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A Respectful Team-based Approach

Women In Optometry traditionally features articles by or about female ODs; this story takes a look at the relationship between a woman in ophthalmology and the importance of relationships between the two professions.

Sharmini Asha Balakrishnan, MD, has always had a deep appreciation for the value and power of vision. As a young child, she and her family traveled far and wide. On her one visit to Sri Lanka, where her family is from, she learned how scary blindness could be and how it could affect individual’s lives. “People who adapt to that blindness are exceptionally resilient and have a tremendous ability to adapt to their circumstances,” she says of those experiences, which were so impactful that they instilled within her a drive to want to help people see their families and the world around them.

Following her undergraduate studies at Harvard University, she attended Washington University of School of Medicine. Dr. Balakrishnan made sure that ophthalmology was a part of her rotation schedule. It’s often not a requirement, and she says that many don’t get the hands-time in this area unless they request it. “You have to have the interest and pursue it, or you could miss out on it,” she says. “I loved that ophthalmology combined my interest in eyes, helping people see, and working with my hands.”


She says that her leap of faith in ophthalmology landed her exactly into the right place as she completed her residency at the University of Michigan Kellogg Eye Center. Upon performing her first resident cataract surgery, she instantly discovered a passion for this procedure of precision and soon found herself wanting to expand beyond cataract into the anterior segment to pursue her interest in refractive surgery, as well. “I wanted to expand my surgical toolbox and become a better surgeon,” Dr. Balakrishnan says. She then completed a fellowship at Baylor College of Medicine in cornea and cataract, and then she worked for two years at University of Louisville as director of cornea and refractive surgery and associate professor. “I had a chance to indulge my academic side—I loved working with the residents and teaching surgeries—but I chose to make the switch to private practice for more of a patient focus.”

For the past year and a half, Dr. Balakrishnan has been a part of the team at Dougherty Laser Vision with its four offices in the valley of Los Angeles, California. She had been working at another LA-based practice when she heard that Paul Dougherty, MD, was looking for a second surgeon. “I wanted to be busier, and he has been a phenomenal mentor,” she says. “It’s been a pleasure.”

Getting started as a young refractive surgeon can be a challenge; many MDs don’t always get the chance to immediately focus on the cases they prefer. Dr. Balakrishnan, who goes by the nickname Dr. Bala to her patients, says that she’s grateful that she has had the rare opportunity to dive into these cases in this practice. She handles a mix of cataract, refractive and some cornea surgery procedures, depending on the need and demand; there are also sutured intraocular lenses, intraocular lens exchanges, iris repairs & reconstructions, and more. She’s in the surgery center a few times per week depending on the month and block schedule, but her schedule varies per week. On other days, she’s seeing patients for LASIK, PRK or implantable contact lens (ICL) surgery. She appreciates the colleagues on her team with whom she can discuss recommendations in challenging situations.


Dr. Balakrishnan co-manages frequently with the referral base and network of optometrists, and she enjoys communicating and maintaining a friendly relationship with these optometrists. These ODs often have long-time relationships with the patients who they are referring and, therefore, are able to provide important information that can be beneficial to learn before performing refractive surgery. She often asks a series of questions to find out of the patient has specific preferences:

  • Are there any sort of technologies that the patient does or does not like?
  • Does the patient like or dislike monovision? Has he or she tried it?
  • Are they a good multifocal candidate?

She encourages ODs to think about these areas when making referrals. “This communication enhances our success,” she says. “I’m always available to our referring ODs; one of the greatest things about co-management is the team effort.” She gives out her cell phone number to these doctors and encourages them to call or text her.

For optometrists looking to become more involved in refractive surgery co-management, she recommends looking for training hosted by local refractive surgeons, who provide these sessions specifically to educate optometrists and strengthen referral relationships. “Open up the dialogue to local practices that you would be comfortable working with,” and leave your worry at the door about losing patients to another provider. “There is no way we are taking patients away,” she says. “Co-managing allows me to focus on what I’m really trained in, and I want optometrists to do the same. It’s a respectful, team-based approach, and patients are much happier with two doctors taking care of them.”

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