Damien Gatinel, MD, PhD
Dr. Gatinel, the head of anterior segment and refractive surgery at the Rothschild Foundation in Paris, is a researcher and innovator with an interest in ophthalmic optics. His most recent investigative forays include taking another look at Zernike analysis to try to make it more clinically useful. In this interview, Dr. Gatinel talks about why ophthalmology as a profession appealed to him, his worldly travel schedule, and why he is so curious.
Interviewed by Laura Straub, CRST/CRST Europe Editor-in-Chief
Nominated by the Chief Medical Editors of CRST Europe
BMC: Who or what drew you to ophthalmology?
Damien Gatinel, MD, PhD: I always wanted to be a doctor, but my heart was also drawn to the basic sciences, especially the hard sciences like math, physics, optics, and astronomy. It seemed logical to me that the perfect combination of these interests would be ophthalmology. When I was really young, however, I honestly thought that ophthalmology mainly dealt with optics and refractive surgery, and I had no idea that you could also do vitreoretinal procedures, for instance. Part of this perception, in France at least, is because we don’t have independent optometrists per se; instead, patients go to their ophthalmologist for refractions. There are many medical ophthalmologists who do mostly refractions and routine checks, in comparison to relatively few ophthalmic surgeons. Naturally, I thought ophthalmology would mainly be a specialty dealing with refractive issues—that’s essentially why I chose ophthalmology.
BMC: Once you realized a little more about ophthalmology, did it influence how you found your niche?
Gatinel: Long before I was a medical student, I was devouring magazines about lasers and technological inventions like that. I really believed that ophthalmology was going to be cool because I could do research in an engineering environment, work with lasers and other fancy technology, and also be a doctor. So even before I had to formally choose a medical specialty, I knew I wanted to be an ophthalmologist, and I knew I wanted to do what I’m doing today in terms of refractive surgery and optics research.
In some ways, it was fortuitous that I had little appreciation of the breadth of subspecialties one can undertake as an ophthalmologist. As a result, I had a precise idea of what I wanted to do, and even when I was exposed to other specialties during my medical studies, I never deviated from this goal. I stuck with refractive surgery and issues related to ocular optics because it’s what most fascinates me.
BMC: In your research, what are you currently working on, and how is it affecting your practice and patient care?
Gatinel: Currently I’m working on a new model for more accurately describing the optical aberrations of the human eye using an approach combining mathematics and physiologic optics. Second, I am also working on keratoconus detection and characterization. Third, I am working on the optical designs for the next generation of trifocal diffractive optics. Additionally, we recently published a paper on an objective cataract grading method, based on lens densitometry measurements on swept-source optical coherence tomography (OCT) scans with the IOLMaster 700 (Carl Zeiss Meditec).1 This method utilizes the cross-sectional image from the swept-source OCT, from which we can calculate an index of cataract opacity. This is a research project we’ve been working on for a long time—and I think it will be a very important milestone, both clinically and from a research standpoint. We’ve also undertaken some research with the HD Analyzer (Visiometrics) in the past. The idea is to define new objective measures for distinguishing between surgery for dysfunctional lens syndrome and true cataract surgery. We have experimented with other metrics in the past and now we are investigating swept-source OCT.
Last but not least, we are working on using deep learning processes and big data to improve intraocular lens power calculations. We are just getting started with this, but we’re excited because I think we can do something great with it.
If anything, my main problem is that I have a hand in many different things all at once. It’s time-consuming to be involved in so many different projects, but I don’t find myself fulfilled by just one field of study. I don’t like to stay in the same track; I like to be doing different things at the same time.
BMC: In February, you won Best Paper at the Wavefront & Presbyopic Refractive Corrections Congress in Denver for your new Zernike formula.2 Can you talk about your research and the paper that you presented?
Gatinel: This research was the core of my PhD work, which I did somewhat late in my career for various reasons. But this project was a long one. It’s aimed at providing clinicians with numbers that make more sense when they analyze ocular wavefronts. The Zernike system was designed by Frits Zernike to describe instrumental wavefront errors, such as what occurs in the optics of microscopes or telescopes, but for many reasons it’s not really suited for human eye analysis. For example, if you try to predict an eye’s refraction from the wavefront Zernike analysis, you will encounter some systematic errors. Similarly, the titration and prediction of the impact of higher-order aberrations may not be clinically as accurate.
I tried to provide a basis of functions that are more directly related to the clinical aberrations that we see in our patients. Now I’m at the stage where I’m comparing the Zernike measurements to this new class of operation—trying, for example, to see if we can predict refractions with greater accuracy. The numbers we are generating match the clinical situation more closely than the Zernike. So far, it’s been encouraging.
Of course, I was only able to undertake this work in close collaboration with mathematicians using a multidisciplinary approach. You definitely cannot work in this field alone; you need mathematicians, statisticians, and computer scientists if you really want to push things forward with any sort of momentum. I encourage my fellows to develop related skills like learning computer programming languages, which were not really required in the past in the field of medicine or ophthalmology.
BMC: It’s fantastic that you can attend as many meetings as you do to present your research. What is the draw for you to attend and present at so many meetings, and how do you prioritize which meetings to attend?
Gatinel: I like to participate in meetings where I’m invited to speak, of course. [Laughs.] Some of them I attend so that I can learn from others, and some I attend for academic reasons. But many I go to for both reasons. I like to present on what I’m doing because I think you really need to interact with your colleagues to receive an objective external critique on what you’re doing. I also like to teach about things I believe are important. So I very much value this aspect of interaction with an audience and receiving feedback, whether positive or negative—it fuels my work and drives me with more energy and stimulus to do better. Mainly I learn from books and papers. But I do believe you need to go to meetings sometimes to be exposed to things you would never imagine or envision. When you go and listen to someone speaking about something you didn’t know about, you glean a little from what he or she says on the podium, but you also learn about what you need to develop the knowledge further—later on, on your own, to become more knowledgeable about that one thing. I would summarize this by saying that I simultaneously learn and realize what I don’t know during meetings, and later I try to fill the gaps by reading books and papers.
When I was younger, I went to many meetings like the Association for Research in Vision and Ophthalmology and the American Academy of Ophthalmology, and then I would sit and learn about what I would like to research further in greater depth. Today, I’m more often in the position of speaker, but I still like to keep my ear to the ground on what others are saying. It often gives me ideas to expand upon what they’ve done or to develop my own research based on something I find interesting.
The other aspect of these meetings is that I like to travel to countries I’m not familiar with. I love to make friends and meet colleagues in different countries. All of these things factor into my decision of whether to go to a given meeting.
BMC: If you had to nominate one creative mind in ophthalmology, whom would it be and why?
Gatinel: Gerrit Melles, MD, PhD, because of his inventiveness and creativity—he has developed many new techniques for corneal surgery. I have had the honor of meeting him on many occasions, and he has a fascinating personality. With all the ideas he has contributed, for instance with Descemet membrane endothelial keratoplasty, he is really an innovative creator in the realm of corneal surgery.
1. Panthier C, Burgos J, Rouger H, Saad A, Gatinel D. New objective lens density quantification method using swept-source optical coherence tomography technology: Comparison with existing methods. J Cataract Refract Surg. 2017;43(12):1575-1581.
2. Gatinel D. A new aberration basis for better ocular wavefront analysis. Paper presented at: Wavefront & Presbyopic Refractive Corrections Congress; February 23-24, 2018; Denver.
Damien Gatinel, MD, PhD
• Assistant Professor and Head, Anterior Segment and Refractive Surgery Department, Rothschild Ophthalmic Foundation, Paris; Director, CEROC, Paris
• Member, CRST Europe Editorial Board
• Financial disclosure: None acknowledged