5Q With Amy C. Schefler, MD, FACS
Amy C. Schefler, MD, FACS, is a surgeon at Retina Consultants of Houston, Blanton Eye Institute, Houston Methodist Hospital, and a surgeon at Children’s Memorial Hermann Hospital, University of Texas Health Sciences.
When did you know you wanted to work in ophthalmology, and what drew you to ocular oncology?
I decided to specialize in ophthalmology after taking a year off from medical school between my third and fourth years. I performed clinical research in ocular oncology that year with David H. Abramson, MD, at Memorial Sloan Kettering Cancer Center in New York City, and I fell in love with the field. I picked a career in ophthalmology specifically with the intention of becoming an ocular oncologist, an unusual career path.
What has been the biggest surprise of your career?
I am continually surprised at how much the American Academy of Ophthalmology’s phrase “a lifetime of learning” is true. I am still learning, even though it has been more than 10 years since I started my training. Science continues to evolve rapidly, both in retina and in ocular oncology, so it is critical for me to make sure that I am always reading journals, attending meetings, watching surgical videos, and teaching residents. I try hard to make sure that I learn at least one new thing every day.
What would you say is a lesson you took from your work with Dr. Abramson or from your work at Wills Eye Hospital that you would want to pass on to those entering the field?
I learned from all my mentors that ocular oncology, like most of cancer medicine, is not for the faint of heart. The very best clinicians are well-equipped to handle difficult situations with patients, such as breaking the news to new parents that their young child has retinoblastoma or informing adult patients that their uveal melanoma has spread to the liver and is likely fatal. These conversations require patience, maturity, and empathy—qualities that are not typically taught in residency but are honed over years of experience (along with the development of some gray hair). I watched my mentors have these conversations with grace and with class.
I also learned from Carol L. Shields, MD, that, in order to have both a dynamic career and a dynamic home life, it is important not to allow small distractions to get in your way, and to recognize that your house will always feel like it is a cluttered, chaotic mess. Dr. Abramson’s wife, Stephanie, a high-powered lawyer in New York, also once told me that the secret to maintaining a dynamic career and a busy family life is to have a “toxic level of caffeine in your veins at all times.” I follow this advice except on OR days.
What novel approaches or techniques do you anticipate will improve pediatric and adult ocular tumor management over the next few years?
With respect to retinoblastoma, intra-arterial chemotherapy has been revolutionary, and, more recently, intravitreal chemotherapy has also been a game-changer. I think two major developments will occur over the next decade that will improve our already high rates of ocular salvage in this disease: 1) the continued modernization and size reduction of interventional catheter systems, which will allow us to steer and direct these catheters further into the ophthalmic artery for even more targeted delivery; and 2) the development of nontraditional, less retinotoxic agents that can be substituted for our current agents and potentially salvage the 30% to 50% of previously treated, highly resistant eyes (currently our hardest cases). At our center at University of Texas, I work with basic scientists in neurosurgery and pharmacology on both of these approaches.
If you could have dinner with any person no longer living, who would it be, and why?
Although I did my training at Bascom Palmer Eye Institute, I never had the opportunity to meet J. Donald M. Gass, MD, a legend among ophthalmic legends. I would definitely love to meet him and would be fascinated to hear his thoughts about current retinal imaging technology such as spectral-domain optical coherence tomography (OCT), swept-source OCT, OCT angiography, and wide-field imaging. When I look back and consider the limited diagnostic testing he had available to him at the time, and yet how much he was still able to discern, it is truly impressive.