• Seeing the World as Wondrous: Q&A With EnergEYES Awardee George L. Spaeth, MD

    As a musician, writer, health coach and poet, George L. Spaeth, MD, wears many different hats.

    Dr. Spaeth is a world-renowned ophthalmologist, a pioneer in the glaucoma subspecialty. Currently serving as the Lewis J. Esposito Glaucoma Research Professor and director emeritus of the Glaucoma Service at Wills Eye Hospital, Dr. Spaeth has published more than 400 papers, 200 editorials and 23 books.

    With a particular passion for defining and characterizing eye conditions and testing vision and functional ability, he’s also nurtured the minds of at least 300 trainees now working in medicine around the world. 

    These efforts have earned him the Academy’s EnergEYES Award, honoring an ophthalmologist who demonstrates the best in energizing young ophthalmologists, serving as a strong role model, and motivating others to get involved. 

    Dr. Spaeth spoke with YO Info about lifetime accomplishments, motivations as a mentor, and the enriching power of poetry. 

    What do you consider your most significant contributions to ophthalmology?

    Dr. Spaeth: There are a few items — my Gonioscopic Grading System for assessing the anterior chamber angle, the Disc Damage Likelihood Score for describing the optic nerve head,\ and my research with Bob Read examining the optic disc in detail. More recently I’ve started using two phrases that I think are a contribution as well: the “City of Patients” and the “City of Doctors.” Doctors live in the City of Doctors. Patients live in the City of Patients. They are different cities. When doctors remain ensconced in their city, they cannot think of health and disease in the way the patients are thinking about it as they live in their own city of patients.

    I’m also proud of the Colored Glaucoma Graph, which allows visualizing the stage, rate of change, and effect of the condition being considered in a particular person. The graph views health and disease in terms of an amalgam of symptoms and findings in which the symptoms predominate. Do they have troublesome symptoms? If they do, they are diseased. If they don’t, they are not diseased. They may develop troublesome symptoms, however, and the way you tell whether this will happen is by serially determining how long the condition is going to continue, how rapidly the condition is changing and whether that will result in the development of troublesome symptoms before the person dies.

    There are also other aspects that are considered, such as whether or not the cognition is reversible as well as socioeconomic factors. All of this information comes together in the graph. My patients all received one, showing where they were and what was happening to them. It not only informed everything I did with that patient. It also reminded me that, as a physician, every decision I make is tentative, experimental, and without certainty.  

    Do you have any particular career advice for trainees and young ophthalmologists first entering practice? 

    Don’t allow yourself to be taken over by business interests or by the arrogance that inevitably wants to capture you as you learn that you are enormously powerful and helpful. You might think, “Boy, I’m pretty great.” You ARE doing something important. You are caring for an incomplete manifestation of the universal. But “great”? Also don’t allow yourself to be taken over by academia. Business and academia—neither is God’s gift to mankind. However, each individual person is a gift. Knowing who you are  and being true to your soul and who you really are is essential—especially if you want to think of yourself as authentic and if you want to make real contributions. Not things that your chair tells you to do, or that your business manager tells you to do, or that your ego tells you to do. What can you as an individual do that matters and that might help another person heal? Or even help the world heal?

    In the end, individuals embrace norms at risk to their soul and flaunt them at risk to their worldly success. It’s a balancing act. You can’t antagonize people so completely that you can’t have any effect, but if you aren’t antagonizing somebody, you’re probably not doing anything of importance.  

    Finally, don’t be afraid to say “I don’t know.” That’s probably the most common phrase I use with patients and often with myself. “I don’t know.” “I wonder.” But you can’t let it stop at that. You have to say “I don’t know, but let’s try to find out.”  

    What motivates you as a mentor?  

    It may be the most challenging thing you can do. Being in love and being loved are more rewarding, but mentoring is a huge opportunity to work with somebody and help that person become who and what they can be.  

    There’s a tremendous danger in being a mentor though: the desire to shape the person to be just like you. But that’s the exact opposite of mentorship. You don’t want people to be your clones. You want them to be themselves as fully as they can be. So you want to support them in that and to tell them when and where you think they are off base.  

    Mentoring is so wonderful because sometimes you can actually help people. And to see that happen is so thrilling. Further, you may receive this enormous, unbelievable reward that the people who you have been working with start working with you, and you become mentored by the people you’ve been working with. You learn, you change, you grow in conjoint collaborative effort.  

    Technology is at the heart of medicine and our civilization. And it’s imbued with the hope of better things to come. But does it always deliver on that promise?

    It’s very hard to know exactly what “better” is. What does “better” mean? As I read medical journals now, one of the things that’s constantly talked about is burnout. Physicians are practicing medicine and finding themselves in a type of practice in which most burn out. Is this “better” than what happened prior? Hardly.

    So, again, what does “better” mean? The atom bomb — it probably did shorten the World War II —but how can we use the words “bomb” and “better” together? How do you answer these questions? They aren’t answered by technology. That’s for sure. But we think they are, and that’s where the danger is. And because we think that, we think there’s always sort of a fix for everything, and there isn’t. We’re especially learning that as we enter the Sixth Mass Extinction, which is totally our own doing. We’re creating this mass extinction largely because of our belief and faith in technology.

    It’s a very complex mix. Clearly, the ability to take out a cataract, put in an intraocular lens and restore the ability of a person to function, perhaps better than they ever have — that’s a huge advance. What a great thing to be able to do. So technology clearly makes things easier, nicer—whether those things are “better” or not is a very different question.

    You’re an extraordinary poet. What inspires you to write and how does it shape your view of the world?

    I think one writes because somehow there’s a thorn inside one that makes one write. I write poetry because it’s a way for me to visualize. I can wrap my thoughts and feelings around the world. I grew up with poetry. My mother was a great believer in memorizing things, so I’ve always memorized poems. You know, it’s wonderful because, in a particular moment or interval of some sort, I can draw on magical words. … As I think about how much I care about the trainees I work with, a Yeats’ poem may pop up such as:

    Had I the heavens' embroidered cloths,

    Enwrought with golden and silver light,  

    The blue and the dim and the dark cloths  

    Of night and light and the half light,  

    I would spread the cloths under your feet:  

    But I, being poor, have only my dreams;  

    I have spread my dreams under your feet;  

    Tread softly because you tread on my dreams.  

    Being able to encapsulate one’s feelings in these things — words that other people have said, or that I’ve said, that are so wonderful. It helps me see the world as wondrous.  

    I also think often of the Lao Tzu poem, “From Wonder Into Wonder Existence Opens.” What does that do to you? It opens you up to wonderful possibilities and different ways of thinking about things. So, do my poems inform my way of seeing the world? They do, because they force me into thinking of things in terms of what is really meaningful—rather than just, “Isn’t that a pretty sunset?” Rather, what makes the sunset pretty? What is it that makes autumn meaningful and melancholy? Poetry deepens our sensitivity to existence.  

    Last but not least, congratulations on the EnergEYES Award!

    Thank you. I live in the same house where I lived with my amazing wife — my major mentor — since 1960. Here I’ve spent time with my children growing up and with my wife who continued throughout her life to have both a brilliant mind and a radical innocence to be able to see the world as children see it and simultaneously as a cultured, sensitive person sees it. And I’ve continued to work with young people from high schools, colleges, medical schools, and residencies. These opportunities have always been essential to my vitality and my enjoyment in life. And for me to be recognized by young people — young ophthalmologists, in particular — as someone who they think was helpful to them is about as great a joy as can be given to me. What an amazing, wonderful thing. So, I’m enormously grateful for just the consideration of the EnergEYES Award. It’s not something I take lightly.