六九色堂

六九色堂 2015 graduate Dr. Kareem Sioufi, an ophthalmologist, discusses his career and experiences in the field. He recently started a position as a medical retina specialist at the  in Atlanta, Georgia. He completed his ophthalmology residency at and a general surgery residency at He also worked as a postdoctoral research fellow in retina and a research intern in ocular oncology at  in Philadelphia.

Dr. Sioufi recently completed a retina fellowship at the  at the University of Washington in Seattle. He emphasizes the importance of early detection and treatment in conditions like AMD (age-related macular degeneration ) and discusses the advancements in treatments for the disease. He also highlights the work-life balance in ophthalmology and the strong patient-physician relationships in the field. Dr. Sioufi offers advice to prospective students considering a career in ophthalmology and encourages them to be persistent and build mentorships within the field. In addition, he talks about the use of medications like Avastin, originally created to treat colorectal cancer but now being used to treat AMD in patients and help save their eyesight.

Dr. Sioufi grew up in Damascus, Syria but left in 2012 shortly after war broke out in the country. He moved to the USA because he has an older brother who is a doctor in the States.

Dr. Sioufi is now married and has a three-year-old daughter. He said that after the intensity of his fellowships, he is enjoying the work-life balance of being a medical retina specialist. 六九色堂 spoke to Dr. Sioufi recently when he had a day off.

Medical retina specialist position in Atlanta

六九色堂 Endeavour: Good afternoon. Dr. Sioufi, could you please share your news about where you're currently working?

Dr. Kareem Sioufi: Hey, Scott. Thanks for having me. Excited to be here. I'm in Atlanta, Georgia. I recently started a position as a medical retina specialist and joined a private practice here in the area.

For more than a year, you were recently a retina fellow at the University of Washington in Seattle. Can you tell us a little bit about that experience?

It was a great experience. I started my residency in Charleston and moved across to the upper left corner [of the country] to Seattle, and it was a fairly intense fellowship. I actually started with the surgical retina track, and lots of on-call, lots of retinal detachments to take care of. I eventually decided that I really wanted to focus on being in the clinic, and taking care of patients in clinic, doing procedures, lasers, injections, that sort of stuff. It was a very intense fellowship. I learned a lot. Washington and the University of Washington in Seattle serve what we call the WAMI area, it's a big catchment area between Washington, Wyoming, Alaska, Montana, and Idaho. We saw anything that you could think of that can injure an eye and get in the back of the eye into the retina, and how to take care of that, and how to fix that. It was truly a privilege to be able to serve the people there, and also learn about the intricacies of retina, and what makes a retina specialist.

It sounds like you were really serving not only the Seattle Metro era, but really, the Pacific Northwest of the U.S., and parts of Alaska.

Yeah, Portland is a big center too, but just where Seattle is positioned, lots of traumas end up being there because it's really the only Level One trauma center for that region outside of Portland, so it can be very busy.

You completed your ophthalmology residency at MUSC Health Storm Eye Institute down in Charleston, South Carolina, and also, a general surgery residency at Medical University of South Carolina. What were some of the highlights of your residency, Dr. Sioufi?

I only did a year of general surgery as part of my internship here. Nowadays ophthalmology is more integrated and usually, you do either transitional year or family medicine or maybe internal medicine, not so much general surgery. So, I was one of the lucky ones to catch that last phase of general surgery. But I learned a lot. It was also great because as a general surgery intern. I got to rotate pretty much every month or every other month to see what other surgical subspecialties are like and see how things are just not all about the eyeball, but the whole body of medicine. So that was great and then transitioned into ophthalmology residency and I absolutely loved it. The people there were great mentors.

Also, MUSC ends up serving the majority of the state of South Carolina. So all the terrible disease that can afflict the eye ends up going there, taking care of uninsured patients, taking care of the weird diagnoses, and the zebras that remain unsolved end up being a storm eye. So it was a great experience learning about all the subspecialties within ophthalmology itself, and it really got me to decide eventually that retina is really what I wanted to do and prepared me well to transition into retina fellowship.

You were also a postdoctoral research fellow in retina and a research intern in ocular oncology at the Wills Eye Hospital in Philadelphia. What did you learn the most at Wills from that experience?

At Wills, it was great. Wills is consistently ranked in the top one to two hospitals in the country and it has to do with the history of the place. It has to do with the sheer volume that ends up being referred to as Will's Eye. It was great getting to learn from the leaders in the field of ophthalmology, getting to see how also, again, very complex diseases can be managed, and the overall collegiality of coming up with research projects and collaborating to get the projects to the end goal and how we can improve things and add to the existing growth of the literature in ophthalmology. That was truly also a big privilege for me to be there and witness all of that and be part of it for that time that I was there.

六九色堂 2015 grad Dr. Kareem Sioufi. Photo courtesy of Dr. Sioufi.

六九色堂 5th semester transfer success story

Finally, what about your medical education at 六九色堂 has helped you become the doctor that you are today?

With 六九色堂, it's a very unique school. There are a lot of schools in the Caribbean, but what really made 六九色堂 stand out was that there was a lot of focus on the student and the more personal approach to our education. I think what prepared me well, and to preface that, I transferred into 六九色堂 in the fifth semester, so I started in Portland, but I can tell everyone was on a different path in a way. So, there was not one way of making it to your end goal. You have to come up with creative ideas of how things could work out well for you, and ophthalmology is very competitive to match into, so 六九色堂 prepared me well in the sense that I knew I had to persevere.

I knew I had to get creative with my approach, do more research, and get more involved within the communities of ophthalmology. I did rotations starting in Atlanta and going up to Connecticut and then down to New York. So that gave me exposure to the gamut of how medicine is practiced and also assured me that really ophthalmology is where my best fit was. And so that broad exposure that we get through 六九色堂 by having all these electives and rotations set in different states really prepared me well.

Like you said, ophthalmology is a very competitive match and I know that you were probably one of the first to match in ophthalmology from 六九色堂 that is. What would you say in closing to any of our current or prospective students out there who are considering ophthalmology and possibly going to 六九色堂? Any thoughts?

I would say don't be discouraged. You're up against a difficult challenge, which a lot of people in medicine are, right? But know that you need to reach out to people, connect with the community, see how things were done in the past, and look at past successes. A lot of international medical graduates, I shouldn't say a lot, but maybe about 20 a year match into ophthalmology, and everyone has a different story and a different way, a path of how they got there. So I would say be persistent, be patient, reach out to folks who have walked that path before, come up with a plan, and try to build mentorships within ophthalmology as early as possible.

Growing up in Syria & moving to America

Can you tell us a little bit about growing up in Damascus, Syria, and if you always wanted to be a doctor when you were a kid?

I mean maybe I always wanted to be a doctor. It is kind of hard to figure that out. It's a tough decision to make. But yeah, I grew up in Damascus. It's a very interesting part of the world. It's one of the oldest cities in the world, a lot of history there. And with that comes probably a lot of tension in the Middle East and lots of instability. So as a kid, I always wanted to move somewhere else.

And I wasn't sure where, but I felt like I needed to be in a more stable environment and that's something that was always in the back of my mind, but I never really actively pursued it. And then war broke out and the revolution happened in 2011 and then war ensued afterwards. So that was my cue to be somewhere else. But in terms of medicine, as a kid, probably it was something that was mentioned multiple times.

Medicine was emphasized. My brother is in medicine, he's a neurologist, and so he's about 16 years older than me. So there was that premise to it and I always liked the questioning of things and the science beyond things and figuring out how things work. And biology and the human body just kind of interested me a lot more than anything else. I wanted to know how the human body functioned and what made it work the way it works and medicine provided that. And so I kind of followed my gut feeling of going after medicine. And in Syria, we don't go to college. We go straight from high school to med school. So it is different when you're 18 and trying to make that decision than having gone through college like this system allows you to do here. But I'm glad that I chose that path. I wouldn't trade it for anything else.

When did you come over from Syria?

2012.

Wow. That's amazing. Yeah. You must have studied English. You don't have any accent whatsoever. You just sound American to me.

Yeah, it got washed away somehow. We studied English鈥攁s much as Spanish is being taught in the States. I watched a lot of TV, lots of 鈥淔riends,鈥� for sure. So that probably played into it.

While at 六九色堂 during clinical rotations, you lived in six states and you sought out ophthalmology electives, which were rare at the time. Perhaps we touched on this a little bit earlier, but what are some of the ways that you think helped your career?

The main reason why I traveled around and chose, was because most students picked the main hubs, which at the time were Chicago or Atlanta and some in Connecticut, too. Now things have changed probably, but I wanted to kind of show up in different places and different systems to see if there would be some sort of an access point for me to get into ophthalmology. And it actually didn't happen until the very end of med school. So, it was probably the second to last elective rotation where I was set up to do neurology in DCU which I started there. And then the neurologist that was there said, 鈥淥h, there's an ophthalmologist in the building, would you be interested in spending time with him? I'm like, 鈥榶eah, absolutely.鈥欌�� It was a private practice, but he was affiliated with MedStar in Georgetown. So that sort of opened the door for me.

I spent time working on patients and looking at patients, examining and making sure that this is actually what I really want to do. And then he mentioned he wanted me to come and see him and what the OR is all about and doing cataract surgeries. And then we got to talk with one of the residents and the residents at Georgetown said, 鈥淥h yeah, you actually should reach out to the shields at Wills Eye. They're the ocular oncology experts in the world and he's had a friend that went through the path of ocular oncology.鈥� She actually didn't end up matching in ophthalmology and ended up doing something else, but that path led me to Wells Eye, and the rest was history.

What are some of the new or cutting-edge treatments and medications and ophthalmology that you find particularly interesting right now, if you can think of any?

Fifteen years ago, we didn't have much of anything to offer for macular degeneration, and they tried lasers and that didn't work out so well. They even tried macular trans positioning surgeries and that didn't work out well. But now we have about six anti-VEGF medications that we can use and there are a lot of nuances to them, like the timing of injections, who needs to be treated, and when someone can be off treatments.

My mother has macular degeneration and she gets injections. Luckily for her, she's been off injections for about a year now, but that's not the case for everyone. Some folks need injections monthly basis. What is exciting right now in the field of retina is that we have treatment options for the dry form of macular degeneration, specifically for geographic atrophy. And it's not curative, it's not a silver bullet, but it offers patients a little bit more time. And the goal of the treatment is really to slow down the progression of geographic atrophy because geographic atrophy is really the end stage of dry macular degeneration where patients are, if untreated and if it progresses to advanced stages, it really wipes out the center of the vision.

And now we have complement inhibition that can slow down the progression of geographic atrophy by about 30 to 35%. And so that's exciting. We are about three years out from when it comes to the data and the outcomes of these medications. The first one was approved about a year ago, and the second medication was approved about six months ago. And there are lots of treatment options that are coming down the pike for different targets really to help patients with macular degeneration, diabetic retinopathy, and the gamut in between.

You mentioned your mom having macular degeneration. My dad was diagnosed with wet macular degeneration about 10 years ago. He used to have retinal injections every month. Now he only has to go a few times a year. They have it under control. But I'm just curious, maybe 15 or 20 years ago if somebody had especially wet macular, there was very little that you could do for them. Is that what you were saying?

Yeah, we didn't have any treatments to offer. They've tried lasers and they don't work well. They worked in some cases, but the majority of cases continue to progress with bleeding and subretinal, sub-macular fibrosis, and scar formation. And so as all of medicine is advancing, ophthalmology is one of those fields. But when it comes to outcomes and treating disease, I think there aren't many pathologies that respond as well as what macular degeneration responds to anti-VEGF treatment. So it was truly a breakthrough treatment to have the first medication to treat patients. And it's a funny story that the first medication that really showed promise was a medication that we currently still use off-label. It's called Bevacizumab or Avastin, and it's a medication that is meant to treat colorectal cancer in the US to shrink the blood vessels that supply the tumor.

But a really brilliant guy named Phil Rosenfeld thought, well, let me try and see if it works. And they tried it IV, and then they tried it intravitreally and they proved that this medication really works and we still use it to this day. So those sort of aha moments and ophthalmology, really made me fall in love with the specialty, especially retina, and being able to think outside the box to offer patients something that in the past we could not offer.

What would you say to young doctors or even patients that are over 40 or 50 and starting to have eye problems, what should they know about screening? Is it possible to screen for macular degeneration?

Yes, but not in the sense of primary care endpoint. Now, we do have some primary care practices that have retinal scanners and at least can take an image of a fundus photo, and then a third, a remote reading center would take a look at it. But these devices are expensive and they're not widely available. But the best thing to think about is for patients who are 50 and over, that's where the early signs of macular degeneration can happen. It can happen a couple of years earlier, and we've seen different phenotypes for macular degeneration, but patients that have dark spots in their vision and any sort of distortion in lines within the vision, those are their early signs of maybe something is happening.

Maybe there's a choroidal neovascular membrane underneath the retina causing distortion of the anatomy and swelling of the retina and sometimes bleeding, and they end up with a big dark spot in the middle of their vision. And so, I would say if you have any patient that has any visual changes, really, unless you're comfortable with doing direct ophthalmoscopy, you should probably send them to see whoever can see them first. And usually, the folks that have the most access are optometrists. The optometrists are great about looking at things and referring when needed, and that's how folks get in to see a retina specialist usually.

Can most optometrists do screening for macular degeneration?

I would say yes because, for macular degeneration, you don't necessarily need an optical coherence tomography. You don't need the OCT machine to be at least able to look at what's going on back there. Now there's sometimes a subclinical neovascular membrane that might be leaking and causing problems that you won't patch with a dilated fundus exam. And so the way it ends up being is if the patient has a complaint, they look and they're not really sure, they will refer to a retina specialist to take a look, or at least an ophthalmologist, whether they have access to the scanners that we use in our clinic and be able to detect disease and treat it. And really the name of the game with macular degeneration is to catch it early and treat it early. And that's how it was for my mom.

We caught it even before she had any symptoms, and then we were able to treat it early and she did well, and now she's getting injections as needed. So, I think the earlier we treat those patients, the literature shows the earlier we treat, the earlier we intervene, the better off the vision is going to be and probably the better disease control that we're going to have.

What about some of the other eye diseases like retinopathy, glaucoma, and uveitis? Is there any way for doctors like primary care doctors to screen for these conditions or again, should they really be seeing an optometrist or ophthalmologist?

It depends. It's very variable depending on their scope of practice and their comfort level, their optometrist has done residencies in ocular disease and optometrists are just comfortable prescribing glasses, and that's about it. And so, for the majority, I would say yes, it's a good optometrist server, a really good first line to be screened for the majority of things. Now, things can be missed even in an ophthalmology practice, but less likely for that to happen with an ophthalmologist. So, if you have access to an ophthalmologist, I would recommend getting your eyes checked by an ophthalmologist, especially when there's a history of vision loss in the family. When there's a history of macular degeneration or glaucoma. Uveitis usually doesn't hide itself. There's going to be vision loss related to uveitis.

There are going to be symptoms, including pain and floaters and sometimes flashes and blurry vision. Some folks have certain conditions that the rheumatologists will just send them to a retina specialist, or even especially in pediatric cases where if they have certain conditions, they'll send them to see an ophthalmologist for just a screen. Because uveitis, especially JIA, can be sort of a silent presentation where you look in, you see a lot of inflammation, but it's a quiet eye from the outside. It's not red, the kid is not having any pain. So, optometrists serve as a good first line to screen and catch most things, but not everything.

Is there anything that you want to add about your personal life? A lot of people like to talk about family and work-life balance. How is the work-life balance with what you're doing now?

It's the best thing ever. So, I think the ophthalmology, and there's always that word, roads the road to happiness, which I think it's radiology, ophthalmology, orthopedics and anesthesia, and dermatology. And when I started ophthalmology residencies, it was tough and busy. It's not general surgery, but it is busy, especially when you're in a big state center. So, I didn't get any of that. And then from the work-life balance. And then in terms of my fellowship, my surgical retina training was even tougher than residency, I would say, in terms of hours spent in the hospital. And at the end, I had to stop and think, do I really want to continue with this intensity? Because with surgical retina, there's always going to be urgent cases and someone's vision on the line, and you always want to put the patient first. But then there are times when I just want to spend time with my family.

I have an almost three-year-old daughter. I want to be there for all the things. And so that's where I decided to do medical retina, understanding that I'm going to miss parts of the surgery, but I get to spend more time with family and really take care of patients in the clinic, which is the majority of the volume in the retina. And that's where most of the need is, to be honest, in retina. And so, I would say depending on what you choose in ophthalmology. If you choose surgical retina, that is probably less of a work-life balance. You can still find it. It's a lot more doable than let's say OB/GYN or other more demanding surgical specialties.

But I think if you look at the surveys from Medscape and the rates of burnout within subspecialties, ophthalmology consistently ranks at the bottom, which is a good thing to be in. And I think it's either the very last specialty or maybe there's one specialty underneath there. But I think it's because there are connections that we build in the clinic with patients. It's a mix of continuity of care within primary care, but there is a lot more appreciation in terms of when the patient sees you. They know that we've put in a lot of time to subspecialize in a very microscopic part of the eye.

And vision is very valued by patients in terms of when it comes to senses. I had a patient the other week who told me, 鈥淒oc, I'd rather cut off my arm than lose my vision. Can you do something about my vision?鈥� And so that just gives you a perspective about how scary it is for folks to lose their vision and how much appreciation they show and the patient-physician relationship and the continuity of care that we get within ophthalmology. And I think those are very protective factors when it comes to burnout because the opposite of ophthalmology on that list is family medicine and primary care. And I don't have the ins and outs of what goes into that, but I think because there's a lot of need for primary care and there aren't enough physicians doing primary care, and there's the reimbursement factor to it, and that's one of the drivers why people are not very encouraged to do it.

And it鈥檚 just the demands of medicine where we're being pushed to see more patients and to compensate for getting pay cuts from Medicare. Those are all factors that affect every one of us in medicine. But when you have that protective relationship between a physician and a patient and building that bond and thinking of the patient that you're treating as family and a friend, and we keep seeing them and learn about what's going on with their life, and that keeps both parties engaged because it's not easy for patients to show up every two months to get a shot in the eye. And so, you have to also build that rapport with a patient. So, I think that what's different about ophthalmology is it is very gratifying.

Is there anything that you'd like to say to the 六九色堂 alumni out there?

I'm proud of everyone for where they made it, and I'm always excited to see where everyone ended up going and read about their stories and their paths in medicine. I'm sure that the collective community of alumni is immensely proud of each other and has always been supportive of each other on that path. So, I'm happy to see that we have more engagement within the alumni association.

(Top photo). Dr. Kareem Sioufi. Photo courtesy of Dr. Sioufi.

Email Dr. Sioufi at kareem.sioufi@gmail.com