What has been most challenging about transitioning from Chair of the Department of Ophthalmology & Visual Sciences and Director of Vanderbilt Eye Institute to Assistant Vice Chancellor?

Ophthalmology is almost exclusively an ambulatory profession, with even most of our surgery performed in an outpatient setting. However, as Assistant Vice Chancellor, a large portion of my responsibilities relates to oversight of a large hospital system. Learning about hospital operations has been a great challenge and will continue to be one for the foreseeable future.

How do you balance your time between your professional duties at the institute and your research?
I have always been quite adept at time management, juggling a busy clinical practice, a research laboratory, administrative responsibilities, and family. However, my skills in this area have been greatly challenged in my new role. In order to free up time for my roles as Associate Dean and Assistant Vice Chancellor, I have reduced my clinical practice dramatically. So far, I have been able to maintain my research program. In fact, my research program is a highlight of my week because the dialogue with my collaborators and staff is completely distinct from anything else I do. Thus, I am hopeful that I can continue to protect this time. Obviously, though, it is essential to have talented colleagues that do most of the heavy lifting.

What advice would you offer fellows about dealing with postop cases?
First, it is essential to pay close attention to all aspects of the surgery, even to those details that may seem the most trivial. Too much diathermy to a sclerotomy site may lead to scleral thinning, which in turn may challenge closure and risk a wound leak. Poor placement of your conjunctival suture knots will lead to irritation. Second, you must be precise in your instructions to the patient with regard to the medication regimen, postoperative positioning, and warning signs to prompt them call you. Finally, you must balance optimism with realism about the ultimate result so the patient waits comfortably while the eye heals but is not unrealistic about the prognosis.

What is your most memorable experience in surgery?
I guess most of us best remember our embarrassing moments. As a fellow in the 1980s–the era prior to liquid perfluoron–repair of giant retinal tears was quite challenging and required the patient to be placed on a Stryker table and inverted into the prone position to perform the fluid-air exchange in order to unfold the giant retinal tears. The surgeons had to lie on their back on a roller with the patient suspended above. After completing this maneuver on a Saturday morning, the attending surgeon asked me to close the sclerostomies, suture the conjunctiva, and give the patient periocular injections of antibiotic and steroid, all of which needed to be done lying on my back looking and reaching upward!

I was successful with all the maneuvers until the injections. After administering the triamcinolone injection, the cornea immediately turned white, and it became apparent that I had injected the triamcinolone into the eye, rather than around it. In those days, we were concerned that triamcinolone or its vehicle might be toxic, so I had to notify the attending surgeon, who had already changed out of scrubs, dictated the operative note, and spoken to the family. He had to return to the OR, flip the patient back into the supine position, reopen the sclerostomies, excise the triamcinolone, flip the patient back to the prone position, repeat the fluid-air exchange, and complete the case.

What is something most people are surprised to learn about you?
Most people are surprised to learn how involved my wife and I are in the arts community. We have collected contemporary photography for almost three decades. In addition, I was an active member of the board of directors of the High Museum of Art in Atlanta, Georgia, and currently chair the board of directors of the Cheekwood Botanical Garden and Museum of Art in Nashville.