We talked to the medical director of the Svjetlost Eye Clinic and president of the European Eye Bank Association professor Iva Dekaris about latest surgical methods of eyesight correction and the post-pandemic future of health tourism
Professor Iva Dekaris, PhD, talks about complicated eyesight restoring surgery as casually as she was talking about the weather. In her twenty-five years of practice, she has performed more than 20.000 surgeries – ultrasound cataract surgeries, cornea transplants, multifocal lens implants – all with the same steady hand, bottomless knowledge and unwavering eye.
Iva Dekaris is one of the most skilled ophthalmologists in the world
Professor Dekaris has perfected her craft at some of the most prestigious academic institutions in the world, published over 300 scientific papers (50 of them in leading international medical journals) and is considered to be one of the most skilled ophthalmologists in the world. Calm and composed, fulfilled professionally and privately, Dekaris, PhD, MD can at her helm at Svjetlost Eye Clinic handle anything life throws at her – even unexpected situations arising from a global pandemic.
It’s wonderful to know that a small country like Croatia is known for quality, and that our clinic uses more advanced lenses and equipment than most European and American eye clinics, explains Iva Dekaris
What’s it like to be a medical director of an eye clinic amid the corona virus pandemic?
We have been working without any breaks. Our day clinic has been taking care of ocular emergencies and performing emergency surgeries, like retina detachment surgeries, which at the time are not performed in public hospitals due to the pandemic. My job as the medical director is to take into consideration all information presented by my expert colleagues from the fields of infectious diseases and epidemiology, and to create protocols for our clinic in respect to the safety of our medical personnel and our patients. At the entrance, we measure temperature of every patient and ask for medical history related to possible contact with those infected with the corona virus. We also check if the patient has been ordered to self-isolate. Of course, we aren’t performing as many surgeries as usually. We are a private clinic, with no other financing than our earnings, so being open and working is good for both our staff and our patients. We haven’t had to let anyone go, which means a lot to all our employees in this precarious moment.
Beauty of the work
Which procedures are the most complicated and why?
High-risk cornea transplants are technically demanding, and post-operative therapy is highly personalized, which means the physician has to monitor the patient over a long period of time. But that’s the beauty of my work: there is very little routine, and you have to keep perfecting your skills and adding to your knowledge. When I was little, my father used to say, ‘The more you learn, the more you understand how little you know.’
How much has ophthalmology changed since you started your specialization?
If someone had told me then how far we would come, I’d hardly believe them. Ophthalmology has changed drastically. When I was starting out, most surgeons performed classical cataract surgery, without the use of ultrasound. That surgery left a long scar on the eye, the organ healed much more slowly, possibility for complications were many and ultimately, the results were less satisfying. During my residency in the University Hospital Sveti Duh, professor Nikica Gabrić, PhD acquired the very first ultrasound device for cataract surgery, so I was in right place at the right time. Cornea transplants were also still performed the old-fashioned way, without checking the quality of the donor tissue in eye banks. We opened our first Eye bank at Sveti Duh in 1995, which allowed us to perfect the procedure. Back then it was just a dream to reach the skill and quality level of renowned world clinics, but these days our clinic welcomes international patients from many more advanced countries, who come for our skill and expertise. It’s wonderful to know that a small country like Croatia is known for quality, and that our clinic uses more advanced lenses and equipment than most European and American eye clinics.
Even after almost three decades of experience, I am still not completely relaxed when operating on a patient with only one seeing eye. That is simply too big a responsibility and the surgeon must be extremely focused, extremely careful, said Iva Dekaris
Many people are afraid of undergoing eye surgery. How important are bedside manners with such patients?
Everyone is afraid of eye surgery and that’s normal. I keep a smile on my face when dealing with patients, give off an optimistic vibe and never push procedures on them, suggesting only exactly what I think would help them. During the procedure I talk to the patient to keep them distracted; sometimes we play calming music in the Operating Room. More than 90 percent of our patients later tell us their fear was unfounded and the procedure was less stressful than they expected. When we get a patient who is simply too afraid for anything else, our anesthesiologist administers sedatives.
When did you become aware of your skill level and realized you could perform any surgery without hesitation?
After several thousand procedures, the skill and the expertise are definitely there. There is no place for fear. Still, no matter the expertise, the eye is a high-risk organ and complications are always possible. No doctor should ever let their ego take the better of them and arrogantly consider any procedure a done deal. That simply is not true. The results of any procedure depend on factors other than the surgeon’s skill. Even after almost three decades of experience, I am still not completely relaxed when operating on a patient with only one seeing eye. That is simply too big a responsibility and the surgeon must be extremely focused, extremely careful. The more procedures of the same kind you perform, the more ‘famous’ you get for it – and the more patients look you up just to have the same procedure done, some with very difficult diagnoses. For me, that means high-risk cornea transplants combined with other eye conditions, often on patient’s only seeing eye.
Born in Paris
You will be president of the European Eye Bank Association until 2022. None of your colleagues have been selected for that duty twice in a row. What makes you special?
My colleagues on the EEBA administrative council often compliment me on several things: I am always the first to give my opinion on administrative processes, the fastest to answer e-mails and the first to openly declare my thoughts on any professional questions. Ever since 1995, I have participated in the work of the EEBA; publishing scientific papers, as well as giving my suggestions on reorganization of the association. As a surgeon I make decisions fairly quickly and without unnecessary discussions, and am used to working long hours without losing energy. Before becoming president, I was on the EEBA Administrative Council, where I always tried to speed things up, to connect our association with other eye health-related organizations with goal of promoting the importance of eye banks in the world of ophthalmology. I worked on promoting the idea of combining scientific and practical work within the association, which has since its foundation been divided between scientifically-oriented doctors and practitioners, who in reality should be working together closely, to be able to better tend to patients. I guess my approach appealed to many in the EEBA, so they selected me for the position twice.
When I was younger, I was certain I would build my career abroad, maybe in Paris or the United States. But after living on my own abroad for a longer period of time – one year in Paris, one year in Boston, several months in Germany and in the Netherlands – I have realized home really is where the heart is, where your family and friends are, revealed Iva Dekaris
You have a good idea of how well equipped eye clinics are abroad and in Croatia. Is there anything your foreign colleagues envy you for, or anything they have that makes you want to trade places with them?
The very first reaction we inevitably notice when foreign colleagues visit Svjetlost is shock. They can barely believe they are in Croatia, as they are all seem to believe clinics on this high a level only exist in western Europe, for example, Germany, or the USA. Our equipment and our medical staff really are on an exceptionally high level. I think they also envy the pace at which we introduce new procedures and methods into everyday practice, and the fact that we are a university clinic working on scientific research. That is indeed rare. As far as trading places with any of them, I don’t think I have anything to wish for, except for maybe the way society in general treats them and values their work. Croatia officially claims to treat private and public clinics equally, but many state institutions go out of their way to himder our work. For example, as a doctor working in a private clinic I was not allowed to register my scientific project, even though our clinic is registered as a research facility. That kind of discrimination would be unthinkable in other European countries or in the States.
You were born in Paris. Do you still have connection to that city?
I was accidentally born in Paris, so to speak. My family lived in Paris because my father was a research scientist at the Pasteur Institute, and we moved back to Croatia when I was still a baby. We do have family in Paris, so I visited that beautiful city often. I also studied in Paris for a year, working on my graduate thesis at the same institution as my father; the Pasteur Institute.
After completing your studies abroad, what made you return to Croatia?
When I was younger, I was certain I would build my career abroad, maybe in Paris or the United States. But after living on my own abroad for a longer period of time – one year in Paris, one year in Boston, several months in Germany and in the Netherlands – I have realized home really is where the heart is, where your family and friends are. I also saw a greater challenge in returning to work in Croatia, using the skills I learned abroad in treating patients here, as well as trying to improve Croatian healthcare system. Abroad, I was a cog in a well-oiled machine of healthcare and scientific research, but here I can work on improving those same sectors. I have never regretted coming back!
Full professor at the University of Rijeka
What are you like as a mentor? Can your guidance motivate your younger colleagues to stay in Croatia?
I do my best to motivate them to do scientific work in addition to their medical practice. Many of my younger colleagues have been inspired to add scientific degrees to their medical specialization. Mentoring is among my favorite facets of my job: working with all those young people makes me feel younger – or so I like to think. I believe my students are satisfied with my methods, as I get many requests for mentoring from colleagues from other private, as well as public clinics. I am especially proud of them, as they have a much rougher time working on quality scientific papers than their colleagues in other countries. Let’s hope they all choose to stay, because without young doctors, we’ll be lost.
You have many female colleagues in Svjetlost – does that mean the owner, Professor Nikica Gabrić, PhD, MD trusts female doctors more, or are there really specializations that appeal to women more?
I don’t think Professor Gabrić trusts female doctors more, nor do I believe that in general you can set a rule about trusting either gender more. There are certain character traits and qualities indispensable for being a doctor – being knowledgeable, hard-working, skilled with your hands, capable of team work and good bedside manners – and they are equally distributed among men and women. That said, as the number of women graduating from medical school is growing, so is the number of female doctors in clinics, as all those traits seem to more often come together in women.
I spend vacations on our beautiful Adriatic, on the isle of Vis or in Gorski Kotar, or in Austria. All I need are a few good books, a pair of sneakers and a pair of hiking shoes to wander around and that’s all, emphasized Iva Dekaris
You have a daughter – are you already letting her in on the joys of medicine? Are you wishing for a successor, so to speak?
My daughter is 12 and still too young for me to consider her talents and inclinations, which are both equally important in choosing a good career and a happy life. Still, I really love what I do, so my enthusiasm for my work surely seeps into daily conversation, as she’s already attracted to medicine and saying she wants to grow up to be an eye doctor. We have already practiced surgical skills on animal models and she loved it. Remains to be seen whether she will ultimately choose medical profession.
You have ties with Rijeka and their University?
My academic and scientific career is primarily tied to The Faculty of Medicine of the University of Rijeka. After excellent professional and scientific results, among them being published in some of the most renowned ophthalmology journals; graduate school at Harvard and defending my doctoral thesis at the age of 32 (which is rather rare in Croatia), the University of Rijeka offered me a teaching and research position. I am very grateful for their offer, which I did not get from the university in my hometown, Zagreb. I am a full professor at the University of Rijeka and an associate at their eye clinic; we perform cornea transplants in Rijeka, and their students come to our clinic for practice. All in all, our co-operation with the University of Rijeka is great, and those who benefit most from it are students and our young colleagues. The University of Rijeka is always ready to welcome experts no matter where they are from, which is something all universities should aspire to. Another interesting detail: I am the official clinical instructor in cataract surgery with the European Society of Cataract and Refractive Surgery, as well as with the University of Lugano in Switzerland – and got both those titles before I finally joined the teaching staff at the School of Medicine of the University of Zagreb.
Svjetlost Eye Clinic is the choice of many public faces from the world of fashion, movies and business. Have you been starstruck by any of them?
I don’t want to name any of them, as they are all patients and should be treated with equal care. As a rule, I am most impressed by normal famous people who don’t ask for a special treatment, who treat our staff nicely and see them as human beings, not just skilled hands at their service.
A little oasis in downtown Zagreb
What damage will the pandemic inflict on health tourism, an important segment for both Croatia and Svjetlost Eye Clinic?
The corona virus has temporarily stopped all health tourism. Usually, around 30 percent of our patients are foreigners. Still, I am not a pessimist and believe that should the crisis be resolved soon, all our potential clients will come back. We will have to be ready to work much more to compensate for losses, but I have no doubt we will be.
What does you life look like outside work? What relaxing hobbies do you most enjoy?
My home and my family, like any other woman. I am lucky to live in a house with a garden, a little oasis in downtown Zagreb. I find joy in spending time with friends, some of whom I have known since high school; in spending time with my family, in quiet and nature. I spend vacations on our beautiful Adriatic, on the isle of Vis or in Gorski Kotar, or in Austria. All I need are a few good books, a pair of sneakers and a pair of hiking shoes to wander around and that’s all. Faraway holidays are no longer my first choice, even though they were when I was younger. These days I prefer Croatia and Europe. Still, I might go back to visit Japan, a country I liked a lot.
Who is your eye doctor? Who would you trust to correct your eyesight?
I rarely go for check-ups and when I do, it’s usually to any of my colleagues at the cornea department. I have no favorites. I still have no need for eyesight correction, but when the time comes, I’d like to be operated on by one of my students. The surest sign you have been a good mentor and good teacher is leaving behind at least one young colleague that has become better than you.
Text Dubravka Tomeković Aralica
Photos Damil Kalogjera and Iva Dekaris archive