Dr. Catherine Cuite is an Oculoplastic Surgeon with the Illinois Eye Center, S.C. She received her bachelor and master’s degrees from Harvard and Radcliffe, Harvard University and her medical degree from Albert Einstein College of Medicine in Bronx, NY.
She did an internship in Internal Medicine at Norwalk Hospital/Yale University in 1994 and an Ophthalmology residency at the Casey Eye Institute in Portland, Ore. She completed a fellowship in Oculoplastic Surgery with the Dean A. McGee Eye Institute in Oklahoma City, Okla.
Tell us about your background. Schools attended, family, etc. What was the most challenging during your college years?
My brothers and I grew up on a small farm in upstate New York. Our town, Cambridge, has one red light and one school (kindergarten through 12 grade). Our family moved there from New York City when I was 5.
We traveled to the city often, but our daily life was rural. I think my parents fell in love with the beauty of the Adirondacks, but I also think they wanted us to grow up in a simpler environment, with nature at our fingertips. I graduated with about 75 other kids in 1984 and lived in large cities for the next 15 years studying at Harvard and Radcliffe, Albert Einstein College of Medicine, and two eye institutes.
One of the toughest things about medical training is constantly being indoors. I remember calling my mother once from medical school. I was tearful and didn’t know why.
As I explained things to her I heard myself saying, "there’s just so much cement here." There are periods during any apprenticeship when you deprive yourself of certain things in order to master your trade. I think being disciplined about that is one of the biggest challenges of a life in medicine.
Describe the typical duties of an ophthalmologist.
Ophthalmologists are M.D. eye doctors. They are trained in four-year medical schools (just like family doctors) and then they complete a residency (three or four years of training specific to medical and surgical care of the eye). I did an extra year of training, a fellowship, in oculoplastics after my ophthalmology residency. During my fellowship I operated five days a week only on eyelids, eyebrows, and the bones and tissues around the eye.
The goal of the Illinois Eye Center is to be the most comprehensive eye care center in central Illinois. We care for roughly 300 patients a day, receive 500 phone calls a day and have physicians in surgery at all three area hospitals. We have physicians trained in each subspecialty area of ophthalmology. For example, we have a pediatric physician, a retinal specialist, a physician specializing in glaucoma, corneal specialists, laser vision correction, and myself.
As an ophthalmologist, the health of the entire visual system is my responsibility. In my particular specialty, I treat the lids, brows, and bones surrounding the eyes.
Who or what encouraged you to become a doctor, specifically an eye surgeon? You have a bachelor’s degree in biochemistry from Harvard University. Were you planning on pursuing another specialty other than in the ophthalmology field? Any regrets?
The first true hero in my life was a veterinarian who came to our small farm in the Adirondacks to care for my kid goat. Timbrel jumped a fence and broke her leg. I gingerly supported her limb for nearly an hour before the emergency vet pulled up the long dirt driveway to our barn. We cast her leg and, almost immediately, she was back to her usual bouncing about. Although I was a farm girl and a nature lover already, this seemingly insignificant incident was my first encounter with medicine and it changed my life. For a long time I imagined I would be a veterinarian. Things changed and 15 years later I got my M.D.
At the end of my third year in medical school, I was planning to do a general surgery residency and a fellowship in hand surgery. I was intrigued by the detail of hand surgery, the functional goals it had, and particularly the creative problem-solving that surgeons used in treating trauma patients.
Anticipating my ophthalmology rotation, I imagined it would be a nice break from the rigors of hospital-based medicine, and perhaps offer some easier hours. When I was directed from the clinic to the OR I was surprised. I hadn’t even realized eye doctors do surgery. I found ophthalmic anatomy was more beautiful than hand, more delicate and varied, more neurologically complex. The functional element was there too, and it was critical. After a few days in clinic I changed my plans again; ophthalmology it was.
Three years into my residency I began to request trauma and difficult cases. In large part, I felt I needed a diversion from the repetition that is so much a part of general ophthalmology.
I noticed the oculoplastic surgeons had a variety of procedures on their OR schedules and their work days were varied. Their patients had functional issues, which were often emotionally charged by personal appearance, pain, or systemic disease. I gravitated toward this work, for I found it challenged and rewarded me as a humanist and also as a creative problem-solver.
After residency I did a year-long fellowship in oculoplastics. That year I found a home. I love this work, even as it exhausts or frustrates me. It is part ophthalmology, part plastic surgery and part its own unique field. When my work changes not only how someone looks, but also how they see, it changes their life. It requires creativity, compassion and thoughtfulness. It brings out the best in me.
Are there women in your field? You decided to study oculoplastics - how many years has this niche been a specialty? Are you the only specialist in downstate Illinois?
There are nearly 200 female board-certified ophthalmologists practicing in Illinois. Five of these women work primarily in oculoplastics. Oculoplastics has existed, although perhaps not to that name, since surgical techniques were first practiced.
Women have contributed to the field throughout this century. For example, in 1926 a female surgeon practicing in France published a textbook on facial surgical technique. The history of the female physician in general is a long and hearty legacy, with, I hope, much more to be contributed by women of today.
Describe the type of patients who might be referred to you?
An oculoplastic surgeon treats a wide variety of problems—disorders of lid and brow position, tumors or infections in these areas, thyroid eye disease and tear duct obstruction, in addition to general ophthalmologic care. I was drawn to oculoplastics in particular because of the surgical creativity it requires. Oculoplastics is also interesting because it involves the face—a unique and intensely personal structure—it is how we identify with ourselves. Our faces determine how others perceive our emotions, intelligence, sincerity and disposition. I think my facial plastic colleagues would agree that to treat a patient’s face with any degree of success you have to be sensitive to how they perceive themselves, and compassionate about how they are perceived by others.
I receive referrals for eyebrow lifts and eyelid disorders, tumors, as well as reconstructive procedures such as replacing an eyelid or removing an eye. As an example, I can help a woman who can no longer wear eye shadow (due to the bagginess of her upper lids) by removing that excess skin. I often treat patients who notice a new growth around their eye when their dermatologist may not want to operate that close to the eye. These are familiar procedures to me.
What do you tell people regarding care of their eyes?
I tell young people that if they don’t want to see me for a premature blepharoplasty or skin cancer removal to use sunscreen now. Use a facial SPF of at least 15 every day whether you are going to the beach or not. Skin care products have gotten much better over the years and regular use makes good sense. We know more now about sun damage, and we need to act responsibly.
Whenever a risk is at all foreseeable, proper safety eyewear needs to be worn. I remove one child’s eye a year because of irreparable damage due to an accident. Most commonly, accidents occur when a child is hit in the eye with a golf club while playing with another child; a lawn mower flings debris into a child’s eye or a child plays with a BB gun.
What questions should a person ask of their surgeon before undergoing an irreversible procedure?
The patient-surgeon relationship is a critical component of the surgical experience for both people. Especially in ophthalmology and oculoplastics where 90 percent or more of our patients are awake during surgery, trust is essential. I encourage patients to ask how many procedures their surgeon has done, not just total but also within the past month. Ask about options, including medical management and what the best and worst thing that could happen would be. If a patient hesitates, I always offer that they "sleep on it," because no one should ever feel pressured into a decision about surgery.
What advances do you expect in the next 5 to 10 years? The next 20 Years?
One advance I hope for daily is a better understanding by the general population of sun damage and how to prevent it. I remove, on average, one tumor from an eyelid per week. These tumors are usually sun-related, so it disappoints me to still see young people being cavalier about sunburns, using tanning beds and generally disregarding sun safety. Another sun issue in an agricultural state like Illinois is occupational exposure by farmers and ranchers. I hope in 2010 people use sunscreen as regularly as they now use toothpaste and deodorant.
As far as advances within the field, the next 10 years will find oculoplastic surgeons again minimizing incision size, furthering their understanding of anatomy so the same results can be achieved with one incision, or even no incisions. I am incorporating endoscopic techniques into my practice, which will permit correction of certain conditions without a skin incision at all. Also on the horizon is a richer understanding of the role of neuromuscular toxins such as Botox to modify muscle tone and behavior and achieve some of our goals without surgery.
What do you like to do in your leisure?
I am an outdoor enthusiast, so depending on the season I’m biking, hiking with my dogs or cross-country skiing. Being out in the wilderness is rejuvenating for me. After a long day, the majesty of a sunset puts it all in perspective.
What is your greatest challenge/reward?
My greatest reward is when a patient says, "I see so much better!" Working in this profession, it is a constant challenge to keep up with an ever-burgeoning body of knowledge. Each doctor in my group attends two weeks a year of meetings outside of the Peoria area to keep current. Surgical seminars, journals and Web sites are a lifelong commitment when your goal is clinical excellence. TPW