Seeing is believing, they say. But for many people who walk into a retinal surgeon’s office, seeing is a difficult thing. Many are facing loss of sight–either permanently or temporarily during a long road to recovery. Retinal surgeons, like Margaret Greven, MD, are sometimes their last hope. They need support to believe that seeing is possible again.
That connection to patients is what drew Greven to ophthalmology and retina, in particular. But retinal surgery is a hard specialty to get into. Medical students don’t see much of it when they’re doing rotations. If you want to be in the field, you kind of have to go looking for it–and even then, the positions are hard to come by.
Greven was lucky. Today, she is passionate about instructing the next group of retinal surgeons that come through her clinic and operating room at Atrium Health Wake Forest Baptist. She wants to make them the best practitioners she can, because she knows that not everyone gets that chance. By helping residents and fellows become competent doctors, Greven is extending the reach of good retinal care, training and mentoring the future surgeons that patients desperately need.
Soon, Greven will have the chance to do this job even more effectively, when the Atrium Health Wake Forest Baptist Eye Institute opens its doors in the Innovation Quarter. This expansive, state-of-the-art facility will not only make it possible for doctors like Greven to see more patients, but will strengthen her ability to train the future generation of ophthalmologists.
Why retinal surgery (and what is it)?
Greven is a vitreous retinal surgeon and medical retina specialist based out of Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina and serving the surrounding areas. That’s a mouthful, but it’s not as bad as it sounds–it’s a subset of ophthalmology that’s focused on the back of the eye.
“On the inside, [the eyeball] is filled with the vitreous gel, and then the retina lines the inside of the eyeball,” Greven says. “It’s basically the film in the camera of the eye that sends the picture to the brain, so if you have any problems with your retina, that really can affect your eyesight and your ability to see.”
Turns out, many things can cause problems for the retina. Things like trauma or aging cause retinal detachments, foreign objects can get stuck in the eye, diseases like diabetes can cause damage, and infections can affect the eye.
The surgeries and procedures that treat this range of issues vary. Retinal surgeons like Greven use tools like laser, gas bubbles, injections, and many other approaches to address the range of issues that affect the back of the eye.
“Really the great thing about what I do is that every day in the operating room is completely different,” Greven says.
From day-to-day, you can find Greven at many different facilities, as well. Sometimes she’s in surgery, some days she’s in the clinic, and some days she’s teaching. Her work for the day can be anything from a routine injection to a complicated surgery.
She also gets to work with advancing technology, which makes her work particularly exciting. Greven participates in clinical trials with some of these advances, and she stays on top of the latest research being done.
“I’m attracted to how quickly technology advances with retinal surgeries,” Greven says. “Innovations and treatments are being developed every day.”
While the varied, challenging work is exciting to Greven, what really keeps her engaged with her work is the relational aspect, where she gets the chance to build longer term relationships with her patients.
“Most patients who come to a retina doctor either already have really significant visual impairment or they’re at risk for developing visual impairment,” Greven says. “For me, helping to take care of those patients who are really in a tough place is incredibly rewarding.”
In addition to high stakes with eye issues, the road to recovery for eye surgeries and procedures can be long and slow.
“Things like retinal detachments happen when you least expect it. Nobody plans to have a retinal detachment,” Greven says. “They can be really emotionally challenging.”
For Greven, these things are opportunities to come alongside patients in difficult circumstances and build a lasting bond.
“I really find it inspiring to figuratively hold a patient’s hand through that process and be their support system,” Greven says. “And then forevermore, when you see those patients, you remember going through that process with them. I can see them now five years later, and I remember the day when I met them and what that was like. And I’m really grateful to be able to help people in that way.”
How did Margaret Greven, MD, become a retinal surgeon?
Generally, doctors don’t just luck into becoming retinal surgeons. It’s a specialized field, and there’s not a lot of exposure to it for most medical students.
“When you’re in medical school, ophthalmology is a two hour-long lecture or something like that maybe during your second year,” Greven says. “And then it’s luck of the draw if you get an ophthalmology rotation.”
And if students do get exposure to retinal surgery and decide to pursue that specialty, the road to becoming a retinal surgeon is a long one. Medical students have to complete four years of residency: one year of internal medicine internship and three years of ophthalmology-specific residency.
“And then to do retina surgery, it’s two additional years after that,” Greven says.
Those residency positions can be very competitive, as well, so getting one of them can be tricky.
Greven was given exposure to retinal surgery at an early age. She comes from a family with many medical practitioners, including both her parents. Her father, Craig Greven, MD, is the current chair of the department of ophthalmology at Atrium Health Wake Forest Baptist, and his work opened her eyes to the possibilities of ophthalmology as a career.
“I remember coming to Take-Your-Daughter-to-Work Day when I was a kid, probably during grade school,” Greven says. “I just remember when I was in clinic with him, seeing the relationship that he had with his patients and how I thought, ‘Wow, I could see myself doing that.’”
For Greven, however, retinal surgery was far from a done-deal. The exposure interested her in ophthalmology, but as she prepared for medical school at Wake Forest University School of Medicine, Greven wasn’t sold on the specialty as her future.
“I went into medical school with an open mind. I thought maybe I would be drawn to something else,” Greven says. “I really liked general surgery–I really liked a lot of things–but I kept coming back to ophthalmology.”
Greven moved to Philadelphia for her residency at Willis Eye Hospital, and she kept being drawn to a retinal specialty.
“It’s just the patients,” Greven says. “It’s the last resort for a lot of patients. If other doctors can’t fix a problem or if there’s an infection or a trauma, you’re really the last chance for the patient. Something about that really appealed to me.”
After attending Stanford University School of Medicine for her vitreoretinal surgery fellowship, Greven returned to Winston-Salem, taking a position on the faculty of the department of ophthalmology at Atrium Health Wake Forest Baptist in 2017.
What does it look like for Margaret Greven to impact the future?
While Greven’s work load is split between treating patients and research, as part of an academic teaching hospital, she also gets to see the future of retinal surgeons on a daily basis.
“I always have a fellow with me in the operating room, and then sometimes in clinic,” Greven says. “And then I work with the residents when they’re on their retina rotation.”
For Greven, training the fellows and residents may be as important to her as caring for patients.
“I think aside from taking care of patients, being able to teach the next generation of retina surgeons and doctors, it’s such an incredible privilege,” Greven says. “It’s amazing to see the transformation that takes place.”
When fellows come to the department, their skill levels vary, depending upon their earlier residencies, and they haven’t had a lot of experience. Over their fellowships, they gain the skills and experience they need to treat patients.
“I just try to teach them everything I know and make them better than me,” Greven says. “We want the people who leave here to be the best that they possibly can be. And when they have all of the knowledge from all of the different faculty here, they have all the tools in their tool belt to be incredible doctors and surgeons in their own right.”
A testament to that transformation is that the latest class of retinal surgery fellows are being hired on as faculty into the expanding department of ophthalmology to treat patients alongside Greven and the others as colleagues, which in turn will give her more time to teach.
Why invest so much time in teaching and training?
Within her own family and throughout her education, Margaret Greven has had a lot of role models, and those examples have helped her succeed in her chosen path. Those examples gave her the exposure and also the strength she needed to be a woman in a STEM field.
“I think the medical field has come a long way,” Greven says. “My mom was a medical student in the 1980s, and she tells stories when she was on her surgery rotation. When they were doing rounds for surgery, they did them in the men’s locker room. She and the only other woman who was on rotation with her just had to sit on the floor outside the men’s locker room and not be part of rounds.”
That was not an experience that Greven had herself, though women were consistently in the minority as she got deeper into the ophthalmology specialty.
“In ophthalmology, there’s more men than women, but the numbers are equalizing,” Greven says. “It’s not rare to be a woman in ophthalmology, but retina is historically a very male-dominated field.”
While the numbers are slowly increasing, typically Greven was surrounded by men. In fact, during her residency, there was a large picture hanging outside the department of all the retina fellows they’d had in the program. They were all men, save one. And during her time there, all the retina faculty except one were men as well.
“When I was halfway through my residency, they hired their first woman,” Greven says. “And I thought, ‘Oh, wow, women can do this.’”
After she got further into her career and started attending conferences, she began to see more women speaking at the conferences who occupied leadership roles.
“That made me feel like I wasn’t the only one,” Greven says.
Despite being the only or one of only a few women in her field during her education, Greven doesn’t remember many negative interactions.
“I felt very welcomed by all of the people that I worked with,” she says. “I’m fortunate to have people who’ve gone ahead of me and have had a much harder time being able to do this, and I feel really lucky to be able to do what I do.”
Those experiences have contributed to Greven’s desire to mentor the students that come through Wake Forest.
“Mentoring is a really special part of being able to work at an academic medical center, not just with the residents and fellows, but also medical students that are interested in ophthalmology,” Greven says. “I have mentoring meetings with them, answer their questions, and let them come and see me in clinic.”
“What I got to do with my dad was see him in action, and that’s what made me feel like maybe this was something that would be a good career for me,” Greven continues. “So I encourage them to come to the [operating room] and see what we do, because how are you even going to know if you want to do retina if you haven’t seen it?”
What’s next for Margaret Greven and the ophthalmology department?
The faculty of the ophthalmology department is not the only thing expanding in Greven’s world. Atrium Health Wake Forest Baptist recently announced the development of a brand new Eye Institute, located in downtown Winston-Salem in the north district of the Innovation Quarter.
Located on Vine Street, this new facility expands the capabilities of the department in all its–and Greven’s–key areas: patient care, education, and research. The department of ophthalmology serves patients in the Piedmont Triad, western North Carolina and surrounding regions, and has facilities scattered across a couple of counties in order to meet patient needs. In addition, the current Eye Center located at the main facility in Winston-Salem supports double the patients it was designed to. With the opening of the Eye Institute, the department will consolidate the majority of its clinical operations into this new building and have the space to properly support its patients.
“I’m really excited about being in our new Eye Institute downtown in the Innovation Quarter,” Greven says. “I think being in the new facility is going to provide a lot of opportunities for us to be able to more efficiently take care of more patients.”
The new Eye Institute is under construction and aims to open in summer 2026. Greven herself had an opportunity to wield a sledgehammer and take down some walls as a part of the “breaking ground” ceremony of what was previously the Inmar Intelligence building. The facilities there will be purpose-built for ophthalmic use, so that patients have a better experience, appointments go quicker, and surgeries are shorter.
The Eye Institute will expand the kind of services patients can receive, with designated spaces for exam services for adults and children, diagnostics and testing suites, operating rooms, and an optical shop to go along with optometry exam areas. With these new resources, they can better address issues in eye care such as early detection of childhood ophthalmic diseases, a focus on eye care and aging, and diabetes and other eye-related conditions that have seen an uptick across the country in recent years.
“I think being able to improve efficiency, to be able to improve patient care is a benefit of this new facility,” Greven says.
Ophthalmologists like Greven will have other opportunities in the new space. In addition to operating rooms on the bottom floor and two floors of clinic space, the Eye Institute will also have room for education and research on the top floor. Designated teaching spaces and a surgical wet lab will expand learning opportunities for medical students, residents, and fellows.
These new educational spaces means a better learning environment for Wake Forest University’s four-year medical students to engage in eye-related specialities, but the department also plans to double their number of residencies, expand their fellowship program into four sub-specialities, and partner with the state community college system to offer advanced hands-on learning opportunities for ophthalmic technician students. For educators like Greven, this is a unique opportunity to influence future ophthalmology practitioners.
The combination of spaces makes the Eye Institute a perfect addition to the iQ, where research and education are large components of the innovation district’s mission. The Eye Institute also significantly expands patient care within the bounds of the iQ, bringing in new populations from Winston-Salem and the surrounding regions to participate in the thriving community here.
“Winston-Salem is a wonderful community, and I think it’s really amazing how much the revitalization of downtown has changed things,” Greven says. “I’m excited to be part of that with the new Eye Institute.”
