Abstract
Interview by Jitesh Patel
Abdhish R Bhavsar, MD, is a retina and vitreous surgeon who was born in Connecticut, USA, grew up in Michigan and has practiced in the Minneapolis/St. Paul (MN, USA) area since August 1997. He graduated from Dartmouth College with an Honors Thesis in Biochemistry and from the Wayne State University School of Medicine with Alpha Omega Alpha honors. He completed his internship in internal medicine at Duke University (NC, USA), his ophthalmology residency at the University of Illinois Eye and Ear Infirmary in Chicago, USA, and his retina surgery fellowship training at the Jules Stein Eye Institute at UCLA (CA, USA). He was also a Heed Ophthalmic Foundation Fellow.
Bhavsar has maintained research interests in macular degeneration, diabetic retinopathy, endophthalmitis and retinal oxygen metabolism. He is a principal investigator in multiple clinical trials in macular degeneration, diabetic retinopathy and venous occlusive disease and also maintains a broad range of interests in managing vitreoretinal, medical and surgical diseases, with additional interests in retinopathy of prematurity and intraocular tumors.
Bhavsar is an active member of the American Academy of Ophthalmology, the American Society of Retina Specialists and the Association for Research in Vision and Ophthalmology. He is a Clinical Assistant Professor at the University of Minnesota and an Attending Surgeon at the Phillips Eye Institute in Minneapolis. Bhavsar is a past President of the Minnesota Academy of Ophthalmology, past President of the Minneapolis Ophthalmological Society, past Chair of the Phillips Eye Institute Department of Ophthalmology, founding Chair of the Minnesota Academy of Ophthalmology Web Site Committee and the state Chair for Diabetes Eye Exam Initiative. Dr. Bhavsar was the first Chair of the American Academy of Ophthalmology Web Advisory Task Force and graduated from the American Academy of Ophthalmology Leadership Development Program in 2001.
□ You currently work at the Retina Center (MN, USA). Could you tell us a little about your background & how you progressed to your current role?
After completing my retina surgery fellowship at the Jules Stein Eye Institute at UCLA, I joined the Retina Center in Minnesota. I first visited Minnesota when the University of Minnesota was recruiting me for a position. I liked Minnesota and decided take a position in private practice at the Retina Center, while maintaining a teaching role at the University and also seeing patients there. In addition, I started a monthly fluorescein conference at the University for the residents. I had a partner for 10 years who suddenly left the practice, and I was alone for 1 year running a two-person retina practice on my own. That year passed by quickly as I ran clinics from 7 am until 9 pm daily, after which I did emergency surgeries until the early morning hours. I then hired another retina surgeon the following year, followed by another the following year and then a third retina surgeon the year after that. Now I am the senior and managing partner of a busy four-person retina surgery practice!
□ What &/or who attracted you to the field of ophthalmology? Is there a reason why you chose to focus on retinal conditions?
In medical school I observed a retina surgery case and I thought it was the coolest thing I had ever seen. I knew at that moment that I would pursue retina surgery for the rest of my life. The retina fascinated me and every time I looked at it, I was amazed at the beauty and function of the retina! I chose Robert N Frank, to be my medical school advisor. He is a medical retina expert and taught me a great deal and also helped me to select my residency program at the University of Illinois Eye and Ear Infirmary in Chicago.
□ What are the typical challenges/scenarios you face on a regular basis as part of your role?
The greatest challenges that I face daily center around staffing our retina clinics with skilled and positive individuals. With a tremendous shortage of certified ophthalmic technicians, and particularly those interested in retina positions, this is a real challenge. We have developed our own training program as well as our own junior and senior leadership development programs within our practice.
□ What do you feel are the benefits & challenges of working in private practice?
The main benefits of working in private practice are that you are your own boss. You can determine which direction the ship sails in. You can be creative and pave new roads, you can do as much research and teaching as you want and you can be as innovative as you would like with your own staffing structure and organizational leadership. The main challenge is feeling like you are Atlas with the weight of the world on your shoulders. When you are ‘Captain of the Starship’ it is easy to take credit when things go well. However it is not so easy to take credit when things go wrong. A good leader will always absorb the blame when things go wrong. You just have to get back up again when you are down, and use your creativity to fly again. Always remember that you can create your own destiny and you can make tomorrow a better day! You can create a better world for you and your staff by keeping a positive attitude!
□ You have worked in the field of diabetic retinopathy. What do you think have been the major advances in the understanding & management of this disease?
The single most important advancement in diabetes has been the DCCT study, which showed that tight control of blood glucose levels dramatically reduces the onset and progression of diabetic retinopathy. The other advancement of course involved the DRS and ETDRS studies, which showed that PRP laser and focal laser could dramatically reduce blindness due to proliferative diabetic retinopathy and clinically significant macular edema.
The single most significant recent advancement in the ophthalmic and retinal aspects of diabetes involves changing the paradigm for the treatment of diabetic macular edema (DME). The DRCR.net laser, ranibizumab, triamcinolone clinical trials have recently demonstrated that anti-VEGF treatments are superior to laser alone which had been the gold standard for more than 20 years. This has dramatically changed the world landscape with respect to DME treatment.
□ Your center participates in clinical trials. Which recent or current trials do you think are particularly promising in diabetic retinopathy? Are you investigating any other conditions?
Although I am biased as a past long-time protocol development and executive committee member of the DRCR.net, I do believe that our greatest promise lies with the DRCR.net clinical trials, and the most significant current study is known as Protocol T, which is comparing aflibercept, ranibizumab and bevacizumab for the treatment of diabetic macular edema. This is the first time in clinical history that three medicines are being compared for efficacy.
I was fortunate to develop and serve as chairman of the DRCR.net Protocol N, which was the vitreous hemorrhage trial involving ranibizumab versus saline injection for reducing the rate of vitrectomy. The study showed that there was not a difference between these two groups. Thus, there is still work to be done in this area.
□ You are part of the Diabetic Retinopathy Clinical Research Network. What have been the aims and successes of this group of collaborators?
The aims are essentially to perform clinical trials in diabetic retinopathy with the goal of furthering our understanding and treatments of diabetic retinopathy while the group of investigators, not industry, owns the data, interprets the data and decides on what, when and how to publish the data.
□ Beyond diabetic retinopathy, what other developments do you actively follow/work on in your field?
I follow and work in multiple areas within retina and essentially cover all aspects of retinal diseases, from infants to adults, from tumors to uveitis, from macular holes to complex retinal detachments and from inherited diseases to macular degeneration. I have actively participated in many other clinical trials for macular degeneration, vein occlusions and even limb ischemia. For many years, I have been working on reporting my results from my retrospective consecutive series of intravitreal injections without topical antibiotics to demonstrate that a very low rate of endophthalmitis can be achieved without topical antibiotics. I believe that antibiotic prophylaxis for intravitreal injections is not necessary and may potentially be harmful. I have been working for many years to convince other retina surgeons of this viewpoint using my own data and data from other clinical trials, particularly the DRCR trials.
□ As a retinal specialist, what are your expectations for the field in the next 5 years?
I would expect great and continued advancements in our understanding of diabetic retinopathy, macular degeneration and inherited retinal diseases. I am hoping for longer lasting medicines in the eye and sustained release treatments. I am also expecting continued advancements in the realm of the artificial retina.
□ What advice would you give to junior ophthalmologists looking to progress in the field?
I would recommend hard work, hard work and then more hard work. Intelligence is great, but do not be satisfied with that. Integrity is of paramount importance. Keep pushing the envelope for greater good!
Disclaimer
The opinions expressed in this interview are those of the interviewee and do not necessarily reflect the views of Expert Reviews Ltd.
Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.