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  • The Way We Were: J. Sebag, MD

    In this issue, Scope interviews Jerry Sebag, MD, a senior research scientist at the Doheny Eye Institute in Pasadena, Calif., and a professor of clinical ophthalmology at UCLA.

    Figure 1: Dr. Sebag at the podium delivering the 2019 Inaugural Robert Machemer Lecture to the European Society of Ophthalmology.

    Dr. Sebag has authored nearly 250 publications, a 925-page textbook, and his Google Scholar H-index is 53, which would be remarkable if he were a full-time academic. However, he has always been in private practice, though he reserves time to work in the laboratory, conduct clinical research and teach medical students, residents and fellows. He is a member of the American Ophthalmological Society, has delivered prestigious named lectures around the world (figure 1), and has won multiple scientific awards and medals, such as the Association for Research in Vision and Ophthalmology’s Silver Fellow Award (figure 2), unusual for someone in private practice. Dr. Sebag is considered one of the world’s leading authorities on vitreous. He has carved out an interesting space between private practice and academia and his road map to this has had enough interesting turns to make him the subject in this next chapter of “The Way We Were.”

    Figure 2: Dr. Sebag with his wife Jacqui receiving the ARVO Fellowship Award from ARVO President Nicholas A. Delamere, PhD in 2010.

    This is part of a series of interviews with luminaries in ophthalmology that has several purposes. We want to understand the world of ophthalmology when they began their careers. Young ophthalmologists, especially residents and fellows, are likely to be surprised to learn how different things were “back then.”

    Alfredo A. Sadun, MD, PhD: Jerry, thanks for this opportunity. Let’s start with where were you born and where you lived? J. Sebag, MD: I was born in Tiberias, Israel to a Moroccan father and a German mother who emigrated to New York City when I was 3. I was raised in the city until leaving after college graduation, to live in Stockholm, then returned to New York at age 24 to study medicine. In 1983, I was awarded a Guggenheim fellowship to conduct laboratory research in Paris where my daughter Natalia was born. After completing residency and fellowship training in Boston, I relocated to Southern California in 1986. 

    Dr. Sadun: What made you choose medicine?

    Dr. Sebag: When I was 12, I wanted to be a Marine. At 14, I bought a Fender Jazzmaster and wanted to be a rock star. By age 16, I wanted to be an NFL quarterback, which lasted one play. In 1968, I learned to program computers at the amazing Bronx High School of Science. That was before almost anyone knew what a computer was, and when I was hired as a computer programmer by the Albert Einstein College of Medicine, it changed my life. Apart from greatly helping to organize my thoughts and actions, these experiences created unimaginable opportunities.

    I often counsel students that the key to success is not just to score well on tests and achieve scholastic excellence. I advise distinguishing yourself as an individual and standing out. Individualism is particularly difficult for an immigrant child whose only desire is to fit in and be accepted, so the messaging can be confusing, especially for a teenager. But, learning to program computers as a 16-year-old separated me from the crowd. Doors opened to paths that enabled me to fulfill my father’s great American dream. I attended Ivy League schools and ultimately became a vitreoretinal surgeon.

    I chose medicine because the first team I worked with at Albert Einstein consisted of neurologists, neuroscientists, psychologists, and engineers studying cortical brain electrical activity during shifts in attention. As the computer programmer on the team, I was included in periodic research meetings. But the meetings could not start until a man dressed in scrubs and a white coat sporting a stethoscope over his neck came striding in. WOW! Imagine the impact on a teenage kid witnessing this lofty level of importance … I knew then that I wanted to be that guy.

    Figure 3: Dr. Sebag on the high seas of California with D. Jackson Coleman, MD in 2013.

    Dr. Sadun: How did this lead to your college choice and experience?

    Dr. Sebag: I went to Columbia College and majored in biological sciences. I was very interested in research as well as clinical care, which posed a dilemma as to whether to pursue an MD or PhD track. I wasn’t able to get into an MD/PhD program, so I chose to pursue the MD track, positing that with an MD degree I could still do research, but with only a PhD I could not provide clinical care.

    Dr. Sadun: Were you a good student?

    Dr. Sebag: In college I grew uninterested in school and wanted to seek global adventures. The summer of my sophomore year, I completed a project programming computers in half the allotted time. Rather than take on another project, I chose to travel throughout Europe on a Eurail pass. I looked at everything but saw little, because I was in such a rush to explore and discover. I should have left school for a while, but the Vietnam war (called the “American War” in China) prevented that, since my draft lottery number was 7, so I begrudgingly stayed in school.

    During my junior year, I won a Columbia summer research fellowship to study computers in medicine at the Karolinska Institute in Stockholm. When the draft ended and I graduated, I took time off from school and returned to Sweden to work on applications of computers to medicine with Professor Paul Hall. For two years, I researched, explored, stumbled, learned and grew. By the time I was done, I was very hungry to study medicine. That was fortunate, because the first-year curriculum at Columbia was very challenging for me, and I was competing for grades with very bright, well-educated students accustomed to studying and taking tests, while I was used to quite a different life.

    Dr. Sadun: Where did you go for medical school?

    Dr. Sebag: College of Physicians and Surgeons, Columbia University.

    Dr. Sadun: Why did you decide to become an ophthalmologist?

    Figure 4: Dr. Sebag with Endre A. Balazs, MD in New York, 2004

    Dr. Sebag: In medical school, I was more attracted to the OR than the medical wards. I thus explored each surgical subspecialty and narrowed it down to neurosurgery, plastic surgery, and eye surgery. D. Jackson Coleman, MD (figure 3), a world-renowned ophthalmologist at Columbia, impressed me and influenced my decision. I then spent four months in the laboratory of Endre Balazs, MD (figure 4), head of eye research at Columbia. It was he who introduced me to vitreous, the subject of my life’s work.

    Dr. Sadun: Did you carry this spirit into internship and residency?

    Dr. Sebag: My internship was a very uncharacteristic (for me) time, since I didn’t read or write a single thing that entire year. But when I subsequently moved to Boston, everything kicked into high gear.

    Dr. Sadun: Tell us about your residency.

    Dr. Sebag: I went to Mass Eye & Ear at Harvard. I arrived in Boston very excited to embark on the definitive phase of my education and training. I donned my white jacket and white pants, wore my white clogs (from Sweden) and walked through the portals inscribed “Massachusetts General Hospital,” or MGH, euphemistically called “Man’s Greatest Hospital.” I had goosebumps all over. I often counsel students to surround themselves with people of different expertises, who are smarter and more talented, driving you to work harder just to keep up. That’s what I found at Harvard (figure 5). For the next years I was taught by outstanding faculty and learned from brilliant fellow students. In life, effort will always compensate for any perceived or real deficiencies, and I was energized by the scholastic environment of Boston and was more productive during those years than any other time in my life.

    Figure 5: Steve Ryan, MD was the Paul Chandler Lecturer in Boston in 1982. (Left to Right) Back row: John Merriam, Richard Sidd, Steve Lebowitz, Jerry Sebag, Steve Ryan, Roy Wilson, Shalom Kieval, Phil Gendelman, Alfredo Sadun, Jeff Gilbard, Frank Spellman. Front Row: John Woog, Jerry LeClaire, George Arzeno, Rich Weber, Michael Wagoner

    Dr. Sadun: Were there any downsides to that experience?

    Dr. Sebag: On the first day of residency, Dr. C. Stephen Foster, director of the residency program, introduced us to ophthalmology by declaring that in the coming years we would meet many patients; we might make 5% better, make 5% worse, and in 90% of cases we wouldn’t make a difference at all. Rousing. I’m not sure what his intent was, but in retrospect, Steve Foster was wrong. Our field has advanced immensely, and we can now offer patients many advanced diagnostics and remarkable therapeutics. Although there were a few missteps during my years in Boston, I learned to approach the care of patients with preparation, respect, and gratitude for the privilege of sharing in their dramatic experiences, both good and bad. I continue to deeply appreciate the glory of this special relationship that is unique to medicine.

    Dr. Sadun: And where did you go for your fellowship?

    Dr. Sebag: At 32, I was selected as a Guggenheim fellow despite my young age. Between my residency and clinical fellowship, I conducted laboratory research at an INSERM [ a French version of the National Institutes of Health] lab in Paris studying a retina-derived growth factor that was ultimately identified (by others) as VEGF. Following that year, I returned to Boston as a retina fellow with the Schepens Retina Associates & Eye Research Institute, Harvard Medical School. 

    Dr. Sadun: How did you get your first job?

    Dr. Sebag: The model I observed during my years in Boston was different from what prevailed at that time for most of the country. Many of the top national and international leaders in Boston were in private practice, not on the full-time faculty at Harvard. So, I interviewed for various academic and private positions, ultimately choosing the latter, perhaps influenced by my exposure to the ophthalmic community in Boston. Making that choice easier, however, was encouragement by someone I knew at Doheny who promised to help me become academic. He was true to his word, for which I am deeply grateful.

    Dr. Sadun: Last question: If you were to do it over again, would you still try and invent an unusual space between private practice and academia?

    Dr. Sebag: Yes, although I would do it a bit differently. I would first join a university faculty for several years before entering private practice. Not only do I see the collegiality, rigors and demands of the former helpful in shaping a young career, but being a full-time university professor gains you “membership” in a community that may be impossible to attain from the outside. In looking back, my ideas, observations and research findings may have been more readily accepted and sooner, had I initially been a full-fledged member of the university community.

    Figure 6: Dr. Sebag with Charles Luc Schepens, MD, in Bruges, Belgium, 2003.

    I’ve learned, however, that you can be academic without being an academic, it just takes more drive, resourcefulness, and patience. But I didn’t do it alone. Over the years, I was extremely fortunate to have learned from the professors and brilliant fellow students at the Bronx High School of Science, Columbia and Harvard. Most notable were Dr. Balazs, (figure 4), father of vitreous, and Charles L. Schepens, MD (figure 6), But after entering private practice, I came to realize that my distinguished teachers at famous universities were replaced by an even more powerful group of teachers — my patients, who became my best teachers.

    I feel blessed, inspired, and moved by the trust they place in me when allowing me to walk into their lives, simply by walking into their exam rooms.