future is going with maybe refractive cataract surgery?

Audrey: Well, I think it's really exciting right now, as both a trained cornea cataract and refractive surgeon, cataract surgery is a refractive procedure.

Gary: Absolutely.

Audrey: A couple of years ago, we actually moved to having an all-femto platform. So, we basically offer femtosecond laser-assisted cataract surgery, we offer that to every single patient, and we don't charge for it. Because, what I was finding is, some of the patients who I felt needed the femto cataract surgery the most could afford it the least. These are your 4+ brunescent cataracts with some loose zonules, or the white intumescent cataract where you go, "Whoa, that capsulotomy is going to be a challenge there." Much as I love South America, that Argentinian flag sign is sort of not a favorite. So, we started offering it basically for no charge. We don't charge for the femto cataract surgery. We do charge for vision correction packages. We have vision correction one and vision correction two, kind of a driving or reading vision package, and then a package that would include your multifocal or EDOF lens, which would be your range-of-vision package.

By doing a large percentage of vision correction, it really allows me to offer the femto for everybody. About 80% of my cataract surgery is what I would call vision correction, so, I'm putting in a multifocal, or a toric, or a toric multifocal, or an EDOF, or something of that nature. Or, it's a previous transplant patient where I'm doing corneal relaxing incisions and their graft at the same time as their cataract surgery. Something like that. I think it's a really exciting time. I love doing all femto cataracts. It's a lot of fun. I really like being able to offer my patients the ability to improve their vision to where they want it optimized, and a lot of the new IOLs, I'm super excited about the adjustable IOL that's coming down the line, also, the innovation in terms of the fluid-accommodating IOLs. Every few years there's just more and more offerings. I think it just makes it that much more fun.

Gary: I totally agree. It's so nice we get an additional tool in our belt, and it's fun to see how smart and innovative people will use that to either drive outcomes in a way we didn't even expect, or piggy back and make one innovation turn into a whole line of other innovations. Audrey, thank you so much for spending some time with me tonight, sharing a little bit about your story, about how you've gotten involved as an advocate both for corneal training and infrastructure through SightLife, and also through OWL. Just all that you do for your patients in Seattle, and all you do for industry, wherever you go. So, with that, thank you so much for being a guest tonight.

Audrey: Well thank you, Gary. It's a pleasure to have some time just to sit down and talk to you.

Gary: Absolutely. Look forward to seeing you at that meeting in the near future.

Audrey: You back.

Gary: Okay, this is Dr. Gary Wortz, with Doctor Audrey Talley-Rostov, on Ophthalmology Off The Grid. Catch you next time.

Gary: There’s so much to learn from the example set by Audrey. When you’re just starting out in your career, it’s worth it to take your time, get your bearings, and when the time is right, make your move. Whether your goal is to join an existing practice, or start your own, having a strategy can help ensure that you end up at the right practice in the right location.

In addition, there’s great personal reward in pursuing passion projects. Becoming active in work that is meaningful to you is a great way to round out your career experience.

When you choose to use your skills to serve a population in need, your efforts can have a ripple effect—helping one person can, in turn, help an entire family, or even an entire community.

With that, thanks for listening to Ophthalmology off the Grid. Until next time.

Speaker 1: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.

10/15/2018 | 35:03

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