Perspectives on Diversity

Duke Eye Center welcomes School of Medicine BOOST Scholars for interactive virtual visit

by Yos Priestley, OD, FAAO

On a sunny Saturday in late March, Duke Eye Center team members from all over the Triangle logged in on Zoom to host scholars from the Duke School of Medicine BOOST program for a virtual visit to the Duke Eye Center (DEC). The BOOST Program is geared toward 6th, 7th, and 8th graders in the local Durham community who are from populations underrepresented in STEM, especially African American, Latino/a, Native American, girls, and students from economically disadvantaged backgrounds. By bringing science alive in a multifaceted and interactive way, BOOST hopes to inspire and support their scholars to be the future of the professional STEM field.

During a typical year, the BOOST scholars participate in monthly Science Saturdays where they engage in hands on science experiments in addition to several field trips to explore a variety of STEM careers. In 2020, COVID-19 brought a halt to all in-person sessions and field trips. As many of us also experienced this past year, this tasked the BOOST program with finding a way to recreate the experience via virtual platforms.

At Duke Eye Center we were eager to take on the challenge and share our love of all things eye with the BOOST scholars. Our entire team pulled together over several months to create new virtual content to be shared via a Zoom platform field trip.

Our clinical and research teams collaborated to create a virtual tour of the eye center clinical and research spaces which allowed the BOOST scholars to have a behind the scenes look at the daily happenings of the Eye Center.

Duke Medical students from the Ophthalmology Interest Group, Terry Lee, Nicholas Johnson, Arathi Ponugoti, and Justin Ma, created a video on eye health topics covering cataracts, glaucoma, and refractive error. They were also present live during the field trip to discuss their journey so far as Duke Medical Students and offer advice on pursuing medicine as a career.

Duke Eye Center Ophthalmology residents, Tammy Hsu, MD and Kevin Jackson, MD, created a “Day in the life of an Ophthalmology Resident” video and participated live to share the challenges and rewards of an ophthalmology residency at Duke.

Several DEC team members also joined live to talk about the wide variety of roles within the Eye Center. Jen Elfring a physician assistant in the neuro-ophthalmology division, Omar Mohiuddin an occupational therapist in the Vision Rehabilitation and Sports Vision division, Anupama Horne, MD the division chief of the Comprehensive Ophthalmology Service, and Elena Francis an orthoptist in the Pediatric Ophthalmology and Strabismus division all participated in live sessions with BOOST scholars. They discussed what they love about their careers and what they might be doing if they were not in the ophthalmology field.

Dr. Angel Zeininger from the Duke Anatomy Department provided an in depth look at eye anatomy with a very interesting sheep eye dissection video. She highlighted the similarities and differences between human eyes and sheep eyes.

Finally, Nora Lad, MD from the Retina Division, shared a fun and interactive session on optical illusions which made us all question what our eyes and brain were telling us. She used some popular illusions as well as famous pieces of art to demonstrate how the brain pathways that help us decode our visual world can also be tricked into perceiving color, motion, and shapes.

In a whirlwind two hour visit we hope to have shared a little bit of what we love about ophthalmology and inspire some future colleagues to chase their dreams. We hope the Duke Eye Center collaboration with the BOOST program does not end here, we plan to continue to be involved in a variety of roles in the future to foster mentorships and create pathways toward success for as many scholars as possible. Furthermore, our virtual tour materials will now be available on our Duke Eye Center website so other programs can access them and hopefully be inspired by the content to consider ophthalmology as a career field.


Ophthalmology Outreach with Duke SNMA

by Jullia Rosdahl, MD, PhD
Featuring Ninita Brown MD PhD (Duke Med and Glaucoma Alumna)
Organized by Duke Med Students Nick Johnson & Kirsten Simmons
With Duke’s Leon Herndon MD & Thomas Hunter MD

On Wednesday evening, March 17th, Duke medical students Kirsten Simmons and Nick Johnson organized an informative session about ophthalmology featuring Ninita Brown MD PhD.  Dr. Brown is a practicing glaucoma specialist in at the Thomas Eye Group in Atlanta, Georgia, and an alumna from Duke School of Medicine and Duke Eye Center’s Glaucoma fellowship.  She is also the president of the Ophthalmology Section of the National Medical Association.  The session began with a great overview of Ophthalmology as a specialty by Dr. Brown, where she highlighted the need for more black doctors especially in ophthalmology; she also shared some of her own formative experiences in ophthalmology. 

A wonderful group of undergraduate and medical students attended, as well as Duke resident Kevin Jackson MD and glaucoma fellow Obi Umunakwe MD PhD who offered their guidance.  Duke Eye Center’s Leon Herndon MD and Thomas Hunter shared their paths to ophthalmology; both Dr. Herndon and Dr. Hunter noted a powerful desire to train and educate future ophthalmologists.  Questions the students asked included how the ophthalmologists on the panel chose their subspecialty within ophthalmology and about whether disparities in care existed in ophthalmology as they do in other areas of medicine.  Dr. Herndon and others noted that this was indeed the case within ophthalmic care and brought up the example of “normative” databases for optic nerve imaging that do not include people of African descent.  The panel also discussed the importance of patient-doctor concordance (aka, having a doctor that looks like you) and adherence to treatments and care.

The program ended with Dr. Brown soliciting advice for medical students just matching into and soon to be applying to ophthalmology: Dr. Umunakwe’s advice to the new residents: “Don’t let the little things trip you up.” Read, be responsible, and be a hard worker.  In Dr. Simmons’ advice for the applicants, she highlighted Rabb Venable program and the “fireside chats” they hosted with residency program directors, and the importance of networking.  This was echoed by Dr. Brown who noted that networking and connections are “crucial” to one’s success especially for minority candidates.

Dr. Brown’s passion regarding the impact black doctors can have on the health and well-being of black populations as practicing ophthalmologists was evident throughout the program, amplified by the panel, and inspiring to the medical students and future ophthalmologists attending.


American Glaucoma Society (AGS) Webinar Series: Tackling Social Injustice & Health Disparities

by Leon W. Herndon Jr., MD

With the groundswell of protests surrounding the death of George Floyd, I thought that the American Glaucoma Society should make a statement denouncing racism in its many forms. I serve as secretary of this national organization, and made my thoughts known, but ultimately, the executive committee decided that making such a statement was not in keeping with our mission statement. With the support of the president of AGS, I was able to put together a social justice series sponsored by AGS where we would start to address issues of disparities in medicine. 

On Friday October 23, 2020 the first of these programs was held: A Question of Color: Understanding Racial Injustice, Healthcare Disparities, and Glaucoma

AGS Secretary, Duke Glaucoma Division Chief and Professor of Ophthalmology, Leon W. Herndon Jr., MD and Duke glaucoma fellowship alum, Josh Stein, MD, Associate Professor of Ophthalmology at the University of Michigan co-moderated the session.  

The webinar featured an all-star panel to address disparities in medicine.

  • Professor Theodore M Shaw, Director of the Center for Civil Rights at the UNC School of Law discussed the topic of Racism in Society
  • Benjamin D. Reese, PhD Former Vice President for Institutional Equity at Duke discussed the topic of Racism in Medicine
  • Alfred Sommer, MD, MHS, Dean Emeritus of the Johns Hopkins Bloomberg School of Public Health discussed the topic of Healthcare Disparities in Ophthalmology.
  • Angela Elam, MD Clinical Assistant Professor of Ophthalmology at the University of Michigan and Caroline Fisher, MD Clinical Assistant Professor of Ophthalmology at Stanford University joined the panel for a Q&A discussion. 

Open and active discussion was held with recommendations made for tackling these healthcare concern.

Action Items:

  • Create teams of AGS members and others who are interested in further exploring these issues.
  • Tap into sources of Big Data to perform some analyses comparing care quality and outcomes for glaucoma and other ocular diseases
 
On Friday January 8, 2021 the second of these programs was held: A Question of Color: Ask the Experts, Where Do We Go from Here?
 
This webinar featured amazing experts, moderators, and panelists for an intimate discussion and Q&A session tackling the implications of social injustice and healthcare disparities for society, education, and medicine.
 
Experts:
  • Michael V. Drake, MD, 21st President of the University of California
  • Eve J. Higginbotham SM, MD, ML, Vice Dean for Penn Medicine Office of Inclusion and Diversity, Senior Fellow, Leonard Davis Institute for Health Economics, Professor of Ophthalmology, Perelman School of Medicine, University of Pennsylvania
  • M. Roy Wilson, MD, MS, President, Wayne State University
Moderators:
  • Donald L. Budenz, MD, MPH, Kittner Family Distinguished Professor, Chair, Department of Ophthalmology & President, American Glaucoma Society
  • Ann Caroline Fisher, MD, Clinical Associate Professor, Byers Eye Institute at Stanford University, Director Diversity, Equity, Inclusion for Ophthalmology Department at Byers

Panelists:

  • Kirsten L. Simmons, MH Sc, Medical Student (MS4), Duke university
  • Chase A. Liaboe, MD, Resident, Ophthalmology, PGY-4, University of Minnesota
  • Connie Sears, MD, 2nd-Year Resident, Stanford University

Watch A Question of Color: Ask the Experts, Where Do We Go from Here?

The American Glaucoma Society (AGS) hosted part three of the webinar series "Social Justice and Healthcare Disparities" featuring guest speakers and panelist from our Asian American AGS community. This session "The Asian-American Glass Ceiling and Behind the COVID Curtain of Biases Toward Asians" was held Friday, June 25th at 5pm EST.

Presenters:

  • Sophia Antoun, MA, Diversity, Equity and Inclusion Education Specialist at Ohio State's Office of Diversity and Inclusion, Presentation Title: Asian American: Our history, our experiences, our identity.
  • Sayako Moroi, MD, PhDChair, Department of Ophthalmology & Visual Sciences, Ohio State University,  Presentation Title: The Myth of the “Model Minority”: Asian Pacific Islander Desi American (APIDA) Representation in Medicine and Health Care Disparities
  • Hendry Ton, MD, MS, Associate Vice Chancellor for Health Equity, Diversity, and Inclusion, University of California, Davis, Presentation Title: Addressing Anti-Asian American Pacific Islander (AAPI) Hate: Healing and Resilience.

Panelists:

OPHTHALMOLOGY RESIDENTS

  • Annie Wong, MD, University of Michigan
  • Rebecca Chen, MD, Cleveland Clinic

GLAUCOMA FELLOW

  • James Liu, MD, Duke University

GLAUCOMA SPECIALISTS

  • Jella An, MD, Assistant Professor of Ophthalmology, University of Missouri,
  • Ta Chen Peter Chang, MD, Associate Professor of Ophthalmology Bascom Palmer

Watch The Asian-American Glass Ceiling and Behind the COVID Curtain of Biases Toward Asians


“Have we asked the Question?” Religious Inclusion within Glaucoma Pre-Op Counseling

by Kirsten Simmons, BS, MHSc

Kirsten Simmons is a 4th year medical student at Duke University School of Medicine, applying to ophthalmology. She is also completing a Master’s of Theological Studies at Duke University Divinity School as a Theology Medicine and Culture Fellow. Within Duke SOM, some of her greatest joys have included serving as the Co-President of the Student National Medical Association- Duke chapter, where she served as an advocate for underrepresented minority trainees.

 

My training within the humanities thus far has taught me that everyone has a value system which dictates decision making, whether big or small. Through identifying and honoring a patient’s value system (which is often crafted multi-dimensionally over a lifetime), one can become more compassionate and effective at understanding adherence practices, delivering news of a diagnosis and guiding patients through variable contingency plans; all critical components of the ophthalmology specialty. Therefore, I was excited to hear Dr. Leon Herndon pose the following question to our team before beginning surgical cases one day: 

“How might patients of the Islam faith consider the XEN Gel stent for their glaucoma disease?”

It was a simple yet insightful question; one that we would aim to discuss collectively throughout my few weeks on the department’s General Ophthalmology elective.

The XEN Gel stent is classified along the micro invasive glaucoma surgeries (MIGS) for glaucoma treatment. This stent is composed of porcine (pig-derived) gelatin that is cross-linked with glutaraldehyde; a composition that helps it achieve permanent hydrophilic properties within human tissue. 

However, according to Islamic purity law, pork and pork products are impure, and people of Islam faith do not partake in its consumption. Despite most medically used gelatins going through various types of radiation and chemical processing that yield it to be “acellular” of porcine components, many Muslims still forbid usage of such.

Thankfully, I had the privilege to connect with a few Muslims within my social circle to gain insight into their interpretation of this specific purity law and how it might impact their options for this glaucoma surgical procedure. I crafted four questions to inquire about their desire for pre-op counseling, what language of inclusivity should look like within counseling, what factors contribute to their personal decision making, and whether or not they believe they would ultimately accept the XEN Gel stent for glaucoma management.

Question #1: “Would you want information of this device’s material composition (porcine-derived gelatin) made known to you?
Unanimous: information regarding the device’s composition should be acknowledged within pre-op counseling.
 
Question #2: “After receipt of this information, how would you proceed with your medical decision?”
One contributor stated they would be willing to receive this device, as long as the Imam (spiritual leader/prayer leader) stated that this medical decision was permissible. They believed that XEN use may be permissible if solely used for preservation of sight. 
Another contributor stated that they would reject this device, and ask for other options, even if those alternative options had lower success rates.
 
Question #3: “How do you learn about which medications and medical products are permissible for you to use in accordance with your religious beliefs?” 
One contributor stated that their elders and family members give them guidance on what is acceptable and what is not. They additionally seek out information on Google and drug profile pages.
Another contributor stated that they conduct a lot of their own research on the internet. They additionally ask pharmacists and members of their community about medication components. 
 
Questions #4: “How can physicians offer pre-op counseling/ inquire of patients’ religious preferences in an inclusive way?”
Consider the following phrase for pre-op counseling of the XEN Gel stent:
“There are multiple surgical devices that we can insert into the eye, to help reduce its pressure. Based on your presentation, our team believes that the XEN Gel Stent would treat this appropriately for you. (Introduce overview of procedure). Of note, the XEN Gel Stent is made of durable gelatin that is porcine (pig) derived. Some patients may have specific religious beliefs that prevent them from using this device. Would this be a concern of yours?”

In light of the different interpretations and ultimate decisions that patients of the Muslim community may have and make, it is imperative that physicians acknowledge the uniqueness of all patients and their dependency on spiritual leaders to aid them in medical decision making. Some patients may only choose the XEN Gel stent if it is their last resort, whereas others may entertain the option sooner within their treatment plan. Above all, informing all patients that this particular device is porcine derived, provides the greatest transparency of this particular surgical option. As a result, the physician should prepare a surgical contingency plan for patients who may reject the XEN Gel stent in an open-minded manner.

I am grateful for the opportunity to have taken the General Ophthalmology elective.  As a 4th year medical student who chose ophthalmology “late”, I was eager to complete my checklist of learning objectives, much of which centered upon clinical skill observation and demonstration. However, the most impactful component of this elective was engagement in the question of how we can tangibly become more inclusive in our language and practice within the ophthalmology department. This experience (and hopefully further research in this topic!) demonstrated that one must not simply bring diverse perspectives and values to a workplace, but audibly engage with others about them. It is my hope that the latter approach will continually yield genuine patient-physician trust, communication and shared decision making.


Glaucoma Chief Dr. Leon Herndon Discusses Race and Diversity in Ophthalmology on AAO Podcast

By: Nicholas A. Johnson, M.S., Duke Medical Student

Two weeks after the murder of George Floyd, Duke Eye Center Chief of Glaucoma, Leon Herndon Jr., MD, joined a panel to discuss the topic of race and diversity in ophthalmology. The conversation was featured on Episode 240 Straight from the Cutter's Mouth: Race in America and Improving Diversity in Ophthalmology a podcast hosted by Dr. Jayanth Sridhar for the American Academy of Ophthalmology (AAO). Dr. Herndon was joined by two of his colleagues, ophthalmologists Dr. Tamara Fountain and Dr. Basil Williams.

In this episode, the group first discusses their personal reactions to the murder of Floyd and the resultant sociopolitical unrest throughout the country. Dr. Herndon speaks of the conversations he has had with his own family, and the fact that he is heartened by the willingness of young Americans to engage in difficult conversations with peers from various backgrounds.

Special consideration is given to the state of diversity within the field of ophthalmology, in which only 2.5% of physicians are Black. Dr. Herndon highlights the commitment of Duke Eye Center to diversity not only in words, but also in action. He notes that the increased enrollment of African American trainees to the ophthalmology residency program at Duke is a sign that the institution is heading in the right direction.

In his closing remarks, Herndon reemphasizes that the importance of diversity in ophthalmology extends beyond improved patient outcomes. He suggests that diverse groups tend to possess more creativity and offer unique opportunities for innovation and collaboration. A commitment to maintaining a robust pipeline of diverse applicants to ophthalmology therefore sets the stage for the advancement of the field.

Listen the podcast 


My Experience Participating in the Rabb-Venable Excellence in Ophthalmology Program

By Maria Gomez-Caraballo, BS, Duke Medical Student

I am a first generation Afro-Latina medical student, and it was at Duke School of Medicine that I first discovered my passion for ophthalmology. Through Duke Eye Center, I was able to attend the Rabb-Venable Excellence in Ophthalmology Research program hosted by the National Medical Association (NMA) this past summer in Hawaii. This conference was one of the most inspiring events that I have experienced as a Duke medical student.

The NMA was founded in 1895 as the nation’s first medical association representing African American health professionals. To this day, the NMA continues to amplify the voices of African American doctors and works to advance medicine in minority communities through improvements in education, quality of care, and medical disparity reduction. The Rabb-Venable Award for Outstanding Research, begun in 2000, is named after Dr. Maurice F. Rabb, Jr. and Dr. Howard Phillip Venable, two leading African American ophthalmologist who mentored their students in the pursuit of research and academic excellence. Today, the program is led by Dr. Mildred Olivier and Dr. Eydie Miller-Ellis, who are dedicated to furthering the mission of the program. Every year, they select medical students, residents, and fellows to present original research and attend an immersive experience for awardees.

At the conference, Dr. Olivier, Dr. Miller-Ellis, and the some of the diverse Rabb-Venable shared advice on being active participants in our medical school experience and overcoming obstacles during clinical years. The program included lectures and workshops on practical matters that are not often covered in medicine’s core curriculum, such as discussions of NEI available funding, what goes into grant selection, and successful grant writing. My personal favorite workshop was the intensive public speaking training, which gave us time to practice poster and podium presentations and interviewing skills. The program culminated with attendees’ poster and podium sessions and award presentations.

Both the NMA and the Rabb-Venable Excellence Research program are platforms where minority students and physicians can seek out professional development, mentorship, and empowerment. I hope this is only the beginning of a long career as Rabb-Venable alumni. It was amazing to be in rooms full of physicians who shared similar backgrounds with the hopeful medical students in attendance, many of us the first in our families to follow this path. I strongly encourage all medical students interested in ophthalmology, residents, and fellows who identify as Black or African American, Latinx, or Native American to submit their abstracts for consideration to attend the August 2020 conference in Atlanta (www.rabbvenable.org). This year will the conference’s 20th anniversary, and we encourage all past participants to return to be a part of the celebration!


Read Previous Perspectives on Diversity Blogs 

Sexual Harassment in Ophthalmology -- #MeToo by Laura Enyedi, MD

Minority Ophthalmology Mentoring Program by Jullia Rosdahl, MD, PhD

Pathways to Physician Diversity by Eleonora Lad, MD, PhD

Reframing our Ways of Thinking about Diversity by Leon Herndon, Jr, MD

InSight into Inclusion by Goldis Malek, PhD

 

More information:

http://cookross.com/about-us/our-team/howard/

https://implicit.harvard.edu/implicit/