Department of Ophthalmology




The Second Year of Residency

Residents:
» Dr. Aldo Espinoza
» Dr. Jordan Patton
» Dr. Kathryn Shmunes
Highlights:
» Time for review course (partial funding)
» No night call July to May (10 months)
» Cataract surgery begins
» Neuro-ophthalmology rotation with Dr. Jeff Odel (NY City)
» Strong emphasis in oculoplastics and strabismus surgery
» Expanding surgical involvment in retina, cornea and glaucoma

With Academic Year 2018 (July 2017) we changed many things of how our rotations happen. It has been an exciting shift and one that seems to be going over well with the 3 residency classes. Four months of the second year are at the downtown division VAMC in 2 two month blocks. The other 8 months occur at the main campus or accessory venues. Included are rotations on pediatric ophthalmology, oculoplastics/neuro-ophthalmology, retina, and cornea. Involving second year residents on cornea and retina was new for this schedule. Each of these other blocks is arranged into 1 month periods. Cornea and retina previously were the domain of the senior year. Likewise no oculoplastics/neuro and pediatric ophthalmology were done in the senior year, however they are now.

While on the VAMC months our resident experience is focused broadly to further establish lessons and skill sets established in the first year of residency. As this is considered a participating institution there is a modicum of independence granted to the faculty in that venue. There is collegiality with the main campus such that they participate in grand rounds, journal clubs, our annual meeting and lectures. They do, however, set their own patterns and govern the educational package with oversight from the main campus. Most of these faculty are represented on this website as adjunct professors. The months during second year at the VAMC serve as the entry point for cataract surgery training. In addition to medical and surgical management of the anterior segment there is considerable involvement with the VA retina clinic, as well as consultation and some oculoplastics.

A word on extracapsular cataract extraction. Dr. John Riffle was chief at the VA from the 1990s through April of 2016. For many years he practiced general ophthalmology in addition to retina. He nearly always taught extracapsular cataract technique as a precursor to phaco based cataract surgery. Extracapsular approaches certainly have their place, but less and less so. The technique which was taught involved large incisions at the limbus with 5-7 sutures and an intensive post-op follow up for refraction and astigmatism management. To have exposure to that approach was a boon to those who desire to carry their skill sets to the 3rd world. I am putting this here because we had some reptutation of sorts as providing that skill set. By the mid-2010's, however, this has dwindled to the point where few "extracaps" are being done. Truly the need for traditional "extracap" has diminished as it has been taken over by phaco techniques for most situations. While this may seem a let-down if you were hunting extracapsular techniques current third world cataract surgery trends have really moved on to small incision extracapsular appraoches which were not being taught. A modern first world training program should really be focused on phaco platforms (and the residents really did not want extracaps!).

In the mid-2000s Dr. Dilip left the university and spent a couple of years in private practice. That significantly limited our resident's experience in neuro-ophthalmology and at that time a clinical rotation in neuro-ophthalmology with Dr. Jeffrey Odel was initiated. Dr. Odel is on the faculty of the Edward S. Harkness Eye Institute of Columbia University which is part of the New York-Presbyterian Hospital system. The training that Dr. Odel has provided is superb with a great depth of education provided in the 4 weeks on his service. Dr. Odel also involves the residents with other New York City ophthalmology educational events. When Dr. Thomas rejoined our department in 2008 the NYC rotation seemed to be less needful to our residents, but as the experience with Dr. Odel has been so positive we have continued to offer this experience. It is not required, nor necessary to meet ACGME needs, so if you prefer to remain in Augusta that is fine as well. For the time being we are maintaining this connection though it may shift at some point in the future.

Another wonderful caveat is the call responsibility for the second years. During this year there is no after hours call responsibility from July to May. "Senior" call starts in May to get the second years back into that groove before they must closely supervise incoming first years in July of their senior year. This also allows the seniors to drop back out of the call schedule for the last couple of months of their residency. During this year our residents are given a week of off-campus leave to participate in a review course which is partially sponsored by the alumni association.

* A little disclaimer...this structure and these parameters are only summaries. We reserve the right to alter them according to the needs of our training program.