Ocular Immunology and Uveitis Fellowship

The academic goal of the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary, simply stated, is to train superb ocular immunologists.  During the fellowship, fellows will care for a wide variety of patients with complex disorders which will enable them to develop advanced diagnostic, therapeutic, and surgical skills for the entire spectrum of ocular inflammatory disease diagnosis and management. Fellows participate in all aspects of patient care including uveitis clinic, retina clinic, cornea clinic, rheumatology clinic, and surgery.

Overview of the Fellowship
The Ocular Immunology and Uveitis Fellowship is an intensive one-year program, during which approximately 80% of the time is spent doing clinical care; the remaining time is available for research. Fellows can spend this time performing clinically-oriented research including writing reviews, case series, and book chapters. 

The fellow’s responsibilities (broadly defined) include examining patients in the various assigned clinics, taking call, providing consults to Massachusetts General Hospital inpatients, responding to patient requests for information or assistance with medical needs, being available for emergency visits, assisting in surgery, and other tasks as required to provide comprehensive patient care.  The fellows are also required to attend lectures and deliver case presentations in Grand Rounds as needed.

Clinical Facilities and Organization 
Facilities: The Ocular Immunology and Uveitis Service encompasses multiple clinics located in the Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital. The facilities at the Massachusetts Eye and Ear Infirmary are fully equipped with examination lanes and state of the art diagnostic technologies. 

Personnel: One of the major strengths of our fellowship is the diversity of our faculty. The following faculty participate in the fellowship training:

• Reza Dana, M.D., M.P.H., M.Sc.
• George N. Papaliodis, M.D. (co-director of the fellowship)
• Lucia Sobrin, M.D., M.P.H. (co-director of the fellowship)
• John H. Stone, M.D., M.P.H.
• Lucy H. Young, M.D., Ph. D. 

Reza Dana, M.D., M.P.H., M.Sc. holds the Claes Dohlman Chair in Ophthalmology and is Professor of Ophthalmology at Harvard Medical School, Vice Chairman of the Harvard Department of Ophthalmology (Academic Programs), and Director of the Cornea, Refractive and External Disease Services at MEEI, and oversees the educational, operational, and administrative dimensions of the Service. He received his undergraduate, MPH and MD degrees from Johns Hopkins, and his MSc degree from Harvard. After residency training at the Illinois Eye and Ear Infirmary, he performed his Cornea and External Disease training at the Wills Eye Hospital, his Uveitis training at the Massachusetts Eye and Ear Infirmary, and his Ocular and Transplantation Immunology training at the Schepens Eye Research Institute, Harvard Medical School. Dr. Dana directs the Corneal Immunology Lab and is a Senior Scientist and Clement Stone Scholar at the Schepens Eye Research Institute. He also directs the NIH-supported K12 Harvard-Vision Clinical Scientist Development Program. Dr. Dana has published over 190 
scientific papers, chapters, and reviews. His main areas of interest include corneal transplant immunology and ocular surface disease and reconstruction.

George N. Papaliodis, M.D. completed his residency in ophthalmology at the University of Texas Southwestern School of Medicine followed by internal medicine residency at the Massachusetts General Hospital. He subsequently completed his Ocular Immunology and Uveitis Fellowship at the Massachusetts Eye and Ear Infirmary and retained on staff upon completion of the training.  In March of 2005, he was named director of the service. He maintains dual faculty appointments in internal medicine and ophthalmology.

Lucia Sobrin, M.D., M.P.H. completed her residency at the Bascom Palmer Eye Institute in 2003.  She subsequently completed the MEEI Retina Fellowship in 2005 followed by a Uveitis and Ocular Immunology Fellowship at the Massachusetts Eye Research and Surgery Institute (MERSI) in 2006.  She then joined the Retina and Uveitis Services as part of the Harvard-Vision Clinical Scientist Development Program. Dr. Sobrin conducts her research on the genetics of retinal and uveitic diseases. She is an Instructor of Ophthalmology at Harvard Medical School. Her clinical interests include posterior uveitis and its treatment with systemic immunosuppresssion.

John Stone, M.D., M.P.H graduated from Harvard Medical School and subsequently completed internal medicine residency at Johns Hopkins School of Medicine.  He completed his rheumatology fellowship at University of California at San Francisco. He is currently the clinical director of rheumatology at the Massachusetts General Hospital.

Lucy H. Young, M.D., Ph.D is an Associate Professor of Ophthalmology at Harvard Medical School.  She obtained her M.D. from the University of Wisconsin-Madison and a Ph.D. in Biology from Harvard University.  She is a graduate of the Massachusetts Eye and Ear Infirmary’s residency and retina fellowship programs.  Dr. Young has a particular interest in infectious retinitis and has a large cohort of patients with this diagnosis which she follows in her clinics. 

Fellow Responsibilities

Clinical Responsibilities: Approximately 85-90% of the clinical fellow’s time is committed to direct patient care on the Uveitis Service.
OUTPATIENT CLINICS: The medical management of ocular inflammatory diseases as well as the preoperative evaluation and postoperative care of surgical cases are considered the cornerstones of the fellowship training at MEEI. Accordingly, extensive exposure to the patients of the full-time staff is required of all fellows. Fellows will examine patients in the various clinics of the Massachusetts Eye & Ear Infirmary (MEEI) and MGH, where he/she will perform the initial examination, form a tentative diagnosis and therapeutic plan, and then present the patient to the attending physician for discussion and final disposition.
CLINIC TIMES: Morning Clinics generally begin at 8:00 am and afternoon clinics begin at 12:30 pm. Fellows are expected to begin seeing patients at this time.
SURGERY: The surgical experience of the uveitis fellow is derived primarily from first assisting on the surgical volume of the Ocular Immunology Service faculty. Generally, fellows will assist on all major and minor procedures.
EMERGENCY ROOM ATTENDING COVERAGE: Each fellow is required to provide 24 half-day sessions per year of coverage in the MEEI EW, during which they see patients and teach residents and medical students.
ON-CALL: Call for the Ocular Immunology and Uveitis Service is divided between Dr. Papaliodis and the clinical fellow (alternating weeks). Dr. Sobrin covers call with the Retina Service.  The fellow on call is expected to manage most issues that arise and examine patients in the ER as necessary.  For any questions or complicated problems and assuredly for emergent surgical cases, the fellow should discuss the case with the attending.
MGH CONSULTS: Most MGH consults are examined by the ER resident on the consult service. Occasionally, the consult is specifically referred to the Ocular Immunology and Uveitis Service.  The majority of these patients are examined in the regular clinic time.  Patients who are unable to transfer to MEEI and require a bedside examination are evaluated by the fellow and subsequently presented to an attending prior to finalizing a note in the patient’s record.
 
Research opportunities and conferences: The fellow will have a variety of research opportunities drawing on the extensive resources of the Harvard Department of Ophthalmology and the Harvard Medical School community in general. There will also be several clinical trial and basic research opportunities available to the fellow.  The Uveitis Service participates in various multi-center trials for ocular inflammatory disease therapeutics.  The fellow will have the opportunity to participate as a co-investigator and attend clinical trial meetings.  He/she will also have the ability to attend the Harvard Medical School Scholars in Clinical Science Program weekly lecture series which teaches the basics of clinical research, study design, data collection and reporting, statistics, and study design.  In terms of basic research opportunities, the Schepens Eye Research Institute (SERI), which is part of the Harvard Department of Ophthalmology and is located near the Massachusetts Eye and Ear Infirmary, has an exceptional ocular immunology program.  Ongoing research projects at the SERI focus on cellular and cytokine regulation of local immune responses in the eye and the characterization of the immunosuppressive and immunoregulating factors within the immune privileged eye.  The Uveitis Service also has established collaboration with Dr. Theo Theoharides from the Tufts Medical School Department of Immunology to examine interleukins in the tear film of patients with scleritis and to investigate mast cell degranulation in an experimental model of multiple sclerosis in mice.  The fellow will have the opportunity to work with scientists from SERI and Dr. Theoharides’s laboratory on basic ocular immunology research according to his/her interests.  In addition, he/she will be able to attend the weekly Molecular Bases of Eye Diseases course which runs September through December at the SERI and includes lectures on basic anatomy and physiology of the eye including the blood-ocular barrier and ocular immunology.  There will be ample choices to become involved in both clinical trial and basic research projects during the fellowship year.

Teaching activities: The uveitis fellows are an important resource for the education of the medical students and residents. They have direct interactions in the uveitis clinics, as attendings in the EW, and for emergency uveitis cases in the EW. The fellow may provide this service independently, or in collaboration with a Uveitis faculty member, depending upon the complexity of the case and fellow’s level of expertise.

Fellow Funding and Benefits
Please note: Clinical fellows must meet the requirements for full (unlimited) licensure in Massachusetts.
 1. SALARY: Currently $40,000/year

 2. MALPRACTICE: Malpractice premiums, through the Harvard CRICO program, are paid for by the Service.

 3. HEALTH INSURANCE: Family health insurance will be provided through the benefits program of Massachusetts Eye and Ear Associates. The fellow will need to contribute to this benefit as well, according to the guidelines of the Infirmary.

 4. VACATION AND SICK LEAVE: Each fellow is allowed 3 weeks (15 work days) of combined vacation/meeting time and (1) personal day per year. Requests for time away from the Service must be submitted in written form 60 days in advance for pre-approved by the Fellowship Director or the Service Director. Up to (5) additional days may be taken with the approval of the Fellowship or Service Director for a major ophthalmology conference or academic meeting at which the fellow is a first author presenting original research (i.e., the fellow has not presented the data before.) The Infirmary’s calendar also includes 9 legal holidays per year. Vacation should only be requested one week at a time. The vacation must not be taken at the beginning or end two-week periods of the fellowship.

 5. PROFESSIONAL MEETINGS: Attendance and participation at appropriate professional meetings is encouraged. Up to (5) days may be taken with the approval of the fellowship or service director for a major ophthalmology conference or academic meeting at which the fellow is a first author presenting original research (i.e., the fellow has not presented the data before.). If the fellow does not meet these criteria, then vacation time may be used. Fellows will be reimbursed for travel to meetings up to a maximum of $1000 per academic year upon timely submission of the appropriate paperwork. 

Miscellaneous
FELLOWS ROOM
A room has been provided for you to secure your coat and belongings. A PC and printer are in the room. All exam lanes are also equipped with networked computers, to be used for clinical and academic purposes. The manager will provide you with a key to the Fellows’ room. Please remember that the Infirmary will not be responsible for personal items that are left in the room. The room, however, is secure and is only accessed by clinical fellows from other services.
MAIL An in-box for your mail and/or important messages has been placed on the 12th floor administrative offices of Drs Papaliodis and Sobrin. This is an important venue for staff members to send fellows important messages. Fellows are urged to check their mailbox frequently for patient telephone call messages, dictations and important mail and memos.
PAGING
You are supplied with a pager that you must wear during business hours and also at all times when on-call. Please respond to your pages promptly. If you change the status of your beeper for any reason (i.e. in surgery, not available), please make sure you promptly reverse the status on your return to clinical duty.
PAYCHECKS
Paychecks may be picked up on the 30th of each month in the administrative offices of Drs. Papaliodis and Sobrin or arrangements can be made for direct deposit.
TRAVEL REIMBURSEMENT
You are provided up a maximum of $1000 per year for travel/meetings. On your return, please complete a “travel reimbursement form” and submit to Bony Nova with original receipts.

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