Back in June, I wrote a blog post about the importance of eye care and the experts who are there to take care of your eyes – ophthalmologists. Too often we take our vision for granted and when something happens you don’t really know where to go other than to your family physician or local optometrist. They’ll be the ones to refer you to an ophthalmologist. Remember, ophthalmologists are the medical doctors specializing in eye and vision care. These eye care professionals can diagnose, treat common eye diseases and can perform surgeries – as well as prescribe and fit eyeglasses or contact lenses to correct vision problems.
I had the opportunity to sit down with Dr. Nawaaz Nathoo, a Vancouver-based ophthalmologist who’s a member of The Canadian Ophthalmological Society and is also a clinical instructor at the Department of Ophthalmology at the University of British Columbia. I spoke with Dr. Nathoo in an effort to learn more about the practice of ophthalmology, his experiences in the field and what a day in his very-busy life as an ophthalmologist entails.
The Vancouverite:. So, we’re currently sitting here at the Department of Ophthalmology at UBC but it’s also part of Vancouver General Hospital (VGH). Can you explain?
Nathoo: Sure. This is a teaching clinic and also an extension of VGH; here we see patients that have gone into the VGH Emergency with an eye problem. If they had a simple eye problem, then the Emergency doctor could probably help them with it. But if it’s anything more complicated, they usually refer you here to this clinic. We’d see you either that same night or in the morning. It’s staffed primarily by residents – these are doctors who have graduated medical school and are training to become ophthalmologists. It’s a five-year training program after medical school. The residents are usually paired up with a senior physician– and I’m the supervising ophthalmologist for today.
The Vancouverite: Are they involved in surgeries with you?
Nathoo: Yes, they usually are – possibly doing the surgery under supervision or helping with different steps.
The Vancouverite: Do you have your own practice?
Nathoo: Yes, I have my own practice as well. I spend two days a week at my office there and I’m here at the VGH clinic about once every second week. We have an operating room downstairs where we do bigger things like cataract surgeries. Upstairs here we do eyelid surgeries and other smaller procedures.
The Vancouverite: You mentioned eyelid surgery. Does that mean you do cosmetic surgery?
Nathoo: It can be cosmetic but most of it is functional, which means that it is causing a problem. Your eyelid has a function – its main function is to protect your eye and cover it. As you get older, sometimes your eyelid droops down and blocks your vision, or it doesn’t close properly, or it rolls in and your eyelashes are poking you in the eye. We can fix problems like that.
The Vancouverite: How does one become an ophthalmologist?
Nathoo: The way medical school works is that it’s four years in British Columbia after you’ve completed your undergraduate degree. The first two years are primarily classroom based with a little bit of clinical exposure. The last two years are full-time in clinics and in the hospital, and in one of those two years, they have a one-week ophthalmology rotation. Then it’s a 5 year residency with specific training in ophthalmology after that. In total, it can take between 13-15 years to become an ophthalmologist.
The Vancouverite: Why did you choose ophthalmology?
Nathoo: I went into university not really knowing what I wanted to do, so I did a degree in science. After going through a number of different options (including dentistry, chartered accounting and even law!) I decided to apply to med school. I went to med school initially to become an anesthesiologist because the drugs are really interesting. But the day-to-day life of an anesthesiologist is very different. From what I saw as a medical student, it’s super high intensity and super high pressure for the start of the surgery to get them to sleep, and then the rest of the time is spent monitoring the patient and keeping them asleep for the surgery. That wasn’t gonna work for me.
I landed on ophthalmology because eye problems and having good vision are so relevant to people’s lives. Sometimes a lot of the other medical specialties are about extending the quantity of life and not necessarily about the quality of life. In ophthalmology, it’s really about quality of life. So patients are interested and motivated and keen to want to do something to help you help them, which is not the case in every part of medicine.
The Vancouverite: For people who do their residency here in BC, do they tend to stay local or move away?
Nathoo: Nearly 70 to 80 percent remain in BC.
The Vancouverite: Most people don’t understand the difference between optometry and ophthalmology. How would you explain it?
Nathoo: There are a few key differences. One of them is surgery. Optometrists do not do surgery. They also don’t require a referral to go see them. If you’re having an eye problem, you have a few choices. One is that you can go see an optometrist, and if it’s something simple, they can help you. They can diagnose a bunch of different things, depending on their comfort level. They can prescribe different types of eye drops. If it’s something out of their comfort zone or it’s not responding the way they’re expecting, or if you need surgery or a second opinion, they would send you to an ophthalmologist.
There’s also the difference in schooling. Ophthalmologists have to go to medical school first so that’s why we’re trained to do surgery and tend to deal with more complex medical issues that also affect the eye.
The Vancouverite: What does your typical day look like?
Nathoo: Every day is different for me, but I’ve chosen to make it that way. I like the variety that my career brings and to me, that’s balance. I find sitting in a clinic to be interesting and fun and I like talking to people, but it’s nice to break up the week with some other types of things as well. I do eyelid surgeries, cataract surgeries and laser eye surgery – and I do a lot of teaching with medical students and residents.
The Vancouverite: What are the best types of patients to treat?
Nathoo: I like treating seniors – who predominantly make up our patient population. The average age of my patients is 70 to 75. Most are very sweet, appreciative and pleasant. That makes it easier.
The Vancouverite: What was the most difficult case that you’ve tackled to date?
Nathoo: There are challenging people who have a lot of things going on in their lives so they can be challenging to work with. There are people who have complicated eyes and medical history and probably a complicated future, so it can be challenging when they’re trying to think through their problems. And there are complications arising from surgeries. The challenge of the surgeries is what keeps it interesting. At the time, however, it can be really stressful.
One challenge is that our patients are generally awake, even in cataract surgery. So, you have to be more conscious of how you present yourself. If you look nervous, then the patient’s going to feel nervous. Therefore, the calmer and more relaxed you are, the calmer and more relaxed your patient may be. Even when there are complications that arise – which is inevitable – the key is to stay calm and think through what I’ve been taught in my training. If you have one surgery that has complications, the next patient who comes into the room doesn’t care that the last one was stressful for you. They want you to start fresh and so you have to learn to take it in stride, to reset and take a breath, then move on and finish the rest of your day and do the best you can for each patient.
The Vancouverite: How do you not take what happens during the day, home with you? Do you have a way to separate that?
Nathoo: One strategy I developed after a few months in practice was to not physically take anything home so if I have paperwork to do, I finish it before I go home. Then I try not to do any work at home, because a) it takes me five times as long when I’m at home, but then b) it also eats into family time and personal time. If there are challenging things that happen, it is hard not to take them home personally and emotionally. As any doctor, if you don’t take things home with you a little bit, then you’re probably not there with your patients from an empathy standpoint. I do take things home and I talk to my wife about it, and I find that’s a good way to work through things.
The Vancouverite: You mentioned you do laser surgery. What is the difference between Lasik and PRK?
Nathoo: In PRK, we just wipe off the top layer of cells that protect your eye, reshape the cornea underneath, and then over the next few days the top layer of cells grows back and now you have a new shape to your cornea to allow you to focus better. In Lasik, we make a slice through your cornea and make a flap. We lift up that flap then the laser blasts away the cornea underneath to change how it’s shaped and how it focuses light. Then we put that flap back down and it sticks down and heals back together. Both Lasik and PRK achieve the same thing; PRK is just right at the surface and Lasik is a bit deeper with the flap on top.
The Vancouverite: Which one’s better?
Nathoo: It’s hard to say which one’s better. Whenever we’re doing laser eye surgery we have to leave behind a certain amount of your cornea and everyone’s cornea is different. If you have a high prescription on a thin cornea, you may only be a candidate for PRK, if at all. If you’re a candidate for both procedures, then it’s your choice. PRK hurts more because we’re wiping away the top layer of cells that normally protect your eye from pain and infection. But once things heal over, you really can’t tell that you’ve had the procedure done and even someone examining your eye likely can’t tell either. Lasik is much less painful and has a faster recovery, but with Lasik you’ll always have a flap there even though it’s healed and stuck down and there’s a tiny risk of flap-related issues down the road. So, there’s pros and cons to both.
The Vancouverite: What are other advancements in vision correction that you’ve seen?
Nathoo: Ophthalmology is an area where there’s tons of technology on the go. One area that’s really neat are these retinal implants for people who have no vision. They put this computer chip underneath your retina and for those who are completely blind (not even able to see light), somehow, they’re able to see shadows. For the average person, this may not sound like a big step forward, but for someone who can’t even see light, seeing shadows or huge objects in front of their face is a huge improvement compared to nothing. Hopefully over the next few decades it’ll really continue to improve to the point where we could potentially give vision back to people who for whatever reason have lost all vision. Things like that are really cool and a hold a lot of promise for people with poor vision.
The Vancouverite: What are some things you’d recommend that people do to maintain healthy vision?
Nathoo: For kids, the biggest thing is to get their eyes checked regularly because we have until age of 10 to fully develop vision. This is a critical period of development in kids where the brain learns how to see from each eye separately. If a child has any kind of eye problem and it goes undiagnosed, it can lead to lifelong poor vision and be irreversible after the age of 10 or 12.
Also, have the kids play outside. There are more and more studies that show when kids play outside, it helps to counter myopia (near-sightedness). I think the theory is that if we spend our entire childhood staring at books or iPads or phones, etc. we end up just becoming nearsighted because our whole world is just focused on things close up. These huge studies have shown that kids who spend more time playing outside, looking off into the distance, tend to be less near-sighted.
For adults, a lot of diseases are asymptomatic at the beginning, so you don’t really notice that they’re creeping up on you. So, it’s good to get checked every so often. Especially if eye problems run in your family, like glaucoma or cataracts, or just if you notice something different that has suddenly popped up, like a change in vision, something new in your peripheral vision, or any other symptoms that seem out of the ordinary.