Age 4 is a big year for many of us. We begin to understand concepts like past, present and future. We learn to take turns, share things and to express anger verbally rather than physically.
Most of us don’t decide on a career path, but Carla Siegfried, M.D., associate professor of ophthalmology and visual sciences, had a vision for her future.
“I was 4 years old when I decided to be a physician,” she says. “It was before kindergarten, and my only interaction with physicians was my pediatrician. So I wanted to be a pediatrician. And I really never wanted to be anything else.”
The good news for us “late bloomers” is that at least she got the specialty wrong. She actually became an ophthalmologist.
Siegfried is the youngest of Doris and Sedley Siegfried’s children. Two of her four older brothers, Barry and Glenn, also attended medical school, but she had chosen medicine long before either one started medical school.
Siegfried attended the University of Missouri-Kansas City’s combined six-year bachelor’s/medical degree program. She didn’t decide on ophthalmology until those six years were almost over.
“I enjoyed surgery, particularly microsurgery,” she says. “I had narrowed my choice to neonatology or ophthalmology when I fell in love with ophthalmology, and to this day, I can’t imagine a more rewarding career.”
As important as life itself
What continues to thrill Siegfried about her specialty is that, in some patients, she is able to restore sight. Many studies have shown that people consider eyesight the most important of their senses. For some, being able to see is nearly as important as life itself.
As a glaucoma specialist, she says the other extremely rewarding thing about her job is that she is able to develop close relationships with her patients over many years.
“I think the attraction is that sharing long-term relationships with patients is a special privilege,” she says. “In some surgical subspecialties, you do a procedure and then send the patient back to a different physician. But we glaucoma specialists help care for our patients forever.”
One of those patients is Michael Valente, Ph.D., professor of otolaryngology and of audiology and communication sciences.
“Dr. Morton Smith was my ophthalmologist when I came to the University in 1986,” Valente says. “When he later left to practice in Wisconsin, I asked him to recommend a new ophthalmologist, and, without hesitating, he named Dr. Siegfried. I was so impressed that she also became my wife’s ophthalmologist. In fact, in recent years, my wife and I have become close friends with Carla and her husband, Bruce.”
A native St. Louisan, Siegfried first came to Washington University as an internal medicine intern in 1989. Working at the then-Jewish Hospital of St. Louis was a kind of homecoming because that’s also the hospital in which she was born. But she did leave again, completing both her residency and a glaucoma fellowship in Chicago. But even during those years, she was connected to St. Louis.
Her residency director and several of the attending physicians she worked with had trained at WUSTL. Her fellowship also involved mentors with connections to the University.
“I worked with Ted Krupin (M.D., clinical professor of ophthalmology at Northwestern University Feinberg School of Medicine), who had worked here with Bernard Becker (M.D., professor emeritus of ophthal-mology and visual sciences) for many years and still had ties to St. Louis,” she says.
She had local ties, too. Her parents lived here, and Bruce Essman, her then-boyfriend, was here, so Siegfried decided she wanted to be here, too.
“I felt that if I could find a good opportunity in academic medicine that I should enthusiastically pursue it,” she says. “That was certainly my preference, but it was most important for me to get back to St. Louis.”
Luckily, she says, WUSTL had an opening for a young, eager glaucoma specialist.
Drawn to the bench
After joining the faculty in 1994, Siegfried spent her time treating patients and teaching young ophthalmologists as residency program director. In addition, she and her husband, Bruce, were starting a family. That didn’t leave time for much research. But not long ago, she experienced what she calls her mid-career transition.
“I said, ‘Why am I here at the University versus private practice? What more can I contribute to this University and our community?'” she says. “And at about that time, I met David Beebe.”
Beebe, Ph.D., the Janet and Bernard Becker Professor of Ophthalmology and Visual Sciences and professor of cell biology and physiology, is a basic scientist who doesn’t interact with patients. Siegfried, however, has much contact with patients. Together, they’re looking at how oxygen levels in the eye may contribute to glaucoma risk. Siegfried measures oxygen during glaucoma and cataract surgery, and she and Beebe correlate the measurements with several risk factors for glaucoma.
The collaboration also involves retinal specialist Nancy M. Holekamp, M.D., professor of clinical ophthalmology and visual sciences. Holekamp heard a lecture about how patients undergoing vitrectomy surgery (removal of the gel in the back of the eye) who already had cataract surgery had a higher risk of glaucoma than patients who still had a natural lens at the time of the second eye surgery.
“Dr. Holekamp and my laboratory had shown that cataract formation after vitrectomy was probably due to excess oxygen exposure in the lens,” Beebe says. “Now, we were also hearing that oxygen may contribute to post-vitrectomy glaucoma, so we joined forces with Dr. Siegfried.”
Siegfried was very excited by the “bench to bedside” concept of collaboration between basic scientists and clinicians that Beebe initiated. She says it has been very successful partly because Beebe’s “enthusiasm is truly contagious.”
The early fruit of those collaborations is evidence that oxygen may be related to a particular risk factor for glaucoma, central corneal thickness. Scientists previously have noted that thickness of the cornea is a risk factor for glaucoma, but no one has explained how it increases risk.
“We’re looking at many ideas about oxygen metabolism and metabolism in general in the eye that nobody’s ever looked at before,” she says. “It’s fun and exciting, and I believe that, in the future, this work will help patients at risk for glaucoma.”
Born: June 8, 1965, in St. Louis
Education: B.A., biology, with honors, M.D., 1989, University of Missouri-Kansas City, 1979
Training: Internship in internal medicine, 1989-90, Jewish Hospital of St. Louis; ophthalmology residency, 1990-93, University of Illinois Eye and Ear Infirmary, Chicago; fellowship in glaucoma, 1993-94, Northwestern Memorial Hospital
Family: Husband, Bruce Essman; son, Joshua Essman, 10; and daughter, Danielle Essman, 7
She’s also using and training other surgeons to use a new technique to treat select glaucoma patients. A device called a Trabectome allows Siegfried to surgically stabilize a patient’s eye pressure with a less-invasive technique, but she says the Trabectome is most useful for patients earlier in the disease process than the point at which they often are referred to her.
“Often I think that if I just could have seen a patient sooner, we would have had a much better chance to avoid the vision damage and alterations to a person’s life caused by vision loss,” she says. “We have many ways to treat glaucoma, but they’re all more effective if it is identified early.”
America’s best idea
When she’s not in the clinic, operating room or laboratory, Siegfried plans annual family trips. With Bruce and children Joshua, 10, and Danielle, 7, Siegfried likes to visit national parks in North America.
“If you saw the recent Ken Burns special on PBS, that’s us,” she says. “We visit at least one national park every year, and now it seems that we are returning to our favorites, like Yosemite this year.”
Not long ago, they were in Jasper National Park in the Canadian Rockies when they encountered another family … of grizzlies.
“Two cubs were romping near our trail, and if they’d somehow crossed it with ‘Mama’ still on the other side, we would’ve been in trouble,” she says.
“I was whispering to my husband that it was time to go, but he kept snapping pictures,” she says. “Finally, I said to my son, ‘Well, Joshua, say goodbye to your dad and your sister because we’re out of here!'”
Siegfried says her family loves to hike and canoe. Other “spare” time is devoted to the American Academy of Ophthalmology, for which she chairs two committees. Life is busy, she says, but very fulfilling.
“Not long ago in the office, a couple of patients hugged me,” she says. “They shared with me that they didn’t know if they would make it to their next appointment, and they just wanted to thank me for what I had done for them. That’s what it’s all about. I have the opportunity to touch people’s lives. That’s what we’re all here for.”