Len Smith, NWT’s only ophthalmologist, retires after 40 years

Yellowknife’s Dr Leonard Smith has hung up his white coat after a 40-year career as the sole full-time ophthalmologist in the Northwest Territories.

His colleagues say he worked tirelessly to ensure residents of isolated northern communities received the same access to eye care as those in larger centres.

He did so in part by running the NWT’s Ophthalmic Medical Technologist Training Program, one of only a few such programs in the country, said Dr Maya Tong, ophthalmologist and assistant professor at Western University.

“Not only does he run one of the only programs in Canada, but his technicians are trained to an exceptionally high standard,” Tong said.

Smith described the ophthalmic technologists hired through the training program as an “army” of 10 clinicians who travel to 52 isolated communities in the NWT and Nunavut to provide screening services, acting as Smith’s “eyes and ears” on the ground.

They perform examinations, diagnose diseases in the eyes, and connect patients to care that would otherwise be difficult to access, Smith said.

“It’s a great practice,” Smith said. “I deal only with interesting problems. It’s amazing the amount of weird stuff you end up seeing.

“The techs, being extremely competent, pick these things up all the time. I don’t know how many brain tumours they have helped diagnose just by spotting a funny-looking optic disc.”

Dr Christine Scott, a locum family physician, said the North has been “spoiled” by the easy access to ophthalmologic services that Smith offered.

“The care that he’s provided through his own work and those of the eye techs, it’s meant that the North has had exceptional, exceptional care for decades,” said Scott.

Smith said he has been planning to retire for some time but felt pressure to delay it without someone to take over his practice.

Now Smith has left his practice, Tong said there could be a gap in service in the North.

“The technicians have always worked with Dr Smith, so they will be able to keep some of the eye care going. But there is absolutely no surgery, no injections of medication or anything without an ophthalmologist there,” said Tong.

A spokesperson for the NWT Health and Social Services Authority said it has recruited multiple ophthalmology locums who will provide these services while it seeks permanent, contracted ophthalmologists.

“There are currently no changes to how clients can access these services, and the public will be informed if there are any changes to service models,” the spokesperson said. 

Additionally, Smith will continue to act as the medical director to the technologist training program “so that the program can continue to train technicians at a very high level,” the spokesperson said.

Humanitarian award

This month, the Canadian Ophthalmological Society is recognizing Dr Smith’s four decades of work by awarding him its first ever Humanitarian Service Award at its annual meeting in Montreal.

Tong, describing Smith as humble, said he only agreed to be nominated for the award in the hope that the spotlight on his role might help attract a full-time ophthalmologist to take his place.

Tong, who worked with Smith as a resident in Yellowknife, said he’s deserving of this award in part because of his diagnostic and surgical skills.

“His ability to triage based on a description of something was really amazing,” said Tong.

“He could hear about the story on the phone or hear a tech talk about something, and he’d know exactly what was going on, and he’d know how to treat it.”

She said this would regularly save patients in smaller communities from having to travel to Yellowknife.

While he never published any research on the topic, Tong said that through his practice, Smith recognized that some Dene people have a genetic predisposition to a severe type of uveitis, a condition that causes inflammation and can lead to vision loss.

Tong said Smith found a tailored treatment that worked for these patients, which included adding an oral medication in addition to the eye drops that would traditionally be prescribed.

“He bothered to know the people. I think he was very ingrained in the community and the culture, very respectful of all those things, and in addition to that, just an excellent physician,” said Tong.

“He also bothered to stay up to date, he bothered to go to conferences, to read, to keep up with how medicine was changing and make sure that he was delivering the best healthcare possible for the patients.

“I’ve been to clinics in other parts of Canada that do not have as good technology as Dr Smith has gotten for the patients in the territories. He’s been a one-man show, just quietly, humbly doing his thing all these years. People don’t even know that he’s here doing it, or how good he is at what he does.”

She said people instead often assume there is no access to ophthalmology services in the North, and that people have to fly south for that care.

“People get free eye exams, they can have glasses made, and anyone who needs surgery, those few people are flown out to Yellowknife for surgery, but other than that, people get to stay in their communities,” said Tong.

‘No crowds, just the outdoors’

Smith is known as an outdoorsman as well as a committed practitioner, Scott said, and he uses his boat, plane and cabin on the Ingraham Trail to get outside.

“I grew up in a big city,” Smith said. “The longer I was up here, each time I’d go back to Edmonton, I’d think, well, that’s enough of that now [and come home to] no traffic, no crowds, just the outdoors.”

Tong said Smith would often take medical students visiting Yellowknife for their residencies out on the land.

Smith said this was in part to give people a taste of the North.

“A lot of people probably don’t know what they might like … I didn’t when I came up here. I never had any thought of catching a fish or flying a plane. Wasn’t in the mindset,” Smith said, laughing.

“These are examples of what is so accessible and easy here, things that just plop right into your lap.”