“In the ophthalmology world, neuro-ophthalmologists are often thought of as ‘the buck stops here’ doctors because they are frequently the end of the line for challenging cases. It makes for a very interesting practice in which I often work to piece together clinical mysteries.”
Aubrey Gilbert, Neuroscience PhD Program alum (entering class of 2002)
As part of her Neuroscience PhD research at UC Berkeley, Aubrey Gilbert worked with “split brain” patients who had the hemispheres of their brains surgically separated as a treatment for intractable epilepsy. This experience inspired Gilbert to pursue medicine after graduate school so that she could treat patients, not just study them.
Gilbert is now a neuro-ophthalmologist and adult strabismus surgeon at Kaiser Permanente in Vallejo, California. Neuro-ophthalmologists have unique training that allows them to treat patients with visual problems related to the nervous system, and Gilbert says she is one of only a small group of full-time neuro-ophthalmologists in the world. As the Northern California neuro-ophthalmology lead for Kaiser, she is sent some of the most difficult cases in the region. Gilbert draws on her deep understanding of neuroanatomy, her clinical training, and her love of puzzles to figure out the often elusive causes of her patients’ symptoms.
Gilbert’s interest in neuroscience began when she was doing a graduate degree in the history and philosophy of science, and became interested in questions around perception and consciousness. She then joined the Berkeley Neuroscience PhD Program, where she studied the influence of language on color perception in Richard Ivry’s lab. She also taught a neuroanatomy lab for most of her time at Berkeley, which she says was key to developing her extensive knowledge of neuroanatomy.
After earning her PhD, Gilbert attended medical school at UC San Francisco. After further training on the east coast, she returned to California to treat patients at Kaiser. Read our Q&A with Gilbert to learn more about her unique career path, life, and experiences in the early days of the Berkeley Neuroscience PhD Program. This interview was conducted in March 2023 and has been edited for length and clarity.
Q: How did you first become interested in neuroscience?
A: I think it probably came through questions about perception and how we interpret the world around us, what consciousness is — all these big, deep questions for which we don’t have great answers. Before I was at [the Helen Wills Neuroscience Institute at Berkeley], I did a degree at Cambridge in the history and philosophy of science, and just spent a lot of time thinking about things. That led to a desire to understand better how the brain works, which brought me to apply to [a] neuroscience research PhD.
Q: What was your undergrad degree in?
A: It was actually in Interdisciplinary Studies, and comprised of a weird mix of biology, anthropology, and poetry [laughs].
Q: What brought you to UC Berkeley to do your PhD in neuroscience?
A: I had never actually been to Berkeley, but I always thought of it as ‘Berserkeley’ — that was my impression of what the place was like — and I just thought it’d be a really interesting place to study some of these questions about consciousness. I was young at the time, in my 20s, and everything just seemed a little bit loose and easy, so I thought Berkeley would be a fun place to be. And the Neuroscience Institute was just starting up — I was in the very first class of graduates.
Q: Did you ever do any neuroscience research, or related research, before you came to the PhD program?
A: I had worked in an acetylcholinesterase lab in Paris before I did my year at Cambridge. And prior to that, I had done undergraduate research in Alzheimer’s and other areas in various labs as a college student.
Q: How was your experience in the Berkeley Neuroscience PhD Program?
A: To put it concisely, it was magical. Everything was fresh and new and everyone was very excited. The community was full of vibrant, interesting, brilliant people. It was really this special time and place to be. Part of it was probably being in my early 20s, where everything just seems kind of exciting, but it really did feel like a lot of interesting things [were] being developed, and people were thinking deeply and asking meaningful questions. And … there was a lot of partying. It was a wonderful community.
Q: Tell me a bit about your research in the Ivry lab.
A: My project was on the influence of language on perception, and how the linguistic categories that we assign to the world around us can actually shape our experience of it. Specifically, I was looking at color perception. A simplified summary of the hypothesis that was being evaluated is that we have a better ability to distinguish among stimuli that we can linguistically differentiate. It is fascinating to think about the variations in how external stimuli are split into various categories and thus possibly perceived differently by speakers of different languages.
Q: What made you want to go to medical school after doing your PhD?
A: During my time at Berkeley, part of my PhD was spent working with callosotomy, or ‘split-brain’ patients. These are fascinating patients who, because of intractable epilepsy thatcould not be managed any other way, underwent a radical brain surgery in which the corpus callosum — the largest white matter tract connecting the two halves of the brain — is cut to separate the hemispheres to prevent the spread of seizures from one side to the other. These patients are really special and have taught us a lot about how the brain works. Without the callosal connection, we can test and study each hemisphere individually. Beyond the fascinating research aspects of studying these patients, I found I just really enjoyed my time with them and thought I would love to understand the medical side of their story and everything that was going on from that perspective better.
Q: Did you go directly to medical school after your PhD?
A: I did. I had to do a bunch of extra prerequisite classes [laughs] because I hadn’t planned on doing medical school to start. So I was in the same freshman physics class at Berkeley as a lot of the pre-meds that I was teaching neuroanatomy to as a [graduate student instructor]. Which was funny because they were way better at it than me. But yes, I went right from Berkeley Neuroscience to UCSF med school.
Q: What made you want to specialize in ophthalmology?
A: Well, that’s interesting. I never would have thought that I would have ended up there when I started med school. I thought for sure I was headed for neurology, based on my neuroscience background and my strong, strong love of neuroanatomy — which really is one of the fundamental things that I took away from [the Helen Wills Neuroscience Institute] and my time there. I taught neuroanatomy so many semesters and just really made it part of myself, such that it has been an anchor that everything else I have done since then has been based on. It’s been very helpful that way.
But I thought I would do neurology, and when I got to medical school and started interacting with the neurology service, there were spectacular teachers and I loved the cognitive parts of the practice (who doesn’t love to play ‘localize the lesion’?), but I found the lack of effective treatments for many neurologic diseases quite depressing. And I thought, well, I wonder what other subspecialties are out there. Then as I went through my medical school rotations, I learned that I very much loved and was kind of good at surgical stuff. So I thought, okay, I’ll do neurosurgery, and I started to shadow that service. But I realized that neurosurgeons have like, a 110% divorce rate, which means it happens more than once [laughs]. So I thought that’s probably not the lifestyle choice for me.
I actually was kind of floundering towards the end of med school, not knowing what I was going to do. Then a med school lecturer from the ophthalmology department, Jonathan Horton, who is a famous neuro-ophthalmologist who works at UCSF and has done some really amazing research on visual neuroanatomy, came to lecture to us and my mind was totally blown away by his descriptions of the visual pathways; how our brains take in, process, and interpret visual information; [and] the dysfunctions that can result from pathology affecting that system. And I thought, wow, I would like to do what he does! So that set me on that pathway and led me to do ophthalmology residency and neuro-ophthalmology fellowship. The other nice thing is that you can actually be a surgeon as an ophthalmologist as well, which is something that I continue to do and enjoy.
Q: Tell me about your job — what are the types of things that you do?
A: The field I’m in, neuro-ophthalmology, is unique and small. In the 2020-2021 academic year, there were only 17 residents who entered formal neuro-ophthalmology fellowships in the U.S., and there is currently a campaign to try to raise awareness and interest in the field because many of our clinic waitlists are months long. We deal with this very specific subset of issues that patients have with vision that originate from neurologic problems, but we also have to think more broadly in terms of the health of the patients we see since a number of neuro-ophthalmologic issues relate to systemic processes that can be vision and/or life threatening. They range the gamut from vision loss to double vision and everything in between.
In the ophthalmology world, neuro-ophthalmologists are often thought of as ‘the buck stops here’ doctors because they are frequently the end of the line for challenging cases. It makes for a very interesting practice in which I often work to piece together clinical mysteries. It’s really fun because I get to play detective and try to sleuth out diagnoses based on the information that I can gather. A lot of times the answers aren’t immediately apparent and take some time to work through. So on a day-to-day basis, I spend the vast majority of my time thinking through cases, and I love it.
Q: What are some of your favorite things about your job?
A: That it’s very, very cognitive. A lot of the cases I actually figure out while I’m swimming laps, because there are things that take a while to work through and require clear thinking space. I’ll have all the information floating around in my head, and it won’t sort itself out right away. Then, all of a sudden, there will be this aha moment where I think — I bet this is what’s going on. Then I can go back and test my hypothesis with various clinical studies and examinations.
And I have great colleagues. I really enjoy the role I play in helping them to evaluate neuro-ophthalmic problems. It is actually similar to the time I spent teaching neuroanatomy at Berkeley because it keeps me constantly learning. Every time I get asked a question to which I do not know the answer (which is all of the time!), I set out on a mission to figure it out. I do a lot of deep dives into clinical literature.
The [strabismus] surgery that I do is very satisfying. There are a lot of things in neuro-ophthalmology that you cannot treat well, but the surgery I do has a good success rate in terms of realigning eyes for patients and helping them deal with double vision issues. Eye misalignment can be a big problem too in terms of making it awkward for people to interact socially, and so the surgery I do can have a lot of impact, which I feel really happy about.
Q: What are some of the causes of the unusual cases that you see?
A: It’s a mix of inflammatory, infectious, infiltrative, neoplastic, traumatic, degenerative, ischemic, and other processes that can wreak havoc on the optic nerves or other parts of the nervous system that contribute to visual function. Patients can come in with bizarre complaints like: my vision is shattered appearing; or everywhere I look I see TV static; or I see everything upside down; or I’m seeing double; or my vision is bouncing; or in bed at night my right eye goes dark; or my eyes hurt when I move them and I can’t see anything centrally; or I just lost vision in the bottom half of my left eye; or — the list goes on and on. We also see patients with non-organic vision loss, and that can be fun to try to tease out. There’s such a wide range of issues that things never get boring. Often the answer is actually in the history if you are listening carefully and know the correct questions to ask.
Q: Were there aspects of the Neuroscience PhD Program that have been helpful to you in your career now?
A: 100%. Like the neuroanatomy training that I was talking about — the fact that I was able to really dive into that subject. I taught the neuroanatomy lab that accompanied Marian Diamond’s neuroanatomy class for basically the entire time I was there. That was so much fun. I learned so much from doing that, because every time someone would ask a question that I didn’t know the answer to, I would go find out the answer.
Q: What do you do for fun?
A: I got really into gardening over the pandemic. I am growing so many different kinds of dahlias and zinnias, and when the weather gets better, I’ll do cucumbers and eggplants and beans and tomatoes too. My backyard is insane. I put plants in any container I can find and arches to trellis things in any open space, to the point that my husband tells me that he thinks I have a problem [laughs]. I tell him there are much worse addictions to have. Also, I live in Marin so the hiking here is amazing. I love doing that, and I swim a lot.
And I have two young children. I have a seven-year-old and a four-year-old, who I had during fellowship and early career. So that was interesting. In fact, I actually ended up taking my ophthalmology boards the day after I gave birth to my first daughter [laughs]. Which is not something that I would ever recommend to anyone, but I passed. Thank goodness.
Q: Do you have any advice for neuroscience PhD students who are considering a medical career?
A: I think that it’s a very challenging but rewarding path. I recommend having some kind of anchor. Find a focus subject in which you really are an expert and allow that to help anchor you as you move forward — in any career path. For me, it was neuroanatomy, but learning anything deeply will serve you well.
Q: Is there anything else you wanted to mention?
A: Just that the pathway through medicine is an ever-humbling one. You’re constantly learning new things every day. It’s part of what I love about it, and it’s really very fulfilling. I have such fond memories and am so grateful for my time at Helen Wills and the foundation that I got there.