Passing the Torch

Listen as Marjan Farid, MD, and host Gary Wörtz, MD, discuss the late Roger Steinert, MD, an icon in the field of ophthalmology who passed away last year. Farid describes the valuable lessons she learned from watching him work and how she tries to emulate him in her daily interactions with patients.

Gary Wörtz, MD: When our field loses someone of great significance, what’s our role in preserving their legacy? What can we do to remember them, honor them, and see that their work and their ideas are carried forward?

Today, Dr. Marjan Farid and I will dig into just that. We talk about the late Dr. Roger Steinert, an icon in the field of ophthalmology who passed away last year.

Marjan is on the faculty at UC Irvine and trained under Dr. Steinert as a resident and as a fellow. She speaks to us about the valuable lessons she learned from watching him work, his unique ability to solve problems that no one else could, and how she tries to emulate him in her daily interactions with patients.

Coming up, on Off the Grid.

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

Gary: This is Dr. Gary Wörtz with another episode of Ophthalmology off the Grid, and today I'm joined by none other than the tremendous corneal surgeon Dr. Marjan Farid. Marjan is at UC Irvine and was a trainee under Dr. Roger Steinert both as a resident and as a fellow. Today, we're going to be talking a little bit about carrying on a legacy, passing the torch. What is it like to carry on after someone so important is gone, and how do we honor someone like Dr. Steinert for all the years of work that he did, by sort of carrying the baton after his passing.

Marjan, thank you so much for spending some time with us, and welcome to the program.

Marjan Farid, MD: Absolutely. Thank you so much for inviting me. I'm so excited to be here talking to you, especially to be talking about Roger Steinert, who is my champion. I'm excited.

Gary: Tell me a little bit about the first time you met Dr. Steinert, what that was like.

Marjan: Perfect. I actually did my residency training at UC Irvine and started my residency training in 2003. That same year, when I was a first resident, is when Roger Steinert moved from Boston to Irvine and joined our faculty. We sort of started there almost at the same time. I was a first-year resident, so at that time I was trying to figure out how to use a microscope, and everything was very basic. I watched Dr. Steinert in his work and building his practice. As a senior resident, I got to operate with him, learn cataract surgery from him, basic cataract surgery, so that was phenomenal. I had a copy of his book, and now I had the real thing sitting next to me, and it was an amazing experience.

I was thinking at that point of just going into private practice following residency, and I remember him speaking to me and really urging me to continue my training and to continue in the field of cornea. I did. I selected a handful of fellowships in Southern California, I didn't want to move, and applied to those. I ranked Roger Steinert number one. I wasn't sure if he would rank me, because I had already been there, and most people don't necessarily choose their own residents, but I matched with him. He had ranked me number one, and I had ranked him number one. It was sort of a match made in heaven for me anyway because that was the best thing that ever happened to me.

Being able to really train with him one on one as a fellow is a unique relationship because a fellow and a mentor are often spending more time together than we do with our families. We're at work side by side every day into the evenings, the OR, sharing all of the work together. You get to learn so much from your mentor and so much about him. One of the most amazing things that I took from that year was learning how to think, really, because that's so important in what we do.

We see patients in front of us, and it's not just about going to the textbook and pulling on the rigid things that we know but really learning to think outside of the box. I remember him sitting and, in front of the patient, putting his hand to his head and just sort of thinking, and thinking outside the box. The things that he would come up with were just amazing, where nobody could figure out what's wrong with this patient who had had previous LASIK and had these high-order aberrations, and you could just see him think outside the box and bring in data and figure out what nobody else could figure out.

That has been the best thing that I've learned from him because, as a diagnostician, I think that that has been such a valuable tool that he's given me.

Gary: Let me stop you right there. You know, really, the gift of learning how to think, what better thing could we hope to pass on ourselves to others who work with us?

Marjan: Exactly.

Gary: What better gift to receive from someone, especially someone like Roger. I want to ask you, this is a little bit of a personal question, what did it feel like to know that you were chosen by Roger Steinert? How empowered did you feel at that moment knowing that Roger Steinert could probably have his pick, let's just be honest, of anyone to train, to be with, and he picked you. How did that make you feel in that moment?

Marjan: I mean, just amazing. You feel so blessed and this feeling of awe that, again, he could have had the pick of his fellows with amazing research backgrounds. I certainly wasn't the top in terms of publications. I didn't come in with all of that. Somehow, he had seen my work and my work ethic, I think, as a resident and felt that that was what he was looking for in his fellow, somebody who is going to work with his patients every day, speak with his patients, operate on his patients. It's amazingly flattering. It was phenomenal.

He really became, over that year, like a father to me. I hope and pray, and he always would tell me how proud of me he was. That is something, because I grew up without a father, and he really filled that role in my work but also in general of this person who's passing on to me his work, his way of thinking, his craft, and me carrying on that legacy.

Gary: That's so interesting. I'm actually from a family of doctors. My dad is a doctor. My uncle is a doctor. My brother-in-law is a doctor. Then I become a doctor. What you're saying, it actually reminds me, just in this moment, of all the conversations I would have around the dinner table with my own father, not really probably meaning to, but he kind of taught me how to think. He's an internist, just retired. He was like Sherlock Holmes. He loved those cases, those people…

Marjan: Exactly.

Gary: He just loved those patients that had been to every other internist in town or maybe had gone to the Mayo Clinic and come back, and no one could figure it out. He relished the opportunity, and he was great at explaining to me just around the dinner table about all the different steps he took in looking at this problem and really unraveling the layers to come up with sort of the Occam's razor of the simplest diagnosis. It's very interesting.

Marjan: That was Roger.

Gary: That's so cool. Fast forward a little bit. You've gone through residency. You hold this man, obviously, in high esteem. He was a lion. I unfortunately never had the distinct honor to meet Roger. That is one of my great regrets in life is that I didn't get to know him. I feel like I'm getting to know him posthumously through talking to people who loved him and everybody who knew him, to know him was to love him I'm learning.

Tell me, there's got to be a couple of interesting stories, funny stories. Tell me some stories. What was one of those interesting things that you saw with Roger. Give us something good.

Marjan: There's a lot of good things. Oh, boy.

Gary: I'm kind of putting you on the spot. That's probably not fair. Is there a particular case that comes to mind where you're beating your head against the wall trying to figure out something that was going on and Roger saved the day?

Marjan: There were so many of those. There was one patient that comes to mind who had had LASIK, didn't really know what was going on, but had fairly good vision, 20/25, 20/30, but really unhappy. It's the unhappy 20/20 or 20/25 patients. No one could figure out what had happened in her LASIK. Again, this was one of those where the patient had been to multiple different doctors, and nobody could really figure it out. The dry eye wasn't too bad because we always jumped to that. This is just at the beginning. This was when I was a fellow, so it was over 10-11 years ago when we were figuring out really higher-order aberrations and their impact on the cornea.

I can't remember the testing we did. We did some topography testing, but I think we had some kind of higher-order aberration. I think it was the old Alcon where you could check the high-order aberrations on the wave scan. I think it was. We found this weird pattern that looked like this flap hadn't been fully put back, and the treatment had hit not only the bed but had also hit the flap, and the patient had this coma higher-order aberration centrally through the vision. This was it. This was matched exactly. He was showing her a pinpoint of light and having her explain exactly which way the light was scattering that was making her unhappy and just finding out what nobody could figure out.

I remember that patient. I remember that case. It was really like a “ah ha” moment that everything, no matter what, everything can be normal. There's something going on, and it can be found. You have to listen to the patient. That was the thing because a lot of doctors had sent this patient away thinking, "Oh, she's crazy." He listened to the patient, and he believed them, and he had them describe to the "T" exactly where the aberration was. Based on that he would then figure out what happened. That was amazing.

I remember that in so much detail.

Gary: That's such an art I feel like. Given the climate that we practice in where we're all being asked to do more with less, time with patients, having that moment to actually listen and to form an opinion. Some patients are crazy. I mean, it's the reality. I think it's possible that we jump to that conclusion maybe a little hastily sometimes.

The other side of that coin is crazy people or people with peculiar personalities also sometimes have real problems.

Marjan: Correct.

Gary: You can be both crazy and have a weird thing going on at the same time. That's really hard to figure out.

Marjan: That's exactly right.

Gary: Those are the patients that are really hard to untangle. Let's just bring the story forward a little bit. You finished your fellowship with Roger, and you stayed on as faculty. Is that correct?

Marjan: Right. Toward the middle of my fellowship he approached me and asked what were my plans. I tried to keep him updated. I was interviewing here and there, and I had really no plans of going academic. He didn't push academics on me. He pushed specifically UCI. You should join this practice, and here are the reasons why. How could I refuse a job from Roger Steinert? I mean, I would get to carry on training under him, if you will, and carry on working with this amazing mentor indefinitely. That was a no brainer to me. At that point, I really dropped everything and decided to join the faculty.

After joining the faculty, I realized that I do love academics, and I'm really enjoying academics and enjoying the research and enjoying the cutting edge with him as a boss and as a chairman of the department. The benefits are watching him interact with industry and move the department into this collaboration with industry to spark more innovation. I watched all of this happen. We would turn around one day and say, "We now have two PentiCams," this was back when PentiCam was new, "donated because we're going to do this and that research on this."

It was wonderful to see that we could really be the center for academic excellence and that industry would help us with that. He really was able to make those bridges.

Gary: It's interesting, it really, kind of, comes back to creating a culture. I’ve heard the stories through the years of how he came out there and really just bootstrapped and built this program, and was able to do it in a way that seems is unique in an academic world. What do you see as somebody that sets UC Irvine a little bit apart from other academic centers? A lot of times you hear from people who have gone into academics, you hear about the frustration, the frustration of “I'm being managed by a big hospital system or a big academic system.” We're a small fish in a really big pond, and people don't necessarily give us our due. At various centers I hear, "I have no control over my staff." It's just a lot of layers of bureaucracy. How's that different at your institution?

Marjan: You're absolutely right. He came in, and he changed the culture. That's exactly the words for it. Many academic institutes have this problem where there's this almost disconnect from the academic research and the research that's being done in industry, and there's this big disconnect. There aren't those bridges. There aren't those gaps. There isn't that communication.

One of the reasons Roger Steinert moved to Irvine is because it was one of the centers for ophthalmic industry in Orange County. His proximity with our institute and all of these various industries and the ability to collaborate with them really changed the culture and allowed us to move forward in our research and in our collaboration in general.

Then, he set the department in such a high standing in the university's eyes. At this point, the department of ophthalmology, even now a year after his passing, is really their star department, if you will, in terms of excellence. We were able to fundraise and build our own eye institute with 100% philanthropic funds. This was all done under his leadership and guidance. This was unprecedented. It was really an amazing feat to take this small obscure department and really make it stand out in the nation and the world as a place of excellence.

Gary: I feel like there's so many lessons to be mined from what he did that could be applied to other departments looking to make a name for themselves. That's probably a whole other podcast or book or whatever you want to call it. It is very interesting when you have the right leader at the top who can shape culture and has given enough leash or leeway to make the changes that are necessary. It really is amazing what can happen. I think this is a really good case-in-point of just having the right leader to come in and craft something that is excellent and honestly something that, thankfully, will outlive him. He created something that was expanse, something that's going to continue living on.

Let's talk a little bit about that. How have you been able to take over some of the things that he was doing, perhaps with research, perhaps with patients, and in many ways carry on his legacy?

Marjan: In every aspect of my patient interactions daily, in my mentorship of my fellows now, I try to emulate how he was with me, and I try to give them that deeper understanding, a way to think, a way to approach every case. I give credit to Roger Steinert almost daily in the OR and in the clinic. I will tell my fellow, "This is how Roger Steinert did it. This is how we're going to learn how to do this particular case.” That's every day.

In terms of my research, he was the first corneal surgeon who took corneal surgery and bridged it with refractive surgery. He's really the one who brought those two worlds together.

Gary: Those were really disparate worlds. Those were worlds that were way, way far apart. For younger residents or guys and gals coming out, in some ways there is still a disconnect in many academic centers between the worlds of refractory surgery and true cornea care. At the beginning, it was almost like a battle front or something.

Marjan: Yeah, there were a lot of people who were very against, for example, femtosecond laser corneal transplant, which hopefully I'm continuing to work in that area and try to push the boundaries, but really to bring it to the forefront of corneal advancement because we really haven't seen a push in full thickness or deep anterior lamellar keratoplasty from what we knew. We know femtosecond laser incisions are better. That's one of the works that I'm carrying on to refine that even more and to make it more accessible to corneal surgeons everywhere. One of the big issues was cost of laser, but now that we have femtosecond laser technology potentially available in every cataract suite, we can bring that technology to a wider corneal world as well. These are the sort of advances that still need to happen and hopefully I'm going to help with leading the way. That legacy is something that I'm passionate about carrying on.

Another project that we started shortly before he got ill was sort of his vision for designing an artificial cornea that could be really used worldwide. There's some exciting collaborations and people that he got us connected with at UC Irvine who are working with material sciences and moving that forward as well. There's some work being done that I'm continuing with Dr. Yee from UC Irvine Material Sciences and so on to see working with different materials and trying to get a feasible artificial cornea designed.

Gary: I know just from our conversation in the past that there are some great ideas. I don't know what they are, because I've told you not to tell me, but you've got some great ideas percolating. I know it. These are probably all skunk works mystery projects that can't be talked about. I'm sure there are so many more things that are happening behind the scenes at UC Irvine, and we can't wait to see the seeds that were planted with Roger Steinert years ago. We're going to see the fruits of those labors come to pass, I would imagine, for years and years to come.

Marjan: I think so.

Gary: Any final words about Roger? I know he meant so much to you, and it's hard. It always feels inadequate when we talk about someone to truly feel like we've done them justice when they mean so much to us. Any final thoughts on Roger?

Marjan: Well, there's lots of final words on him, but here was a man who was an amazing ophthalmologist but also an amazing person. Humble and approachable and lovable at his level where even anybody working around him at whatever layer of work they were doing, technicians, office staff, colleagues, residents, where he was equal in his love and respect for humanity and people who were doing service with him.

That's something you don't see every day and made him really stand out as a human being and one who sort of saw this future of ophthalmology and this collaboration between all levels, between industry, academics, private practitioners, to advance our field. A wonderful man, a wonderful father, a wonderful husband to his family, who I feel I'm part of now as well and love them all. We just hope to carry on that legacy and remember him continuously in what we do.

Gary: Well, I know that he is very proud of the work you and everyone at UC Irvine are doing to carry on his legacy. I don't know that I've ever met or heard of someone who is so widely revered, loved, and respected, and I guess it's our job to learn the lessons from him and carry on that legacy. Thanks, Marjan, you're always welcome to come back as a guest. Look forward to seeing you at our upcoming meeting sometime soon.

Marjan: Absolutely. Thank you so much for having me, Gary.

Gary: Absolutely. This has been Dr. Gary Wortz with Ophthalmology off the Grid with Dr. Marjan Farid. Until next time.

Gary: We’re lucky to have people in the field like Dr. Farid, and everyone at UC Irvine, to carry on the legacy of someone who was as beloved and respected as Dr. Steinert.

He stood out as someone who saw the future of ophthalmology. He was an outside-the-box thinker who showed others a different way to approach problems, and how to really listen to a patient before forming an opinion.

Dr. Steinert’s influence helped turn a small ophthalmology department into a place of excellence. With the efforts of people like Marjan, his legacy will live on for years to come.

This has been Ophthalmology off the Grid. Thanks for listening.

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