Visionaries and educators

I asked Dr. Robert (Bobby) Osher to contribute an article to this special cataract issue. And not just any article. I wanted him to share what has driven him to teach cataract surgery to hundreds of thousands of eye surgeons worldwide. One of my staff, David Grogan, was a photographer in Miami when Dr. Osher was training there. He was impressed that Dr. Osher wanted myriad photographs for his teaching library. That library, which now holds many thousands of photographs, drawings and videos, feeds thousands of lectures and articles. Dr. Osher has used and continues to use virtually every advanced technology (including YouTube) to improve his students’ learning experience. His current demanding schedule demonstrates his continued passion. When I wrote this, he was speaking that week at the University of Minnesota and the Mayo Clinic. He continues to teach at most major meetings — in addition to coordinating "Telling It Like It Is,” the cataract surgery conference born out of rebellion and growing out of what Dr. Osher would say is the need for the truth. Dr. Osher has received about every teaching award available, including the Lifetime Achievement Award at AAO.

To me, being known as someone who bears good fruit is about as good as it gets: This Bobby Osher story, I think, says it all. In 1993, he flew to Zurich to attend ESCRS but got stuck 50 miles away because of a dishonest cab driver. He was lost and alone, or so he thought. Soon after putting his thumb out, a car pulled up and lowered the window. The driver said, “I know you. You are Bob Osher. I watch your videos. I learn from you. Please get in.” Like that surgeon, and countless others, I have learned from him, and I thank him for his countless efforts to improve patient care.

Now please read, in his own words, what makes this amazing teacher do what he does.

— Johnny Gayton, MD

The teacher

Bobby Osher, MD, tells it like it is — the ‘it’ referring to teaching, of course.

I love to teach: I don’t know exactly why. I just know that I’ve devoted more than three decades to teaching cataract surgery to just about any audience anywhere.

I appreciated my own teachers. Between my second and third year of medical school, I spent time with J. Lawton Smith, MD at the Bascom Palmer Eye Institute. What a devoted, enthusiastic and committed teacher this charismatic man was. Every day was a frenzy of pearl gathering. Students would flock to his clinic from all over the world. He taught so many vital lessons. “One cannot always cure,” he’d say, “but one can always comfort.” About life he’d say, “The truth is not defined by the majority opinion.”

UNUSUAL PATH

When I returned to medical school, at the University of Rochester, I noticed there wasn’t a single neuro-ophthalmologist in the city. I asked the chairmen of ophthalmology, neurology, neurosurgery and radiology if I could organize a monthly neuro-ophthalmology conference in exchange for permission to examine patients with various neuro-ophthalmic criteria. They reluctantly agreed.

The conference gained in popularity, surpassed by only medical grand rounds in size. I met and influenced classmates like neuro-ophthalmologist Jeff Odel, MD. My addiction to teaching had begun.

In lieu of an internship, I was accepted to Wills Eye Hospital for a one-year fellowship with Norman Schatz, MD. He turned me loose and let me teach other residents and students, despite not having a day of residency under my belt. The chief, Tom Duane, MD, and the head of oncology, Jerry Shields, MD, recognized my passion early on and each invited me to undertake major projects that were published.

After Wills, I again headed to Bascom Palmer for a formal residency. While there I would organize grand rounds whenever I could and enjoyed teaching the junior residents and the legions of medical students.

NO PLACE LIKE HOME

I would have been satisfied with a life in academic medicine, but the next great teacher in my life, my father Dr. Morris Osher, asked me to spend six months with him before moving on. A quiet, kind man with extraordinary integrity, he was devoted to each patient and taught me to treat every patient as if he or she were family.

He was the first to talk about many cataract surgery complications, including cystoid macular edema with iris-supported IOLs. From the day I began working with my father, cataract surgery superseded all other interests.

LEMONADE

Upon returning home to Cincinnati, I tried to contribute to the medical school, but the chairman forbade me from working with the residents.

As often happens, a lemon can be transformed into lemonade. I founded the Cincinnati Eye Institute, built a new facility with an ASC and hired dozens of talented fellowship-trained ophthalmologists. I learned to never discourage young ophthalmologists, which made me a much better teacher.

My hunger to teach grew. In 1982, I introduced the first ophthalmology video symposium at the annual AIOIS meeting (now ASCRS). Prior to this time, no one had organized such a symposium, especially one covering challenging cases and complication management. Subsequently, the video symposium has debuted in more than 50 countries, and is now seen annually at all AAO, ASCRS, and ESCRS meetings.

The next year, I started the Audiovisual Journal of Cataract and Implant Surgery, the first video journal in medicine. I believed that surgery could not be taught from the podium or the textbook. It had to be taught by watching procedures through the microscope. I obtained the support of the president of Alcon, and the predecessors of what are now AMO and B+L. More than three decades later, the Journal is viewed quarterly by more than 30,000 surgeons and is a member benefit of nine ophthalmic societies, including AAO, BRACRS, ESCRS and the Canadian Ophthalmology Society.

Dr. Osher doing what he loves.

FELLOWS

My favorite venue for teaching is Operating Room #5 at CEI. Cincinnati might be home for me, but my students are from all over the world. From Brazil alone, I have taught eight fellows. A surgeon from Mexico has just departed and another from Russia will arrive next month. I treasure these relationships.

Last month, Delta Airlines informed me that I was a member of the 3 million mile club. I’ve no doubt that virtually every mile has led me to, and back from, a teaching commitment. Surgeons in New Zealand, Argentina and Japan have welcomed me and then bid farewell the next day. I taught at five residencies this past summer then proceeded to teach six of the next eight weekends. There is something special about passing on knowledge that will help a colleague tame a challenging case or manage a complication successfully.

A RADICAL NEW MEETING

Seven years ago, I was informed that I had violated the new CME guidelines for mentioning product names during my symposium at the Hawaiian Eye meeting. Because I had been assigned the topic of New Products in Cataract Surgery, I told the CME company I could not pantomime the names.

Its response: There is a zero-tolerance policy and to accept the one-year suspension. I not only accepted my punishment, but expanded it, insisting it be a lifetime ban.

I began a meeting called Cataract Surgery: Telling It Like It is! Because this meeting was devoid of CME, a group of free-thinking gifted teachers could devote four days to cutting-edge techniques, challenging cases, complication management, tough IOL selection, innovative devices, drugs, and wet labs from early morning to near midnight. The faculty has since expanded to more than 30 surgeons. Our last meeting attracted 525 ophthalmologists and 118 exhibitors.

FORTUNATE FATHER AND SON

I’m fortunate that the chairman of ophthalmology at the University of Cincinnati offered me a full professorship. This lets me teach and buy dinner for the residents every month or so. I have also been given the privilege to organize sessions in the main program at AAO, ASCRS and ESCRS.

Perhaps my fortunes have peaked now that my son, James, has joined CEI as a retinal specialist. We keep my complications in the family! I am proud that he won the Golden Apple Teaching award during his fellowship.

When I started practicing with my father, I had two goals in mind: I wanted to take excellent care of my patients and to teach as much as possible. I realize that the gift I received from my teachers is the same gift that I hope to pass along. OM