RetinaLink had the distinct pleasure to meet Dr. Talia R. Kaden at the annual Vit-Buckle Society meeting in Las Vegas earlier this year. Dr. Kaden shares her impressions in transitioning from her retina fellowship to practice, who her mentor is, advice for first year fellows, evaluating technology in the operating room and other sage wisdom in this month’s RetinaLink Profile.
RetinaLink (RL): Please outline your academic background.
Talia R. Kaden, MD (TRK): I studied applied math at Harvard, where I was not pre-med. After 2 years working at an HIV/AIDS research lab and taking post-baccalaureate classes at night, I went to Yale for medical school. During medical school I had the opportunity to do a Howard Hughes Medical Institute Research Fellowship at the NIH for a year. I did my internship at Memorial Sloan Kettering Cancer Center, my residency at New York University (NYU) and completed a fellowship in a combined program between at NYU, Vitreous Retina Macula Consultants of New York (VRMNY) and Manhattan Eye Ear and Throat Hospital, where I currently practice.
RetinaLink contacted Drs. William Schiff and Gaetano Barile about Dr. Kaden joining their group and they said, “We are excited Talia has joined our group at Manhattan Eye Ear and Throat Hospital. Talia is smart and talented. We’re looking forward to watching her career progress and think her ceiling is limitless. With outstanding young physician-surgeons like Talia joining our ranks, we will all be in wonderful hands.“
RL: Why did you decide on retina?
TRK: At the NIH, I spent a year studying mitochondria in the retinas of hibernating ground squirrels. We found that these squirrels selectively protect their retinas long after other organs have shut down due to oxygen deprivation. I found it fascinating that even unconsciously, it was clear that this was an important organ. As my training continued and my understanding of just how complex and fascinating this neural tissue was, I was hooked.
When I then began to operate, I was amazed at the skills needed to be an excellent vitreoretinal surgeon. While doing a buckle, you utilize the principles of a strabismus surgeon. When suturing an IOL, it is crucial to be conscious of the delicate anterior segment anatomy. Vitrectomies require unrelenting patience, focus and attention to detail. To be a great vitreoretinal surgeon requires both a deep knowledge of anatomy coupled with great creativity, which certainly keeps things interesting!
Finally I really appreciate the patients for whom I am able to care. For patients with age-related macular degeneration, we are hopefully helping to transform a diagnosis that was once one of tremendous morbidity to one that is chronic, yet often manageable and vision-preserving. In the case of patients with diabetes or retinal detachments, they are often in the prime of their lives and their careers. If we can intervene in a positive way to protect their vision, we have impacted not only the patient but also their family and their community.
Deciding on retina was the best decision I made in residency and I feel lucky every day that I get to practice in this field.
RL: Who is your female mentor(s)?
TRK: My older sister is a high-volume cataract and glaucoma surgeon, a mother of three, and one of the funniest women I know. She has always been there to encourage and support me. Having someone who knows exactly what training can be like, about the emotional toll of a challenging case and about the balance required to be a parent and a physician is a tremendous gift.
RL: What do you find most challenging professionally?
TRK: Recognizing that there is not always a single right answer for a patient and their care and that some level of uncertainty is part of being a doctor and a surgeon. I’d like to know that I’ve always done the right thing for my patients, to ensure that my care is evidence based and thoughtful, but I know that each patient is not a question on a multiple choice test and that the right solution for one might not be the same as for the very next patient. Learning to tolerate and accept that ambiguity is something I think about regularly.
RL: What’s your preferred small gauge platform?
TRK: I most often use the ALCON 25G+ system though I do like to add in the 27G+ cutter for some of my tractional retinal detachments.
Dr. Kaden shares her 25G surgical video (click on the arrow above to watch her video) recently featured in Retina Specialists https://www.retina-specialist.com/article/pearls-for-rd-repair-after-ruptured-globe.
This 55 yo man had a ruptured globe secondary to a construction accident and subsequently developed a retinal detachment. His pre-operative VA was bare light perception. Surgery to repair his retinal detachment was performed 2 weeks after his ruptured globe repair. Three months post-operatively, his vision was CF.
RL: What is your opinion of Intraoperative OCT? If you utilize it, does it change your surgical plan?
TRK: I believe that the future will likely involve the integration of a lot more data intraoperatively, which I think can only be positive for the patient and surgeon.
RL: What is your best advice to the incoming fellows that start in July?
TRK: Be open to feedback, be honest and get to know your patients – they’ll remind you of why you put in such long hours.
RL: What is the best advice your Attendings provided?
TRK: “Take what the eye gives you” which I’ve interpreted to mean be humble in your approach. Recognize that every step from anesthesia to post-operative positioning needs to be careful and considered. Move judiciously and thoughtfully, with respect for the eye and the anatomy.
RL: Do you like to evaluate new devices and technology when they become available?
TRK: Absolutely! I think we all learn when we develop new technology and push the field forward.
RL: What is your favorite thing to do when you have some free time?
TRK: I have two small children so time spent with them is always a treat. If I’m on my own, running in Central Park, especially when the cherry trees are in blossom in the spring, is magical.
Dr. Talia Kaden can be reached via e-mail – firstname.lastname@example.org