1. How has your father's work in pediatric ophthalmology influenced your career?
My father, Fernando Arevalo-Coutinho, MD, (1928-1989) was a prestigious pediatric ophthalmologist in Caracas, Venezuela. He was the Director of the Children's Hospital of Caracas during the mid 1960s. Everyone who knew him remembers him with love and admiration. I went into medical school to be an ophthalmologist, like my father. When all my classmates were wondering what subspecialty career to choose, I was already learning from my father at his clinic. He was my first professor of ophthalmology and he gave me all the opportunities necessary to reach my goals.

My father died when he was 60 years old; I was a second-year resident. It was a difficult time, but my father's death gave me the strength to pursue my career with even stronger determination and to continue the family tradition that he started in ophthalmology. I finished my ophthalmology training in Caracas, Venezuela. I then completed a 2-year retina and vitreous fellowship from 1992 to 1993 in Bogot‡, Colombia at the Barraquer Institute and the Fundacion Oftalmologica Nacional, University of El Rosario. After this intensive training, I went to the United States from 1993 to 1995 for a retina and vitreous/uveitis and intraocular inflammation fellowship at the University of California, San Diego. The following year, I went to Philadelphia, Pennsylvania, for an ocular oncology fellowship at Wills Eye Hospital. The physical absence of my father made me more determined to reach the level of excellence that he achieved and the level of excellence he encouraged me to achieve.

2. What is the mission of the Arevalo-Coutinho Foundation for Research in Ophthalmology?
The Arevalo-Coutinho Foundation for Research in Ophthalmology was founded in 2000 to honor my father. The foundation is a nonprofit organization that helps residents pursue subspecialty training in retina and vitreous at our institution. The foundation pays for two scholarships a year to spend 2 years at the Clinica Oftalmologica Centro Caracas. Thus far, we have trained fellows from Colombia, Ecuador, Peru, Argentina, and Venezuela. Our fellows have given over 250 presentations at national and international meetings and published over 150 papers in English and Spanish. The foundation also pays for surgical procedures for poor patients in our country. Since 2000, the foundation has treated more than 1,600 indigent people.

3. How do you balance your time between teaching, research, and your director responsibilities?
I balance my time through organization. I work at one facility so that I do not need to travel and lose time sitting in the world famous traffic of Caracas. In addition, working at one place allows me to work while waiting for patients or for surgery to begin. I wake up at 5:30 am each day. At 7:30 am, I begin classes with my fellows. Clinic starts at 9:00 am and closes at 5:00 pm, although many nights I work at the clinic until 8:00 pm. Tuesdays and Thursdays are my surgery days, but I try to do all surgical cases on Tuesday so that I can dedicate Thursdays to research. I travel to approximately 20 international meetings a year, which disrupts my schedule. However, I love teaching and interacting with my colleagues worldwide.

4. What is your perspective on the major issues concerning practicing medicine in your region?
Health care in Latin America is divided between the government-based public care sector and a private practice sector. Approximately 80% of hospitals are government owned; very few are privately owned. There is insufficient government spending on education and health care. Private groups have financed the enormous changes and advances that have characterized ophthalmology in the region. As the budgets of governmental institutions progressively dwindle, there is a widening gap between public and private institutions. In private facilities, a patient can find the best possible care with the most advanced equipment and well-trained personnel. In public facilities, however, it is rare to find good equipment. Although there are well trained and highly motivated personnel in the public facilities, limited resources prevent health care providers from helping their patients to the fullest extent.

The significant achievements made by ophthalmologists in Latin America have been reached mainly through the extensive teaching programs either organized or sponsored by the Pan American Association of Ophthalmology (PAAO). The PAAO has also been responsible for stimulating a sense of pride among ophthalmologists who participate in elevating the standards of medical practice in their countries. Retina and vitreous has become a subspecialty in Latin America, thanks to those few who had the opportunity to train in the United States and Europe.

Over the past few years, pharmacotherapy has become an important part of treating vitreoretinal diseases. Unfortunately, many of these new treatments are out of reach for Latin American patients due to escalating costs. In 2005, at the 23rd Annual Meeting of the American Society of Retina Specialists Meeting in Montreal, Canada, we explored the possibility of scientific collaboration to find alternative treatments for our patients as well as ways to publish our work. Later that year, a research group from Latin America based on a combination of academic achievements and friendship was envisioned at the 2005 American Academy of Ophthalmology meeting in Chicago. During the 2006 World Ophthalmology Congress in Sao Paulo, Brazil, a group of 11 centers from eight countries (now 13 centers from nine countries) was officially established as the Pan American Collaborative Retina Study Group (PACORES). Of the 70 presentations that have been given at international meetings on behalf of PACORES, eight have already been published.

5. What is the most exciting experience that you have had traveling?
My most exciting experience is traveling with my family. Unfortunately, that does not happen very often, as my son is 12 years old and has responsibilities at school. I can recall several exciting experiences, such as riding an elephant on the streets of Mumbai with my wife and son and riding camels around the pyramids of Gaza with them. I will never forget the look on my son's face the first time he heard me give a talk in English at the 4th International Conference of Ocular Infections in Japan and drivng a convertible with my son at the Macula Society Meeting in Palm Beach this year. He even gave me pointers for my talk in Palm Beach, and congratulated me at the end for following his advice!