Medicine and mountaineering have more in common than most people think: both demand focus, endurance, humility, and split-second decision making. This page is a space for stories, insights, and lessons I’ve gathered on glaciers, in the OR, and during moments of quiet reflection.

I hope these notes offer clarity, inspiration, or simply a moment of curiosity.

1. Between Sutures and Summits
The mental focus required at 29,000 feet mirrors the calm I need during a complex graft. In both worlds, hesitation can cost you — but presence can save everything.

There’s a strange familiarity between the summit ridge of a Himalayan giant and the quiet tension of an eye under a surgical microscope.

At 29,000 feet, your world narrows: one crampon step, one breath, one clipped anchor. In the OR, it’s one suture pass, one graft interface, one millimeter of corneal clarity. Both require full presence — no room for ego, no tolerance for distraction.

I’ve learned that mastery isn’t loud. It’s measured. It’s quiet. It’s in the moment you don’t panic when things go sideways — whether a storm rolls in or a graft folds mid-insertion.

Sutures and summits have taught me the same thing:
Precision saves. Presence heals.
 

2. What Mountaineering Taught Me About Patient Trust
Climbers rope up because we trust each other. In surgery, that rope is invisible but just as real — woven from precision, transparency, and human connection.

When climbers rope up, it's not just for safety — it's an act of trust. You're tied to someone else's decisions, pace, and presence. You don't summit together unless you move as one.

In the OR, I feel the same responsibility. A patient is trusting me — with their vision, their fears, and their future. There's no rope between us, but there’s something even more invisible and sacred: belief. They believe I’ll be prepared. That I’ll guide them through what they can't see.

Mountains taught me that leadership isn't about being the fastest — it's about being reliable. On summit day and surgery day, my first job is to make others feel secure.

Because trust isn’t just earned at the top — it’s built every step of the way.

3. Your Cataract Surgery Is Not "Just Routine"
A short reflection on why every case, even the simplest, is personal.
There’s no such thing as just routine when it’s your eye, your vision, your future.

Cataract surgery is one of the most refined procedures in medicine — and yet, every eye is different. Every cornea, every lens, every patient’s expectations are their own summit. It’s not about removing a cloudy lens. It’s about restoring clarity, depth, independence, and confidence.

For me, each case is a fresh climb: a precise path with no room for shortcuts. I prepare like I would for any technical route — with intention, care, and complete focus.

Because when you're trusting me with your sight, there’s no such thing as routine.

There’s only personalized precision.

4. Precision in Imperfect Conditions

Not every surgical day unfolds smoothly. Some days are marked by unexpected changes, logistical challenges, or team dynamics that feel misaligned. These moments don’t always show up in the operative report, but they shape the experience just as much.

When the OR is under pressure, it becomes even more important to stay grounded. For me, that means holding on to the values that guide every case: focus, respect, presence, and precision.

There are times when communication feels off, or when the energy in the room isn’t quite in sync. That’s when I lean into patience — not because it’s easy, but because it matters. Because every patient on the table deserves our full attention, regardless of what’s happening outside the surgical field.

Even on difficult days, I believe in showing up with clarity, consistency, and care.

5. Is Ametropia a Disease—or Just an Optical Variation?

When we think of medical conditions, the word "disease" often implies damage, progression, or risk to our health. So, where does ametropia—commonly known as refractive error—fit in?

Ametropia refers to vision conditions like myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. These occur when the shape of your eye causes light to focus incorrectly on the retina, leading to blurry vision.

But is it a disease?

Not exactly. Ametropia is considered a functional optical variation, not a disease. It doesn’t damage the eye or cause inflammation. In fact, it’s one of the most common visual conditions worldwide and can usually be corrected with glasses, contact lenses, or refractive surgery.

However, in very high levels, myopia or hyperopia may be linked to increased risks—like retinal detachment, glaucoma, or other complications. In such cases, ametropia becomes more than just an optical issue—it becomes a risk factor for disease, but still not a disease itself.

So why consider treatment at all?
Because clear vision is vital for everyday life. For certain lifestyles—like mountain climbing, aviation, or high-performance sports—freedom from glasses or contacts can be more than convenient. It can be essential.

🧠 Bottom line:
Ametropia isn’t a disease. But it’s a common and correctable optical condition that, when treated properly, can significantly improve your quality of life.

📍If you’re experiencing blurry vision, start with a comprehensive eye exam. We’ll help you understand what’s going on—and what options are right for you.

Stay tuned for more Field Notes
Surgical pearls, Climbing lessons, Mental performance, Patients' stories.

Want me to write about something specific?
Reach out via Contact Page or send me a DM on Instagram @everestvisionmd.

Genetics — what’s solid vs. still evolving

• TCF4 CTG18.1 repeat expansion is the dominant genetic driver in European-ancestry FECD (≈70–80% of cases in many cohorts); recent work highlights tissue-specific instability of the repeat and mechanistic links to aberrant RNA/splicing programs (e.g., MBNL1 sequestration). PMC+2The Lancet+2

• COL8A2 (early-onset) and SLC4A11 variants are established contributors; a 2023 systematic review reaffirmed SLC4A11 causality while casting doubt on ZEB1/LOXHD1/AGBL1 as primary FECD genes. PMC+1

• Population work continues to refine prevalence by ancestry and analytic methods (e.g., long-range PCR/Nanopore) for CTG18.1 sizing. ScienceDirect+1
  
  

Mechanistic notes. TCF4-repeat pathology is associated with toxic CUG RNA, altered alternative splicing, ECM dysregulation, and stress/apoptosis phenotypes in corneal endothelium. Oxford Academic+1

Hormonal biology — estrogen signals are nuanced

• Epidemiology: In a large cohort of postmenopausal women, current menopausal hormone therapy (MHT) showed a protective association with incident FECD, while estrogen exposure duration or serum estradiol were not clearly linked. PubMed+1

• Experimental data: Lab studies report selective, context-dependent effects—some models show estrogen metabolite genotoxicity and corneal endothelial cell loss (exacerbated without NQO1), whereas others show potential protective signaling. Bottom line: cell-type, dose, and redox state matter; clinical implications remain unsettled. PMC+1

Pathways driving disease and repair — TGF-β and ROCK signaling

• TGF-β: Elevated TGF-β1/β2 promotes cEndMT/EndoMT, cytoskeletal remodeling, ECM overproduction (guttae), and faster but dysregulated migration in FECD cells; recent data implicate m6A (METTL3)–TGF-β crosstalk in sustaining EndoMT. PMC+2PubMed+2

• ROCK signaling: ROCK inhibition (ripasudil/netarsudil/Y-27632) enhances endothelial migration/adhesion, counters fibrosis programs, and may shift signaling away from profibrotic TGF-β toward repair phenotypes—forming the biologic rationale for DSO+ROCKi strategies and for supporting cell injection therapies. Liebert Publications+2PMC+2

Emerging/novel therapeutics

1) Descemet Stripping Only (DSO/DWEK)

• Concept: remove central guttae/Descemet while preserving peripheral endothelium, allowing centripetal repopulation (often augmented with topical ROCK inhibitors).

• Outcomes: Multiple series show ~90% corneal clearance in carefully selected eyes (central disease, healthy periphery), with BCVA improvements and durability to 5–7+ years; time-to-clearance typically ~6–9 weeks (range wider without ROCKi). ResearchGate+2Review of Optometry+2

• Comparative context: DSO can restore clarity but tends to have thicker corneas and different posterior geometry than DMEK at 6–12 months, underscoring case selection and patient counseling. MDPI

• Evidence base remains primarily cohort/case series; selection (confluent central guttae, minimal edema, adequate peripheral ECD) is critical. Cureus
  
  

2) Cultured endothelial cell injection therapy

• Approach: anterior-chamber injection of lab-expanded allogeneic CECs with adjuvant ROCK inhibitor; supine positioning facilitates monolayer formation.

• Long-term signal: First-in-human 5-year follow-up (Kinoshita group) showed sustained corneal function and ECD in most eyes after a single injection. ScienceDirect

• Guttae regression: A 2024 JAMA Ophthalmology study reported decreased guttae after cultured CEC therapy for FECD—supporting not only edema resolution but morphologic improvement of the posterior surface. JAMA Network

• Clinical development: U.S. phase 1/2 dose-ranging trials (Aurion Biotech; neltependocel + Y-27632) have completed initial enrollment; broader datasets are pending. EyeWorld+1
  
  

3) Mitochondrial augmentation (early-stage/experimental)

• Rationale: FECD endothelium exhibits mitochondrial dysfunction and oxidative stress susceptibility.

• Preclinical/early translational: Mitochondria infusion into compromised corneal endothelial cells improved survival and molecular phenotypes in ex vivo/early studies; clinical feasibility for early FECD is being explored but no pivotal trials yet. PMC+2AAO+2

4) Pharmacologic modulation (adjuncts/bridges)

• Topical ROCK inhibitors can accelerate stromal deturgescence post-DSO and enhance migration/adhesion in ex vivo DSO models; prospective controlled data are limited but growing. ResearchGate+1

• Targeting TGF-β (and upstream epigenetic nodes like METTL3-m6A) is an active preclinical avenue to limit EndoMT/ECM deposition while preserving regenerative migration. Nature+1

📄 Download the full 1-page Scientific Summary (PDF) below

As both a refractive surgeon and a mountaineer, I’m often asked whether rock climbing could negatively impact the delicate fine motor control required in eye surgery. Recently, a colleague asked me if climbing “ruins the small-motor skills of the hands” — a concern that floats around among surgeons.

Let’s look at the evidence.

The Myth

Rock climbing is thought to make the hands too strong, stiff, or clumsy — impairing the precision surgeons rely on for microsurgery.

The Evidence

1. Grip Strength and Endurance

• Studies consistently show that climbers develop greater grip strength and finger endurance than non-climbers.

• This added strength doesn’t harm dexterity; it provides reserve capacity. For surgeons, that means less fatigue during long surgical days.

2. Dexterity and Fine Motor Skills

• Research on dexterity finds neutral to positive effects in climbers. Some studies even show small improvements in agility and coordination.

• Importantly, controlled trials demonstrate that even after extreme fatigue (e.g., 24 hours of continuous climbing), fine motor tasks like knot tying were not significantly impaired.

3. The Real Risks: Fatigue and Overuse Injuries

• The main risk to precision is short-term fatigue after hard sessions or overuse injuries such as pulley tendon strains (“climber’s finger”).

• Chronic stiffness or injury could affect delicate control — but these are preventable with smart training and recovery.
  
  

Practical Takeaways for Surgeon-Climbers

• Timing matters: Avoid maximal climbing sessions right before surgery days.

• Listen to your body: Address finger or tendon pain early; rest is better than risking long-term injury.

• Balance training: Include antagonist muscle exercises and mobility work to keep the hands supple.

• Recovery is key: Well-trained, rested hands = precision and endurance in surgery.
  
  

Conclusion

The belief that climbing makes surgeons “clumsy” is a myth. On the contrary, climbing builds strength, resilience, and body awareness — all of which can support surgical performance. With smart load management and recovery, climbing and surgery can coexist seamlessly.

As someone who thrives in both the operating room and on high granite walls, I can assure you: strong, trained hands + recovery = precision + endurance in surgery.

The Global Myopia Epidemic

The prevalence of myopia has reached epidemic proportions. Holden et al. projected that by 2050, nearly 5 billion people (≈ 50% of the global population) will be myopic and 1 billion highly myopic, with profound public health implications (Ophthalmology, 2016).

High myopia (≤ −6.00 D) significantly increases the lifetime risk of retinal detachment (5–10×), myopic maculopathy (20–40×), and open-angle glaucoma (2–3×). These trends are driving increased contact lens use and early surgical intervention interest.

Contemporary Management Strategies for Myopia

Myopia management now spans optical, pharmacologic, behavioral, and surgical approaches, with strategies selected based on patient age, myopia progression rate, and ocular anatomy.

1. Spectacles

• Standard correction for most low-to-moderate myopes.

• Peripheral defocus-modifying designs show promise for axial length control (Cheng et al., Br J Ophthalmol, 2020).

• Protective coatings (UV, blue light) add comfort and long-term retinal protection.

2. Contact Lenses

• Soft, RGP, and scleral lenses remain first-line for optical correction.

• Multifocal or dual-focus lenses (e.g., MiSight) have demonstrated 30–50% slowing in myopia progression (Chamberlain et al., Ophthalmology, 2019).

• Orthokeratology (Ortho-K) temporarily reshapes the cornea overnight, flattening the central curvature; meta-analyses show ~40–50% reduction in axial elongation when properly fitted and maintained.

3. Pharmacologic Control

• Low-dose atropine (0.01–0.05%) remains the most evidence-based pharmacologic intervention, reducing myopia progression by 30–60% with minimal side effects (Yam et al., Ophthalmology, 2019).

• Commonly used in combination with optical or behavioral therapies.

4. Behavioral Modification

• Outdoor light exposure (≥2 hours/day) and frequent breaks from near work are protective against axial elongation.

• Pediatric counseling and parental education form the foundation of early intervention.

5. Surgical Correction

• Once axial growth stabilizes (typically ≥21 years), procedures such as LASIK, PRK, SMILE, or phakic intraocular lenses (EVO ICL) offer long-term correction.

• The EVO ICL (Implantable Collamer Lens) is particularly beneficial for moderate-to-high myopia (-3.00 D to -20.00 D) or patients with thin corneas unsuitable for laser surgery.

• ICLs preserve corneal tissue and provide reversible correction, with excellent optical quality and minimal dry-eye induction.

• Refractive lens exchange (RLE) may be appropriate for older patients with early presbyopia or lens opacity.

Clinical takeaway: Early management of myopia progression in youth is prevention-focused, while refractive surgery—including EVO ICL—in adults provides definitive optical independence and eliminates cumulative risks from chronic contact lens wear.

Contact Lens Materials and Oxygen Dynamics

Hydrogel vs. Silicone Hydrogel

Traditional hydrogel lenses rely on water content for oxygen permeability (Dk ≈ 20–40), whereas silicone hydrogel (SiHy) lenses achieve 5–7× higher Dk values (up to 175) through silicone’s intrinsic permeability. SiHy lenses thus reduce hypoxia-related sequelae such as limbal redness and microcysts but do not mitigate infection risk.

Despite superior Dk/t, overnight wear with SiHy lenses increases microbial keratitis (MK) risk 6–10× compared to daily wear (Stapleton F., Ophthalmology, 2008).

Contact Lens–Related Microbial Keratitis (MK)

Epidemiology

• Daily soft lenses: 3–4 per 10,000 users annually

• Extended/overnight wear: 15–25 per 10,000 users

• RGP lenses: ~1 per 10,000 users
  (Stapleton F., Eye, 2012)

Top risk factors:

• Overnight wear

• Water exposure

• Poor case hygiene

• Smoking and poor compliance

Pathogens

• Bacterial: Pseudomonas aeruginosa (most common), Serratia, Staphylococcus spp.

• Fungal: Fusarium, Aspergillus

• Protozoal: Acanthamoeba—rare but sight-threatening; 70–80% linked to water exposure (Carnt N. et al., Ophthalmology, 2023).

Prevention and Hygiene Pearls

• Replace cases every 1–3 months; disinfect with multipurpose or peroxide-based systems (not tap water).

• Avoid “topping off” the solution.

• Hydrogen peroxide systems provide superior disinfection (Rosenthal R., Eye Contact Lens, 2021).

• Daily disposables consistently show the lowest MK risk.

CDC Data (2020): Over 80% of U.S. contact lens users report at least one high-risk behavior (overnight wear, water exposure, or poor replacement schedule).

Visual and Quality-of-Life Outcomes

• FDA PROWL studies: >95% of LASIK patients achieve 20/25 UCVA or better; >90% report improved QoL (JAMA Ophthalmol., 2017).

• SMILE: Comparable outcomes with reduced postoperative dry-eye risk.

• EVO ICL: Provides high-definition visual quality with minimal induction of higher-order aberrations and excellent patient satisfaction, particularly for high myopia.

• PRK: Ideal for thin corneas with normal topography or ocular surface irregularity like EBMD patients.

• 
  

Cost-Effectiveness

Over a 10-year period, the cumulative cost of contact lens wear exceeds LASIK or ICL, accounting for solution and replacement costs (Rein DB., Arch Ophthalmol., 2006). Breakeven point: 6–8 years post-surgery.

Key Takeaways

• Contact lenses remain safe when compliance is excellent—but cumulative infection risk is substantial.

• The lifetime infection risk of refractive surgery (including EVO ICL) is lower than the annual risk from extended contact lens wear.

• Refractive surgery offers stable, long-term correction and freedom from daily maintenance, making it highly suitable for active, visually demanding lifestyles.
  
  

References

1. Holden BA et al., Ophthalmology 2016

2. Stapleton F et al., Eye 2012

3. Carnt N et al., Ophthalmology 2023

4. Shahgoli SS et al., Clin Ophthalmol. 2023

5. FDA PROWL, JAMA Ophthalmol. 2017

6. Solomon KD et al., JCRS 2003

7. Rein DB et al., Arch Ophthalmol. 2006

8. Rosenthal R et al., Eye Contact Lens 2021

9. Packer M., Clin Ophthalmol. 2018