In this new series, I (F.S.) set out to have conversations with ophthalmologists that highlight shared experiences, insights, and the collaborative spirit of the ophthalmic community. With the help of my comoderator Eric D. Rosenberg, DO, MScEng, we interview individuals on the leading edge of innovation about their career journeys, interests, and thoughts on the future of ophthalmology. For the first article of this series, we sat down with Cristos Ifantides, MD, MBA.
Faraz Syed, BS, MS: Why did you choose to focus on the anterior segment, and what aspects of fellowship do you see as the most challenging for fellows?
Cristos Ifantides, MD, MBA: I love to see the immediate benefit that anterior segment surgeries can provide patients. Although I enjoy all aspects of ophthalmology, the ability to reverse a patient’s blindness in an hour attracted me to the field. I find reversing blindness across the globe to be one of the most important things that I can do.
Mr. Syed: I have to agree, Dr. Ifantides. While I was rotating with an anterior segment surgeon this past month, we experienced that often. Maybe once per week, a patient would stop the physician and give them a hug or start crying while thanking them for restoring their vision. It was an amazing experience!
Dr. Ifantides: Exactly. In regard to challenges for fellows, we can break it into two parts: challenging procedures and nonprocedural challenges. Complex cataract cases are difficult for many fellows, and that just means we need to make sure they get enough exposure to them. This includes operating on patients with dense cataracts, white cataracts, and small pupils or performing an extracapsular cataract extraction on a dense cataract, which is difficult and becoming less commonly performed.
Outside the OR, our biggest challenge is mindset. We need to be better at teaching residents and fellows how to question ideas in a polite way. Once upon a time, putting an IOL in the eye was considered malpractice. So, we have only achieved the innovations and advances that we have today through a healthy amount of questioning.
Eric D. Rosenberg, DO, MScEng: I agree. Learning the foundational knowledge is important, but foundations shift. Being able to realize that and know what to hold on to and what to innovate with is what makes a world-class leader.
Mr. Syed: What do you see as the next big challenge in anterior segment?
Dr. Ifantides: It’s a very exciting time! We’ve got cellular transplants and new accommodating IOLs in the works and all sorts of other emerging therapies. Ophthalmology keeps producing better patient outcomes year after year. We keep innovating, setting the bar higher, and pushing the envelope.
Mr. Syed: I have to agree. First, we had penetrating keratoplasty then deep anterior lamellar keratoplasty, then Descemet stripping endothelial keratoplasty, and now Descemet membrane endothelial keratoplasty. Just when you think treatment can’t evolve further, cellular transplants arrive.
Dr. Rosenberg: Definitely, Faraz. There is always something new on the horizon in ophthalmology. Cellular transplants have everyone’s attention right now, but there will be something to come after. It is an exciting time to be coming out of medical school right now with AI, large language models, and digital twining. You will be the innovators and will be teaching us next. One of the coolest things about our specialty is, when technology and biology advance, ophthalmology advances with them.
Mr. Syed: Pivoting to global ophthalmology (GO), what technologies in the world of GO are you excited about?
Dr. Ifantides: Livestreamed surgical teaching in the world of AI has me very excited. We started with a microscope and camera that could stream to an iPad. Next, we streamed to the Internet with some lag, then with virtually no lag. Now, thanks to Eric and his team, we are livestreaming in 3D straight from the OR. Other pioneers like Ivo Ferreira Ríos, MD, and Lukan Mishev, MD, are pushing the fields in simulation training and augmented reality, respectively. These advances are completely revolutionizing not just how we teach but accessibility to learning as well. Imagine doing 10,000 surgeries before your first live surgery, and your first live surgery can be performed in Mumbai while your mentor is in San Francisco, or vice versa.
Mr. Syed: I saw you present on a panel discussion at the AAO annual meeting in 2024. You made a point to include economy and infrastructure building into the mission of GO. Tell us more about that.
Dr. Ifantides: We need to practice GO with both relief and development in mind. We typically provide the relief. We visit other countries and provide temporary services, but when we leave it sometimes creates a vacuum of care. Why is that? Typically, it is not economically viable to continue the same care. If there were great jobs available at every level of eye care, from technician to ophthalmologist, the jobs would be filled, and patients would receive their surgeries. However, when this infrastructure is missing and the care is dependent on a donation-based supply chain, economic success is a challenge. What are we doing that is harming eye care economies abroad? Often, it is flooding communities with free eye products or not teaching or operating under the purview of local surgeons.
To prioritize development, we must work toward creating the same opportunities for our colleagues in other countries that we have here in the United States. There are great surgeons around the world who want to make a difference but may never get the chance without the proper systems in place.
Editor's note: This article was adapted from a recorded interview. To hear the full conversation with Dr. Ifantides, listen below.
