LUCY SCHULTZE

When you’ve chosen one disease as the prime target of your practice, you want to be in the middle of its battleground.

That’s what led glaucoma specialist Dr. Sarwat Salim from Yale University to the Hamilton Eye Institute at the University of Tennesse Health Science Center in Memphis.

“Glaucoma is a very serious disease and is very common in African-Americans,” she said. “The need for specialists is so profound in this area, given the demographics here. I wanted to be part of that mission.”

Salim joined the department of ophthalmology in the fall as an assistant professor. Today, she’s providing both medical and surgical treatments to glaucoma patients from Tennessee, Mississippi and Arkansas, while also guiding UT medical students, residents and fellows. She aims to set aside a day each week to spend in the operating room, and one to focus on her research in new therapies.

Born in Pakistan and raised in New York, Salim received her medical training through the accelerated bachelor of arts-medical doctorate program at the City University of New York and State University of New York-Health Science Center in Brooklyn.

She completed an internship in internal medicine at Montefiore Medical Center in New York and a residency in ophthalmology at SUNY-Health Science Center in Brooklyn, where she served as administrative chief resident.

Her glaucoma fellowship was at Yale University School of Medicine, Department of Ophthalmology and Visual Science. She is a diplomate of the American Board of Ophthalmology.

Salim’s choice to focus on glaucoma allowed her to delve into the technical field of ophthalmology while also dealing with patients more broadly. Certain systemic medications can increase risk for glaucoma, while its treatments can in turn have systemic side effects.

“As a glaucoma specialist, I feel like I take care of the patient as a whole — not just the eyeball,” she said.

Beginning first with medical management, the treatments Salim provides are aimed at correcting elevated intraocular pressure, which causes glaucoma through damage to the optic nerve.

“When significant damage takes place there, people can lose vision — and the vision they lose is irreversible,” she said. “The key is to try to detect it and to intervene early so you can try to preserve vision.”

If medical treatment is not successful in relieving the built-up pressure, Salim moves on to laser treatments, applied to the eye’s natural drainage canal to help it return to normal function.

As a final resort, incisional surgery allows Salim to make a new drainage canal for her patient’s eye. She and UT colleagues are currently using a new surgical device, the Ex-Press™ Mini Glaucoma Shunt, which diverts fluid from inside the eye and also prevents the canal from closing up again.

“The procedure is not new, but the brand is new,” Salim said. “UT has been using it for a few years under Dr. (Peter) Netland, my director, and we’ve been very pleased with the outcomes so far.”

Glaucoma, a leading cause of blindness in older adults, is often undetected until the point at which it starts causing vision loss — when it is already well-advanced. For that reason, Salim is hopeful that new genetic research will some day provide patients and physicians with a head start on detection and treatment.

“It would be wonderful if we can detect who is likely to get glaucoma,” she said. “We don’t have that answer yet, and I don’t think we’re anywhere near it. But it is something we hope for.”

Although the causes of glaucoma are not fully known, its primary risk factors include age, positive family history and African descent. Past eye injury and some medications such as steroids can also be risk factors for glaucoma, which affects more than 3 million people in the United States.

In addition to her work with the American population, Salim travels extensively as part of medical mission teams, performing both glaucoma and cataract surgeries in places like the Middle East, Central America and Asia. Devoting at least one or two weeks of each working year to this service, she has gone abroad through several different organizations, depending on which schedule fits hers. She has also done some trips on her own.

Over the years, her strategy for making an effective difference in such a short timeframe has evolved.

“In the past, I was directing efforts more to doing the cases myself,” she said. “But I have learned that when I do that, I’m helping some individuals, but I can only do so many. Once I leave, they’re just waiting for me to return.”

Instead, in recent years, her focus has been on transferring her skills to the local physicians who will remain to help their communities.

“I try to be available if they have any questions about management or surgical techniques,” she said. “I think the impact is greater that way.”

Outside of work, Salim enjoys music — she plays the saxophone — as well as running, long walks and pleasure reading.



July 2008