Interview with Dr. Maria Liu of Berkeley Optometry; Teacher, Researcher, Clinician

Dr. Maria LiuAround Berkeley Optometry, Dr. Maria Liu is known to have quite a few academic degrees. The Beijing native practiced ophthalmology in China and served as a marketing manager for Alcon in China. She relocated to the United States in 2000 and applied to Pacific University College of Optometry. While waiting for her admission to the OD program, she obtained her MBA “because she was bored.” Her extensive work with myopia as an MD in China prompted her to study the epidemiology of myopia for her MPH degree, as well as conduct research in myopia progression under Dr. Christine Wildsoet for her PhD degree. Last October, Dr. Liu became a Fellow of the American Academy of Optometry at the 2012 Academy Meeting in Phoenix. She accomplished all this before the age of 36.

Currently, Dr. Liu keeps herself busy as an optometry triple threat at UCBSO by seeing patients in the clinic, conducting research on myopia, and teaching Evidence-Based Optometry and Ocular Pharmacology. In her free time, Dr. Liu swims, plays tennis, and plays Xbox, particularly Halo.’s Rebecca Lee sat down with the newly inducted Fellow to discuss her multiple degrees, eye care in China, performing ocular surgery, and her fellowship.

RL: You’re an accomplished individual with many letters after your name, including MD, MPH, OD, MBA, and PhD. What motivates you to keep pursuing higher education?

ML: I grew up in a family where the parents have a very strong influence on their kids. I did what my parents wanted me to do without knowing what I wanted to do. It took me a while to actually get to know what I want to do. Serving patients is one of my highest priorities. When I was working back in China as an MD, the medical practice in China focused more on ocular pathology treatment rather than improving the ultimate quality of life for the patient. So a lot of patients still have pretty bad vision after surgery, which can be corrected with specialty devices like custom-design contact lens, but nobody is interested in doing that because it’s not surgical. I got frustrated with that kind of mindset and workflow, so that’s why I decided to come to the United States and pursue my OD training, which focuses a lot more on improving the quality of life of the patient.

In terms of PhD, I got exposed to research opportunities while I was doing my OD. I feel like as a practitioner we can actually contribute a lot more to vision science and vision research by doing clinically relevant research, so that’s why I decided to come back for PhD training.

MPH is a slight side track from my PhD training. I’m interested in understanding myopia, which is a huge epidemiological problem, not only in China or East Asia, but a very critical problem worldwide. So understanding the public health impact of myopia itself, as well as how we can apply those general concepts to other conditions is really a great interest to me.

RL: Out of that group of academic degrees, your MBA seems to stand out. Is it true you got your MBA because you were bored?

ML: The year before I came to the US, I worked for Alcon China as a marketing manager. I enjoyed the business aspect of eye-related products or medical devices. After I came to the US while I was waiting on the admission to optometry school, since I didn’t have work visa, I could only go to school or stay at home. I figured learning a little bit more about marketing and financial management, as well as getting myself cultured to the US was a better use of time than sitting at home, doing nothing.

RL: Do you have any regrets having gone into ophthalmology in China?

ML: I don’t want to put it as “regrets.” I do miss doing surgery. Frankly speaking, before I started practicing optometry, I didn’t realize how limited the scope of practice of optometry was, especially in certain states like California, where we have a pretty strong medical lobby that limits us, even with minor surgical procedures. So I do miss the surgery but I really enjoy helping patients in whichever way we can rather than just focusing on the ocular pathology side.

RL: Other than its primary concern with ocular pathology treatment, how else does eye care in China differ compared to the United States?

ML: The first difference is right now, eye care in China is considered a secondary or tertiary area, where the national insurance won’t cover most of the eye care procedures, including cataract. People are paying out of pocket for most of the eye care, either in medication or procedures. There’s no preventive care in China in the eye area. If you have a patient coming into the hospital with no complaint, just wanting a routine check-up, they will consider you out of your mind in China. For general health, there was no concept of physical checkup in China probably 5-10 years ago. But now people are starting to realize the importance of routine check-ups. So I hope this is going to be a trend for eye care, but it’s probably going to take a while because there’s no national subsidized coverage in this area.

The second difference is we don’t really have an official optometry education in China. We don’t have this profession. Optometrists in China are considered as refractionists. You’re responsible for getting the prescription for glasses, and the training in this area varies a lot. There’s no regulation requesting the licensure of who can prescribe glasses or contacts. You can get your glasses or contacts from street vendors. In a hospital setting if you’re an MD, because of the intense vigorous training, everybody wants to do surgery. That’s where the money is coming from. That’s how you get the respect from patients. You don’t get the same level of respect by prescribing glasses. Very, very few ophthalmologists are aware of the full scope of optometry. People are still focusing on pathology treatment. But the major areas that are absent in China are specialty contact lenses, low vision, binocular vision. There’s very limited pre- and post-strabismus surgery, vision therapy, and measuring binocularity.

RL: There’s a lot of controversy regarding optometrists performing surgery or laser procedures. Coming from a medical background, do you think that optometrists should be able to perform surgical procedures?

ML: The medical professions are fully aware of our competence in and capacities for doing those procedures. There’s nothing too complicated about the procedures themselves. We’re talking about Lasik or laser treatment for retinal problems. I think it’s more of a competition for opportunities, competing for patients. They consider that once they release this kind of eligibility or privilege to optometrists, it’s going to be very difficult to maintain their prestige, their high margins for service. So I don’t think it’s an issue of competence, more of a competition and business opportunities.

RL: Since you miss surgery, have you ever considered moving out of California to a state with a wider scope of practice, somewhere ODs can perform surgery?

ML: I do enjoy the diversity of my work here in Berkeley. I’m currently involved in clinical teaching, didactic teaching, as well as research, so I couldn’t really find a nicer place where it’s a prestigious school, where obviously being a faculty here means a lot to me. Considering all the aspects together – the diversity, the climate, the job opportunity for my husband – I probably won’t consider moving somewhere else just because they have a wider scope of practice.

RL: Which job at Berkeley do you like more: teacher, researcher, or clinician?

ML: I like all of them. It’s really hard for me to choose which one is better than the other. During my PhD training, I actually taught multiple classes. First of all, I feel like staying in the animal facility the whole day, five days a week, 12 hours a day  is really not how I see myself for the rest of my life. So, I really enjoy the diversity, the combination for everything. You sometimes get inspiration from doing something else, and that helps – doing research helps with my teaching – teaching helps me generate certain ideas too. There is some sort of synergistic effect of all the different aspects of my job here. So I can’t really say which one I like the best.

RL: How did you get started in research, specifically myopia control?

ML: Myopia has always been the area I’m most interested in because I’ve seen so many cases in refractive surgery. I saw a lot of high myopia and pathological myopia. Many of them with very serious retinal complications with permanent vision loss, and I fit a lot of ortho-K lenses in China starting in 1997.  My empirical experience with ortho-K is that I know they have some effect in controlling the progression. But I’m always interested in understanding the fundamental mechanisms from systematic clinical trials, why they’re working. In terms of research opportunities, I was very fortunate to get the first K12 grant from NIH, and I was actually the first K12 trainee at Berkeley. They paid your compensation at the equivalent of faculty level instead of a regular PhD student, so you get a very nice package without the financial burden of committing into long-term research, and you get a very nice support and you get to choose your mentors.

RL: Would you encourage all optometry students to go into research? Do you think that will benefit their clinical practice?

ML: I know research isn’t for everyone. I hope everyone can do a little bit of research or be passionate about research, but I know some people came to UCBSO just to become a clinician, and I have no problem with that. In my mind research is really not about doing experiments. It’s keeping a curious mind and always thinking about what we’re doing, how we can improve what we’re doing. So it’s really the research mindset I like our students to carry rather than purely doing research or experiments. If you’re not doing research, at least you can appreciate why certain research projects are done and how you can take advantage of that, applying new findings, discoveries, or innovative treatments to your practice.

RL: Let’s talk about the most recent letters added to your name: FAAO. What does it mean to you to become a Fellow this year?

ML: The Academy has always been considered a recognition of your expertise, your involvement in academics or optometric teaching. Being a Fellow of FAAO has always been one of my goals. You need to have a certain number of publications, and I applied right away. If I see this letter behind someone’s name, I know they are intensely involved in either teaching or optometric research, so I just wanted to be one of them.

RL: What were the requirements?

ML: Advanced research training, either Master’s or PhD, certain amount of publications, and then the oral exam.

RL: What was the oral exam like?

ML: It’s very casual. For the scientific section, it’s a whole bunch of scientists talking about your research area, which is supposed to be the area you know most. During my interview they mostly asked epidemiological trend of myopia, and how the recent change in our lifestyle, mostly the increased usage of hand-held devices both in adults and younger generations, how that affects myopia and the progression. It’s more like a discussion rather than just testing you.

RL: You originally went into medicine because your parents told you to. If you do have kids, would you push them towards a certain direction for a career or would you let them choose?

ML: I know it’s not the good thing to do, but I think I might put a lot of influence on my kids too.  It’s just a very subtle balance between giving them freedom, having them explore around versus finding the most efficient path for them so they won’t regret wasting so much time doing something less meaningful. I had a tough childhood, not much time playing around, spending most of the time studying and taking advanced courses. But I appreciate what my parents put me into. I saved one year in primary school, two years in middle school and high school, and I got into the primary school one year younger than most other kids, so I saved four years before going to college. That gave me four more years exploring around after I finished college – I worked for industry, I did my PhD, and I know I enjoy patient care. Maybe I want to do that to my kids, but they’re probably not going to be happy about that.

RL: How would somebody else describe you?

ML: Let me tell you how I want myself to be, what kind of person I want other people to think. First I want people to like me, rather than “This is a very good researcher, but the personality is horrible.” I want to be someone who either colleagues or students can talk to if they have problems. So I want to be amicable and friendly. I hope they think of me as a funny person rather than a total nerd. That’s how people view scientists anyway. So hardworking, friendly, …I want people to think me as very logical and very passionate.

RL: Each of your degrees could be considered as a milestone in your life. What’s your next goal?

ML: My goal is to be a very good teacher and researcher at this point. No more degrees. The day I submitted my dissertation, my husband was joking, “The law school is right next to your building. Maybe you should go get a J.D.” No, no more degrees. I just want to be a very good teacher, and I want to help patients. I want to not only teach concepts or ideas, but also try to inspire our students and hopefully influence them on a more profound level.

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