Mary Lou Lewis, MD, is a recognized trail blazer in ophthalmology, having been one of the first women in retina nationally and internationally. She received her medical degree in 1967 from the University of Iowa, Roy J. and Lucille A. Carver College of Medicine where her interest in the field of ophthalmology began with a fascination of ophthalmic instrumentation. She completed her internship in 1968 at the Jackson Memorial, University of Miami and ophthalmology residency at the University of California San Francisco in 1971.
In 1972, Dr. Lewis became the first woman to complete her fellowship training at the Bascom Palmer Eye Institute. There she served as the first female faculty member under the chairmanship of Ed Norton, MD. She taught at the University of Miami Miller School of Medicine as Professor Emeritus of Ophthalmology and published pivotal research projects that express her immeasurable impact on the field. She devoted her career to the institute until her retirement. She continues to advocate for women in the field to receive equal opportunities.
Please share an impactful moment that shaped your career. Was there a time in your career when you witnessed history in the making?
In 1971, I went to Miami and started my fellowship at Bascom Palmer and everybody was very welcoming. Dr. Norton created an atmosphere of collaboration and we shared ideas. I never felt any competition with others. I don't think that existed. At least I wasn't aware of it.
The only problem I ran into after I joined the faculty was that some patients were uncomfortable with a female retina specialist. My attitude was that somebody who's got a retinal detachment, who may well lose their vision is under a lot of stress and they don't need any more stress being insecure about who is taking care of them.
So, I solved that problem by telling staff that whenever they made an appointment for me, they were to say that the appointment would be with Dr. Mary Lou Lewis because just saying Dr. Lewis didn't tell them enough about who they were getting. I had no problem after that.
Being at Bascom Palmer with Robert Machemer, MD, at the beginning of vitrectomy was tremendously impactful for all of retina and for patients. It was really fantastic to be part of that.
David Kasner, MD, was the one who really started vitrectomy when he decided that there were cases where the vitreous was the culprit and he would do vitrectomies with Wech-cel sponges -- just pulling it out and cutting it off. And then Dr. Machemer got busy in his garage making his machine.
At one of the courses we had early on, people were talking about the fact that Dr. Machemer’s vitrectomy machine was doing the trick and that he used endoilluminators, while the rest of us just had coaxial illumination, which was really tough to use. One observer in the course said that using the coaxial illumination with a microscope was like trying to explore a closet with a pen light and not being able to touch any of the walls, while using the endoilluminator was like turning the light on in the closet. It was a tremendous time.
What career accomplishment provides you with the greatest sense of satisfaction?
I don’t consider myself one of the pioneers, so to speak. The greatest enjoyment I got out of my practice came from my relationships with the patients.
I specialized in macular degeneration. At the time, intravitreal injections to treat macular degeneration had not yet been introduced. It was a challenge to help patients adjust to their disabilities. Some patients did wonderfully well using computer programs that spoke to them. I had one patient with severe macular degeneration who went into a retirement center and used his computer to rewrite the center’s bylaws and get music from Germany. He remained very active, but he was, unfortunately, the exception. It was sad because a lot of people were pretty disabled. Intravitreal injections came on the scene after I retired.
So, if you met a patient for the first time with wet AMD in both eyes, it sounds like you would schedule a follow up with them, even though there was nothing to be done medically.
Yes, we treated some patients with laser. And, when the injections came in, the laser went out the window, because you were treating lesions that were very close to the center of the fovea and it was determined that only about 14% of the cases were treatable with laser. But we were able to treat some of them.
What do you feel is the most significant development or change in the practice of retina?
I think the various imaging techniques have really changed things remarkably. You don't have to look at the fundus with a contact lens, you've got a machine that will do it on the basis of the layers of the retina. It has been a big step forward.
Can you share any advice for future generations of retina specialists?
In all aspects of medicine and other fields, the people who do the best are the ones who apply themselves and make commitments. It is a very difficult thing to have a career that is busy and where you are doing surgery and raising kids. You've got to be willing to make sacrifices. Also, I recommend finding a spouse who is willing to make sacrifices.
How do you imagine the practice of retina will change by 2040?
I think the extraordinary imaging devices now available are going to be utilized more and more for telemedicine, allowing more patients to be evaluated remotely. I think this is already happening with premature babies.
Our sincere thanks to Dr. Lewis for sharing her retina reflections.
(Retina Reflection published 2022)