Hampton Roads Eye Associates, a division of Riverside Health System
Even before she went to college, Denise Chamblee was fascinated by eyes – although it didn’t occur to her to devote her career to caring for them until much later. She didn’t even decide to go to medical school until her second year at the University of Texas at Austin.
She earned her Bachelor’s in Liberal Arts, but liked science as well, excelling in those classes. Her “aha!” moment came when she realized she wanted a profession that would allow her to work with people, doing something to help them. She moved to San Antonio to study medicine at the University of Texas Health Science, and kept an open mind about specialties, knowing only that she wanted to do some surgery, but not exclusively.
A chance pairing with an advisor led her to pursue her interest in eyes. “The school tried to assign advisors we’d have something in common with,” Dr. Chamblee says. “Jean Holt, like me, was from Missouri. She was also an ophthalmologist. She was a great influence, introducing me to aspects of ophthalmology that cemented my fascination. She showed me I could have a more normal life in ophthalmology than in some other specialties.”
Dr. Chamblee completed her internship and residency in ophthalmology at the University of Oklahoma, followed by a fellowship in pediatric ophthalmology at Children’s National Medical Center in Washington, DC. The appeal of working with children was irresistible: “There’s something innately beautiful about days filled with children. Their laughter, their hugs, and their innocence keep me smiling, refreshed and focused on what’s really important.”
When they’re seated in front of her, the most important thing is being able to communicate with these young children. “It’s definitely a skill to communicate effectively with kids who can’t describe what they’re seeing,” Dr. Chamblee explains. “That’s one of the challenges of pediatric ophthalmology that I still love: getting good eye exams, even on patients as young as two, who tend to squirm around.” The only pediatric ophthalmologist in her practice, Dr. Chamblee has filled her office with toys and games that keep her patients engaged, and also allow her to determine how they’re seeing.
While the field of pediatric ophthalmology is still relatively young, technology has provided her additional tools. “With my technicians (who she proudly notes have been with her for twenty-plus years), I can essentially measure the power of their glasses without them telling us a thing,” she notes, explaining: “A retinoscope projects a beam of light into the eye. When the light is moved vertically and horizontally across the eye, we observe the movement of the reflected light from the back of the eye. We then introduce lenses in front of the eye and as the power of the lenses changes, there’s a corresponding change in the direction and pattern of the reflection. We change the lenses until reaching a power that indicates the patient’s refractive error.”
Because early diagnosis and intervention are so critical to preventing blindness, Dr. Chamblee is excited about a recent innovation that is bringing younger patients to her much sooner. “Photoscreening is being done by school nurses, pediatricians and vision-focused groups,” she says. “It uses a special-purpose camera to determine whether a child has risk factors and should be referred to a specialist. By detecting special light reflexes from each eye, images are produced that can help identify refractive errors and ocular misalignments, which place children at risk for amblyopia. We can then dilate their eyes and assess the need for corrective lenses or surgery. It’s particularly useful with pre- or nonverbal children.”
And because there’s a critical period in visual development after which it may be too late to intervene, photoscreening is – or should be – a routine part of every well-child visit. “It’s really making a difference,” Dr. Chamblee says, “particularly for kids whose eyes aren’t misaligned and don’t signal parents that something’s awry. I’m seeing kids at an earlier age and identifying problems I’d never see at that age just five years ago.”
Another promising development is in retinopathy of prematurity, a disease that causes babies born before term to lose their sight. “We’ve always done a laser procedure if they get to that point where blindness is likely,” she says, “but there’s a treatment being used now in certain cases – injection of a vascular endothelial growth factor inhibitor. The research is concentrating on dosage, timing, and effect on other organs.”
The most common cancer affecting children’s eyes is retinoblastoma, and while Dr. Chamblee sees it only once or twice a year, there’s good news on that front as well: “These patients used to lose an eye, but today, if we can diagnose and begin to treat it early, even if there are tumors in both eyes, we can usually save both.”
Like many of her colleagues, Dr. Chamblee worries about the increasing amount of time physicians are required to spend on administrative tasks that have no relation to hands-on patient care. “Especially dealing with infants and children, and with their anxious parents, I want to focus all my attention on each little child in front of me,” she says.
When she’s not caring for their eyes, Dr. Chamblee advocates for children. She devotes her few discretionary hours to service on the Board of Achievable Dream School and to mentoring through the New Horizons Governor’s School for Science and Technology – no doubt hoping to inspire students as Dr. Holt once inspired her.
