You've trained and worked across very different systems: Mexico, the US, Manitoba, and now Quebec. What experiences most shaped the ophthalmologist, educator, and leader you wanted to become?
I sometimes call myself the "North American Free Trade ophthalmologist" because I've been a little bit everywhere. One thing I've learned is that while we all set structured goals (get into med school, match into a specialty, land a fellowship), it’s important to stay adaptable. You need a vision of where you want to go in principle, but if you're too rigid, you'll miss opportunities.
When I started medical school, I was certain I'd always practice in Mexico City. I'd even picked the hospital. But then I met a mentor who had trained with Professor Barraquer in Colombia, the father of refractive surgery, a true innovator who developed a precursor for lamellar corneal surgery that eventually gave us LASIK. His ability to perform any surgery with elegance and precision shaped me deeply. I never planned on that encounter; it came from simply being open and present, but it fundamentally changed my trajectory.
That opened my mind. At a basic science course, I met Canadian trainees from McGill who introduced me to the department chair at the time, and doors started opening. After training in Montreal, I did a fellowship in Florida, went back to Mexico, and eventually, through another set of coincidences, ended up in Brandon, Manitoba. I thought I'd be there six months. I stayed twenty-five years.
I think of life like a tennis match: you never know where the ball is coming back, but you stay ready, you swing, and you keep going.
What are the biggest differences you've noticed between ophthalmology in Mexico, Manitoba, and Quebec?
The core difference between Canada and Mexico comes down to access. In Mexico, the public system covers many people through government institutions, social security, and welfare-based eye institutes, some of which do incredible work and research. But the best equipment and resources tend to be concentratedin the private system, and not everyone can afford it.
In Canada, the public system may not be perfect, but it covers the entire population. Having experienced disparities in access elsewhere, I am a strong advocate for the Canada Health Act. I don't believe that access to healthcare should depend on how much money someone has. That said, Canada faces its own challenges: an aging population, growing demand, and the need to keep pace with advancing technology within a publicly funded model.
Comparing Manitoba and Quebec specifically, Manitoba offered stability. I served as the only ophthalmologist covering a population of 200,000 residents, and that stability allowed me to tailor my practice, secure the best phacoemulsification equipment, and bring a femtosecond laser for cataract and corneal surgery to Brandon (making it the first hospital in Canada to have one)! Quebec has a larger scale and more complexity, but also more political challenges affecting how physicians practice.
One concept I'd love to see Canada adopt more broadly is digital triage. My daughter, when she lived in Switzerland, could log into an app when her baby was sick, speak with a clinician by video, and receive a specific time to come to the emergency department without hours-long wait in a crowded room. We're actively working on similar quality improvement and digital health initiatives at McGill right now.
You've built a simulation-based education centre at McGill that's becomea hub for training and research. How did that come about?
It goes back to my final year of medical school in Mexico. I was introduced to a mentor who ran an experimental surgical research lab, and I trained in microvascular surgery on rats. That's how I fell in love with microsurgery and gravitated toward ophthalmology. He also ran a structured surgical skills course for general surgery residents, and that idea of hands-on, curriculum-driven training stayed with me.
Years later in Brandon, I partnered with industry to create the Brandon Ophthalmic Surgical Course, which consisted of a weekend boot camp for residents covering ergonomics, suturing, phacoemulsification, and IOL techniques. It grew until we were bringing thirteen to fifteen residents to theprairies multiple times a year, and eventually staff wanted to attend too. That concept became a precursor for the skills transfer courses now offered at COS, and of course, our McGill simulation curriculum.
When I interviewed at McGill, I discovered a deep culture of simulation already in place - the Steinberg Centre, the MUHC simulation facilities - and I knew this was where the concept could truly thrive. Six months before even moving to Montreal, we started planning. We found funding through generous donors and strategic partnerships, secured space, and built something I believe is unique worldwide.
The centre combines diagnostic simulation (slit lamp simulators, direct and indirect ophthalmoscopy) with five dry-lab work stations equipped with microscopes, virtual reality modules, and haptic-feedback surgical simulators. Residents can train on phacoemulsification machines from the three major companies. But we didn't want a show piece that collects dust. We built a graded curriculum, tracking systems for accountability, and a research arm overseen by a biomedical engineer managing over twenty projects in AI, robotics, materials design, and surgical education.
The official centre opened in February 2025, and it's already expanding beyond McGill. Our staff and residents have partnered with Orbis for international teaching missions. We're developing a long-distance curriculum with Eyes on Ukraine for trauma cases and corneal suturing. And we're in early talks with another international organization to train physicians in the techniques most needed in underserved regions.
Do you think simulation can make ophthalmology training more equitable?
Depends on how it’s utilised! If someone donates a simulator and leaves it in a room with no supervisor, no supplies, and no curriculum, it just gathers dust. Simulation only works with sustainable commitment: access for learners, structured feedback, mentorship, and accountability.
That said, the potential is real. There are simulators designed specifically for underserved populations, with modules for manual small-incision cataract surgery and virtual physician trainers available around the clock. The challenge is getting the machines where they're needed and building the ecosystem around them.
At McGill, we try to extend access wherever we can. Elective students visiting from other countries get dedicated time on our simulators. Right now, I have a student from Mexico spending mornings on slit lamp diagnosis modules, which represents training she wouldn't have access to at home.
And equity goes beyond geography. We're building sustainability funds so fellowship positions aren't limited to those who can pay or find sponsorship. Great talent exists everywhere, and training shouldn't be gated by financial circumstance.
What about the non-technical side of surgical training? Do you feel that simulation learning can help learners with confidence, judgment and areas that may vary due to heterogenous patient exposure?
This is something we've been intentional about from the start. You can have all the knowledge and technical skill in the world, but without the right mindset - meaning confidence, stress management, communication - you won't be as successful.
Our soft launch included sessions on surgical mindset alongside technical training. We've hosted speakers from the Canadian Medical Protective Association, because interestingly, most surgical lawsuits relate not to negligence or technical errors, but to non-technical skills. Patients who experience complications but feel supported often end up being the most grateful, because they know they can count on you. We've also established an annual visiting professorship in ocular simulation, bringing international leaders who teach not just technique, but curiosity, innovation, and the human side of surgery.
