Midway through my education at University of California in San Diego, I was meeting with guidance counselors about what type of medical field I might like, and I hadn’t decided. So I went home for the holidays and talked to my dad’s friend who was an optometrist. It didn’t hit my consciousness until this family friend went over all these elements about why the optometry profession was so wonderful, including nice healthcare profession where you can interact with patients but it doesn’t have blood involved. [Laughs] I perked up at that. Really? No blood? Well, optometry sounded like a good idea.
I went to Omni Eye Specialists in Denver to do one of my externships. Denver is a mile high, it’s very dry, and we saw dry eye patients all the time. I liked that setting so much I ended up doing a residency there. So for the next year, I spent quite a bit of time seeing dry eye patients. At the time, I loved retina the most because I loved taking fundus photographs. I was responsible for sending out sample slides of patient cases to practitioners. I loved that. One of my instructors, Karla Zadnick from Berkeley, had been recruited to go to Ohio State. She said, “Why don’t you consider getting your PhD in Ohio? We have an opportunity to make a difference.” So, off I went to Ohio. I was thinking about the topic for my PhD work. At the time there wasn’t a lot of place for research in retina. Since I’d seen so many dry eye patients in Denver, I thought, “I think I’m interested in dry eye.”
My PhD work really did focus on ocular surface disease and dry eye. As part of the PhD training, I had taken a course in biostatistics and epidemiology. I had taken so many of those courses and was so interested, I figured it wouldn’t take much for me to actually complete this degree as well. I had to round out taking some classes in healthcare policy and a culminating research experience, do analysis, and write a large paper. I was able to graduate with a degree pretty much simultaneously. The university wouldn’t allow you graduate with the same degree in the same quarter, so I graduated with the Masters in Public Health first and then the next quarter with the PhD.
The focus of that research mostly has been to look at the profiles of the lipids that you can collect. Over the last 10 years we’ve been working to identify the major components of lipids in meibomian secretions to improve the understanding of how that helps create a stable tear film. We have uncovered some types of lipid species that weren’t known previously that are important in the stability of the tear film. We’ve been able to categorize patients that are in these data sets as “dry eye” or “not dry eye” and look for differences in their lipid profiles. Indeed there are some. There are interesting questions we have yet to explore, such as if a woman goes through menopause at an earlier age or if she has a more symptomatic menopausal period, will that lead to a higher predominance of dry eye. Not all women who go through menopause have dry eye—the disease is so multifactorial.