In this episode, Logan and Lexie explore vision, eye health, and public health with guest Dr. Christine Sindt, Clinical Professor of Ophthalmology and Visual Sciences at the University of Iowa. Dr. Sindt serves patients on the frontline and is also an innovator/inventor/business owner.

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Logan Schmidt:

Hello, everyone. Welcome back to From the Front Row brought to you by the University of Iowa College of Public Health. My name is Logan Schmidt, and I am joined today by Lexie Fahrion. And if this is your first time with us, welcome. We’re a student-run podcast that talks about major issues in public health and how they’re relevant to anyone, both in and out of the field of public health.

Logan Schmidt:

Today, we’ll be chatting with Dr. Christine Sindt, director of the contact lens service and clinical professor for the University of Iowa Department of Ophthalmology and Visual Sciences. Dr. Sindt holds seven US patents and has over 150 publications. She also serves as a consultant optometrist for the Iowa City Department of Veterans Affairs Medical Center.

Logan Schmidt:

Welcome to the podcast, Dr. Sindt, and did I leave out anything?

Christine Sindt:

Well, I’ve been here for 28 years almost, 27, 28 years. So there’s a lot to cram into those few sentences, so yeah.

Lexie Fahrion:

Well, to kind of go off that, thanks again for being here with us. Could you just talk a little bit about your career path throughout these 28, 30 years and what led you to picking optometry as kind of your specialty and area of interest?

Christine Sindt:

Yeah. I like to say it found me and most of my career path has been being aware that there’s opportunities and exciting things that are around me all the time. And then finding what aligns with who I feel that I am. And really being curious and exploring things that are out there. I like to say that, every six months I don’t want to be doing the same thing that I was doing six months ago, that doesn’t mean that I’m not tackling the same problems. I just want to constantly be looking at them in different ways and being creative and inventive and coming up with new things to help patients to help me in my practice, so it’s been a lot of fun. It’s been a lot of fun. Yeah.

Christine Sindt:

I came out of my residency right here to Iowa and so I really started my career. I was on a professional and scientific track and then became assistant professor and associate professor and full professor. And there’s a lot of things that you have to do to work your way up at a university. They look for people who have name recognition for the university, people that are known internationally, people that lecture, people that serve on their national boards. People that are really changing their profession and are integrated into making it better. And that’s how you work your way up through, through a university system.

Logan Schmidt:

Well it seems like you’re in a field that you’re able to explore these ideas and have ever-changing duties upon advancing medicine. So can you speak more upon the burden of ocular diseases on public health and how that has evolved throughout your career?

Christine Sindt:

Right. So vision is so integral to how people react or relate into the world. And vision issues can be on many levels. It can be, we think is it just somebody can see or they can’t see? But it’s also do they hurt? Do they not hurt? What do they have to do or accomplish in their life to be a productive member of society?

Christine Sindt:

Are there diseases that are generational? Do we have genetic things that we need to think about? Are there diseases that people acquire from the community? There’s many things out there, viral infections, epidemic keratoconjunctivitis, COVID, all these things can affect people’s vision. And so it’s on so many levels. We think of the vision affecting public health, or coming from measures within the community. And you can’t just think of them about like eyeballs sitting in the chair. It has to be the person wrapped around the eyeball and the life wrapped around the person and the community wrapped around the life and the world wrapped around that community.

Christine Sindt:

So it’s really any that you jump in on it. It’s a very interesting thing. I have friends that do public health, optometry and public health, and ophthalmology and public health worldwide on a national level. And they look at very specific populations of people, how do vision issues affect minorities? How do vision issues affect people who are under the poverty level? How do they affect women? It’s very interesting when we really sit back and we look at each individual case.

Christine Sindt:

People who can’t get to eyecare. Are there other ways, do we need to get eyecare to them, access to medicine? It’s all incredibly integral. It’s not just about an eye exam, like you may have had an experience with an eye exam.

Lexie Fahrion:

Absolutely. I love that visual that you gave of, it’s not just the eyeballs in the chair, it’s all these layers surrounding it. And one of those levels that we talk a lot about in public health is the policy level. And you were recently featured on the Alliance of Vision and Vision Research’s World. I’m going to mispronounce this word, my apologies, Keratoconus? Day congressional briefing.

Christine Sindt:

Karatoconus.

Lexie Fahrion:

Karatoconus.

Christine Sindt:

Keratoconus, yes.

Lexie Fahrion:

Keratoconus. Okay. Awesome. Well, thank you. Learning something new already. Could you talk a little bit about what that was, and what the end goal of it was?

Christine Sindt:

Yeah. So keratoconus is a condition where somebody’s cornea starts to get thinner and when it gets thinner, it develops a bump on the surface of the eye. And that bump is like looking through a bumpy window glass, right? So if you ever looked through a window that has an optical wave or a bump in it, and everything looks distorted through the window, when somebody has keratoconus, that is what their vision is like.

Christine Sindt:

We used to think that keratoconus was a disease of about one in 2,000 people. And now we know that it’s a disease of about one in 200 people. Which really means everywhere you go every day, you are running into people that have keratoconus. And these people see suboptimally and that is going to affect their career choices. This is a disease that comes up early in people’s lives, typically as teenagers or young adults.

Christine Sindt:

So it’s going to affect their career choice. It’s going to affect the decisions that they make in the world for themselves, for their family, for future generations. And so it it’s a very serious condition. The other thing is it’s an entirely, well, not entirely, but it’s fairly preventable. If we diagnose early, there are treatments for it. If we diagnose early, we can correct the vision. It doesn’t have to get to be as bad as, it doesn’t have to be blinding. People can avoid corneal transplants if we diagnose it early. So it is something that we really need recognition for. We need dollars to do more research on it.

Christine Sindt:

One of the main ways that people get keratoconus is through rubbing or through eye rubbing their eyes. And so we need some public awareness of, don’t rub your eyes, don’t get in there and itch your eyes.

Christine Sindt:

But that also means that we need to be thinking about things like, why are people rubbing their eyes more now? Is it screen time? Younger children are spending more time on screens. When you’re on screens, you’re not blinking as much as you normally do. And so your eyes dry out, when your eyes dry out, they hurt the itch, they burn, people rub.

Christine Sindt:

Allergies, do we have more pollutants in the air? Are there more allergens in the air? Are people more allergic? Is there something that we need to be thinking about that is causing more of these atopic symptoms that we see, these allergic symptoms causing people to rub their eyes more. So it’s very multilevel and multifactorial. It’s not just a disease that people get. It’s something that is affecting, something that is happening to them, something that they are doing, and then causing this downstream effect. So there needs to be more awareness of research on what is causing it. Why is it causing it? How do we prevent it? How do we treat it? Because it is quite common.

Logan Schmidt:

On the topic of this, and limiting the progression of disease. I did a quick search of your company and I’m pretty sure it has something to do with keratoconus. So can you speak upon, EyePrint Prosthetics and its contribution to improving the vision of those with ocular conditions?

Christine Sindt:

Yes. Thank you. So 15 years ago or so, I was very frustrated with what I had available to help people see, what my options were. And I really felt like I needed to have more control. I had a lot up in my head and I really felt like if I had a platform, a playground, if you will, where I could try different things and to help my patients, to help these people that have become so dear to me, in my patient population. And so I started thinking about what’s the best way to get information. And so I developed a process by which we can take an impression of somebody’s eye and then scan that into 3D space. And then I basically have their virtual eyeball, which is kind of funny because my initial statement was, it’s not just eyeballs sitting in the chair, and I kind of created a way to have just the eyeball sitting in my chair. And then when I have all that information about the shape, I can create these lenses that are the exact shape of somebody’s eye.

Christine Sindt:

So we always think of contact lenses as being perfectly round. Well, it turns out nobody’s round. Everybody has their own unique shape, and I’m understanding that more and more now that I have thousands of impressions that I can look at and compare eye shapes from right eye to left eye, to different populations of people, male, female, different ethnicities. And really see if there’s common trends. But having these impressions of the eye allows me to create a contact lens that’s exactly the shape of somebody’s eye.

Christine Sindt:

Think like an orthotic shoe, where you step into the foam, and then you create a shoe around your foot. Contact lenses, historically, if you think of you have a bunion on somebody’s foot, that you keep trying on shoes until you find one that doesn’t hurt the bunion, versus creating a shoe to go around the bunion.

Christine Sindt:

And that’s really what I’ve done with these custom contact lenses. And then that allows me to put advanced optics on the lenses, from that has sprung this smart contact lens technology, where I’m working with a company who has these microscopic cameras that we then embed, because these lenses are perfectly stable. They don’t rotate move or do weird things. So then I can put these little cameras in it and they can project images onto the retina, sort of like a heads up display. We can use one of the projects I’m working on right now with a group at another university is taking my platform and then culturing cells and 3D printing corneal cells. It’s just a research project we’re working on, but basically 3D printing cornea cells for transplantation into humans.

Christine Sindt:

So the information that we have from really understanding the 3D aspect of somebody’s eye has so many different directions that we can go into. Not just contact lenses, but, medical health devices.

Christine Sindt:

That’s what I do is my second job. My primary job is just seeing patients here at the hospital.

Lexie Fahrion:

So that’s in all your free time?

Christine Sindt:

That’s my free time. I also have four kids.

Lexie Fahrion:

Well, that sounds, that’s incredible. And I’m absolutely fascinated by the way that you took your ideas and essentially your frustration at the current system and said, “I’m going to create something that does this better.”

Lexie Fahrion:

Can you talk a little bit more about any, maybe challenges you face in going that direction, or just stuff that you learned in taking your ideas and essentially starting a business to help other people?

Christine Sindt:

The biggest thing I’ve learned is that, I can’t do it alone. That, really opportunity is around us constantly. It is literally around us all the time.

Christine Sindt:

It’s what builds people forward, brings people to where they need to be, is connection with other people, talking to other people, putting yourself out there. It’s not about being afraid to fail. It’s about recognizing resources, right? And I think that when people have a feeling like, “Well, what if I fail?” Well, what if I fail? What if it doesn’t work? I do something else. I got plenty of other ideas, right? I mean, it’s okay not to have something be successful the first time. And it doesn’t happen overnight. It’s not like, I had an idea and I do it, and then it’s done. It’s not like a paper that you turn in, right?

Christine Sindt:

These things go on for years sometimes, before they actually come to fruition. Sometimes it’s just about meeting the right people.

Christine Sindt:

So for this 3D project, it was about reaching out to other people at the university and figuring out this polymer that I needed. And then from there I needed somebody who could write my software, because I don’t know how to do that. So then it was a matter of all of a sudden I’m realizing that I’m in a conversation, with a person who’s the person to write my software. And once I have trust, I pitch that idea to that person. It’s about this constant connection.

Christine Sindt:

Recently, one of the projects I’m working on, I need this certain biomolecule. And I’ve been trying to reach out to the company. This is a great story. I’ve been trying to reach out to the company and really haven’t been able to connect with them. They’re not really that interested in talking to me.

Christine Sindt:

And I was recently in Boston a couple of weeks ago at my academy meeting. And the academy meeting was over and I get into the Uber to go back to the airport, and I get into the Uber and it should be like a five-minute ride and we’re driving, and we’re driving. It turns out the Uber driver totally made the wrong turn, right? So now it’s like a half hour later, I’m still in this Uber. And so, what do you do? You talk, you talked, right? You chitchatting with this guy, right? And so I’m chatting with this guy and he’s like, what do you do? And I gave him my elevator pitch about what it is. And all of a sudden he turns to me and he says, oh my gosh, he’s the representative for the company that I needed to talk to.

Christine Sindt:

So I totally had this opportunity to give my elevator pitch to the exact person I needed to talk to in order to be able to make the connections, to get everything set up so I could get to the people to hear me on what it is I was trying to work through. And he heard how genuine and how real this is, this project that I’m working on.

Christine Sindt:

And so you just never know who you’re going to run into. You never know if your Uber driver is going to be the person that you need to know on some level. And so that’s kind of my mantra in life is just connect with other people. If you want to do anything, just find people that have resources or are better than you, or don’t waste your time on people who don’t, or won’t bring value to, or don’t treat you well, they’re not worth it.

Logan Schmidt:

Yeah. That’s a perfect story too, and it example for finding opportunities when you least expect them. And the stars aligning to find the perfect match to help you establish a project and go forth with it.

Logan Schmidt:

Can you speak upon the collaborative portion of your work and how UIHC and ophthalmology is the rapport of the institution and this department is such highly ranked. What about collaboration? And what about UIHC creates an environment for such prestige?

Christine Sindt:

Yeah, there’s things that go both ways, right? Is when you become faculty here in the department, you become family. And so, I genuinely enjoy and care and just really love actually, my fellow faculty members that work in the department. I regard them so highly. I think that they’re very smart people and they are just so passionate and caring and they just want to be better. They want to be better for the patients. They want to be better for themselves. They kind of want to make sure that their carbon footprint meant something on the earth. And I think that when you work with a group of people like that, it would be nearly impossible not to want to be better yourself. I think that for me, there was always this constant feeling of, I need to, I want to belong. I want to be valued by these people. I want to be someone that brings that kind of value back to these people. And I think that kind of collaboration, it makes the department better, but it really makes us better. And I think that is good for patient care.

Christine Sindt:

And beyond, the reputation of the department is great, but more so than that, we’re here for the patients that come to see us. And we want to make them better. Like we genuinely want to make them better. And just by carry on that level, I think brings us to the next level. We are all so focused on that person, not on our ourselves, and publishing, and being super awesome ourselves, but sort of on that, why am I doing this, focus. And I think that that just makes us better. We publish, we share, we talk, we go to meetings, we serve on national boards, all of us, all of us. The whole department.

Lexie Fahrion:

That’s amazing. It’s definitely a great example of how that collaboration over competition mindset can really just benefit everybody.

Lexie Fahrion:

I kind of want to jump a little bit into what you call your first job treating patients. Because we’ve focused a lot on your second job so far. But I want to acknowledge that lots of folks don’t have the opportunity to go and see an eye doctor or a specialist. So if you could just broadcast kind of a message to those people. What’s one thing that you would like them to know about their eye health or preserving their eye health throughout their lifetime?

Christine Sindt:

It’s hard, not everybody gets an opportunity, or makes the opportunity to see an eye doctor.

Christine Sindt:

I think that there are a lot of ways to accomplish that. That we really need to think about, put more information or more energy towards… An example would be here at the University of Iowa, 20 years ago, I would say, they started a program called Kids Site. And they partnered with the Lions EyeBank, and using photo screening, they’re able to go out into the community and they screen, here in the state of Iowa, every child five and under gets photo screened for vision issues. Because we know that if we catch vision issues early on, many people don’t have to have vision issues the rest of their life. So really focusing on our little, our most vulnerable people. People that do not have the ability to advocate for themselves, I think is a place where there is a lot of resources needed to have.

Christine Sindt:

And I really commend the University of Iowa and the state of Iowa and the Lions EyeBank for bringing that Kids Site program forward. And 20 years on now, we have amazing data to show how well this works. It’s economical, it’s inexpensive, it harnesses these amazing volunteers across the state. But the American optometric association also has a program called InfantSEE, where doctors can sign up to become on this registry of doctors who will give free eye exams to little people, to infants and young children. And people have the ability to go to the InfantSEE website and find a doctor that’s close to them. I think that we are developing a new age. We have one of our physicians here at the University of Iowa, Dr. Abramson, is working on a telehealth telescreening, so that it doesn’t replace a full eye exam.

Christine Sindt:

But again, when resources are limited and not everybody has full access to healthcare, to be able to do some telehealth screenings, can really, really help maybe sort out the people that are in greatest need and use resources. If you have one reader that can read 50 or 60 eye exams in a day is different than being only being able to do say 20 full exams in a day. And then sort out the people who need the most help and target them. So there’s lots of ways that we, here at the University of Iowa, are trying to sort of look into that public health aspect of getting access to vision care.

Christine Sindt:

I do know that pretty much every optometrist I’ve ever met, I always say that if I was abandoned at the airport and stuck in a city, I could probably call an optometrist and they would come and take me in, in case of crisis. They’re an amazing group of people. And I would say that if people really feel like they’re having a problem and they are genuine about it, ask, and find out what the resources are. There’s many resources out there that people are not aware of.

Logan Schmidt:

It seems like the Department of Ophthalmology at UIHC is making the most out of their resources and looking at adversity as an opportunity to be innovative to ultimately enhance population health.

Logan Schmidt:

The one last question I have for you is, looking back at your career and how you got started and where you were at now, what is one thing that you thought you knew, that you are later wrong about?

Christine Sindt:

I would have to say almost everything I’ve known has at one point been deconstructed and reconstructed in my brain. I think that there’s a natural learning curve to everything that we know. And I joke and say, you know it, then you don’t know it. And then you truly live it and believe it and know it again.

Christine Sindt:

You go through and you learn these things from books, right? And you learn things from other people, but until you experience it’s hard. It’s hard to like, feel it, there’s this thing about knowing something intellectually, and then there’s breathing it. Where you just know it to your core to be true, or to be a certain way. And I think that being open to really making mistakes, I’ll tell you what I’ve made mistakes. I have not always done things appropriately. I’ve made mistakes where things haven’t gone as where I felt that they should. And it’s made me a better person. It’s made me a better doctor. It’s made me more genuine and more authentic, when I can recommend things to people.

Christine Sindt:

And so I wouldn’t say there’s one thing, almost probably would be hard to sort that through.

Lexie Fahrion:

No, I think that that is a fantastic kind of just quote to end on from someone who’s obviously done some amazing things over her career. And is continuing to do amazing things, to just tell everyone else to be open to failing, be open to learning from your mistakes. And to really just keep learning throughout your entire life.

Lexie Fahrion:

So I would just love to end on you saying that and thank you again for being with us today. This has been a great episode. I feel like we could keep talking for hours, but want to be respectful of everyone’s time.

Lexie Fahrion:

So thank you again, Dr. Sindt.

Christine Sindt:

All right. Thanks and good luck.

Alexis Clark:

That’s it for our episode this week. Big thanks to Dr. Sindt for coming on with us today.

Alexis Clark:

This episode was hosted and written by Logan Schmidt and Lexie Fahrion. This episode was edited and produced by Alexis Clark.

Alexis Clark:

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