When ophthalmologist Almira Manzano, MD, left her home in the Philippines to embark on a three-month international observership at the Sue Anschutz-Rodgers Eye Center, located on the University of Colorado Anschutz Medical Campus, she felt a bit hesitant. It was her first time visiting Colorado, where she knew no one — but her nerves did not hold her back from pursuing a greater mission: to further develop her skills as a pediatric retina specialist so she can further advance eye health care for her local community.
Manzano grew up in Dagupan City, a coastal city in the Province of Pangasinan in the Philippines. It’s the same area where she currently works as a retina specialist — a type of ophthalmologist who provides care to patients experiencing issues with their retina, which is a layer inside the eye that detects light and transmits key visual information to the brain. As one of only a few retina specialists in the community, many patients — including children — are referred to Manzano, whose previous training primarily focused on treating adults.
"Treating pediatric retina cases is not straightforward and is very challenging. It requires prompt diagnosis and treatment because it will greatly affect the child's future," Manzano says. “Physicians like me have a responsibility to continue to learn and improve ourselves for our patients.”
Driven to expand her expertise, Manzano applied for a program through the International Ophthalmological Fellowship Foundation to spend the summer at an internationally recognized ophthalmologic center. When she saw that the Sue Anschutz-Rodgers Eye Center offered the opportunity to learn from renowned experts on treating pediatric cases, she knew it was the place she wanted to go. Over the past three months, Manzano shadowed pediatric ophthalmologists and pediatric retina specialists in the CU Department of Ophthalmology as they treated complex cases in the eye center and at Children’s Hospital Colorado.
One of the reasons Manzano pursued becoming a retina doctor was because there are a variety of retina diseases in her community, and services were not readily available then because of a lack of specialists.
Retina specialists like Manzano can treat people with eye conditions like age-related macular degeneration (a leading cause of vision loss among older adults), diabetic retinopathy (vision impairment from diabetes), retinal detachment or tears, and other retina-related issues.
“It’s a challenging and humbling specialty, but you can help a lot of patients,” she says. “In the Philippines, we see a variety of retina diseases associated with systemic diseases, especially diabetic retinopathy.”
Manzano has spent much of her career working to make eye health care more accessible to people in her hometown, because patients have historically had to travel about four hours to the capital city of Manila to get specialized eye care, and not all patients are able to do so.
After completing her retina fellowship in Manila in 2017, Manzano decided to return to where she grew up in Dagupan City because there were only two retina specialists in the community. She was primarily working as an adult retina specialist, but after some time, she began receiving more referrals to treat pediatric patients with retinopathy of prematurity (ROP), an eye disease that can lead to vision loss and affects infants born prematurely or who weigh less than 3.3 pounds.
She began going to different neonatal intensive care units (NICU) in the area and treating pediatric patients. However, given her limited exposure to pediatric retina cases during her medical training, she felt a need to expand her skillset so she could feel more confident in treating these patients moving forward.
"I began attending conferences and courses internationally to learn more about treating pediatric patients and learn from the experiences of other specialists, because it can be really challenging. I felt that I needed to be updated and learn more, especially in treating ROP, because the bulk of my pediatric practice is ROP screening," she says. "When I found out I would be able to come to CU and rotate at Children’s Hospital Colorado, I was excited."
One of Manzano’s favorite aspects of learning at the Sue Anschutz-Rodgers Eye Center was shadowing leading pediatric retina specialists like Scott Oliver, MD, Marc Mathias, MD, and Emily Cole, MD, as they consulted and treated cases at Children’s Hospital Colorado — which is ranked among the top 10 best children’s hospitals in the nation, according to U.S. News & World Report.
“I was able to attend Dr. Cole’s retina clinic at Children’s Hospital and go on NICU rounds every week. I also attended Dr. Mathias’ genetics clinic, and I got to see a lot of retinoblastoma cases at Dr. Oliver’s clinic. I usually shadowed them in the procedure center and operation room,” she says, adding that she also met a team of clinicians, including doctors and nurses, who manage ROP cases — the same type of team she hopes to duplicate at her practice in the Philippines.
“Being exposed to a variety of pediatric cases and seeing how they manage them has helped me gain knowledge and a new perspective that I can apply in my practice back home,” she says. “I may not have all the diagnostic and imaging machines that doctors have here at CU and Children’s Hospital, but I've learned how to hone my clinical eye for pediatric retina cases during my stay here. I am hopeful that, one day, we can have this technology at our hospital back home, too.”
Looking ahead, Manzano is excited to apply the lessons she’s learned at CU into her own teachings and clinical practice to benefit future generations.
"Learning is a continuous journey. Even though I've already been practicing as an ophthalmologist for a while, I always believe that there are still a lot of things to learn. We need to update ourselves, and we do that to provide better service for our patients," she says. "I'm grateful to have had this opportunity at CU. It has inspired me to do more and be more confident in handling pediatric retina cases."