At the American Glaucoma Society meeting in March, six glaucoma specialists sat down to discuss the expanding role of women in the field of glaucoma. From the challenges women face in a male-dominated field to the importance of taking the right approach when negotiating their first job contract, these exceptional women discussed the role of empowering others like them to take the field even further.

Marlene R. Moster, MD: While the number of women in ophthalmology lingers around 30% overall, we are closing the gap in glaucoma.^1-3 From 1992 to 2020, the proportion of women finishing fellowships and becoming certified glaucoma specialists increased from 21% to 56%.² To our panelists: Why did you choose glaucoma?

• Mary Qiu, MD: Between my third and fourth year of medical school, I did a research year, and I was lucky to have met a near-peer mentor, Dr. Sophia Wang, who was one year ahead of me, and is now a glaucoma specialist at Stanford. Mentored by Sophia, I did a lot of field research. During residency, I met other female glaucoma surgeon-mentors, such as Dr. Amanda Bicket, all of whom I respected. I saw myself in these women, and I found that I really enjoyed the surgeries that I learned along the way. So I chose glaucoma.

• Eydie G. Miller-Ellis, MD: When I started in glaucoma about 30 years ago, there were very few women mentors. I chose glaucoma because of the patients I was seeing during my residency at the University of North Carolina in Chapel Hill. Many who came in for routine eye examinations ended up with a glaucoma diagnosis. They had no idea what glaucoma was or that their vision loss was irreversible. They assumed they would walk in, we’d prescribe eyeglasses, remove their cataract, or initiate some type of treatment to enable them to see again. I saw firsthand the huge need for both glaucoma and overall eye health education in the community. I felt that I could make a difference here.

• Natasha Nayak Kolomeyer, MD: I, too, was influenced by my mentors and by the strong relationships I developed with my glaucoma patients during residency. We had a continuity clinic, and I remember one patient, a 90-year-old woman who developed a complication after having a tube shunt placed. I found that connecting with my patients and their families personally and educating them about this disease is one of the most rewarding aspects of my glaucoma practice.

• Shivani Kamat, MD: It’s amazing how much mentorship can shape what you end up liking and choosing. When I started my residency, I was not even remotely interested in glaucoma. But I had a wonderful mentor—a glaucoma specialist, Dr. Shuchi Patel—who I honestly just liked being around. We had a lot of fun in clinic, and she taught me a great deal about the field. As I learned more about glaucoma, I found it to be one of the more intellectually challenging subspecialities, and I was intrigued by that.

I was also intrigued by the surgeries. When I was applying for fellowship, MIGS was starting to explode, and I was excited about the potential of the various surgical options that we would have to help protect our patients and treat in a more proactive manner.

• Dilru C. Amarasekera, MD: I was drawn to glaucoma because of the long-term relationships we develop with our patients. I had some amazing mentors at the Wills Eye Hospital, where I was a medical student, resident, did my fellowship, and where I am now a faculty member, particularly in the glaucoma department. So when I was deciding on a specialty, I turned to them. They were a big influence in my decision to choose glaucoma.

Choosing the Right Practice Setting

Dr. Moster: Once you decided to specialize in glaucoma, what did you look for in a practice setting? Did the number of female MDs on staff factor into your decision?

• Dr. Amarasekera: Probably the number one thing I was looking for was people I could trust. Sometimes it’s difficult to know where you would be a good fit. I trusted the people at Wills Eye because I’d been with them for so many years. By the time I started, the majority of staff were women. I don’t think I realized how important that was to me. Being able to discuss issues that are unique to women and female surgeons has been quite helpful.

• Dr. Kamat: When the time came to choose a practice, my husband was finishing his fellowship in the Detroit area, so I took a job at Kellogg Eye Center. I didn’t think I would want to stay in academics long term. I wanted to work where there were at least one or two senior glaucoma specialists, because I value mentorship, and I wanted to learn and grow from that experience. I didn’t really think about how many women were there at the time.

It wasn’t until I started that one of the senior glaucoma specialists, Dr. Sayoko Moroi, took me under her wing. I didn’t ask. She didn’t give me a choice. She just said, “I’m mentoring you.” And it was the best thing ever. She believed in me from the start, and I’m grateful for that. She’s the reason I became the fellowship director there. Having a female mentor like Dr. Moroi can change the trajectory of your career.

• Dr. Kolomeyer: We can’t always find a practice that meets all our criteria. Sometimes, looking for people whom you can trust and who have similar values as you do is just as important. There were no other women in the glaucoma group when I joined, but the men in the practice really valued family and were easy to trust. I’m lucky to be in that situation.

Dr. Moster: Dr. Qiu, you are thinking of changing your location and your practice. Tell us a bit about that.

• Dr. Qiu: For my first job out of fellowship, I chose the University of Chicago because Dr. Kathryn Colby was the chair. I had met her at a Women in Ophthalmology conference a few years back, and I wanted to work with her to build up a glaucoma division at a small but growing department. But during the pandemic, she left to become chair at NYU. Looking forward, I wanted to build a fellowship program at the University of Chicago, but that wasn’t possible because I was the sole glaucoma surgeon, doing clinical research while taking care of patients.
While taking some time to decide my next career move, I was in close contact with my mentors from fellowship at Cole Eye Institute in Cleveland, men and women who have been supportive of me over the last five years. I knew I could turn to them, whether I wanted to discuss a clinical issue or a research issue. When they heard that I was contemplating a move, they asked me to come back to be involved in the fellowship leadership. These were people whom I trusted, and my values aligned with the values they have for their department. I’m happy to be returning to the place where I trained to help build that program.

• Dr. Moster: I’ve been hearing a common thread: trust. When making your decision about a practice, whether the mentors are men or women, it’s important that you trust the people you’re working with to be your staunch allies who encourage you to advance and grow.

Is Academia For You?

Dr. Moster: In academic glaucoma, the proportion of female faculty is now 40.5%.³ In fact, several of our panelists are professors. What drew you to academia?

• Dr. Miller-Ellis: I did my glaucoma fellowship at Yale with Dr. Joseph Caprioli, and they hired me to stay on after I finished. At the same time, I had the opportunity to practice glaucoma and become chief of ophthalmology at the West Haven Veterans Administration Medical Center. My career goal had not been academia. I looked at a few private practices and then decided Yale was the best opportunity, the best fit for me. I found the environment incredibly stimulating, whether I was educating residents, fellows, or patients.
After Yale, I worked at Virginia Commonwealth University in Richmond for two years then returned to Philadelphia, where I grew up. I’ve been at the University of Pennsylvania for more than 20 years. I’m now on my third chair, all of whom have been very supportive in terms of my career development. During my years at Penn, the glaucoma division has grown. There are now seven of us. Six are women.

• Dr. Kamat: My husband was doing a retina fellowship in the Detroit area, so I thought I’d work for a year until he finished and then we’d figure out where to go from there. I didn’t necessarily have any expectations for the job I was going to start at the Kellogg Eye Center, but I found it to be an amazing experience. I started to realize how much I love education, teaching, and being around trainees. I didn’t expect to love it as much as I did. I’ve stayed in academics ever since. I’ve had some amazing mentors, both male and female. Our chair at the time, Dr. Paul Lee, was awesome, very pro-female, lifting women up. It was a wonderful family-friendly department, and it was an environment where I thrived.

• Dr. Kolomeyer: I love giving to my patients, but I also love growing in other ways. I’m really interested in research exploring the intersection of glaucoma and public health. I’ve grown a lot in that area, as I didn’t always know what I wanted to dive deeply into. I’ve been finding my passions over time—for example, empowering our glaucoma patients to communicate familial glaucoma risk to their family members. Academia is a good balance for me, as it involves collaborating with people both in and outside of our institution, but it’s also related to what I’m doing with my patients day-to-day. Finding that balance makes me more excited when I’m doing research, and it also reinvigorates me when I can relate that research back to my patients.
It’s also nice to be surrounded by people who are interested in teaching and education. Now that I’ve been in practice for six years, I find I like being associated with people who are younger than I am and have youthful energy. I tend to build off that energy. It’s a good reminder of why we went into glaucoma. One of my favorite times is interviewing for the residency and fellowship, because it reminds me of the journey it took to get here. I continue to be grateful for that and to give my all every day.

Dr. Moster: What advice do you give to people just finishing fellowship? Do you recommend that everyone try academia first, or go to private practice? What makes an academic glaucoma physician shine?

• Dr. Qiu: I don’t recommend that everybody necessarily start their careers in an academic role if they know themselves, their families, their priorities, and what makes them feel fulfilled. It can be difficult to know what you want in a job when you have just finished your fellowship. It’s likely that your mentors are all in academia because you trained under people who are academic glaucoma specialists. So, I think it’s tempting for many people to at least consider academia because that’s where their role models are.

Dr. Moster: Do you have advice for people who are considering academia?

• Dr. Qiu: If a trainee is considering academia, I advise applying to various institutions to get an idea of what’s out there. Within the spectrum of academic jobs, they’re not all built the same. I try to encourage people who never thought they could be in academia to at least think about it if they like teaching, at a minimum, and they like answering questions.
A lot of academia involves asking yourself, “What is the most confusing or frustrating part about how I practice or perform surgery? What can I do to fix that or make it better? And how can I spread that information to my peers?” That’s what academia means to me: teaching trainees, devising better ways to do things, and then telling the world about it. I think that will resonate with many people, even if they didn’t think about it before.

Know your Worth:
Negotiating Tactics to Bring to the Table

Dr. Moster: In 2022, there were no medical specialties in which women earned the same or more than men.5 While the gender pay gap across the field of ophthalmology is smaller than the gap across all medical specialties ($81,220 vs. $110,000), in my opinion, it is still huge. With that in mind, how did you learn to negotiate, and what advice do you have for dealing with pay disparity?

• Dr. Qiu: When I was negotiating my second job, I had five years of experience behind me. I’d made friends with a network of glaucoma specialists, both men and women, who were my age or a little older. I learned that it’s okay to talk to your friends about compensation, so that you know what might be fair for you. Employers may tell you that details of compensation are confidential, but that only helps them, not us. There’s no rule that says you can’t ask your friends how many dollars per RVU they’re paid in their department. As I interviewed for various jobs, that knowledge gave me more context for what people were paying.
In negotiating my next job, the hiring team was quite supportive, bringing me on to do exactly the academic job description that I wanted, and they made a strong and fair offer. I focused my negotiations on how we would build my job description, so that I could succeed and help the division succeed while managing the teaching and research missions that we both wanted to do. I believe a negotiation is less contentious when you and your employer are on the same page, working toward common goals. If you’re not, maybe you shouldn’t work there. Ideally, you will find an employer who will treat you fairly and support you, regardless of your gender, because you’re trying to accomplish the same goals.

• Dr. Kamat: I agree with Dr. Qiu, particularly her point about having open communication with a circle of friends. That makes such a big difference, whether it’s salary, consulting fees, or any other type of compensation. I’m one of a group of people both within and outside my institution who are open and honest with one another about this topic. Traditionally, compensation is not discussed openly, but I think it can help you gain insight and perspective into what you’re being paid, as well as help you with future negotiations.
My husband is the financial guru in our coupledom, and he’s advised me to not be apologetic about asking for things that I need and are important to me. At the end of the day, it’s a business transaction between you and someone else, and you are your own best advocate. All they can say is no, and it’s worth an ask. Be true to yourself, and don’t be afraid to be vocal about what you need.

• Dr. Amarasekera: Negotiation, particularly for salary, can be awkward and uncomfortable, and I think women especially may feel more uncomfortable having these conversations. This is something we need to become more comfortable with because it’s so important to advocate for ourselves. Going into your first job, I think it’s a good idea to interview broadly to get a sense of what different practices have to offer. Once you have an idea of what different employers are willing to offer, you have negotiating power when you ultimately find the practice that you would like to join.

Dr. Moster: Dr. Kolomeyer, were you comfortable negotiating? If you had to do it again, would you do it the same way?

• Dr. Kolomeyer: I definitely could have been a better negotiator. I’m happy with how my contract turned out, but we can always learn and grow. It’s a different situation when you’re staying at the same institution after fellowship. I think if you feel more comfortable promoting yourself and negotiating when you’re changing jobs, you can have different asks. When you’re staying at the same place, however, you understand what you can and cannot ask for. You really need to prioritize what you ask for, and you have to know what you’re bringing to the table.
Renegotiating my contract, and even just prompting that discussion, I was somewhat confused about what I wanted: did I want to make more money? Did I want to have a more consistent day? Did I want to be able to pick up and drop off my child one day a week? What did I really want? It was more of an internal battle because I was such a feminist and I wanted to grow, grow, grow, but I also wanted to be a realist and balance my priorities at home.

Challenges Unique to Women

Dr. Moster: What has been your biggest challenge coming into ophthalmology, in general, or glaucoma specifically, that men probably didn’t have to face?

• Dr. Amarasekera: From a clinical perspective, especially as a younger woman, it may be difficult for patients to take you seriously or trust you as their surgeon. I’ve had patients ask me how old I am, and sometimes that can kill your confidence, but you have to know that you’re well qualified to be their glaucoma surgeon. Once you project that confidence, patients trust you. As a surgeon, I think this probably happens to women more frequently.
From a career growth perspective, sometimes it can be more difficult for women, particularly women who are reaching for leadership positions, because a woman who is outspoken and direct may be perceived more negatively compared to a man with the same qualities. While that’s not always the case, it can be a limiting factor.

• Dr. Qiu: Some of my struggles have come in the OR, because I’m the only glaucoma surgeon. I introduced many procedures that the OR staff had not seen before, and I didn’t have a glaucoma colleague to echo what I was saying about the critical pieces of equipment we would need. For example, my viscoelastic preferences seemed quite particular to the staff, as the cataract surgeons didn’t need the same ones. If the sole glaucoma surgeon was male and had made the same requests, I don’t think he would have been questioned.
My husband started his job at the same time and place as I did. As a white male surgeon, he has definitely not faced the same issues that I have.

• Dr. Kolomeyer: I’ve been lucky that I haven’t been in that situation very often. I’ve developed trust with my patients, so they don’t question my age or experience as often. When I first started out, I think I was hypersensitive. Maybe I’ve matured in six years, and I’m not as sensitive to it now because I take it in stride. Dr. Qiu, you bring up a great point. We talk about the perceptions that our patients and our physician colleagues may have, but we don’t talk as much about the administration and staff.

The Elusive Work-Life Balance

Dr. Moster: We’re all faced with the challenges of decreasing reimbursement, increased expenses, and the pressure to see more patients. Managing these pressures while maintaining a fulfilling personal life is an ongoing balancing act. How do you achieve a work-life balance that makes sense for you and your family, and how do you avoid career burnout?

• Dr. Amarasekera: I believe it’s important to leave work at work and to keep home at home. Having a supportive partner is a great help. It’s nice to have someone to chat with about things that aren’t work-related when I come home. Spending time with friends is also important and helps release stress. I think hobbies outside of medicine are extremely important, too. I’ve tried activities such as painting and drawing, working out, and yoga, all of which help me to decompress after work.

Dr. Moster: Dr. Kamat, you’re part of a power couple. How do you maintain work-life balance so that you enjoy going to work the next day and your husband feels the same?

• Dr. Kamat: It’s a work in progress for us, and I think it’s a daily struggle for many people. Nowadays, our time is a precious resource. I encourage delegating and outsourcing what you can, even things like getting grocery delivery, so you can focus your attention on what’s really important to you. It’s important to have support at home and at work and to be vocal about what you need.
I like to be by myself, to sit in my room with my dogs and just be. If that’s what self-care means for you, do that for half an hour a day or half an hour a week, whatever works for you. I think women find it difficult to say no; we worry about how that might be perceived. But prioritizing your mental health is vital.

• Dr. Kolomeyer: I think we all tend to be perfectionists as women glaucoma specialists. But it’s okay to not be perfect at everything and to recognize what’s important in this moment. Ask yourself, “What do I want to be really good at? What am I okay with being not so good at? What can I have someone else help me with?”
In this season of my life, it’s important for me to be present at home. When I get home, my two kids run over to me, and it’s the best feeling in the world. It’s an easy way to forget work and just be present for them. When I’m at work, it’s go, go, go. As soon as I walk in, there are patients ready to be seen. It’s good to be present in both times, but sometimes they conflict and we’re just doing the best we can. Having groceries delivered, having excellent childcare, these things are important for me personally. My husband is also a physician, and we both realized getting dinner ready on a weeknight is just too stressful. I might get home 20 minutes earlier, but I’d rather use that time to hang out with my kids and read books with them instead of struggle to prepare dinner. So, we’ve started getting a weekly meal delivery service, and I feel good knowing that I chose what we wanted, and our meals are freshly cooked and healthy. Dinner’s ready fast. We eat. We have quality family time together, and I don’t feel that stress.
Work-life balance will look different for different people. When you find what works well for you and your family, you can continue to be your best self at home and at work.

Dr. Moster: How do you manage the stresses of clinical practice?

• Dr. Kolomeyer: As practices and procedures evolve, sometimes you can eliminate steps to make things more efficient in the current landscape. In the clinic, technicians and scribes can handle some tasks, freeing you to do what only you are qualified to do. There are different layers of assistance in terms of what the staff can do to help you work more efficiently. As things get stressful, it is also important to have a variety of support networks, such as glaucoma colleagues and women ophthalmologist colleagues at your practice, and, of course, your friends and family. I feel lucky to have different groups I can lean on for support as needed.

Dr. Moster: Dr. Qiu, how do you avoid burnout?

• Dr. Qiu: I’m always planning our next vacation. My husband and I like traveling to far-flung places. Last summer, for instance, we traveled to Svalbard, Norway, where we saw polar bears in the wild.I also really feel what Dr. Kolomeyer said about the phases of life. We have no children, and my husband, who’s also a full-time surgeon, is doing a night and weekend MBA program. When we come home from work, he’s doing homework, and I’m in the home office editing surgical videos. I consider that my hobby. To me, it’s like painting or going to the nail salon. It’s my quiet alone time and I find that relaxing.
In this phase of life, my husband and I are both very busy on nights and weekends, but he will be graduating from his MBA program, and we’ll be moving back to Cleveland soon. We’ve discussed how our work-life balance may look different in this next phase compared to the first five years of our life together. We anchor on the things that are important to us, such as how we spend our time together, or how we plan our next vacation. We also respect that work is important to both of us, and we have to make the right time to do that—whether it’s during business hours, or nights and weekends, as long as we’re on the same page about how we spend our time.

The Future of Glaucoma

Dr. Moster: Glaucoma care is tremendously exciting and advancing right now. What excites you about the future? Is it drug delivery? Newer devices and procedures, treating patients earlier in the game, where the paradigm shift is going to change? How do you feel about this new explosion in glaucoma?

• Dr. Kamat: We’re fortunate that we have so many tools in our toolkit that enable us to treat patients in every phase of their disease. I’m excited about sustained drug delivery and about new laser and surgical devices. There’s still much that we don’t know about glaucoma. I’m excited to learn more about neuroprotection, for example, in the coming 5 to 10 years. We’re fortunate that we’ll be able offer many different options to our patients in the not-too-distant future.

Dr. Moster: Dr. Kolomeyer, what advice would you give glaucoma surgeons starting today about what to expect within the next 5 to 10 years? Where should they direct their attention?

• Dr. Kolomeyer: I’d advise them to make the most of every opportunity. From every surgery, try to really understand the indications. Think about what you would do and if you would have done anything differently. Think about what you would like to see in the future, what tools you wish you had. Bring passion to whatever you do and make the most of your skill set. Don’t be afraid to look at things in a different way.
We’ve come a long way, but we also have far to go. We’re treating a blinding, irreversible disease, and we need people who care, people who will continue to move us toward preventing blindness. I’m excited about being able to identify glaucoma patients earlier, educating them, and leveraging technology.

• Dr. Amarasekera: Ten years ago, glaucoma care looked very different from how it looks today, and in another 10 years it will look completely different again. I would encourage new glaucoma specialists to keep an open mind and try new things. Don’t limit yourself to what you were taught in fellowship. Learn new techniques, work with new devices. That’s how we will continue to advance the field.

In Closing

Dr. Moster: This has been terrific discussion. I want to thank you for your knowledge, your enthusiasm, and your honesty. Not only will sharing your thoughts and advice help each of us today, but it will also help many glaucoma specialists and ophthalmologists. I want to thank Glaucoma Physician magazine for the forum to enable us to do this today, and Thea Pharmaceuticals for providing an unrestricted grant to make this roundtable possible.

References

1. Fairless EA, Nwanyanwu KH, Forster SH, Teng CC. Ophthalmology Departments Remain Among the Least Diverse Clinical Departments at United States Medical Schools. Ophthalmology. 2021;128(8):1129-1134.
2. Steren BJ, Yee P, Rivera PA, Feng S, Pepple K, Kombo N. Gender Distribution and Trends of Ophthalmology Subspecialties, 1992-2020. Am J Ophthalmol. 2023;253:22-28. 
3. Afzali K, Fujimoto DK, Mohammadi SO, Lin KY. Race and Gender Shift among Academic Glaucoma Specialists in the Last 5 Decades. J Curr Glaucoma Pract. 2023;17(2):98-103.
4. Fathy CA, Cherkas E, Shields CN, et al. Female Editorial Authorship Trends in High-Impact Ophthalmology Journals. JAMA Ophthalmol. 2021;139(10):1071-1078.
5. 2023 Doximity Physician Compensation Report. https://press.doximity.com/reports/doximity-physician-compensation-report-2023.pdf.
6. Templeton K, Bernstein CA, Sukhera, J, et al. Gender-based differences in burnout: Issues faced by women physicians. NAM Perspectives. 2019. Discussion Paper, National Academy of Medicine, Washington, DC.