Dr. Marsh-Tootle’s career has emphasized visual enhancement of children with vision impairments on a local, national, and international level. Dr. Marsh-Tootle served as the UAB Pediatric Optometry Service Director from 1994-2004. Under her leadership the pediatric patient population increased from an average of 4-6 patients per day to 25-30, culminating in a sustainable pediatric population that supports new clinical, research, and educational initiatives that continue today. The clinic was also among the first pediatric optometry groups to participate with the Pediatric Eye Disease Investigator Group (PEDIG).

 

In 2004, Dr. Marsh-Tootle was awarded an NIH R01 to teach pediatricians how to enhance knowledge and attitudes regarding preschool vision screenings and pediatric eye conditions. In partnership with a pediatrician from Children’s of Alabama, she created a web-based education program for pediatricians that is now accessible worldwide. She is the first OD at UAB to receive an R01 grant.

 

1. What year did you graduate from UABSO? I graduated from UAB in 1985 with OD and MS degrees and completed a residency at the Tuscaloosa VA the next year.

 

2. Describe your optometry career path and major accomplishments.  After residency, I started at UABSO working at the Sparks Center, a multidisciplinary service for children with neurodevelopmental conditions. Our students were able to hone their skills in this difficult population, and then discuss (with colleagues from neurology, nursing, physical therapy, nutrition, and psychology), how to fit eye and vision management into a comprehensive treatment plan for children with multiple handicaps. I developed an interest in pediatric vision screening around this time due to the availability of early photoscreeners, which were forerunners of handheld autorefractors.  

 

This interest led to establishing Preschool Peepers, which eventually succeeded in screening roughly 50,000 preschoolers in nearby child-care settings. At this time, I also had an NIH grant to develop automated acuity testing which I piloted at the Jewish Community Center.  Within days of learning that my R01 to continue this research was denied, I was asked to lead the Pediatric Optometry Clinic. Under my leadership, but by no means without the cooperation of students, colleagues and pediatric staff, we increased the pediatric patient population from a starting average of 4-6 (!) pediatric patients per day to 25 – 30, culminating in a sustainable pediatric population that supports new clinical, research and educational initiatives today.  

 

By the time my older sons were in elementary school and my youngest at daycare, NIH reached out to me, Drs. Tom Norton and Jane Gwizada to develop the COMET study which grew to include clinical centers led by Dr. Ruth Manny at the University of Houston and Dr. Mitch Scheiman at Pennsylvania College of Optometry. Together, we launched and sustained a highly successful clinical trial lasting 14 years, for which UAB recruited and retained the highest number of children. 

 

In 1999, we were asked to be among the first pediatric optometry groups to participate with the Pediatric Eye Disease Investigator Group (PEDIG), an NIH funded network of optometrists and ophthalmologists who primarily study amblyopia and strabismus, and who continue to provide sound evidence-based treatment protocols that benefit children across the nation. 

 

With COMET and PEDIG underway, I continued my interest in preschool vision screening, participating in the National Expert Panel to the National Center for Children’s Vision and Eye Health (which published national guidelines for screening and data management) and an Expert Panel for the Vision Chair for UNESCO (which investigated sustainable pediatric eye care in Nicaragua). With this background, an R01, and a colleague who is a Professor of Pediatrics at UAB, I wrote a web-based educational module to enhance preschool vision screening in office-based settings, recruited pediatricians in Alabama, South Carolina, and Illinois to participate, and then studied their pre- and post-participation vision screening rates in children with Medicaid. 

 

This last study was a whopper, and I needed everything I had learned from my research, patient care, and administrative duties to complete it! Last but not least, it has been my privilege to participate in optometric clinical and educational projects in India, Central, and South America, and to learn from colleagues across the world who do the most for their patients with whatever they have at hand. 

 

3. What about this profession piqued your interest? I was a psychology major at UW Madison with an Honors thesis from the Harlow Center for Biological Psychology, and after graduation faced a choice of entering graduate school and preparing for a career as a research psychologist, versus entering a medical profession. Ultimately, I was drawn to optometry because it offered me a perfect blend of clinical and research opportunities.  

4. Who/What influenced the direction of your career? Nothing stated in #2 could have happened without the help of many, many others. I started as a Masters's student with Dr. Tom Norton, who was already an internationally known and respected researcher when I was just starting.  My first “small grant” from NIH and the subsequent R01 application couldn’t have happened without the help of Dr. Michael Loop, who is a keen observer of children and cats.  

 

My interest in preschool vision screening would not have grown into a sustained research endeavor without the help of Dr. Dave Corliss, who introduced me to data analysis and database management.  Preschool peepers took many hands, starting with Ms. Trana Mars (still in pediatric clinic!), Michael Hill (now at the UAB IRB office), Bart Roegner (former COMET kid), Terra Brackett (who earned her BS and master’s degree while managing Preschool Peepers, and currently teaches in the Birmingham school system) and many work-study students who are now successful Optometrists, Drs. April King, Aimee Lam, Alexia Vaughn, Lakeshia Story, and Lateshia Walker. 

 

Building Pediatric Clinic was dependent upon the help and initiative from all the pedes docs, including Drs. Weise, Frazier, Hopkins, Lee, Rutstein, Lei Liu, all of our residents, and of course, all of our past students. The COMET study required the sustained effort of the lead personnel mentioned above, but equally of the pedes docs, all of whom participated in some role, and of the coordinators who really clinched the participation, especially Nicholas Molodiko, Dr. Cheryl Jackson, Cathy Baldwin, Michelle Bowman and Dr. Carey Dillard (who is now practicing Optometry in La). 

 

The R01 in 2004 would not have happened without the contemporaneous national and international panels, or without the cooperation of Dr. Terry Wall at the UAB Department of Pediatrics. Finally, nothing could have been published without the database management and statistical skills of Dr. John Tootle, without whom I could not have had a happy or successful life at home or on the job. I am glad to have the opportunity to thank everybody above but sad that I cannot mention many, many others who have enriched my life and made all the effort worthwhile.

 

5. Would you ever have thought your optometry career would take this direction? Why or why not? I did hope that my career would take the direction it did. Of course, being a doctor and a researcher takes a lot of preparation and drive. The specifics were and remain a bit of a mystery, but the general path is even better than I hoped it would be.

6. Do you have any advice for someone interested in this field? I always have lots of advice! First, don’t doubt that Optometry can be a very good profession for you. Start with a review of your undergraduate classes and make sure you get all the prerequisites for Optometry school.  

 

If your grades are sufficiently high, take the next step and shadow optometrists in community or academic practice to decide whether you would enjoy Optometric patient care or research. Neither I nor any of my colleagues, ever said “No” to a prospective student who asked to shadow us in clinic. Notice how each doctor emphasizes facets of optometry that interest them most, either by promoting a specialty such as contact lenses or pediatrics or vision therapy or by developing a certain type of patient population they find most rewarding. 

 

If you’re interested in research, find an opportunity to work with a researcher, possibly as a work-study, a technician, or with a patient-based study. Keep your eyes open to the realities of managing a lab or a clinical trial and decide if that is a good fit for you. If you’re very serious about research, try to author or co-author a short publication as early in your decision-making process as possible. Once you decide, do well on OAT and possibly GRE’s and take the leap!