The December 2012 Optometry Student in Focus is Kevin Willeford of SUNY Optometry, class of 2014. I personally had the opportunity to work with Kevin in pediatrics clinic and to see him progress through optometry school. He is certainly a remarkable student who will do great things for this profession. I believe that Kevin’s motivation to push the bar in the areas of research and binocular vision are not only great for his future career but also act as a motivator to students out there who desire something more out of optometry. I wish Kevin the best and our team honors him for his achievement. Visit the Student in Focus page for more information. Congratulations Kevin.
1) You are being nominated for “Student in Focus” of December 2012 because of your recent accomplishment in publishing the paper Smoking and Age-Related Macular Degeneration: Biochemical Mechanisms and Patient Support. Can you please tell us a little bit about the paper?
There are many epidemiological associations we learn about in optometry school (e.g., smoking and AMD), however that is all we learn- the association. I wanted to dig a little deeper and find out exactly how smoking increased one’s risk of developing macular degeneration. The paper Dr. Rapp and I wrote outlines three basic ways in which the many chemical compounds found in cigarette smoke have an adverse effect on the eye. Cigarette smoke, in addition to causing damage to the ocular surface, directly damages the photoreceptors and retinal pigment epithelium with free radicals, renders the tissues less able to defend themselves against such damage, and reduces nutrient delivery by harming the vascular supply (i.e., choriocapillaris) as well.
The major problem is that not many people associate smoking with vision loss. The second part of the paper focuses on ways to educate smokers about risk factors and most importantly, how to support patients in the challenging task of smoking cessation. Providing support to patients starts with asking them if they smoke and can be as simple as referring them to a smoking cessation hot line. Optometrists are doctors, but along with that distinction comes the job of teacher as well. It is our responsibility to share our knowledge with patients: assuming your patient knows why smoking is bad for their ocular health could lead to permanent vision loss.
2) What motivated you to write this paper?
As I mentioned above, I wanted to know more! As often is the case in optometry or medical school, there is such a large amount of material and so little time that only the basics are covered- this can make a subject boring or hard to understand because many pieces are missing. My strategy to understanding all of the material is not to memorize all of the facts, but instead to look up more about the subject so the basic science behind the phenomenon becomes clearer. The relationship between smoking and age-related macular degeneration was one that kept on popping up on power point slides, so by the third or fourth time I figured it was important to understand. Plus, like a true science nerd, I think biochemistry is interesting.
Additionally, smoking is a voluntary (albeit very addictive) behavior with avoidable consequences. If I were to advise a patient to quit, I wanted to be able to confidently tell them why it was harmful to continue smoking. I felt my advice would be taken with more weight if it came with an explanation, instead of saying “just because.”
3) Can you provide a short summary of general instructions about how you go from taking and idea and getting it published?
First, I would advise any student looking to publish a paper to find a faculty mentor to help them along the path. Before I wrote this paper, I had little knowledge of the topical content of each journal and what they generally published and did not publish. Dr. Rapp helped me gear the paper towards Optometry and Vision Science by emphasizing both basic (e.g., mRNA, protein function) and clinical (e.g., optometric implications) science. Even a student writing independently could benefit from the advice of a more experienced faculty member- half the battle is knowing what journal to submit to!
Second, this may sound obvious, however, a topic of personal interest should be chosen. If doing a review, this makes doing the prerequisite literature search and reading much more pleasurable to do. If a student is looking to publish original research with a lab mentor, choosing a laboratory in an area of interest is even more important, since this tends to require a longer commitment.
Lastly, the topic must be relatively untouched. It is disappointing to have a groundbreaking (at least, in your mind) research question only to find out it was answered in 1993. So, before going through months of writing and editing, make sure you are answering an unanswered question!
So to sum up, find a mentor and next time you find yourself wondering “why”, start looking for the answer.
4) As a student you clearly are pushing the bar and doing more than the average student. What is the reason you have gone above and beyond?
Thank you for quite the compliment! Putting my perfectionist and associated personality traits aside (I know other optometry students can relate), two things are left. First, I want to provide the best service/care to patients as possible. That reads as a “corny admissions answer”, but I can think of many times I went to a doctor and felt like I was not advised correctly or that the doctor did not know what they were talking about. This is not to say I won’t make patients feel that way too, however I would like to reduce that possibility as much as possible! Reading all of the course material, understanding it, and putting time into extracurricular activities (such as research) have all helped build my clinical knowledge base so far.
Second, I think I could have been equally as happy as a research scientist- maybe not alone in a room with rats, but pipetting all day long doesn’t sound too bad to me. I was afraid to commit to an intense graduate research program after undergrad, but after taking part in the Master’s program here at SUNY I feel more confident and ready to do so. So at this time, it is my desire to head back in that direction and marry my optometric knowledge with my interest in research.
5) Do you have plans to do more work and research in this area or others?
Most of my spare time in the past few months has gone towards writing and publishing two papers that arose from my master’s research with Dr. Ciuffreda. First, we devised an objective way to assess visual attention with the visual-evoked potential and compared this one’s subjective visual attentional state (a target cancellation task). Next, we refined the testing protocol to achieve the most accurate measurements in the shortest amount of time- every clinician’s goal.
As I mentioned above, after optometry school, I would love to have the opportunity to take part in a PhD program or a research fellowship of some sort. As far as the topical area is concerned, I’m generally interested in neuroscience and attention, but I am open for anything.
6) We know you have a passion for Binocular Vision and Behavior Optometry. You work closely with Dr. Ciuffreda and the NORA organization. What are your plans for the future in this area?
I became interested in this area because of a binocular deficiency of my own (I have Duane’s type I). Although not disabling, seeing double at least 15-20 times a day and having to use my head to look to the side (instead of my eyes) can get a little annoying. Thus, I can understand what many of the vision therapy patients go through. I think having a basic understanding of the accommodation and vergence systems, along with their interaction with each other, is an asset that sets optometrists apart from our medical counterparts. Although not everyone will have asthenopia or binocular vision disorders, for those who do, optometrists have the chance to be the doctor that finally solves a patient’s problem.
There is no doubt that vision therapy works when indicated: there have been published objective recordings of improved accommodation, vergence, and version movements for both normals and amblyopes, following therapy, in the literature since the 1970s. Convergence Insufficiency was recently investigated in the CITT study, but there remains many more conditions that could whose benefit remains less understood/studied (e.g., the other Duane-White classifications, muscle pareses, traumatic brain injury). I have grazed the surface of optometric care of TBI patients, so I hope to learn a little more about this area in the coming years.
7) What is your advice to students who want to get involved and do something beyond just classes? How do they go about achieving their goals?
You have to make sure class is taken care of first, and to do this, making a schedule definitely helps. You don’t have to stick to it minute by minute, but reviewing a little bit of the material everyday makes exam time a lot less stressful and opens up time to do other things down the road (and on the weekend!) Besides the usual time management, know that extracurricular activities offer an opportunity to learn too- not from books, but in supplementary ways that can be much more interesting!
8) What is your opinion on learning in classes and clinic versus balancing extra-curricular optometry on the side?
Having been in clinic for a few months, I think the first two years of the optometric program serve as a buffet of sorts to allow you to sample everything at least once. That way, when you see it again, you can at least say “Hey, I vaguely remember what that is!” The real learning experience comes from patient encounters. What they say about putting a name to a face is true, but in reverse- clinic puts a face to a name. Remembering the presenting signs of a vitreal hemorrhage was difficult with a bulleted list in Times New Roman font, but after seeing them on my 58 year old black male, I won’t forget!
Clinic also helps students learn in an unexpected way- by letting you make mistakes. After two years of graded assessments, the thought of making an error gave me an anxiety attack. However, now I am slowly realizing that mistakes are… (get ready for the catch phrase)… “teachable moments.” Although putting in my own birthday on the Humphrey Visual Field resulted in my 68 year old patient showing a generalized depression, nowadays I always check that the date is correct and can have a good laugh about it.
9) How can students read your paper? Any closing thoughts?
Search for “Smoking and Age-Related Macular Degeneration: Biochemical Mechanisms and Patient Support” in the November 2012 issue of Optometry & Vision Science. I think anybody can do what I have done, because having an inquiring mind is at least part of why all of us are part of the optometric field in the first place. The more you know, the more you can make your friends look bad while watching Jeopardy…that’s a big motivator for me!