HCDM 4 | Pediatric Ophthalmology

 

For a variety of reasons, kids can be born with or develop debilitating eye conditions from a very early age. These are the sorts of problems that the sub-specialization of pediatric ophthalmology deals with. In this episode, Dr. Richard Marn brings in Mount Sinai Hospital Opthalmologist, Tamiesha Frempong, MD, MPH to explain what pediatric ophthalmology means and what sort of conditions it deals with on a daily basis. Dr. Tamiesha also shares the variety of things that she does as an academic physician as well as the outreach programs and mission work that she is involved in. If you are considering a specialized career in ophthalmology, this episode is perfect for you as Dr. Tamiesha shares the qualities that can help you succeed in that career, as well as resources that will help you on your way.

Listen to the podcast here:

Pediatric Ophthalmology From The Practitioner’s Eyes With Tamiesha Frempong, MD, MPH

Before we get to our guest, I want to remind everyone to please visit the website for this show. You can do a number of things there. You can learn more about the show and each guest. You can also sign up for my email list so I can let you know when the next show will be available. Finally, you can contact me. Why would you want to contact me? If you think there’s a health career you’d like to know about or a guest that we should maybe invite to the show, you will find that a lot of our guests early on in the show will be people that I have worked with or that I know, personally. They are fantastic at their job.

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Our next guest is a good friend of mine, Dr. Tamiesha Frempong. She is a board-certified ophthalmologist and a pediatric ophthalmologist. She attended Yale University for college with a degree in Psychobiology. She then became a Fulbright Scholar receiving a research grant. After that, she attended Yale medical school. She also completed a one-year Master’s of Public Health degree at Yale. She then went on to a medicine internship at Mount Sinai School of Medicine. She did her ophthalmology residency at the University of Pennsylvania School of Medicine and finalized her training at the Duke University School of Medicine in Pediatric Ophthalmology and Strabismus Fellowship.

She has several awards. One I already mentioned was a Fulbright research grant, but she also is part of the AOA or Alpha Omega Alpha Honor Society. She belongs to several appointments such as a member of the Women in Ophthalmology, the American Academy of Ophthalmology, and the American Association for Pediatric Ophthalmology and Strabismus. She has presented several lectures and presentations at various meetings in multiple countries. She is assistant professor at the Department of Ophthalmology at Mount Sinai in New York. She is the Director of Services of Pediatric Ophthalmology at Elmhurst Hospital in New York and is Vice Chair of Diversity and Inclusion at Mount Sinai Health System in New York City. I enjoyed this interview with this good friend of mine and I hope you enjoyed it too. Let’s get started.

Welcome to the show, Dr. Frempong. How are you?

I’m great. I’m so happy to be here.

I’m very happy you’re here with us in this episode. For our readers, Dr. Frempong and I have known each other for a long time. When I was at Mount Sinai, we used to work together doing pediatric surgical cases and we have a lot of fun. I would say, at least in my view and assessment, is that you’re a fantastic physician and surgeon. You are super intelligent, kind, caring and empathetic. I wanted you to know that.

Thank you, Dr. Marn. I’m grateful. We’re fortunate to be healthcare workers, physicians or care providers, if you will, because we have every opportunity every day to show compassion, generosity and kindness. Those are some of the things that I love the most about the work we do.

We have a unique position. As a career, I would describe yours as an ophthalmologist but you specialize in pediatric ophthalmology. Is that an appropriate description? If so, what are your responsibilities?

Healthcare workers are fortunate in that they have every opportunity every day to show compassion, generosity and kindness. Click To Tweet

It is. We all train as general ophthalmologists first and then we can sub-specialize. My subspecialty is pediatric ophthalmology and adult strabismus. What that means is I do everything for kids, whether that means managing things as simple as glasses and amblyopia, which is a situation where they may not see well out of one eye for a variety of reasons, and may require patching or other types of intervention to help improve vision and the weaker eye. In addition to any other kind of pathology or disease that happens to the eye in kids.

Believe it or not, kids can be born with cataracts or develop cataracts as they grow. They can be born with or develop glaucoma. They can be born with a droopy eyelid, which we call ptosis, which can cause them to lose vision and various other pathologies of the eye. I would manage those. For adults, I manage strictly double vision or ocular misalignment. There are various conditions that can cause that. Some of them are systemic and some are isolated to the eye. The management for that in adults could be medication versus a special type of glasses called glasses with prisms in them or actually surgery to correct the ocular misalignment and relieve their double vision if they have it.

You mentioned strabismus, what is that?

Strabismus is misalignment of the eyes. In order for us to have good binocular vision, meaning we’re able to use the two eyes well together and we have good depth perception, we need the two eyes to be aligned and working well. When one eye is off center or not in alignment with the other eye, patients with good vision in each eye typically have double vision. Kids have a lot of adaptive mechanisms because their brains are so plastic and can adapt to various conditions. Adult brains are not as plastic or adjustable. An adult with a new onset, misalignment of the eyes, as long as they have good vision, not blind in one eye right or have severely decreased, they will have double vision.

Kids rarely complain about double vision. In the acute setting when it first happens, if they’re old enough to appreciate it, they may have double vision and they would close an eye to eliminate the second image and that kind of thing. Strabismus is also called squint for that reason because kids early on in the development of their misalignment may close an eye or squint an eye in order to eliminate the double vision. Their brains are adaptable that their brains learn how to suppress the second image, which is why strabismus or ocular misalignment in kids can cause vision loss. It’s a use it or lose it situation. If you don’t use the eye, you will lose the vision when you’re young.

You obviously take care of very young children, almost newborns, don’t you, at times?

Yeah, absolutely.

Vision is also personalized. In other words, what I see is not what you’re going to see versus something that’s an injury on an arm where everybody can see it. How do you know a kid who can’t even talk yet verbalize that they have a problem? How do people even know to check for that?

Vision is a subjective experience. Just because somebody can see doesn’t tell you how well they can see. You can tell whether or not somebody can see. We’ve all seen maybe blind people in our lives and they don’t seem to fixate well. Their eyes may be wandering. If you happen to have ever seen a truly blind person, especially somebody who has been blind from early on in life, they will develop something called nystagmus or they can develop nystagmus depending on the cause of their blindness.

HCDM 4 | Pediatric Ophthalmology

Pediatric Ophthalmology: Vision is a subjective experience. Just because somebody can see doesn’t tell you how well they can see.

 

Nystagmus is shaky eyes so their eyes don’t sit still. It’s like dancing eyes. It moves around a lot. Nystagmus early on in life tells you that your child or a child is not seeing well. Also, children aren’t born with 20/20 vision. Their vision probably at birth is about 20/400. It’s blurry. They’re not seeing well. As the visual system develops, their vision develops better and they start picking up fixation. They start tracking. They may stare at whoever is feeding them. Faces are a good visual target for kids. They like faces. They would hold on to your face or if you hold a toy in front of them, they will follow it.

There are very crude ways of making an assessment of whether or not someone can see or not. Let’s say a child had problems in their vision in one eye. Let’s say that one was fine and one eye wasn’t seeing well. Sometimes if that happens, I told you it’s sort of a use it or lose it kind of phenomenon, but it’s kind of a chicken and egg thing. If the eye is not straight, they’ll lose vision but if the eye doesn’t see well, it won’t be straight. Sometimes strabismus can be a result of poor vision. In that situation when a child comes in and often that may be a warning sign to the parents that there’s something wrong with an eye or something wrong with the vision.

I may be totally normal too. I may be anatomically normal, but there’s something in the visual pathway, that visual system that’s not working well. In that case, a child comes in or even a nonverbal baby. The parents are concerned. There’s a problem. The vision is not good. One eye seems to be wandering all the time or intermittently wandering, but they noticed that the eyes aren’t always straight. In that situation, if you cover the wandering eye, put a hand over the wandering eye or put an occluder over the wandering eye, the child will still be fine, cooing and playing. If you put in a hand or an occluder over the good eye or the sound eyes, then the child would become fussy, pushing your hand away and letting you know that they’re not seeing well.

You can do some things to exacerbate the situation and help lead you down to maybe a diagnosis down the line.

I wouldn’t say exacerbate but just to uncover it. Some kids are born without an eye, but most people are born with two eyes. If one eye is working well but the other eye isn’t, a child may not be aware of that. A child may be fine and they will never complain. That’s why children when they do to their pediatricians even as babies and they have their well-baby checks, the pediatrician will make some sort of crude assessment there as well. They also do vision screening once the child is old enough to cooperate with that type of test, where they attempt to check the child’s vision one eye at a time because with both eyes open, the child may seem to see well with no problem. If you occlude one eye, especially the good eye, you’ll uncover the problem in the problem eye.

You work in an academic center, the Mount Sinai Hospital. What is your typical day like working in that type of location as a pediatric ophthalmologist?

When you work in an academic setting, the day can be varied because some days, you may be in the office seeing patients all day. In some days, you could be in surgery. That’s true for any doctor whether you’re in private practice or in an academic setting. What’s different about being in an academic setting is that you also have academic-type of responsibilities. For example, you may have to give lectures to students, whether that be medical students or residents or fellows. You may serve on various committees.

When mountain did have the Alpha Omega Alpha Society, I was a member of that committee. It’s an honor society in medicine to select medical students and residents or faculty members who’ve been nominated to join that society. I was part of that and it requires going through applications, having meetings and making those straight decisions. I’m also part of something called the grievance committee at the medical school. If an issue comes up, whether it be sexual harassment or some way that a faculty member or student feels that they’ve been harmed, discrimination, various issues can come up. I would be part of a committee to hear those issues and make some judgments about them.

These are all responsibilities that I take seriously. I feel honored to be a part of them. It’s a lot of work and but it also gives us an opportunity to have fairness and equity in the system. My day could be being in the office seeing patients, being in the operating room doing surgery, giving lectures or having various meetings with regards to the committees that I’m a part of. The other thing that I do, too and I started for our department at Mount Sinai is the East Harlem Health Outreach Program for Ophthalmology. I do that with medical students. That is a student-run organization that provides free medical care to indigent people in the East Harlem community. People who don’t have insurance and who could not get care otherwise. I would staff an ophthalmology clinic. Initially, I was doing it alone, but now several of my colleagues have joined in. We all share the responsibility and that’s done on a weekend, usually a Saturday, once or twice a month.

Charity begins at home. There are plenty of people in need in our own backyards. Click To Tweet

As an academic physician, you’re able to not only do your clinical work, but you participate in some administrative activities, some lecturing and even some outreach. This is something that you choose. It’s not something that people are requiring you to do necessarily

Some of it is in alignment with your personal interests and values. As an ophthalmologist, one of the nice things about ophthalmology is that it lends itself well to mission work, international work and volunteering. I also work for a foundation called the Virtue Foundation and also another foundation called the West African Health Foundation. For the past years, I’ve been going to Mongolia and also to Ghana to do free surgeries for patients in a rural part of Mongolia and in a village in Ghana. To teach local providers and to help them with the overflow of cases that they have. In some of these rural areas, there may not be a pediatric ophthalmologist.

In fact, we only go to places where there’s a need. In the capital in Ghana or even in Mongolia in Ulaanbaatar, there are wonderful ophthalmologists. There are pediatric ophthalmologists there. There’s no reason for me to be there. In the rural areas, that’s where there’s a dearth of providers. That’s where we spend our time. I couldn’t justify going to these exotic types or interesting places because charity begins at home first. Because of that, I decided to reach out to the medical students who were part of this East Harlem Outreach Program to establish an ophthalmology arm of it because there are plenty of needy people right in our own backyards.

Some of the things you may initiate, but some of the things you’re invited to do. Some of these administrative tasks because somebody thinks that you may provide a unique perspective or you may be well-suited to participate in something like this. I am already a member of the AOA Society or Alpha Omega Alpha and for that reason, I was asked to join the committee at Mount Sinai to select future candidates and the grievance committee was something I was invited to do. I enjoy all of the committees but I particularly enjoy that because I’ve heard several cases now and I do think being a woman of color that I would bring a unique perspective to making certain decisions that can affect somebody’s career or future. That one, I was invited to join and I’m honored to do so.

When you’re in the clinic, what does your day start like? Do you show up at 8:00 or 9:00? How many patients a day do you see? You see them, they come in and sit in a chair and you have a lot of tools. Can you describe some of the specifics of the tools you use when you examine somebody?

It depends on the age of the person. Needless to say, what I would use on a baby is not the same thing I would use on a 17-year old or a 65-year old. In any case, the day typically starts around 8:00. Fortunately, we have technicians that also assist us right. They would be the first point of contact after the patient is checked into the office. The technician would take the patient into a room and get a bit of history, know why the patient is there and whatever other medical problems they’ve had. What other surgeries they may have had, what medications they may be taking and they then would do the basic exam.

The basic exam would include checking vision. If the patient is wearing glasses, checking to see what is in their glasses and checking refraction to see if what they need to see well jives with what they’re wearing. If they’re not wearing something, then they may need to be wearing something which may be the reason why they came in. They’ll check vision, refraction, eye pressure and I would come into the room. I would come into the room, I would introduce myself if I don’t already know the patient, find out a little bit more details about why they’re there or if we’re already managing a condition that they have finding out, how our interventions are working for them.

I may sometimes have to repeat some parts of the exam if I find some inconsistencies like I expected them to see better or I don’t expect them to see as well as what was recorded. Sometimes that can happen in amblyopia. A child has decreased vision in one eye, maybe we’re patching and giving them glasses and that sort of thing and they come in and then their vision is miraculously better. I’m like, “I think I’m a good doctor, but I don’t think I’m a magician.” I would recheck the vision and find that the technician didn’t realize that the child was peeking. The child was not fully occluding the good eye. The vision that was measured in the weaker was actually coming from the good eye. Kids don’t do that to be dishonest. They’re trying to win. They’re trying to be right and make you happy. That’s always a little pearl to consider. If the numbers don’t make sense, recheck it like if you check somebody’s blood pressure and it seems way higher than their normal or way lower than their normal. I would check the ocular alignment, if that’s an issue for them, and I may have to put in dilating drops so we can also examine the back of the eye.

This is part of the clinic but you also do surgery. How is that different than what you’re doing in the clinic?

HCDM 4 | Pediatric Ophthalmology

Pediatric Ophthalmology: Ophthalmology lends itself very well to mission work, international work and volunteering.

 

The environment is different. I love surgery which is why I chose a surgical subspecialty. In the office, you’re seeing patients, prescribing things or even discharging them from your practice if they’re fine and don’t need anything, although people usually need at least an annual exam to make sure everything is okay. That’s an in and out. Patients are coming in and going out and all day, it’s that same thing. In a typical day, I may have anywhere from 30 to 50 patients on the schedule for a given day.

In the operating room, it’s a smaller number of patient. I may have on a busier day 6 or 7 and on a lighter day, maybe 3 or 4 cases on. The cases may vary. It may be a cataract case. A lot of what I do is strabismus because that’s more common. It could spin the age range. That environment is different, clinic environment versus the operating room. The operating room is controlled. It’s all a team-based approach but the thing I love so much about surgery is the dance we do. It’s this choreographed dance. When everybody is doing their job and doing it well, it’s beautiful.

There are times when you’re operating, you don’t even really have to say much. Everybody in that zone is following along with surgery and knows what you need and is making adjustments to helping your exposure or what have you. Also, Dr. Marn, working closely with your anesthesiologist can make or break a case. I’ve been lucky in working with you and Dr. Renee Davis and other pediatric anesthesiologists at Mount Sinai that contribute to an efficient and pleasant work environment.

Do all ophthalmologists do surgery?

No, but many do. Probably the majority do. There are some neuro-ophthalmologists who don’t do surgery at all. That’s one specialty that may not do surgery. There are neuro-ophthalmologists who still do some surgery or to do surgery. Medical retinas specialists don’t do surgery in the operating room, but they would do intraocular injections, injecting medicine directly into the back of the eye or front of the eye. They would do laser procedures in the office. They’re procedure-oriented, but they wouldn’t be doing surgery as such in the operating room.

Can you tell us a patient that you took care of that left an impression on you?

There are many. One pops up in my mind that touched my heart when I was a resident. When I was a resident, we do a lot of cataract surgery on adults in residency. People who are general ophthalmologists or cornea specialists or glaucoma specialists may continue to do a lot of cataract surgery in their regular job. For me, my adult cataract surgery experience was concentrated in my residency. I remember there was this woman and I can’t remember exactly where she was from. I know she was Asian and I know she didn’t speak English. She came in for her cataract eval with her son. Her vision was horrible. She saw counting fingers vision. If you put fingers up in front of her, she can see that but anything beyond that, she couldn’t see. She had dense white cataracts.

I remember doing her first cataract, first eye and it was a difficult case because her cataracts were dense. We had to use quite a bit of energy in the eye. The next day, we always see patients on what we call post-operative day one. The day after surgery, she had a lot of corneal edema. Her cornea was swollen and it was a little cloudy. Her vision was certainly better the day after surgery than it was before surgery, but it wasn’t anywhere near perfect. A week after surgery, we saw her again and she came in hugging me. She is like, “Good doctor.” Her son told me that a few days ago or about five days after the surgery, she woke up one day and started ferociously cleaning her house because she said, “This place is dump.” She hasn’t seen it in so long because her vision was bad. That was a touching moment because you took this person from practical blindness to good vision.

I have another story. This also was in my residency but the lesson was reinforced in my fellowship. A woman came in with what we call anisocoria. She had a difference in pupil size. One pupil was small and one was big. That’s a neurologic emergency because it could be something going on in the brain that could kill you. She comes into the emergency room and they do a million-dollar workup. She has an MRI and all this stuff to look to see if this woman is having some pathology going on in her brain. She comes and they called ophthalmology.

Being a good eye doctor means understanding the whole of medicine and the human body. Click To Tweet

We came to evaluate the patient and we found out that her dog had a corneal ulcer and part of the treatment for the dog was using atropine eye drops. It is an eye drop that dilates the pupil. She ended up having some of the drop on her finger not realizing, rubbed an eye and dilated her own pupil. Atropine can last for a week. The key there was getting the appropriate history. I remember when I was in my fellowship, I trained at Duke with a preeminent pediatric ophthalmologist who is also a neuro-ophthalmologist, now the chair of ophthalmology at Duke. His name is Ed Buckley. He’s masterful in this specialty.

Patients would come to him from all over having gone to all the preeminent programs in the country for whatever their issue was right. They go to Bascom Palmer, Johns Hopkins and all these great places. They would come to him and sometimes the solution or the diagnosis was simple. He would say, “Do you know what this patient needed? A doctor who listens to them.” Sometimes it’s just getting the right history. Sometimes we get caught up in what we’re seeing that we forget to ask the patient, “Tell me what happened? When did this start?” We’re trained to do that. That’s why it’s important to have a pattern and a system of doing things so that you don’t skip through steps. Have a systematic approach to every patient so that you don’t miss something.

Often, I think of ophthalmology as a technical specialty. You highlight that it is technical, but you also have to still be very much of a physician and take a thorough history and not focus just on the eyes.

I’ll tell you something about that. I remember when I was in medical school trying to decide what to do. Initially when I came to medical school, I thought I wanted to be a general pediatrician or maybe a pediatric hematologist because I had a huge interest in sickle cell disease. I did some research in that before medical school. That’s where I was leaning. I said absolutely not surgery because some of the personalities of the people in my medical school class who wanted to be surgeons were the uber type A’s and super aggressive. I’m certainly type A. We call them gunners in medical school. That wasn’t my personality.

One of my first rotations in medical school was ENT and the head of ENT at that time was a man called Clarence Sasaki. Again, a masterful surgeon who would do complex head and neck dissections. For various reasons, I was very into it. I loved being in the operating room. I was a good assistant as a medical student. Our job is to suction, keep the smoke away, dab the area of blood and retract the tissue to help with visualization. I did that well. He noticed that I was paying attention and that I was following along.

At the end, he would throw me a bone and teach me how to close skin. He told me I had good hands. He was encouraging me to do ENT. Now, I regret not exploring that more. The reason why I did it was because he was doing all these complex surgeries and I was like, “This is stressing me out. I don’t want to do that.” In any case, once I thought I could be a surgeon and I realized how much I loved it, I learned more about ophthalmology. I did a rotation and enjoyed it. It’s technical, but when I was trying to decide on ophthalmology, I thought, “I’m going to learn all this medicine and be an eye doctor and focus on this one organ. I don’t know if I could do that. That seems like silly.”

It seemed silly to me at the time until I understood that as an ophthalmologist, you still have to be a doctor. You still have to understand systemic diseases and systemic diseases with ocular manifestations because sometimes the first sign of your cancer, whether it be your breast cancer or your liver cancer or whatever, can manifest in the eye. Your first sign of diabetes or an impending stroke can happen in the eye. You still have to be a whole doctor and you still have to understand medicine and the human body to be an eye doctor and to be a good eye doctor to take good care of the patients that entrust their vision and their lives to you.

I want to get to your origin story because you alluded to it, but before we move on, what is your favorite part about your job?

As I said, I love surgery. I was talking about it with one of the anesthesiologists and people talk about that flow state or being in the zone. When I’m operating, what is 1 hour or 45 minutes, for me, feels like five minutes. It’s one of those times where my everything, all my efforts, my mind, my focus is concentrated. I enjoy surgery but I think equal to enjoying the surgery is enjoying the human relationships. I think that as an ophthalmologist, as a doctor in general, you meet many people with many backgrounds who invite you into their space, literally. You’re close to the person. They invite you into their lives. They share intimate things with you. They trust you and that’s an experience that I feel privileged to have and as doctors, we’re all privileged to have. I always think of it as it’s the patient’s choice to choose me or to come to me, but it’s my privilege to be their doctor. I enjoyed that part of it.

HCDM 4 | Pediatric Ophthalmology

Pediatric Ophthalmology: Sometimes we get so caught up in what we’re seeing that we forget to listen to what the patient has to say.

 

Is there any part of your job, even the job description that is not exciting or even mundane at times?

It’s not like every day it’s rainbows and ice cream. Sometimes patients can be frustrating. I’ll tell you during COVID, I’ve been working at Elmhurst. I’m not a critical care doctor or pulmonologist. I don’t have a specialty that is critical in this COVID pandemic, but I do think as a healthcare worker, again, I have a duty to help and a duty to serve. What I have been doing are video visits. I’ve been going into the hospital and I’ve been covering the vented patients, the patients on ventilators, particularly those patients because we did notice that some of them are having exposure keratopathy. That means that sometimes in vented patients, they can’t close their eyes because they’re paralyzed and they’re heavily sedated.

Which is why, Dr. Marn, in all of our cases that we do or even cases that you do that’s not eye cases, you always take the eyes shut. When we’re operating on one eye, we always tape the other eye shut to protect the eyes. Some of the vented patients are always closing their eyes all the way and the eyes are constantly exposed to air. It gets dry, the conjunctiva gets swollen and can bulge out. The cornea can develop abrasions and scars. We noticed that when we were helping out with these video visits, me and one of my colleagues, we then decided, “We should take charge of all of the vented patients with these video visits. That way, we could do bedside eye exams.”

We created a flow sheet to help the nurses and doctors on those units on how to manage these conditions and how to evaluate who needs what. I’ve been doing that. With the video visits, families are grateful and it’s been an emotional and sometimes emotionally draining experience because you’re part of an intimate moment with families that ordinarily as the doctor, you would not be in the room necessarily while the family is visiting. That’s a private moment. You get to be a part of that moment and sometimes it’s emotional. People are crying and the horror and fear on the family members’ face when they see their family members sick and on the vent has brought me to tears during those visits.

Some family members and one that I can think of in particular that makes me sad when people can be caught up in their own grief and challenging time that they don’t also think about other people. There’s one family that demands multiple visits a day. It upsets me to an extent and I feel bad for being upset about it because I understand their grief and their hard time. The hospital has been accommodating in honoring their requests for three visits a day. I don’t do it. I go once a day and another teammate goes later on in the day back to that particular family. Now, the problem has decompressed quite significantly, but in the beginning, when there were many patients, you had to be a bit judicious with the time that you spent in each patient’s room so that every family can see their family member.

Sometimes that thing would bother me. I know patients are people just like doctors or people. Sometimes we’re imperfect and selfish and I’m sure I am too. Sometimes when people behave in a way like that, it does make me upset and disappointed. Those are some of the things in the work and you can imagine. If you’re in an office and a patient is waiting a long time, I get their frustration too, but that’s what it’s going to be sometimes. Let’s say another patient is there who has an emergency and you have to spend a lot more time dealing with their acute issue. It’s going to delay the day for everyone else. Sometimes you would hope that people can give you the grace that they would hope somebody else would extend to them or for that if they were the one in an emergent situation.

Do you think there are any particular skills or qualities that make up an ideal ophthalmologist?

For ophthalmology in general, having good surgical skills if you’re going to be that type of doctor who does surgery, that’s important. Not every doctor is a good doctor, not every surgeon is a good surgeon and it’s important to know your strengths and your weaknesses and be honest about that. What makes a good ophthalmologist is what makes a good doctor in general. It’s integrity, honesty and being willing to be committed to your patients and be committed to their well-being. If the patient has or if there’s a bad outcome, you have to be willing to stick with it and see them through it and hopefully get to the other side of it.

It’s not always success in everything and some of that is what the body is going to do and some of that may be what intervention you chose. Maybe there’s a better one or maybe there’s a different one that might work better for this patient. It’s important to be committed to the long haul. Some things are the low-hanging fruits and a lot of what I do tends to be low-hanging fruits, which is why I like what I do because it’s satisfying. It’s like instant gratification.

The qualities that make for a good ophthalmologist are honesty, integrity and commitment to the patient’s wellbeing. Click To Tweet

What do you mean by low-hanging fruit for ophthalmology?

What I mean is like that Asian patient I talked about in my residency. She went from blind to a week later seeing great. In medicine, that’s a lot of chronic disease. Personally, I don’t like chronic disease. I like problems that I can diagnose, fix and we’re all happy and high five, but they’re not always going to be that way. You can’t pick and choose. You can’t say, “This patient is going to be too difficult or this case is going to be too difficult. Let me send it to somebody else.” If it’s out of your skillset, then certainly do that. If it’s just inconvenient or going to be too much work, you can’t be that kind of a doctor. I think what makes a good doctor and what makes a good ophthalmologist is that honesty, integrity and commitment to your patient’s well-being.

You talked about it briefly on how you started thinking about becoming an ophthalmologist, but even before that, were you always interested in medicine? Was that something that was on your mind when you were in high school or in college?

I know a lot of doctors have this story. I do and it’s the truth. When I was six years old, I said, “I’m going to be a doctor because I want to take care of my grandmother when she’s old.” I didn’t know what that meant. I knew I loved my grandmother so much and I wanted to make sure she was always okay when she got it. That’s what I said and my family just wouldn’t let it go, “Miesha is going to be a doctor.” Everything I did from that early on, I was a serious student. I cared about my grades and academics. I studied. My parents are immigrants and to an extent, that’s almost like a blessing to me because they didn’t have a lot and they were focused on keeping shelter and food for us.

They didn’t know extracurricular things for us. We were pretty much latchkey kids because they worked and we stayed home alone. There were three of us from my siblings and I had other cousins and we all lived in this house that my grandmother owned with multiple apartments in it. We would all go to school together in a pack and come home in a pack. That’s what we did. I think that because my parents were not so knowledgeable about enrichment things for kids or whatever. They were trying to make ends meet for us that I had to find those things for myself. Early on, I felt responsible for my success and maybe that’s just God’s grace and blessing and not through my own efforts. Somehow that thought came into my head that I needed to be responsible for my future at a young age.

I was a studious student and teachers recognize that and would tell my parents that I should get into this extra talented and gifted thing and what have you. I went to a math and science-focused high school. I did research at Long Island Jewish Hospital for three summers when I was in high school and out of that one of the researchers, Henry Eisenberg, who’s now passed, he was a microbiologist, allowed me to participate in a research project that they were doing so I had a publication in high school.

You were proactive about your direction. You sought that research out. The research didn’t come to you. You said, “Let me look into this.”

Yes, however, there was a woman. Her name is Carolyn Snipe who also passed away several years ago from pancreatic cancer. She was an administrator at Long Island Jewish Hospital. Her daughter was a year ahead of me in high school and we were friends. Her daughter was at the time more interested in journalism. She wasn’t pre-med or anything like that. She was a journalist for a while and is now doing other things. Miss Snipe started this research program at LIJ targeted towards underrepresented minorities in my high school. I’m not taking credit for calling them up and doing. I’m saying there was a parent who happened to be in hospital administration who started this program.

There were several of us from my high school who now are doctors because of Carolyn Snipe and this program and this early exposure and support we got so we program. Mount Sinai has something similar too, but let me say this. It wasn’t until I was in college that I was thinking, “I never considered anything else. I want to be a doctor, why?” At that time, I started taking history of art and psychology of religion and all these other types of courses to broaden my scope. I didn’t go to medical school right away. I got a research fellowship but before I even did the research fellowship, I spent a few months working in healthcare consulting in Washington, DC.

HCDM 4 | Pediatric Ophthalmology

Pediatric Ophthalmology: Not every doctor is a good surgeon. It’s important to know your strengths and your weaknesses and be honest about them.

 

That’s when I was like, “I don’t want this office work thing. I think I should stick with medicine.” Who knows? Maybe I didn’t do it long enough or I didn’t find my niche or whatever. The thing about medicine is that made me realize that this was better for me that it’s that impact. The impact on people’s lives directly that was fulfilling and continues now to be fulfilling to me. My point is, I pigeonholed myself early on. I never considered or explored other things. I’m not saying that it is a good thing. I don’t think it’s a good thing. It worked okay for me because I was focused and targeted. It’s not necessarily the way I would advise other people to approach medicine, if I had to do it all over again.

What would you do differently?

I would have been a lot more open-minded about other things. I would have read a lot more just in general. Whatever you can get your hands on, read. Be knowledgeable. Don’t make decisions in a vacuum. There were other types of programs out there. There’s something called INROADS and SEO. I think it’s Student Education Opportunity or something like that. It was also available in my high school and in other people’s high schools. I recommend people to look into those. In those situations, those are more targeted towards business. Students get placed in a company and that’s in college or high school. They get mentors and you learn different career paths in the business sector. That’s one thing.

I think that as a child of immigrants, I was thinking more along the lines of stability. Look at COVID wreaking havoc on the healthcare industry and ophthalmology in particular. We’re probably one of the hardest hit specialties. Our patient census has gone low relative to how many patients we were seeing as a practice, as a specialty in the country, but certainly in our department. In any case, medicine was safe in a lot of ways and suited my values and personality. There are other things that I could have to and I don’t regret going into medicine. It’s been a blessing. I also wished that I had been a little bit more open-minded about other things.

You did mention how the current pandemic has changed your career. There are other things that are happening. There are other big changes whether it be changing technology, social media, climate change, and the pandemic. Where do you see ophthalmology and pediatric ophthalmology? What changes do you expect years from now in your career for yourself personally or in the grander scheme of things?

I think that technology is probably going to play an even bigger role in our specialty. I think that this pandemic alone has pushed a lot of ophthalmologists and certainly in our department towards telemedicine. We’ve been talking about telemedicine, but now we’re doing it because we have to. There was no other way to see our patients and know what problems they’re having and help them get whatever it is they need or even know that they’re in an emergency situation and need to come in despite social distancing and this pandemic. There were patients that we have had to see on an emergency basis, things that absolutely need acute care. That’s been happening. We’re going to have to find ways to use technology to make remote care a reality. We’re going to have more artificial intelligence in our practice to help with screening, improving access to ophthalmologists where you may not need to be in an office with somebody. You can maybe have a device on your phone or some kiosk that you go into that does a complete whatever and sends that information to the doctor. It’s going to be a lot more tech-heavy and a lot more not as in office-based practicing.

Is there any way or any resources that you could recommend someone to look into, listen to or read about, or organization to research online or call to learn more about your specialty and career?

This generation or the way we live now, information is now at our fingertips. You don’t have to go to a library anymore and look up books and check them out. You can go on the internet. Go on YouTube and check out ophthalmology. There are surgeries that you can watch on YouTube or on the internet. There is the American Academy of Ophthalmology website for pediatric ophthalmology. There’s the American Association for Pediatric Ophthalmology and Strabismus. The University of Iowa also has a lot of information and I think they had a website that was almost like a forum-based.

There’s something else called StudentDoctor.net that I was addicted to when I was in medical school. It is a forum of either people in residency or people applying for medical school or people applying for residency. You can get a lot of information about different programs and about the application process. I remember when I was applying for residency, waiting for interview letters, people would post on there like, “Such and such program sent out invitation letters yesterday.” If you got it in a few days, you know you got an interview. If you didn’t, they did not invite you for an interview. You can remember what a stressful time that was. It was nice having those resources out there.

Quiet the noise around you and be honest with yourself. What makes you feel joy? What makes you feel a sense of purpose or motivation? Click To Tweet

If you want to learn anything about anything in medicine, Google it at Google videos or YouTube videos. It’s almost like that rabbit hole. One link leads to another link, but the information is there and I would definitely encourage people to do their homework. Don’t make decisions in a vacuum. One other piece of advice I would tell people is I remember when I was in medical school, I had gone to the same place for medical school and college. My research mentor, we did this research together from the time I was in undergrad throughout my college time. I went to him when I was trying to figure out what to do and I said, “I’m thinking about dermatology.” In dermatology, you still have procedures and maybe I would have been a Mohs surgeon or a hair transplant surgeon.

He said to me, “Miesha, people who want to help people don’t become dermatologists.” That’s not true. That’s his opinion. That’s not a fact, but when you’re young and you don’t know anything, somebody who’s been your mentor who knows so much more than you, you accept that. You say, “I’m not going to do that.” I regret not remembering that or not knowing that at that time. Advice is just a suggestion. You can take it or leave it and ask multiple people. Nobody knows everything so constantly seek advice and guidance in everything. Even until now, I’m an experienced physician and what have you, but I still will call up mentors or my peers to ask their opinion about the management of this or how I should handle that. I’m always seeking advice, even my college friends. I called on them for advice on something important related to my work and none of them are doctors. They were helpful in giving some advice and guidance. Always seeking guidance is helpful and it can come from various places. It doesn’t have to come from another doctor or a super educated person. It can come from many different sources.

Miesha, there’s one thing that I wanted to talk about and I haven’t brought it up yet. I only found this out after I got your resume and your CV. You were a Fulbright Scholar.

Yes, thank you.

That’s cool because only a handful people get to receive that honor every year. Can you tell us what that is and what you did with that scholarship?

It’s a research fellowship. It’s quite competitive and prestigious and you get support for, in my case, it was research but other people do other types of projects. I told you I was interested in sickle cell disease. Mine was a project looking at the dysfunction of the spleen in patients with sickle cell disease and how that compares to Ghanian population, patients in Ghana versus patients in the United States. I got support for that. I had done a pilot study the year before and I had had some evidence that this was worth studying. I then created a proposal and a grant application and was supported by Fulbright for that work.

Where were you doing research during that time?

I was in Ghana, in Kumasi. It’s the second-largest city in the country at a hospital. It’s a hospital linked to their second largest medical school, the Science and Technology Medical School in Ghana. That’s where I had been based. It was a meaningful experience.

HCDM 4 | Pediatric Ophthalmology

Pediatric Ophthalmology: Technology is going to play an even bigger role in ophthalmology. This pandemic alone has pushed a lot of ophthalmologists towards telemedicine.

 

Are there any other parting thoughts for a student interested in your career or even lasting life advice?

It’s important to be honest with yourself. At some point, quiet the noise around you. Don’t worry about what somebody else would think or what your parents will think or whatever. When you’re making decisions like this that’s going to impact the rest of your life, do seek advice and guidance. I’m not saying ignore what they think, I’m just saying, take a moment to pretend like you were in this island onto yourself and be honest with yourself about what’s the thing that makes you jump out of bed in the morning. What makes you feel joy? What makes you feel a sense of purpose or motivation?

It may not be medicine. It may be something different. Be honest with yourself about what that thing is and try to figure out how to get closer to that thing. You may even be able to get closer to that thing indirectly through medicine or a part of medicine or what have you, but it’s important to be honest with yourself about what you want. A lot of times and certainly for me, I did a lot of what was expected of me or what was required to get to the next level without examining, “Is this what I want?” or “Is this the best way to do this?” Be bold in some ways too. It may mean leaving your comfort zone, where you live, your neighborhood or your country even. I say, ask those questions to yourself a lot. Ask it over and over again. At different times in your life, that question may mean something different to you.

Miesha, thank you so much for being part of this. This is wonderful information you gave and perspective. I think a lot of people will benefit from it.

Thank you for asking me, Dr. Marn. I’m grateful.

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About Tamiesha Frempong, MD, MPH

Positions: ASSISTANT PROFESSOR | Ophthalmology ASSISTANT PROFESSOR | Medical Education ASSISTANT PROFESSOR | Pediatrics

Specialties: Ophthalmology Strabismus Pediatric Ophthalmology

Language: English

Hospital Affiliations: The Mount Sinai Hospital Mount Sinai Morningside and Mount Sinai West New York Eye and Ear Infirmary of Mount Sinai Mount Sinai Queens Mount Sinai Brooklyn Mount Sinai Beth Israel

Phone: NYEE – East 102nd Street 212-241-2477 NYEE – East 85th Street 212-241-2477