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ANDREA TOOLEY: Welcome to the Mayo Clinic Ophthalmology Podcast, a weekly podcast on all things ophthalmology brought to you by Mayo Clinic. I'm your host, Dr. Andrea Tooley.

ERICK BOTHUN: And I'm Dr. Erick Bothun. We're here to bring you the latest and greatest in ophthalmology medicine and more.

ANDREA TOOLEY: Dr. Sophie Bakri is the Chair of the Department of Ophthalmology here at Mayo Clinic. She joins us today to talk about her vision for the future of Ophthalmology.

ERICK BOTHUN: Dr. Sophie Bakri is the MacMillan Professor of Ophthalmology, a vitreoretinal surgeon, and Chair of the Department of Ophthalmology here at the Mayo Clinic. Dr. Bakri's research focuses on pharmacology for age-related macular degeneration, diabetic retinopathy, and venous occlusive disease. She is also a principal investigator on numerous multicenter clinical trials on novel drugs for retinal disease.

Dr. Bakri serves on the editorial board of the American Journal of Ophthalmology Retina, Seminars in Ophthalmology, and OSLI Retina. She served on committees on the Macular Society, Retinal Society and AAO and is a board member of the American Society of Retinal Specialists. She has won numerous awards recognizing her work in ophthalmology, and we are honored to sit down with her today.

SOPHIE BAKRI: Well, thank you, Erick, and thank you, Andrea. And I am honored to participate in this podcast with you today.

ANDREA TOOLEY: Welcome. We're so happy to have you here.

ERICK BOTHUN: It's an honor. It's a special treat, as there have been a variety of changes in our department. And being here as a podcast is one of those changes that we have been part of. But, Andrea, you know that journey a little bit better than me, even, as the ideas for this and culminating led to us being here today.

ANDREA TOOLEY: Yes, exactly. I want to give you all the credit for starting this podcast. This was your idea. And as the chair of the department, I know it's something that you wanted to start. And Erick and I are really enjoying getting to start this podcast. And so talk to us about why you wanted us to start a podcast, what this means to you, what you think this means for an academic department to have a podcast.

SOPHIE BAKRI: Well, thank you so much. First of all, I'm honored that you're helping with this, not only helping, but really running the show. Obviously, everything we do is a team effort. And our successes are due to the success of the team. So why a podcast? Well, I think we have to really rethink the way that we consume information. I think our lives have all become extremely busy, but yet there's this word out there, work-life balance, work-life integration.

And I think that for most ophthalmologists listening, having a podcast is a great way to consume information, yet also work out, maybe enjoy the commute to work a little bit more and so on, so forth. And we have an outstanding department. We have tremendous faculty. And that's just ophthalmology.

Of course, we have the Mayo Clinic. And there are tremendous resources. And we hope through this podcast to really bring and share some of the learnings of the faculty in our department, but also within Mayo Clinic, because it's just great. It's such an honor to be part of such an integrated healthcare facility.

ANDREA TOOLEY: I'm so excited, selfishly, to just get to sit down with some of the people, not only in our department, but at Mayo at large, especially being junior faculty. There's so many senior faculty in the department that you don't know all of the exciting things they're doing. Or maybe you want to pick their brain. So I'm selfishly very excited about that and then even getting to connect with ophthalmology at large, connect with other people that we might bring as guests on the show, see what people want to hear about, what people want to listen to while they're working out or on their commute. It's all very exciting.

ERICK BOTHUN: Yeah, I echo that. Mayo is such a unique institution, in my opinion, that it really is anchored on relationships and teamwork. And I think the environment here is one of collaboration, connecting, learning from each other and yoking efforts forward clinically in research and teaching. In my time here, I've celebrated all the opportunities we have to do that, just on a granular basis, even on a patient-to-care, moment-to-moment basis, how intentional the institution is to connect with each other, to support patient care.

In that light, I agree with you. It's exciting to think about episodes to have moments to connect with each other in our department and beyond, to learn from each other and share those moments in ways that are packageable for wherever people are and whatever they're doing to hopefully be blessed in their clinical practice and care.

ANDREA TOOLEY: Yeah, exactly that. There's a lot of opportunity for innovation here. And I know that you have a lot of vision for innovation in the future of ophthalmology and being a chair and kind of getting to decide where healthcare is going, what we want to focus on, and what we think the future is. What's your kind of overall vision for ophthalmology? This is a big question. But just thinking about innovation and where we can go, what do you see as a department chair?

SOPHIE BAKRI: That's a very long-winded question with a very long-winded answer, Andrea, but I'll do my very best. So ophthalmology is a field that is just so ripe for innovation. As you know, there is so much coming out there. And as a department chair, what I want to do is I want to facilitate the transformation of our faculty's ideas into products that may help patients. And I think that mentorship is going to be key to this.

We know over the years, we all come up with certain ideas, better ways to do things, better ways to build a mousetrap. But then what? Do the ideas die? Well, we don't want them to die. We actually want to benefit from all these ideas. And we are setting up robust mentorship programs to help junior faculty, such as yourself, come to us with ideas in a safe environment and coach you as how to bring that idea to fruition.

Now, we've had many, many successes in the department. Some of our senior faculty really have made great strides in research. One example is a glaucoma drug that is now in clinical trials. And that, I think, is something that we have to celebrate. We have one of our more junior faculty as well, learning from the senior faculty, about his glaucoma drug and his mechanism and now, moving along that pathway to translation.

In retina, we have moved from perhaps one person initially working on stem cells to an entire team working on the full spectrum of stem cells, from how we're going to cultivate them, to how we're going to implant them on the retina, to creating surgeries and best practices.

And so I think we've really come a long way. But one of the hallmarks that Mayo Clinic is the team science approach. And I think that is something where we don't work in silos. We're encouraged to not only knock on doors, but keep our doors open and be receptive. And when I think about the number of projects in our department, we have collaborations with radiology. We have collaborations with biomechanics, immunology, the pulmonary department.

The list goes on. I'm struggling here to think because as I go through each faculty member, everybody has a collaboration. We have grants, R01s, that are being written in collaboration with other departments, with multi PI, co-PI things. And so really, what we want is to have people think innovatively, but also not hit a ceiling.

So that's one of the things that I really want to do. I think many of us along the way have kind of stumbled on things by accident. We've made mistakes. We've learn from our mistakes. Maybe we hit something the third time. But wouldn't it be better if we can coach and mentor the right way, so that people can get on the path that they wanted to get on right from the beginning?

ANDREA TOOLEY: I love that.

ERICK BOTHUN: One of the things I've been humbly naive about, but very excited to learn more about, and certainly as I think is coming in a collaborative way, not just within a department, but across Mayo, is AI, artificial intelligence. We're learning more and more about big data and how that be processed. But just you're in a different seat than many of us, as you see this collaborative work happen, or this upswell of energy around AI. Share with us how special that is happening here at Mayo and might impact our department.

SOPHIE BAKRI: So one of the first things that I'm going to acknowledge is that Mayo Clinic as a whole has an initiative known as the Bold Forward 2030 Initiative. And when an institution has an initiative labeled that way, that immediately tells us that they are supportive of our initiatives and our goals with that. So that's the first thing, and I think that's fantastic.

Secondly, Mayo Clinic already has a lot of AI capabilities and continues to build capabilities and has collaborations with Google and Inference. And a lot of great things have come out of AI in other departments. Now, ophthalmology is a very unique field because we can pretty much see everything. We can see the retina. We can see the optic nerve. And what we have uniquely at Mayo is a collection of images, a collection of data, that also correlates with patients' systemic information.

And so to tell you how important this is, as you know, a department chair typically appoints faculty leaders for different areas. For example, Andrea one of the vice chairs for education. And Erick, you're the vice chair for quality. But we have appointed a vice chair for artificial intelligence and digital health, really outlining the importance of that as a trajectory that we want to go in.

So one of the first things is to look at how we make our data curatable or really understandable by this. We are building what we're calling an AI playbook, so that again, going back to mentorship, but when a faculty member comes and says, I want to study the relationship between x and y, we have a way that we can guide that faculty member. So AI is definitely one thing, but how is AI going to help our patients?

So we have to think about the future of ophthalmology. We have to think about the aging population, really the stagnant number of ophthalmologists, and how we are going to serve a growing population. Now, the traditional way is that we see everybody face-to-face for every visit. And if you take glaucoma, for example, or diabetic retinopathy, you assess for progression as an ophthalmologist. But wouldn't it be great if we can have a machine assess for progression and we bring the patient in when they need an intervention or when they need surgery?

Aligning with that AI is how are we going to serve patients at home? And that's where digital health comes in. And we will be partnering with companies externally, as well as building our own products, to be able to monitor some of these conditions. Some of it involves hardware. We've already created some hardware for wide angle fundus viewing, which is very exciting, and you'll hear more about in the future. But think about glaucoma monitoring. Think about home fields. Think about home OCTs.

So really, it would be not only nice to know when we need to see the patients, and remember, many of them come to Mayo Clinic from rural areas. They come from really far away. And we have to think about healthcare disparities as well. People can't afford to come to the physicians. Some of them can't afford the trip. So how do we make it easier for patients? And I think that there's a tremendous role for digital health and a tremendous role for AI in these areas.

And the other thing you may have heard is that AI, in some areas, can help and tell us things that a human being cannot. So looking at a nerve enter, is it male or female, or what's the gender of the patient, for example?

ANDREA TOOLEY: That's mind blowing. It's really amazing, the potential opportunities and what we can learn, especially with the retina and the optic nerve. There's so many things, subtleties there, that clearly machines are picking up that we're not. That blows my mind.

ERICK BOTHUN: I think it's fascinating. We're sitting in a building here at the Mayo Clinic called the Plummer Building. And the Mayo brothers, the two doctors that really put this place on the map quite a while ago, one of their first hires was Dr. Plummer. And he had many transformational ripple effects.

But part of his biggest impact in healthcare was the transformational idea that instead of carrying around a little packet that was my chart and you took it home every day, your chart was owned by the institution and went to every patient visit with you and thus starting internal medical records. And that's what Mayo has benefited patients through for so long. It's changed the way we think of information, patient information, that lets us care for them in an individualized way, but also learn from information in a collective way.

So as we sit here in the Plummer Building, which kind of got that going within medicine, and you think about, this is really a transformational thing. In one sense, it puts healthcare back in the convenience and accessibility of the patient. It allows the patient to go back to contribute to their chart, even though they may be at home monitoring their pressures or visual fields, allowing us to better care for them, improving their charts, but also improving the way that we collect data, analyze data, and transform care in the future.

So that just was sort of a neat perspective of where we've come from, walking around with a little piece of paper to having a collected medical record and advance the way we study data through the REP study-- that's what we call our studies here in the Rochester Epidemiology Project-- but also just how AI is going to take that to a new level that in one sense might be intimidating, but through leadership like yours and here at Mayo, to understand, as you articulated, we want AI to be something that every new physician comes into or new care provider comes into the Mayo Clinic and be able to interface, not just with the patient, not just with a medical record, but with a mechanism of evaluating the medical record that takes all of our care to a new level.

SOPHIE BAKRI: Yeah, you mentioned the word intimidating. And I just really want to comment on that. I think there are some physicians and ophthalmologists out there that feel that AI may replace them. And it's absolutely not true. I think that AI will assist us, but also enhance us and enhance our ability to care for the patient because--

ERICK BOTHUN: It might open up new opportunities and new expansion of things that we really didn't know how to study or treat.

SOPHIE BAKRI: So we don't know what we don't know. And I think AI is teaching us that. And in some situations, it's given us a little bit of a wake-up call about just how strong the capabilities are. So you're right. It's absolutely transformational. And I hope that we can make new discoveries, new associations, new linkages. And being able to link that entire patient chart, including, for example, the genetics is just going to be incredible. So I'm really looking forward to it. And it may be a capability that every faculty member will either come in with in the future or develop at some point.

ERICK BOTHUN: I'd like to go back, and you talked about new ideas that go from bench to bedside. And there are so many different opportunities that people come up with. And some of them in places just sit, as you talked about. Here, there's been a number of areas that I've seen in my short time be on the cusp of changing care everywhere, drug delivery included. But share with us just a little bit of your perspective on a couple of those. And I say drug delivery in light of how important that is in a patient-- how do we say-- not ease of ease of delivery, but also disease-impacting way, what drug delivery, as an example, might do for patient care in the future.

SOPHIE BAKRI: Yeah, absolutely. So looking back at how research used to be, people did research, and myself included, because I think this topic is really interesting. And so you do the research. The topic is interesting. And then you go back and you find that there's been some other related information. And then you say, gosh, this is so interesting. I think we could really make something of it.

And then you go to the venture's office, and they say, sorry, there is some prior art somewhere in some language and some literature. This is not going to go anywhere. And then you start to understand why it's important to consult with these professionals early on, so that by learning what's been done and learning the new directions that you could potentially take your research in, or sometimes really small tweaks, you could actually create something that could get into the hands of patients, or should I say, could get into the eyes of patients.

And I think that that's one of the things, again, about team science. Again, we used to work in silos a long time ago. And then silos became teams. And now the teams have gotten bigger. We get we get counsel. And the goal really is that when you have an idea, how quickly can we get it into the eyes of patients? So I think that's really been a tremendous transformation over at least the past decade. And I think patients have really benefited from that.

In terms of drug delivery, there's a lot of exciting things coming out. One of the things I will say, and I have a special interest in in drug delivery, I spent a long time poring over the literature. And I finally understood why. There's so much literature on the topic. But it doesn't go anywhere. It just wasn't quite tweaked the right way. And so I think that with our new team capabilities at Mayo, as I mentioned, we'll be able to hopefully mentor faculty to get the right direction the first time, still within the realm of their interest, of course, but really so we can move things along quicker.

Drug delivery is a fascinating area. There's so many ways to deliver drugs to the eye. And the beauty of the eye is it's accessible, and we can deliver medication locally in a way that doesn't cause systemic side effects. So I think it's really been a very attractive target in general industry because they understand that you can deliver it easily. You can study it. You can image it. And so I think that the field has benefited as a whole from that.

ANDREA TOOLEY: Just as you said, industry, how do we tie all of this work into our partnerships with industry, our goals for helping reduce health disparities, using big data, using AI, and fostering innovation, creative research? How do we partner? How do we work with industry to make that happen?

SOPHIE BAKRI: No, I think the word partnership, collaboration, you're exactly spot on, Andrea. Again, in the past, there used to be the university setting. And then there was the industry setting. And now, one cannot survive without the other. When we create ideas here at Mayo, we know that the physicians and the scientists, we know what they're good at. They're good at doctoring, taking care of patients, and creating the science.

The training they haven't had is how you get that drug into the eyes of patients. And that's where our industry partners come in here because they can license one of our patents and they can take that along. And that allows the physician to go back to seeing patients and then maybe thinking about the unmet need and thinking about what else we can do.

I have to say that internally I get very frustrated when a patient asks me a question and I hear myself saying, I think we've reached the limit of science, or I'm sorry, I don't think there's anything we can do, or when they ask me, why? I say, that's a poorly understood condition. And I find myself now writing this stuff down, saying, I'm at Mayo Clinic. There's really no excuse. We have to find the answers to these questions. And it's only by having physicians in the clinic that we're able to assess that unmet need and bring it back.

So I think if you don't collaborate, I think that's a real problem. And I think there are certain stages at which you collaborate. And even within industry, there are small companies and there are big companies. And they have to decide when they've reached the limit of their expertise and it's time for them to involve yet another partner. So I think skills of teamwork, collaboration, good communication are going to be really essential to moving anything that we do forward.

ERICK BOTHUN: So I just want to thank you for sharing with us. You are in such a unique position as you are shepherding so many of us along this journey, expanding new opportunities in care, but also in research and development. And it's a treat to be able to sit here and say we have a new opportunity in media relations. And so we thank you for your leadership to this point and are excited for the future of ophthalmology and the future of our department, for our patients both locally and beyond.

SOPHIE BAKRI: Well, thank you, Erick, and thank you, Andrea, and I look forward to working with you on this new endeavor and sharing what we've all learned along the way.

ANDREA TOOLEY: Thank you so much.

You can find all episodes of the Mayo Clinic Ophthalmology Podcast on our website.

ERICK BOTHUN: Thank you for listening, and we definitely look forward to sharing more next week.

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