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 for first ten months
» Cataract surgery begins (extracaps available)
» Neuro-ophthalmology rotation with Dr. Jeff Odel (NY City)
» Oculoplastics and strabismus surgery

The four month block of the second year at the participating VAMC is managed by the Chief of Ophthalmology in that institution, Dr. John Riffle who has been honored as an outstanding educator by prior residents.  He and his team of ophthalmologists assembles a rotation that focuses on a broad general ophthalmology experience.  This rotation serves as the entry point for cataract surgery training. An uncommon feature of our program is ongoing exposure to extracapsular techniques.  Most ophthalmologists in training no longer receive this instruction although confidence with it is of tremendous value when complications arise or should the resident be interested in 3rd world eye care.  Phaco techniques remain key, however, and are rapidly introduced after the extracapsular approach is understood.  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.

Another of the four month blocks is devoted almost entirely to training in pediatric ophthalmology. This service is managed by our assistant program director, Dr. Stephanie Goei, who holds a joint appointment with the department of pediatrics. The clinical experience is divided between the main campus and a satellite offices on Washington Road (about 15 minutes from the main campus). The Children's Medical Center (CMC) is an adjoining hospital which is entirely devoted to primary and subspecialty pediatric care. It opened in 1998 (though its roots are in the late 1800's) and it's innovative approach has drawn the interest of many other metropolitan areas that have been considering opening such a facility in their community. All pediatric surgery is done in that hospital as are all inpatient consults on the wards and in the associated neonatal and pediatric ICU's. Given this connection and her dual appointments the training in pediatric ophthalmology is widely scoped from retinopathy of prematurity screening and management, to cranio-facial and genetic disorders, measurement of ocular deviation in strabismus, amblyopia, routine pediatric eye care, retinoscopy, and examination of children in general.  In the operating room the resident will be assisting on pediatric cataract surgeries and will be primary surgeon on cases such as strabismus, nasolacrimal duct obstructions, ptosis repair, examinations under anesthesia, etc.  As we have no fellows there is opportunity to perform re-operations and vertical muscles. There is an accompanying adult strabismus clinic with surgical involvement. While the graduating resident will not function at the level of a pediatric trained ophthalmologist they should feel very comfortable examining children and doing horizontal muscle surgery.

The final rotation of this year is dedicated to oculoplastics and neuro-ophthalmology. Dr. Dilip Thomas has been involved in resident training for nearly 10 years and he coordinates this 3 month experience (see below for 4th month of this block). During the 3 months you are with Dr. Thomas the time is chiefly at MCG though the VA and the Augusta State Medical Prison do provide significant additional pathology with accompanying surgical exposure. Most of the time with Dr. Thomas deals with functional oculoplastic issues, e.g. nasolacrimal duct obstruction, ptosis, facial and eyelid reconstruction, nerve palsies, enucleation and exenteration, blow out fracture repair and thyroid eye disease. While there is an emphasis on functional oculoplastics the cosmetic vantage point, e.g. Botox injection, is a growing venue.

Dr. Thomas is also a very competent neuro-ophthalmologist and manages this service for us. This service is an MCG, referral only, service and while provides suitable educational exposure is not a clinical emphasis in our department. Dr. Thomas briefly left MCG Eye Care several years ago and during his absence 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 and there is 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. Even since the return of Dr. Thomas' to our department our residents annually request that we continue to offer this experience. For the time being we are maintaining this connection.

During this year there is no call responsibility for the first 10 months.  Call starts in May when the senior residents drop off the call schedule for the final two 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.