James A. Katowitz, MD: The Perspective of 45 Years in the OR

James A. Katowitz, MD, has been an attending surgeon at The Children’s Hospital of Philadelphia for 45 years and has been affiliated with ophthalmology at the Perelman School of Medicine at the University of Pennsylvania for more than 50 years, as a medical student, resident, and faculty member. Currently professor emeritus in the Department of Ophthalmology of the Perelman School of Medicine, Katowitz is director of Oculoplastic and Orbital Surgery at CHOP, and also serves as director of Oculoplastics at the Edwin and Fannie Gray Hall Center for Human Appearance at Penn Medicine.

He has served as president of the American Society of Ophthalmic Plastic and Reconstructive Surgery, and is a fellow of the American Academy of Ophthalmology, the American Association of Pediatric Ophthalmology and Strabismus, and the American College of Surgeons, and has held many other prestigious professional leadership positions. In addition to publishing more than 150 scholarly articles, he edited the first definitive text on oculoplastic disorders in children, Pediatric Oculoplastic Surgery.

Last spring, the Scheie Eye Institute honored Katowitz as Distinguished Alumnus at the 136th Annual Scheie Eye Alumni Meeting, and CHOP hosted the inaugural James A. Katowitz Lectureship, given by Geoffrey Rose, MBBS, DSc, director of the Orbital Unit at Moorfields Eye Hospital in London. Katowitz continues to tackle some of the most difficult challenges we see at Children’s Hospital, including microphthalmic orbits, tearing problems, complex ptosis, and orbital tumors in children. His adept and experienced management of these complex problems, his engagement with both his patients and our clinical trainees, and his irrepressible optimism and enthusiasm have influenced hundreds of ophthalmologists and thousands of patients.

We asked Katowitz about his experiences and observations, and asked him to share his advice for those who would like to emulate his success as a physician, teacher and author.

How has the field of oculoplastic surgery changed over the course of your career?

One of the most important changes in oculoplastic surgery has been the evolution of cosmetic considerations in facial and eyelid reconstruction. We now recognize the importance of appearance as well as function, not just for adults but also for children. There is also a better understanding and acceptance of the psychosocial impact of appearance in the developing child. This has led us to offer more support and improved techniques for both patients and families as they deal with facial abnormalities and surgical interventions.

Perhaps one of the most unexpected changes is what constitutes accepted approaches to patient care. When I started practice, surgical specialties were more like fiefdoms: Everyone was in their own separate department, doing their own thing. Now patient care is much more integrated and collaborative, which is better for patients and their families.

This has been especially true at CHOP in terms of interdisciplinary collaboration. Good examples are the craniofacial service at CHOP and the Center for Human Appearance at Penn, which bring together Ophthalmology, Plastic Surgery, Dentistry, Psychology, Social Work, Speech, Audiology, and other services in order to maximize children’s ability to function as well as possible in their future endeavors. These collaborations assist families by unifying care and procedures, brainstorming alternatives, and formalizing a process by which care providers can learn what parents want and expect.

What new treatments or innovations do you anticipate in the future for your patients?

Developing therapies guided by genetic information specific to various eye and vision problems has now become a reality. We have already established a successful gene therapy trial for retinal degenerations here at CHOP, and I think additional gene therapies will rapidly become more important in medicine, and especially for pediatric ophthalmology.

In terms of surgical advances, more emphasis on endoscopic techniques, minimally invasive approaches, robotic surgery, and telemedicine is evolving. When I went to Kenya a few years ago, we connected with ophthalmologists there who not only had little experience with oculoplastic surgery, but also had limited resources for arranging meetings and case conferences.

Since we returned, we have continued to use email and photos to collaborate with these doctors. Even this limited form of telemedicine can help remote providers establish proficiency in oculoplastic techniques in their local communities.

What advice would you give to ophthalmologists beginning their careers?

First, appreciate the opportunities you have been given. Work hard and listen. Listen to your mentors, of course, but also listen carefully to your patients and to their parents. Each child presents as much more than just a surgical problem. Each is a whole person and also part of a family constellation. It is really important to understand why they have come, what their problems are, and how they should be treated. We have to remember that we are physicians and not just surgeons, and should be sensitive to the psychosocial impact of problems. Second, find an area or areas of ophthalmology that you love and emphasize this in your practice as much as possible. This will bring you the expertise to excel as well as to enjoy your work.

How have you balanced your professional career with your personal life? What advice would you give to colleagues who tend to be workaholics?

Personally, family has always been the most important thing and the greatest influence on my choices, such as where to live and where to work. I think it is too easy to get absorbed in patient care and academic pursuits, and as a result, family needs can be pushed aside. For me, it was important to get home for dinner as much as possible. Just  having everyone around the table at the end of the day was important for all of us, even just to ask: “How was your day? Did anything important happen?”

Putting professional pressures aside for family time was a priority. In addition, while it was hard to find time as a couple with so many family commitments, my wife and I always tried to maintain a reasonable balance. We also shared carpools and most household chores as equitably as possible, which I think set a good example for our three sons.

The last thing I would like to say is that, as worrisome as the future of medicine may seem today, we are blessed to be able to work in this field. I think most of us choose a career in medicine because we want to help, to make things better, to do something significant for other people, and to feel good about what we are doing. I think the opportunities for fulfilling these motivations will always be there in a medical career. In pediatric ophthalmology as a subspecialty, we are particularly lucky in that we are   really doing primary care for eyes — which allows us to see these kids for years. We watch them grow up and get to know them and their families. We are lucky to be doing this work.