Dr. Alejandra María Parra-Morales is a highly skilled ophthalmologist specializing in glaucoma and cataract surgery. She currently practices at Clínica Villoria Oftalmólogos in Vigo, Galicia, Spain. Dr. Parra-Morales has extensive experience, having served as a Resident Physician at Complejo Asistencial Universitario de Salamanca and completed observerships at Prism Eye Institute in Canada Ramon y Cajal Hospital and Clínica Baviera in Spain.
Her training includes courses and specialisation in anterior segment and glaucoma surgery. Dr. Parra-Morales also has a strong background in public health research and patient education.
Tell us about your early career. What inspired you to pursue a career in ophthalmology?
I studied medicine in Colombia in my hometown Bogotá. While I did my student rotations in my third year of med-school I had one week of ophthalmology with Dr. Toro a neuro-ophthalmology specialist who was eager to teach us all a doctor needed to know about eyes.
It interested me so much, that tiny world that seemed like a whole universe to me, then I decided to pursue an elective rotation of 1 month. After a few days, I knew ophthalmology was my calling and decided to plan my way into residency and this beautiful career ever since.
Could you share some key experiences during your education that have shaped your career?
I was privileged to train in one of the best med-schools in my country as well as many high-ranked centers with amazing attendings that taught me so much not only about medicine but about life.
I would highlight my med school elective rotation where I did 6 months of ophthalmology prior to starting residency. Had the privilege to observe as a medical student the service of ophthalmology of San Vicente Fundación in Medellin which has one of the main centers of intraocular tumors in South America. After that, I went abroad to Barcelona where I did an elective rotation in Sant Pau Opthalmology service where I decided to pursue ophthalmology in Spain.
I got a spot as a resident at Salamanca University Hospital and had the best time of my life as I grew as an eye surgeon and finished with an observership in Glaucoma and complex anterior segment in Toronto which was a cherry on top for my residency training ending. Of course, there are more experiences but these few I mention shaped the doctor and surgeon I am today.
Could you tell us more about your experience observing at GAASS in Canada under Dr. Ike Ahmed and his team?
I had the privilege of observing the GAASS team a year ago; during a few (intense) weeks. I got to be with the team (residents, fellows, and attendings) who were extremely kind to me, answered all my questions, and gave me surgical tips.
Of course was able to be in the OR to watch as they performed new techniques and technology such as new MIGS (itrack, gatt, hydrus, ECP, istent infinite); MIBS (preserflo and xen mainly), and even some facorefractive and refractive surgery.
But the highlight of my experience wasn’t the science behind it but the people; their mentality, their kindness and humbleness. Got to feel as one of the team and even now we keep in touch and they help me with my cases which I am extremely grateful for as I endure my first year in glaucoma.
You have plans to pursue a fellowship. Could you share with us what motivated this decision and what you hope to achieve?
That’s a tricky question. I come from an American academy where having a fellowship was crucial to practice medicine but trained in a European background where sub-specialists rarely have done fellowships as they learn from senior attendings and start practicing on their own.
I think good specialists can be trained in both ways but definitely, after my first year as a glaucoma attending pursuing a fellowship has crossed my mind (being on your own is an absolute challenge). So a fellowship is one of the decisions I keep in mind for the future.
What tips and advice would you give to young ophthalmologists starting their journey?
I still have a long way ahead, but there are a few things that I think are very important to keep in mind.
First, be humble, as surgeons have the privilege of changing patients' lives with our hands but sometimes what patients value the most is a good person behind the white coat that listens to them and tries to do their best for their patients.
Second, study and try to be the best you can be. Train and keep getting involved in courses to give the patient the latest trends in your field.
And third, this is advice given to me by Ike Ahmed: never feel that you don’t belong. Even if your practice is tiny; or you don’t practice groundbreaking surgery or are just starting in the field go ask the questions, make changes, innovate and feel you deserve to be there and you belong where you are.
Are there any courses, books, or resources that have made an impact on your career and you would recommend to others?
Yes; as you can tell I like to train and study and I think as surgeons is imperative to start with certificacions as ICO exams during residency and EBO as last year residents or new year attendings.
I would recommend two books you have to read in your first year as a resident: The Wills Eye Hospital Manual and the Kansky (Clinical Ophthalmology). During residency, AAO books are a must and they really help you during your different rotations and are an excellent guide for the boards.
As resources for surgery, I have to say YOUTUBE is my main resource when learning new surgeries. There is so much material from TOP ophthalmologists over the world I would recommend especially to look for: Uday Devgan (cataractcoach), Ike Ahmed (all related to glaucoma and complex anterior segment), and GAAS team fellows that have awesome material are Valentina Lozano (in Spanish as well) and Ana Miguel (in French as well).
Could you talk about some challenges you face everyday and how you overcame them?
Patient satisfaction and expectations can be challenging, especially in a field like glaucoma and cataract surgery. I overcome this by being very clear and trying to explain every possible outcome beforehand to the patient.
When I have a challenging case I usually try to ask senior colleagues for advice before taking action. I am very clear with the patient if unsure on what to do next and take every detail into consideration to decide a treatment or an intervention. Of course, there are always cases that feel outside my reach and when that happens I prefer to refer the patient to an experienced surgeon for the needs of the specific case.
On the other hand one of the main challenges as an attending is the responsibility behind it; is not easy to go out there and start doing surgeries by yourself, especially, innovating in a system that prefers to go safe and treat patients with classic therapies and surgeries when there is evidence-based technology that has proven better.
Surrounding myself with colleagues who love to innovate and having mentors who have the same mentality as me has given me a lot of courage to do what I do, which I believe is the absolute best for my patients.
How many surgeries do you do? How did you get started and how are you improving so rapidly with your surgeries?
Well, as a first-year attending I move in between private practice and cataract surgery at a public center. I have glaucoma and general ophthalmology clinic 4 days a week (usually have morning and evening clinic) and one day a week I have a full day OR with mainly cataract surgery, 14 cases a day usually (a lot of complex cases because I have patients that have been waitlisted for cataract surgery for months and sometimes years).
In clinic, I also do procedures like SLT laser almost every day and every other week I have a morning for glaucoma surgery (MIGS or MIBS). Thankfully, I'm not doing on-call shifts at the moment so I use my weekends to rest and go on getaways in beautiful Galicia, where I live.
Could you tell us about some specific difficulties you encountered during your residency and how you tackled them?
I started my residency in 2019. As you can imagine I was a PGY-1 when COVID hit Spain. Having to be outside my comfort zone and helping with COVID units really shaped my training but of course, I lost lots of training in my field (less ophtho cases, less clinic and less surgery).
I also encountered that in Europe residents face a lot of work that is not supervised. So as a young resident, you have to learn a lot by yourself (even though my senior residents helped me SO MUCH). But still, in the first year, I had to be on call and resolve eye urgent care by myself many days a week. That’s when I started studying really hard not because I had an exam as before but because I needed the knowledge to help my patients.
I've always been an artistic person so I started taking notes and learning lettering in my free time and that was en ophthodiary started as my study notes. It turned out these notes helped me and my co-residents as a fast “go to” when we had doubts and resulted in an ophtho-community where we help each other as colleagues.
How important are networking and mentorship? Do you have advice on how young professionals can seek out opportunities?
Very important. Many of my first jobs and opportunities have been through mentors and networking. I think you have to get out there; go to meetings of your specialty of interest; go say ''Hi'' to the people you look up to. Ask for advice and mentorship. The rest will come with time.
What are your future aspirations and goals? What do you hope to contribute to the ophthalmology field in the coming years?
For the next years, I am hoping to grow my surgical skills and continue to develop the Glaucoma Unit at my private practice. I am really trying to make a difference in how we approach glaucoma. Especially here in Galicia where PXF and glaucoma are very very common and there are very few centers that believe in an interventional approach.
What is a conference/meeting that is a must-attend for any young ophthalmologist in your personal opinion and why?
No doubts, in Europe: ESCRS. Great meeting, great courses a lot of learning, and the best ophthalmologists of Europe and America reunited in one place. Even if you do not do refractive surgery you can learn from Phacorefractive, complex cataract, glaucoma, retina, and other fields. As well as networking and very good times with colleagues.
Alejandra María Parra-Morales, MD, FEBO - Social media links:
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