From firsts to the future: A pioneer's perspective on ophthalmology

(Image Credit: AdobeStock/McCarony)

As Ophthalmology Times celebrates its 50th anniversary, the moment serves as an opportunity to reflect on the innovations that have defined ophthalmology and to highlight the pivotal role women have played in shaping the field.

To commemorate the occasion, Sheryl Stevenson, executive editor, caught up with cornea and refractive surgeon Marguerite B. McDonald, MD, FACS, to discuss the evolution of the field. McDonald has achieved numerous historic firsts, including performing the world’s first laser vision correction procedure, the first excimer laser treatment for hyperopia, the first wavefront-guided laser surgeries in the United States, and the first Epi-LASIK procedure in North America.^1,2

In practice with the Ophthalmic Consultants of Long Island in New York, McDonald is also a clinical professor of ophthalmology at New York University in Manhattan and at Tulane University School of Medicine in New Orleans, Louisiana. She is a staff physician at Manhattan Eye, Ear and Throat Hospital; Island Eye Surgicenter in Westbury, New York; and Mercy Hospital in Rockville Centre, New York.

What are the most significant changes you’ve seen in the field of ophthalmology, whether in technology, training, or patient care?

Marguerite B. McDonald, MD, FACS: For sure, cataract surgery. It has undergone a radical change during my professional career and even during my training. I know I will sound like Methuselah here, but when I was a first-year resident, none of the staff doctors put in IOLs, the patients all had a huge incision with 8 to 12 sutures, and [they] stayed in bed postop for a week. Can you even imagine?

When I was a second-year resident, the young attending physicians who were just finished with their training [and] trying to make a name for themselves started putting in IOLs. By the time I was a third-year resident, all the patients got an IOL. Now, they weren’t very good IOLs in the beginning; they caused a lot of problems, but at least patients weren’t staying in bed for a week anymore. It was just during a 3-year period that all these advances happened. Then the revolution of phacoemulsification, given to us by [Charles] Kelman, [as well as] small-incision surgery [and] foldable IOLs—all of it is so astonishing. It is incredible how it has changed our patients’ lives.

People go in for surgery now, [are] out an hour and a half later, and go to dinner that night. They see distance, intermediate, and near, if they wish. It’s been a revolution with a capital R and such a joy to have participated in all of it and watched it. The pantheon of the gods certainly has Kelman in it, that’s for sure. He changed our lives forever.

Refractive surgery has certainly changed. When I started my education, there really wasn’t any. Dr [José Ignacio] Barraquer in Colombia was doing some innovative refractive surgery [keratophakia and keratomileusis], but almost nobody else was. Radial keratotomy became popular right after I finished my fellowship, and then the excimer laser, of course, with which I was intimately involved. Things have changed so much—LASIK, SMILE [small incision lenticule extraction], all the things we have now—with incredible safety and efficacy records. I like to say in ophthalmology, when you take a 1-week vacation and you come back, you have to catch up. You really do. That’s how fast it changes.

Pharmaceutically speaking, when I started, the only eye drops for glaucoma were pilocarpine, phospholine iodide, and eserine. They were all we had. Patients hated them. Some of them had to be taken 4 times a day. They didn’t work very well.

Look at what we have now, plus all the fantastic surgical solutions for glaucoma, like minimally invasive glaucoma surgery and filters. In addition, we didn’t have good antibiotics either. Patients with corneal ulcers were routinely admitted to the hospital. They were put in isolation with three 8-hour shifts of nurses putting drops in, like chloramphenicol, which was removed from the market because it caused aplastic anemia in a tiny percentage of patients. I cannot remember the last time I admitted somebody to the hospital for a corneal ulcer, because the drugs are so good now. In every single way, ophthalmology has changed. I’m not sure there’s another subspecialty in medicine that has changed as much as ours over the [past] few decades.

What early challenges did you face as an ophthalmologist and as a woman in ophthalmology, and how did you navigate them?

McDonald: When I started my career, there was tremendous resistance to change. I think we’ve gotten better at that as time [has gone] by. But back in the day, ophthalmologists did not like new things. I remember when most of the top professors in ophthalmology were against IOLs and putting plastic in a patient’s eye. They were certainly against the excimer laser. The pushback against laser vision correction was enormous; it was considered immoral to fire an industrial laser at the line of sight of a patient who just didn’t like [their] glasses. Editorials were written about it. [The research team was] castigated from the podium and in print. As the years have gone by, people are more open-minded. Now we’re getting used to thinking that something that was once impossible is now possible, so I don’t see as much pushback against new ideas anymore, which is a wonderful thing.

As far as being a woman, it has had its challenges, that’s for sure. I don’t think men swing their legs out of bed in the morning and say, “How can I oppress women today?” That’s certainly not what happens. Sometimes, especially in the past, assumptions were made about women in ophthalmology that may not necessarily be true—innocent assumptions like, “I can’t put Dr Mary Smith on this committee; she has 3 small children under the age of 10,” or another innocent assumption of what her life must be like.

I always give this advice to younger women ophthalmologists: speak up. You can say, “Dr Jones, I know you’re putting together your committee. If you have space for 1 more person, I’d love to contribute.” Then address the elephant in the room. In the next sentence, you say, “I have 3 children under 10, but I have a very supportive spouse, the best nanny in the world, and my children have 4 of the most active, young grandparents who help me tremendously, so I can make room for this in my schedule. Please think of me if you need someone.”

That’s my advice to young women—speak up. People aren’t mind readers. Men aren’t mind readers. If you want to be on that podium and give a talk, or if you want to be on a certain committee, speak up. You don’t have to be pushy; just let them know you’re available. You could even detail why you’re available, [and] that you have all these support systems in place that allow you to be available.

What do you believe are the most important things institutions and senior professionals can do to support and empower women entering the field today?

McDonald: I don’t think you have to change the criteria for women at all; just become cognizant of any assumptions you might be making. For instance…an innocent assumption [like], “She can’t possibly have the time for [or interest in] this.” Keep the playing field completely flat and reexamine your entry criteria for any position to make sure you’re not making assumptions about a woman that are not true.

What are you most excited about for ophthalmology and for women in ophthalmology?

McDonald: Continued advancements in cataract surgery. Real accommodating IOLs are just around the corner. That is the Holy Grail—to give somebody the ability to see like they did when they were 16 [years old], at all distances [and] without any aberrations.

Women should realize that things are getting better every day. At the beginning of my career, there were no women on the podium, [and] there were almost no women in the audience. Most of the women in the audience were someone’s assistant or secretary, taking notes. And now look—half the people on the podium are [women, and] half the people in the audience are [women]. Nobody cares what you wear, as long as you’re clean, neat, and show up on time. Back in the early days of my career, everything was examined…. Now you can wear a formal suit [or] a cotton dress and cowboy boots; you can wear anything you want, as long as the content is good and relevant to your audience, which is great. In that regard, we’re like the men. Some men show up in a suit. Some men show up in khakis and a polo shirt. Nobody cares. It’s all about content now.

Is there anything else that you would like to add?

McDonald: Stay excited about ophthalmology. It can be a drag sometimes with the changing reimbursement from the government. We get paid less and less for things that take more and more of our time, skill, and expertise. [With] the changes that accompany private equity and all the things that are impacting us now—you can get down and burned out. We shouldn’t be. We still have the best specialty in all of medicine…. We’re lucky. There’s very little cancer in ophthalmology. For the most part, we make people exceedingly happy and change their lives forever. You have to remember that when times get tough.

References

1. Landau E. Her vision: better, clearer sight. CNN. May 17, 2013. Accessed July 18, 2025. https://www.cnn.com/2013/05/17/health/lifeswork-mcdonald

2. McDonald MB. Celebrating a pivotal moment in laser vision correction history. Ophthalmology Times. November 19, 2020. Accessed July 18, 2025. https://www.ophthalmologytimes.com/view/celebrating-pivotal-moment-laser-vision-correction-history