The Mass. Eye and Ear Glaucoma Fellowship Program

Introduction

 The Glaucoma Fellowship at the Massachusetts Eye and Ear Infirmary began under the tutelage of Drs. Chandler and Grant in the mid 1960’s.  The glaucoma fellowship has graduated numerous Professors of Ophthalmology, Glaucoma Service Directors, Academic Chairpersons, Deans of medical schools, a Chancellor of a university and a former president of the American Academy of Ophthalmology.  In addition, many community-based glaucoma specialists are graduates of the glaucoma fellowship at Massachusetts Eye and Ear Infirmary.  They serve to enrich the fellowship with their teaching contributions.

 Our mission is to train fellows to manage the most difficult glaucoma cases while creating an atmosphere where one can explore career development through teaching and clinical research.

 The fellowship is one year in length and is clinically intense.  The fellow’s responsibilities include evaluating patients; taking call; providing consultation for inpatients at Massachusetts General Hospital; staffing the Mass Eye and Ear Emergency Room; responding to patient requests for information; being available for emergency and routine visits; preparing charts and patients for laser and incisional surgery; assisting during glaucoma laser and incisional surgery; preparing articles for journal club; teaching residents and other students who rotate through the service; and other tasks as deemed necessary by the glaucoma faculty.

Clinical Facilities and Organization

Facilities:

The Glaucoma Service is located on the first floor of the Massachusetts Eye and Ear Infirmary.  The current facility is fully equipped with examination lanes, procedure rooms, and diagnostic services.  Diagnostic tools include Humphrey visual field machines that run SITA and Glaucoma Progression Analysis software, a Goldmann visual field machine, a Frequency Doubling Perimtery instrument, a Pascal dynamic contour tonometer, an ultrasound biomicroscope (housed on the 12th floor), A scan and B scan units (the B scan unit is also on the 12th floor), an OCT3 and a GDx (an HRT is available on the Comprehensive Ophthalmology Service, and spectral domain OCT is available on the Retina Service).  A full range of photographic services is available, including slit photography, goniophotography and digital photography for optic nerve documentation.  We use an electronic medical record system linked with an image management software tool called ANKA. 

Personnel:
Stacey Brauner, MD
Teresa Chen, MD. 
Cynthia Grosskreutz, MD, PhD
Louis R. Pasquale, MD
Douglas Rhee, MD
Lucy Q. Shen, MD
Angela Turalba, MD 
Janey L. Wiggs, MD, PhD

Stacey Brauner, MD completed her residency and glaucoma fellowship at Massachusetts Eye and Ear Infirmary in 2007.  She joined the Glaucoma Service at Massachusetts Eye and Ear Infirmary starting in September 2007 and is also very active on the Comprehensive Eye Service.  

Teresa Chen, M.D. completed her residency at University of Illinois Eye and Ear Infirmary and a fellowship in glaucoma at Massachusetts Eye and Ear Infirmary.  Dr. Chen’s research focuses on developing novel optic nerve imaging technology and clinical issues related to pediatric glaucoma.

Cynthia Grosskreutz, MD, PhD completed her residency and fellowship in glaucoma at the Massachusetts Eye and Ear Infirmary.  She also received a Ph.D. in pharmacology at the University of Iowa.  She sees patients on the Glaucoma Service roughly 3 days per month as she is the Director of Translational Medicine at Novartis.  

Louis R. Pasquale, MD completed his residency at Temple University Hospital and a glaucoma fellowship at Johns Hopkins University Hospital.  He is Director of the Glaucoma Service at Massachusetts Eye and Ear Infirmary and Director of the Glaucoma Fellowship.  His research interest involves detecting previously undiagnosed glaucoma using novel screening tools and understanding the pathogenesis of primary open-angle glaucoma and exfoliation glaucoma. Dr. Pasquale has an NIH grant to study gene-environment interactions as putative risk factors for primary open-angle glaucoma.

Douglas Rhee, MD completed his residency at Wills Eye Hospital and fellowship in glaucoma at Bascom Palmer Eye Institute. After his fellowship he served as an attending ophthalmologist at Wills Eye Hospital. He joined the Glaucoma Service at Massachusetts Eye and Ear Infirmary in September 2005.  Dr. Rhee is funded by the NIH to study the role matrix metalloproteinases play in trabecular meshwork function.  Clinically, Dr. Rhee maintains a strong interest in pediatric glaucoma

Lucy Shen, MD completed her undergraduate work at MIT, following a medical degree in the Health Sciences and Technology Program at Harvard Medical School. At the Jules Stein Institute of UCLA she obtained her Ophthalmology Residency and Glaucoma fellowship.  Her research interest is in the area of structure-function relations in glaucoma.

Angela Turalba, MD completed her residency and served as Chief Resident at MEEI.  Subsequently she completed a glaucoma fellowship and joined the Glaucoma Service in 2010. She is an outstanding teacher and has a strong clinic interest in traumatic glaucoma. 

Janey L. Wiggs, MD, PhD completed her clinical residency and fellowship at the Massachusetts Eye and Ear Infirmary. She also completed research fellowships in molecular and ophthalmic genetics at the Massachusetts Eye and Ear Infirmary.  She obtained a PhD in biochemistry at University of California, Berkeley.  Initially she joined the staff of MEEI and then later worked at the New England Medical Center.  Subsequently, she returned to MEEI where she pursues her work on identifying genetic determinants of various forms of glaucoma. Her work is strongly supported by the National Institutes of Health 

Fellow responsibilities

A. Clinical responsibilities: Approximately 80% of the fellow’s time is committed to direct patient care on the Glaucoma Service.  The medical management of glaucoma cases as well as the pre- and postoperative care of surgical cases is considered an essential aspect of fellowship training. It is not critical that the fellow see every patient but it is very important that the fellow evaluate cases thoroughly, formulating a tentative diagnosis or differential diagnosis as well a management plan.  Fellows do not have to attend any external clinics but they are expected to serve in the Emergency Department one session a week for 6 months.  A detailed schedule of clinical responsibilities will be provided when the fellow starts in July. 
Another major component of fellowship experience involves assisting in the operating room.   Fellows are expected to be in the OR long before the attending and ensure, to the best if their ability, that surgical plans are implemented.  A surgical schedule will be provided but there will always be add-on cases and fellows are expected to assist on these cases at the discretion of the attending and the call schedule. 
Glaucoma fellows will take call for the Glaucoma Service approximately every third week.   The on-call fellow is responsible for all emergency medical and surgical admissions to the Glaucoma Service during weeknights and weekends.  An assigned attending will be on call at all times and available for immediate backup of complicated cases, admissions or surgical procedures.  Any changes to the on-call schedule must be processed through the manager of the Glaucoma Service.  If the fellow is unable to provide on-call coverage on any given pre-assigned week, then they must find coverage from amongst the other housestaff in the call rotation.  
    
B. Educational responsibilities: Glaucoma lectures are held Friday mornings (dates and times will be posted).  These lectures will be didactic in nature and cover all the glaucomas and their treatments.  Glaucoma journal club will take place monthly. All faculty and fellows are expected to attend.  Faculty and fellows will take turns presenting an interesting and important recent paper of their choice.  Grand Rounds is held on Thursday morning at 8:00AM.  All fellows must attend Grand Rounds.  Once or twice per year, the fellow will be responsible for presenting a case at Grand Rounds.  Each year there is a Fellows Course. Each fellow is expected to write a review paper and make a 10-minute presentation. The theme of the Fellows Course dictates the choice of a distinguished visiting faculty and the topic for the paper.     

C. Research responsibilities: There are many opportunities to do clinical research at MEEI and the fellow is encouraged to pursue a research project.  In order to successfully complete a project a fellow is encouraged to conceive and plan their work before they arrive in Boston.  The faculty will be happy to provide resources and assistance in this regard.  While research is not mandatory, preference will be given to applicants who demonstrate strong clinical capabilities and a proclivity to research endeavors. 
 Fellows who have strong academic inclinations should be aware that MEEI holds a career development grant allowing the institution to extend a K-12 award to a fellowship-trained ophthalmologist. While competition for this award is typically fierce, MEEI fellows who demonstrate strong research potential will be given careful consideration for this award.  K-12 awards give a graduating fellow junior faculty status with 80% protected time for research.

D. Listed below are selected recent original peer-reviewed publications of the faculty.  The purpose of this listing is to give the applicant an idea of the scope of glaucoma research interests at MEEI:

Brauner SC, Berry JL, Pye J, Lee EG, Rhee DJ  Effect of Saline Conditions on the Tensile Strength of Ophthalmic Sutures Ophthalmic Surg Lasers Imaging 2011 Mar-Apr;42(3);148-51

Brauner SC, Walton DS, Chen TC Aniridia Int Ophthalmol Clin. 2008 Spring;48(2);79-85

Brauner SC, Chen TC, Hutchinson BT, Chang MA, Pasquale LR, Grosskreutz CL  The Course of Glaucoma During Pregnancy: A Retrospective Case Series Arch Ophthalmol. 2006 Aug;124(8):1089-94

Wu H, de Boer JF, Chen TC Reproducibility of Retinal Nerve Fiber Layer Thickness Measurements Using Spectral Domain Optical Coherence Tomography J Glaucoma 2010 Sep 16
       
Yi K, Mujat M, Sun W, Burnes D, Latina MA, Lin DT, Deschler DG, Rubin PA, Park BH, de Boer JF, Chen TC Imaging of Optic Nerve Head Drusen: Improvements with Spectral Domain Optical Coherence Tomography  J Glaucoma 2009 Jun-Jul; 18(5):373-8
      
Dohlman CH, Grosskreutz CL, Chen TC, Pasquale LR, Rubin PA, Kim EC, Durand M Shunts to Divert Aqueous Humor to Distant Epithelializd Cavities after  Keratoprosthesis Surgery J Glaucoma 2010 Feb;19(2):111-5
     
Jea SY, Mosaed S, Vold SD, Rhee DJ Effect of a Failed Trabectome on Subsequent Trabeculectomy
J glaucoma 2011 Feb 17
     
Kang MH, Oh DJ, Rhee DJ Effect of Hevin Deletion in Mice and Characterization in Trabecular Meshwork Invest Ophthalmol Vis Sci 2011 Jan 10

Chen LJ, Tam PO, Tham CC, Liang XY, Chiang SW, Canalas O, Ritch R, Rhee DJ, Pang CP
Evaluation of SPARC as a Candidate Gene of Juvenile-Onset Primary Open-angle Glaucoma by Mutation and Copy Number Analyses Mol Vis 2010 Oct 8;16:2016-25

Turalba AV, Grosskreutz C A Review of Current Technology used in Evaluating Visual Function in Glaucoma Semin Ophthlmol 2010 Sep-Nov;25(5-6):309-16

Kanoff JM, Turalba AV, Andreoli MT, Andreoli CM Charachteristics and Outcomes of Work-Related Open Globe Injuries Am J Ophthalmol 2010 Aug; 150(2):265-269

Montezuma SR, Gopal H, Savar A, Turalba A, Cestari DM, Torun N Silent Sinus Syndrome Presenting as Enophthalmos Long After Orbital Trauma J Neuroophthalmol 2008 Jun;28(2):107-10
    
Pasquale LR, Kang JH Female Reproductive Factors and Primary Open-Angle Glaucoma in the Nurses’  Health Study Eye (Lond) 2011 Feb 18

Wood SD, Asefzadeh B, Fisch B, Jiwani A, Lee RK, Conlin PR, Pasquale LR The Relationship Between Diabetes Mellitus and Exfoliation Syndrome in a  United States Veterans Affairs Population: A Case-control Study  J Glaucoma 2010 Jun 23

Pasquale LR, Willett WC, Rosner BA, Kang JH  Anthropometric Measures and Their Relation to Incident Primary Open-angle Glaucoma Ophthalmology 2010 Aug;117(8):1521-9

Fan BJ, Wang DY, Pasquale LR, Haines JS, Wiggs JL  Genetic Variants Associated with Optic Nerve Vertical Cup-to-disc ratio are Risk Factors for Primary Open Angle Glaucoma in a US Caucasian Population Invest Ophthalmol Vis Sci 2011 Mar 11

Fan BJ, Wiggs JL Glaucoma: Genes, Phenotypes, and New Directions for Therapy J Clin Invest 2010 Sep 1;120(9):3064-72
  
Fan BJ, Figuieredo Sena DR, Pasquale LR, Grosskreutz CL, Rhee DJ, Chen TC, Delbono EA, Haines JL,  Wiggs JL  Lack of Association of Polymorphisms in Elastin with Pseudoexfoliation  Syndrome and Glaucoma  J Glaucoma 2010 Sep;19(7):432-6

Fellow funding and benefits

SALARY: Currently $50,000/year

MALPRACTICE: Malpractice premiums are fully paid by the Glaucoma Service.

HEALTH INSURANCE: Family health insurance will be provided through the benefits program of Massachusetts Eye and Ear Associates.  Depending upon the plan selected, all or a large portion of the premiums is included in the benefits package.

VACATION AND SICK LEAVE: Each fellow is allowed 3 weeks (15 work days) per year.  All time out must be pre-approved by the Glaucoma Service Manager and by the attendings affected by the fellow’s absence.  The vacation may not be taken at the beginning or end of the fellowship.

PROFESSIONAL MEETINGS: Attendance and participation at appropriate meetings is encouraged.  Fellows will be allowed one week (5 work days) to attend meetings but coverage for missed clinics and call must be arranged. Fellows will be reimbursed for travel to meetings (AAO, ASCRS, ARVO, AGS, etc) up to a maximum of $1500 per academic year if they present at the meeting they attend. 

2010– 11 Glaucoma Fellow schedule (the 2011-12 schedule is subject to change)

Fellow #1 (Starting July in 3 month alternating blocks with Fellow #2). Fellow #1 starts on the TC/LS rotation.

Monday: TC clinic all day 

Tuesday: OR with TC; if no OR go to LS clinic 

Wednesday: TC clinic in AM and LS clinic in PM; if LS has cases in OR priority is to be with her.

Thursday: with LS OR 2nd Thursday**; other times for research. 

Friday: 1st Friday AM of the month free; otherwise in LS clinic all day
 

Fellow #2 (Starting July in 3 month alternating blocks with Fellow #1). Fellow#2 will start on the AT/DR/LP rotation

Monday: Glaucoma clinic with DR in AM and JW/CG in PM. In September, AT starts on the service as a new glaucoma attending.  She is tentatively scheduled to have OR on Monday.  If she does, the 1st priority is to the OR but you will have to see the post ops on Tuesday before the AM ER shift starts.  

Tuesday: ER in AM; glaucoma clinic in PM with SB on the 2nd Tuesday; other times use for research.  

Wednesday: OR / lasers with either LRP or DR

Thursday: Clinic with DR in AM (but see LRP postops when appropriate) and LRP in PM 

Friday: DR clinic in AM and free in the PM in the 1st block; free in the AM and with AT clinic in the PM in the 2nd block.

OR = Operating Room
ER = Emergency Room
TC = Teresa Chen, M.D.
CG = Cynthia Grosskreutz M.D., Ph.D.
LRP = Louis R. Pasquale, M.D.
DR = Douglas Rhee, MD
AT = Angela Turalba, M.D.
JW = Janey Wiggs, M.D., Ph.D.
SB = Stacey Brauner, MD

*ER is only required one half day session for 6 months out of the year.  The 3-month alternating blocks of time apply to Glaucoma Service obligations only. 

The fellow on Dr. Pasquale’s block will be expected to attend Saturday clinics. Saturday clinics run from September to June.

Miscellaneous:

Mail
An in-box for your mail and / or important messages is located on the Glaucoma Service.  You should check your mailbox frequently for messages, patient-related matters, and other correspondence. 

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 (in surgery, not available), please make sure you promptly reverse the status on your return to clinical duty.

Application process:

Applications can be found on the San Francisco Matching Program’s website at www.sfmatch.org . Only completed applications will be considered for interview.  A completed application consists of a completed AUPO centralized application form and 3 letters of reference.  Generally the deadline for receipt of completed applications is mid October.  Note that if the fellow matches, a staff application to MEEI will also need to be completed immediately after the match.  Interviews will take place at MEEI in Late October or early November.  Any questions regarding the fellowship can be directed to Dr. Louis R. Pasquale at via email at louis_pasquale@meei.harvard.edu .

 Page updated May 6, 2011