Vitreoretinal Fellowship of the Retina Service Massachusetts Eye and Ear Infirmary and Harvard Medical School

Program Director
Shizuo Mukai, M.D.

Faculty

• Evangelos S. Gragoudas, M.D., Director, Retina Service
• Ivana Kim, M.D.
• John I. Loewenstein, M.D.
• Joan W. Miller, M.D.
• Lucia Sobrin, M.D.
• Lucy H. Y. Young, M.D., Ph.D.
• Demetrios Vavvas, M.D., Ph.D. 
   

Contact: Suzette Profio
Tel: (617) 573-3913, Fax: (617) 573-3698
Suzette_Profio@meei.Harvard.edu

The Program
Length of program
Two years (Start date is July 7)

Fellows per year
Three

Selection criteria

• Board eligible in ophthalmology
• ACGME-accredited ophthalmology residency or equivalent
• USMLE parts I, II and III passed
• Full Massachusetts license
• Evaluation of application material including curriculum vitae
• 3 letters of recommendation, and 3 evaluations by supervisors
  one of which is from the Residency Program Director
• Personal interviews
• Ophthalmology Match process

Educational objectives
Competency in the diagnosis of diseases of the retina, vitreous, and choroid including techniques of:

• Comprehensive examination of the retina, vitreous and choroid
• Fluorescein angiography
• ICG angiography
• Ultrasonography
• Optical coherence tomography
• Competency in surgical management of vitreoretinal diseases
• Competency in laser treatment of retinal and choroidal diseases
• Carry out a significant research project to be presented at national or international meetings and to be published in a peer-reviewed journal
• Ability to critically review clinical and research articles

Curriculum

• Participation in Retina Service clinics, surgeries and lasers
• Participation in Retina/Macula Conference, Retina Service
  Tutorials, Grand Rounds, and Fellows Course
• Research projects under supervision of Retina Service preceptors
• Supervision and teaching of residents and medical students in the Retina Service and in the Emergency Department
• Attendance and presentation at meetings such as: Association for Research in Vision and Ophthalmology (ARVO)
  Retina Society
  American Academy of Ophthalmology (AAO)
   

Supervision

• Shizuo Mukai, M.D., Program Director
• Retina Service attendings during clinical responsibilities
• Retina Service research preceptors during research

Evaluation process
Evaluation by the Retina Service faculty every six months.

Appointments During Fellowship
Clinical Fellow in Ophthalmology
Massachusetts Eye and Ear Infirmary
Clinical Fellow in Ophthalmology
Harvard Medical School
Clinical Fellow, Department of Surgery
Massachusetts General Hospital

Funding sources
Retina Service (First year $40,000, second year $45,000)
This can be supplemented by Heed Fellowship (100% of stipend to the fellow) and other extramural and intramural fellowships or grants (50% of stipend to the fellow, 50% to the Retina Service)

Duty hours
Clinical coverage: Monday-Friday, 8:30 a.m.-5 p.m.
(50% during first year)
On call one week every three weeks during the second year

Years in existence
31 years (1977 to present)

Introduction
The Vitreoretinal Fellowship of the Massachusetts Eye and Ear Infirmary and Harvard Medical School was established in 1977 and offers comprehensive training in the surgical and medical management of diseases of the retina, vitreous and choroid. This is accomplished through extensive opportunities for hands-on participation in subspecialty clinics and in vitreoretinal procedures under the supervision of the Retina Service faculty.
The mission is to train highly motivated individuals to become leaders in the field. The two-year fellowship is unique in that it provides an intense clinical experience while allowing ample time to engage in significant academic pursuits. As a result, the fellowship has been successful in producing extremely well trained vitreoretinal specialists who also have experience in basic or applied ophthalmic research. The Vitreoretinal Fellowship has graduated numerous professors of ophthalmology, retina service directors, academic chairpersons, and a dean of a medical school. In addition, many private-practice based retina specialists are also among our graduates.

Clinical Facilities
The Retina Service is located on the 12th floor of the Mass. Eye and Ear.The current facility is fully equipped with examination lanes, procedure rooms, and state-of-the-art diagnostic equipment. We routinely perform Heidelberg and Zeiss spectral domain OCT, digital fundus and anterior segment photography, fluorescein and indocyanine green angiography, SLO videoangiography, Panoret and RetCam photography, B-scan and A-scan ultrasonography, and UBM.

A fully equipped Laser Center is also located on the 12th floor. The lasers include argon, diode, YAG, Pascal, and PDT systems.

Clinical Responsibilities

1. Surgery
Extensive opportunities for participation in vitreoretinal surgery and laser procedures are provided. Emphasis is placed on gaining hands-on surgical experience, particularly in state-of-the-art vitreoretinal surgery including 20, 23 and 25 gauge surgical systems. In addition, each fellow will gain experience in the management of complicated vitreoretinal retinal conditions including ocular trauma, intraocular foreign bodies, and complex retinal detachments (proliferative vitreoretinopathy, giant retinal tears, complicated proliferative diabetic retinopathy, and pediatric retinal detachments). Fellows serve as primary surgeons or first assistants depending on the complexity of the case and the ability of the fellow. The fellow will also assist on, or in some cases supervise with the Retina Service staff member present, cases where a resident is the surgeon. Fellows actively participate in the preoperative, intraoperative and postoperative management of all patients managed in the Retina Service.
 

2. Medical Retina
More than 2,500 fluorescein angiograms are performed annually in the Fluorescein Angiography Unit of the Retina Service. Indocyanine green angiography and SLO videoangiography are also performed. The second year fellows, working with the residents on the retina rotation, supervise the interpretation and reporting of angiograms. There is a weekly Retina Conference, at which time particularly interesting cases are prepared and presented by the resident to the first year fellows. In general, the majority of the cases presented are medical retina cases, although surgical cases are occasionally presented. The Retina Conference is a cornerstone in the teaching of fellows, and aims to create a systematic approach towards the diagnosis and treatment of retinal disease. The second year fellows serve in a teaching capacity to assist the residents as they prepare the cases.
In addition, medical retina patients are seen in every clinic, and the fellows gain extensive experience in the diagnosis and management of macular diseases. The fellow also has an opportunity to treat patients with a variety of posterior segment inflammatory disorders. Furthermore, a unique aspect to the fellowship is the extensive exposure to the diagnosis and management of intraocular tumors.

3. On-Call Schedule
As the only ocular emergency center in New England, the Emergency Department at the MEEI draws patients from a large geographical area with significant vitreoretinal disease. This allows for the fellow to be involved in the surgical and medical management of interesting and often complex cases. The call duties also include coverage of established Retina Service patients. Call is covered one week at a time and is shared amongst the six fellows, with the clear majority of call taken during the second year of fellowship. The first year fellow will only have a limited amount of call in order to facilitate educational and research pursuits.

Educational Responsibilities
Fellows have traditionally played an integral role in the education of residents. During the first year, fellows serve as attending staff to the residents in the Emergency Department one half day per week.

Although fellows are not responsible for giving didactic lectures to the residents, they are involved in helping organize Retina Conference cases (as mentioned above), and in addition, the fellows are responsible for presenting a case at Grand Rounds approximately once per year. Each year there is a Fellows Course at the Mass Eye and Ear. Once during the fellowship, the fellow is expected to write a review paper that will be published as in an ophthalmic journal, and deliver a 10-minute presentation at this course.

There is a tradition of excellent teaching by the Retina Service fellows, and this has been well appreciated and recognized by the residents. Many of the annual Fellow of the Year Award given by the residents for the best teacher among the fellows have been given to a Retina Service fellow.

Research Responsibilities
The fellowship provides significant time toward the pursuit of basic, clinical, or translational research. The Retina Service will help applicants prepare applications for support from private sources (e.g. The Heed Foundation, Fight for Sight, Inc., etc.) and public sources (e.g. NIH National Research Service Awards). According to the bylaws of the Mass. Eye and Ear Fellowship Committeee, the fellow will receive 50% of any stipend in addition to his salary while 50% goes to the Retina Service (except for the Heed where the fellow receives 100%). The Retina Service fellows have been extremely successful in getting external funding such as the Heed Fellowship.

Research opportunities are currently available in many areas. The Retina Service faculty members are involved in a wide variety of projects encompassing a full spectrum of investigation from clinical trials and epidemiology to basic science bench research. Many examples can be viewed at the following web sites:

Ophthalmology Researchers
Ophthalmology Researchers
Ophthalmology Research
Ophthalmology Research
Ophthalmology Research Labs
Ophthalmology Research Labs
The fellow can also tap into the extensive research community in the Boston area. Even within ophthalmology and eye research, this community is quite extensive, and includes the Schepens Eye Research Institute and Joslin Diabetes Center to name a few. It is required though that the fellow designs projects in which a Retina Service faculty is an integral member of the research team. The faculty member serves as the intramural research preceptor for the fellow.
Many of the Retina Service fellows have been quite successful in research leading to numerous publications in peer-reviewed journals including Nature. In addition, they have been very successful in winning awards such as the Heed Fellowship, Michaels Award, Retina Society Fellowship Award, ARVO Travel Award, and Paul Kayser International Scholar Program of the Pan-American Association of Ophthalmology.
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. Two of our former fellows have received the K-12 Award including Lucia Sobrin on our current faculty.

Fellow Funding and Benefits
Salary - $40,000/year during the first year, $45,000/year during the second year

Malpractice - Malpractice premiums are fully paid by the Retina Service.

Health insurance - Family health insurance will be provided through the benefits program of Massachusetts Eye and Ear Associates.

Vacation/Sick leave - Each fellow is allowed three weeks (15 work days) per year. All vacation time must be planned in advance and be pre-approved by the Retina Service.

Meetings - Attendance and participation at appropriate meetings is encouraged. Each fellow is required to attend one meeting per year although most attend more than one. The first year fellows usually attend ARVO, and the second year fellows usually attend AAO. Second year fellows also attend meetings for retina fellows sponsored by groups such as the ASRS. Fellows are reimbursed for travel to meetings up to $1,000 per academic year.

Application process
The Vitreoretinal Fellowship participates in the San Francisco Match Program, and getting a match number and having the number in our files should be at the top of your priority. It is expected that the applicant will be Board eligible in Ophthalmology, have performed an ACGME-accredited ophthalmology residency or equivalent, and will be eligible to obtain a full license in the state of Massachusetts (see Selection Criteria on page 1).

Only completed applications will be considered for interview. It is your responsibility to make sure that your application is complete. Applications consist of a completed Harvard application form, CV, 3 letters of reference and 3 evaluation questionnaires (forms available from Suzette Profio) from the same individuals that wrote the letters of recommendation. One of the letters should be from the Residency Director, and at least one letter should be from a retina specialist in your residency program. Do not send more than three letters unless the fourth letter is from a research preceptor. Applicant interviews are generally conducted in mid October, and it is advised that applications be submitted well in advance.

 

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