Women in ophthalmology series: Ms Neeru A Vallabh gives advice for finding multiple mentors


The glaucoma specialist talks about navigating the world of research, and the realities of motherhood, as a clinician

March is Women’s History Month, and the 8th of March is International Women’s Day. Throughout the month, Ophthalmology Times Europe is celebrating the impact of women in the industry with a series of video interviews showcasing female leaders.

Ms Neeru Vallabh, PhD, is a Clinical Senior Lecturer in Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, and an Honorary Consultant Ophthalmologist for Glaucoma at St Pauls Eye Unit, Liverpool University Hospitals NHS Foundation Trust. Research has become a large part of her life, but when she first began her career, she didn't realise it was something she would like to pursue. Luckily, Ms Vallabh had strong mentor figures who encouraged her to pursue the right path for her.

Ms Vallabh told Ophthalmology Times Europe about the realities of navigating parenthood and academia simultaneously, and shared her pearls for finding mentors who empower and uplift their mentees. You'll want to take notes––another vital piece of her advice.

Here’s her advice for the next generation of ophthalmology leaders.

The below transcript has been lightly edited for clarity

Hattie Hayes: Hi, I'm Hattie Hayes and I'm the editor of Ophthalmology Times Europe. March is Women's History Month and over the next several weeks, we'll be speaking to female leaders in ophthalmology about the industry, gender equity and leadership. Joining me today I have Neeru Vallabh. Thank you so much for speaking with me. I really appreciate your time.

Neeru Vallabh, PhD: Thanks for the invitation. I'm really excited to meet you today.

HH: First and foremost, I would love to know: What's something that you know now, whether it's a piece of advice or something you've learned in the field, that you wish you'd known earlier in your ophthalmology career?

NV: Yeah, so it's, it's interesting, I think there's there's several aspects to this. So there's one thing from a clinical training point of view, whereby I realised that actually, I would rotate through different specialties. And often I would learn different valuable surgical tips or clinical pearls from certain clinicians. But because of the nature of time and then moving on to other subspecialties, I often wouldn't make an a log or any sort of record of what I'd been learning and those, those little pearls and tips, I wish I'd taken time to document them reflect on them a little bit more. Even things like surgical videos, in hindsight, that's something that I really wish I had done, taken those down at the time when I was doing those procedures. So they're just invaluable in the future to look back on and reflect on and to help cement your learning further, because the nature of our career is that we're continuously changing. And we can't always remember all of these valuable tips. So that was one thing that I really wish I did.

I also wish I did a bit more surgical simulation alongside my surgical training. So often I would use wait until the day of the surgery. And often you may have the skills say if you'd been away for a week or two or something like that, for example, I wish I'd taken the time to do surgical simulation alongside my surgical training. So even things like suturing practicing suturing, it was really only something I started doing during my fellowship in [Manchester Royal Eye Hospital], when I was with Cecilia Fenerty [MD, PGCertME, FRCOphth], another inspirational woman who's now a professor in Manchester Royal Eye Hospital, she would suggest surgical simulation, running through surgical steps before you do the surgery itself. So that was one thing that I think, in hindsight, I should have done much earlier on and would have helped to enhance my training and my surgical comfort from an earlier stage rather than later on in my training.

The other thing I realised early on is we often focus just on the clinical and the surgical aspect of what we do. And there is a stage where you become a consultant or a senior, and every week is very similar. You are essentially as skilled as you need to be, though there is always room for innovation and new change. But I think what I realised early on was, it was useful to have a different interest aside from just the clinical. So whether that be research, leadership or management, it gives you the opportunity to develop a different side, a different skill set, which you can then use when you become more senior. And it also then gives you the opportunity to have newer and different challenges outside of just your clinical work. So for me, that was research, and it was only till I was about year four of training that I realised I wanted to do research and go into academia. But I think it's always useful to keep your eye open for other interesting opportunities, which you can take on early on. And then you can go on to flourish in those and develop them later, when you do become a consultant or a senior. You find them fulfilling and satisfying, and it adds a different dimension to your usual workload, essentially.

HH: What do you think is the biggest challenge for young ophthalmologists who are just now entering the field? Where do the biggest opportunities present themselves?

NV: At the moment, one of the big challenges – I have to speak more from a glaucoma perspective, because I'm a glaucoma clinician. But if we look at the condition at the moment, at present, we have 70 million people with glaucoma worldwide. But we know by 2040, that's going to increase up to 111.8 million. So the disease burden is is vastly increasing. I think often, as young ophthalmologists, we think very much about the here and now what we're doing with regards to patient care. But the thing we have to look ahead to is the sort of the way that we're going to provide that care for that huge expanding number of patients that have that clinical need. Especially because in glaucoma, we're still not able to cure the condition or reverse the condition. We're simply trying to prevent it from getting worse. So although young ophthalmologists may not have the foresight to see that at this current stage, that is going to be something that's going to be a challenge for them when they start their clinical practice. And so I think, for example–just in the UK because I can only speak from our experience–we acknowledge that the use of other professionals to help provide that care, whether that be optometrists or glaucoma nurses, have been a real strength for us to help provide this ongoing care. I think the difficulty, the big challenge that we're going to face, is how do we continue to deliver this crucial care for our patients? And how do we get them seen in a timely manner to ensure that they don't go on to develop sight loss? So that's going to be something that, unfortunately, is still there. And it does apply to many other ophthalmic conditions also.

In regards to innovation, I think AI is absolutely something that's going to be a vital part of this. The beauty is, we're going to be able to have newer methods for monitoring the condition and diagnosing the condition. And I think as our understanding of how we use this increases that will help to ease the clinical burden from us as clinicians, so that we can then look to focus on the management once we've been able to adequately monitor these patients. The other beauty with glaucoma at the moment is we have a lot of innovation, in terms of microinvasive glaucoma surgeries and microinvasive bleb-forming surgeries. So it's quite an exciting time at the moment. I think there is a lot of innovation within that space, and I think that that does continue. But we also look ahead toward neuroprotective therapies for glaucoma. I think that will be something in the future that will hopefully be a real game-changer to help prevent progression of the condition further, as well as using other biomarkers to help determine patients who are more at risk, and who need more regular monitoring, compared to those who are less risk. Often we can't tell [the difference] as clinicians, when we first see them in the clinic.

HH: Tell me about a mentor figure who has had a positive impact on your life, whether that's in your professional or your personal development.

NV: In 2013, when I was year four of my ophthalmology training, that was when I realised that I wanted to do some more academic clinical research. And it wasn't something that I had come across until I started working in St. Paul's Eye Unit [at Royal Liverpool University Hospital]. I noticed that some of my peers were doing PhDs and MDs. That was what really inspired me at that point, was seeing what colleagues were doing and thinking, "Well, is this something that interests me? Is it something that I could do?"

Having not done that in the past till that point, apart from the odd paper here and there, I met Colin Willoughby [BSc (Hons), FRCOphth, MD], who was a professor who had just moved to Liverpool at that point. It was a great time, because he was just starting and looking for interested, enthusiastic individuals to do research. And he was the person that I got in contact with, particularly because he had an interest in mitochondrial genetics in glaucoma. And then that formed the basis of my research degree.

It was interesting, because at that stage in time, I'd had one child, and I wanted to expand my family and have had another child, but I was a bit concerned how this would impact on my ability to do research or coming out of research. And it's funny, because at that early stage, I spoke to him and said, "You know, I'm just being honest here, I'm a mother, I would like to have another child, and would that impact on my training?" He was extremely understanding of my situation. And not only was he a mentor from a clinical perspective, because of his excellent skill set, from a research perspective, because of his innovation and his knowledge–even today, he's always someone that that I can bounce ideas off. But he was also understanding of me as a person.

He supported my decisions, he understood that I had life outside of my work that I needed to strike that balance with. So it was...I think that's always been a very valuable part of how a mentor-mentee relationship has been, is that he knows it's not just me as an academic clinician, but it's me as an academic clinician-mother. And when you speak about women in ophthalmology, I think that's important to be open and honest about these things. The reality is that we do have a life outside of our career, and we can absolutely strike a balance.

Life changes. I think we sometimes can start on one career path and realise that it's not for us. So a lot of people you speak to them and they say, well, actually, "I want to do viteoretinal," and then a couple years later, they actually want to do corna. You just think well, how do you change from that to another? When it comes to finding those mentors, like I say, my feeling is that you can have have multiple mentors along the way. [Work on] finding people who help to empower you. Similarly, I was speaking about confidence, and sometimes people can be overconfident. That's also a risk as young ophthalmologists. And I think it's important that there's someone who can give you the insight to your clinical or surgical ability, so that you then can readjust accordingly. So it really depends on your personality as an individual, as to what you require to do the best in your career and your field. It is sometimes the mentors you meet or the rotations that you have, where you learn and are inspired by others.

And it is okay to change. I think there's a point where you will be a consultant or the most senior person in your field. That's what you'll be doing every day, and you want to enjoy what you do. I think it's important to explore all those options and if that path changes, then that's fine. It's important to to experience all of those different placements and, and then to use those to help guide your future.

HH: Well, thank you so much. This is all wonderful advice, and I really appreciate you sharing it with me and with our audience.

NV: No worries. Thank you so much for having me.

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