• Spring 2021 Editorial - Changes


    Five years ago, M. Bruce Shields, MD, became the editor of Scope Newsletter. His debut editorial was titled, “Changes” as he announced the passing of the baton, which he picked up from the late David W. Parke, MD.

    Alfredo A. Sadun, MD, PhD - 2021 Editor, Scope Newsletter
    Alfredo A. Sadun, MD, PhD - 2021 Editor, Scope Newsletter

    Dr. Shields wrote of the big shoes that he had to fill in 2016. It was the same year I joined the Academy’s Senior Ophthalmologist (SO) Committee after Dr. Shields, a dear friend and mentor for decades, persuaded me that I had a role to play.

    At the SO Committee, I learned about the efforts and challenges Academy SO members face. By the way, we SOs comprise about 40% of Academy membership. So, our perspective is broad. Scope is sent to 9,000 Academy members, both domestic and international. We feature articles on ophthalmic history, interesting hobbies, book reviews and issues through the prism of having lived ophthalmology for a long time. And, of course, we welcome readers (and authors) below age 60 as well.

    I write in part to introduce myself as the new editor of Scope. The title, “Changes” matches that written by my predecessor, Dr. Shields, but it applies in the more general sense, as well. This past year has been a year like no other. 

    The big elephant in the room has been the COVID-19 pandemic and its effects on both our personal and professional lives. By the time you read this, our lives will have been upended for more than a year. Our health, that of our family and friends and colleagues, has been affected or jeopardized, as have our professional lives. Every patient I see is now separated from me by at least two masks. Our work is slower and tedious and, at least speaking for myself, not seeing my patients’ smiles, makes it just a little less rewarding.

    My Socratic method of teaching medical students, residents and fellows in the clinic has been strained. The interactions my wife and I have enjoyed with our children, grandchildren and friends have been appreciably compromised. I’m sure, to paraphrase Russian author Leo Tolstoy’s’ Anna Karenina, that “every family suffers COVID in their own way.” Each ophthalmologist and all of you have been affected differently, but profoundly, by this pandemic and its indirect effects. As a result, we’ve all had many changes, professionally and personally. And change is hard.

    Economists and psychological modelers talk about the constant balance between the conflicting needs to get information and to use that information. They describe schemes to optimize behavior in what they call, “explore/exploit.” There are times that we want to try changes that allow us to learn more things about our environment (explore). And other times we would rather take advantage of what we already know and what is available (exploit). Whether we choose to explore, or exploit depends on how well we are doing and how distant is the time horizon.

    As an example, that preceded COVID-19, if I were to spend a few weeks at a new vacation house, I might, on arrival, try several new restaurants. Even after finding a few excellent choices, I might want to press on and explore new ones. I would emphasize exploration. But as the last days of vacation arrived, I would probably choose to revisit my favorite places.

    Similarly, we all did a lot of exploration while in college. We tend to explore most when we are young and less as we age and our lives became more settled. That is wise. But this optimal strategy also demands that we explore more when the environment changes. As well, if we feel we’ve changed, so our tastes may have also changed and exploration should be emphasized. As the title of this piece says, we are experiencing sea changes. So, let’s rethink this trade-off.

    With a change in circumstances, we need to re-shift the balance towards explore. COVID-19 was a game changer. The COVID-19 pandemic transformed many things, primarily the practice of ophthalmology; the nature of teaching and research in academics; the process of retirement; life in retirement; relationships; and many of us are waiting for things to “go back to normal.”

    First of all, this is turning out to be a long wait. Secondly, we are all coming to the realization that there will be a new normal, but it won’t be returning to the same old thing. So, even as old dogs, we must commit ourselves to learning new tricks. One of my favorite satisfactions was from teaching the medical students and residents in my little entourage. Now I’m learning to lay out my thoughts in these pages of Scope. It is time to shift to exploring not only the environment, but our own talents and passions, before we can optimally exploit what we’ve learned.

    I look forward to connecting with new and old friends through these pages. New challenges await and I am sure they will be rewarding. This is also a good time to pause and thank those that enabled this opportunity.

    I thank the many people who help us put together the issues of Scope. Firstly, most of the heavy lifting for this publication is done by Neeshah Azam, who as SO’s program coordinator and Scope’s assistant editor oversees every article, and Gail Schmidt, the Academy’s director of ophthalmic society relations. I also thank, Daniel Albert, MD, MS, and his assistant Jane Shull for our ophthalmic history content; Thomas Harbin, MD, MBA, who remains as editor of our book review section. John Stechschulte, MD, is organizing articles on the many subtle challenges of retirement. Members of the SO committee will continue to contribute content and worthy articles; and most particularly Samuel Masket, MD, our committee chair whom I intend to make an integral part of this publication.

    I would also like to take this opportunity to encourage you, our readers, to get involved. If you have a special hobby, if you like to write, or comment on a book you have read, let us know and we will share it with our colleagues in Scope. Please send your inquiries to my attention at scope@aao.org.

    Further Resources

    For those interested in a mathematical model of optimizing explore/exploit, read “The Exploration-Exploitation Dilemma: A Multidisciplinary Framework,” by Oded Berger-Tal, Jonathan Nathan, Ehud Meron and David Saltz (PLoS One 9(4), 2014).

    You may also wish to read the book review in this issue of Scope that further explores this Explore/Exploit strategy.