Professor Gerard Sutton has been appointed the inaugural Sydney Medical School Foundation Professor of Corneal and Refractive Surgery at Sydney University. He’s been an ophthalmologist for 16 years and believes he has at least another 16 in him. We put some salient questions to him.
Q: How did you come to chose ophthalmology as a career?
A: Initially I was planning to do neurology due to my fascination at the time with the workings of the brain. After a frustrating term as a neurology resident however, I complained to the specialist in charge that despite all our efforts none of our patients were getting any better. He realised I was results-oriented and suggested Ophthalmology. I transferred over and have never looked back. I love the surgery and the fact that whether it is LASIK, cataract or a corneal transplant, the patients are generally happy. In this position you can make a difference to people’s lives. Being an ophthalmic surgeon is a privilege.
Q: How long was the training process?
I have always done clinical research which I believe is the best way of staying on top of your field and ensuring your surgical decisions are based on the latest published studies
A: It took me 13 years from the time I entered medical school at the University of New South Wales in 1981 to become an ophthalmologist. I then completed three more years in subspecialty training in Corneal and Refractive Surgery. So I guess that’s 16 years all up… but it was a fun journey and I would like to think I am still learning and improving my skills to this day.
Q: You were the first Australian to complete a Refractive Fellowship overseas…
A: That’s right. I spent time in the U.K. at Moorfields and St Thomas’s and also in Erlangen, Germany.
Q: Did you always want to become a Professor?
A: No! I always saw myself (and still do) as first and foremost an ophthalmic surgeon. I have always done clinical research which I believe is the best way of staying on top of your field and ensuring your surgical decisions are based on the latest published studies. I then completed a Doctoral Thesis with Professor Charles McGhee in 2009. He was a great help and role model, encouraging me to consider a Clinical Academic role. He appointed me a Clinical Associate Professor in 2007. It really evolved from there. I increasingly saw the importance of both clinical and basic scientific research and enjoyed it.
Q: Who were some of your other main mentors? Do you have any favourite stories from your time with them?
A: I have had many mentors. I was the inaugural fellow at the Eye Institute in 1994 and benefited from Chris Roger’s and Michael Lawless’ teaching in corneal and refractive surgery. I then went overseas and worked with some of the great surgeons of the time including Dr. Arthur Steele at Moorfields and Professor Fritz Naumann in Germany. Fritz was probably the best surgeon I’ve ever seen and he taught me a lot. I also greatly admire Professor Doug Coster from Adelaide and Professor John Marshall from St. Thomas’s in London.
I went over to London in 1994 for an interview for one of the prestigious fellowships at Moorfields and at St Thomas’s and my strategy was to take over a corneal specimen of an eye that had PRK and then a transplant. It was a very rare piece of pathological tissue and I hoped to ingratiate myself with the Professors by bringing it over. We didn’t fully understand the pathology of PRK at the time and it was like gold. I kept it with me the whole trip and it did elicit some probing questions when going through customs! I had stopped off at Kuala Lumper to give a few lectures at a conference and whilst waiting at the hotel for the departure time to London, I had a few drinks by the pool. Well one thing led to another and when I arrived at the airport, I realised I had left the container with the cornea beside the pool. There was insufficient time to get back to the hotel, so I called the hotel and arranged for a taxi to get to the airport ASAP. I saw my overseas fellowships disappearing before my eyes, but fortunately the container arrived just as they were announcing that if I didn’t board the plane immediately I would be left in K.L. I arrived in London, presented the specimen and got the fellowship.
Q: In your day-to-day clinical work, what are the main eye conditions that you have to deal with?
A: My practice is primarily related to surgical problems in the anterior segment; laser vision correction, cataracts, corneal disease and keratoconus.
Q: What are the main surgical procedures you perform, and do you have a favourite and why?
A: One of the main surgeries is refractive Surgery. LASIK is the most common procedure I do, but I also do ASLA (PRK), Phakic IOLs and, increasingly, Refractive Lens Exchange with the newer premium IOLS.
I also perform cataract surgery, corneal transplantation – especially the newer techniques such as DSEK and DALK, keratoconus surgery including cross-linking and intra-corneal ring segments, and pterygium.
My favourite is LASIK (which I have had myself) followed closely by cataract surgery. The results from these operations are truly phenomenal. I also enjoy the surgical finesse required with the newer corneal transplant procedures aero-DALK and DSEK. They are elegant almost artistic activities.
Q: Can you tell us a bit about your research work and interests to date? What are the key questions you would like to research in the future?
A: My research is mainly clinical, but I am also leading a basic science research team investigating a new finding in keratoconus which we made last year. This is very exciting and we are looking at avenues to develop new treatments modalities to prevent keratoconus progression. I have to say the scientists I work with, Professor McAvoy and Dr Madigan at the Save Sight Institute, are the intellects behind this research.
I also like clinical research because it allows me to remain at the surgical cutting edge and be in a position where I can assess new treatments critically and base my surgical choices on evidence-based medicine.
Q: Your new appointment as Professor of Corneal & Refractive Surgery at the Sydney Medical School Foundation sounds exciting. What sort of activities will that involve?
A: It is exciting but there are also many challenges. Given that is a Surgical Professorship, I will obviously be doing Refractive, Corneal and Cataract surgery. I will also be running the Keratoconus Research Programme and the new Refractive Surgery Degree which I set up last year. It is due to be launched internationally in 2011. So it basically formalises my commitment to research and teaching. The position is perfect because it takes up two days a week and leaves me to spend three days in my Surgical Private practice at Vision Eye Institute (VEI) Chatswood.
Q: You’ve been in group ophthalmology practice for several years now. What has been the main advantage for you in being a part of an organisation such as Vision Eye Institute, as opposed to being in a small practice?
A: The biggest advantage is that we can have the newest and best technology. We also continually challenge and learn from each other. When I was appointed to the Professorship I was invited to join a number of other practices both small and large but in my opinion VEI Chatswood is the best practice in Sydney. The culture has always been about providing the best surgical treatment for our patients and therefore about wanting to be the best at what we do. This attitude also lends itself to clinical research so in the end it was an easy choice.
Q: You also do some charity work overseas. Can you tell us about that?
A: Whilst I have done five surgical tours to Cambodia and Burma, I must point out that there are many other ophthalmologists who have done and continue to do considerably more aid work overseas than I have. It is actually reassuring to see just how many ophthalmologists and optometrists in Australia do their bit in this way. I do enjoy my time with the Myanmar Eyecare Project and supporting Dr Geoff Cohn, the director of the programme.
Whilst in the past I have been simply performing cataract and corneal surgery in these countries, I am now planning to work at a different level and I have set up workshops in Yangon (Burma) where surgical skills are taught to the local ophthalmologists. This allows skill transfer in subspecialty areas such as cornea and oculoplastics. I have finally built a relationship with the Professor in Yangon but the political situation is unstable and can be frustrating.
Q: You’ve lectured all around the world. What’s the best place you’ve been to where you had some time for a bit of R & R?
A: I have lectured I think on every continent but really there is only one answer as to my preferred destination – New Zealand. The South Island of New Zealand is one of the most beautiful places in the world. I get there any chance I can. Next March I will be the keynote speaker at the NZ Cornea and Contact Lens Society meeting in Queenstown. It should be fun, I can’t wait.
Q: Some of us know you like to go fly-fishing. What’s the captivation there? Any other favourite pastimes?
A: I do love fly fishing. In some ways it is very much like eye surgery. It is about precision, patience and the pursuit of perfection. Both activities for me are totally engrossing. And I can just as easily get in “the zone” operating as I can fishing. The difference however is that when you are fishing, you are immersed in spectacularly beautiful places. It feeds my soul and renews me. It was in truth the main reason I had LASIK last year. Without readers I was struggling to tie my hooks on, which was a real problem in the middle of a South Island braided river with a blustery southerly. Now tying on the hooks is a piece of cake… catching the fish is another matter!
I like to keep fit and enjoy touch football and play three times a week. Family time is also very important to me and I try to strike the right balance between work, family and recreation although that’s not always easy.
