Third-Year Rotations (PGY-4)

The goal of the third-year of the Harvard Medical School Residency Program in Ophthalmology is refinement of knowledge, judgment, and technical skills learned in the preceding two years, and the development of professional maturity essential for the resident to become a well-trained, capable ophthalmologist.

The third year offers a period of intensive ophthalmologic surgical training. The residents build on surgical skills acquired in the first 2 years of residency by performing cataract, glaucoma, anterior segment, open-globe, and retina surgeries during this year. Every operative case is staffed by an attending surgeon and the quality of teaching in the operating room is exceptional.

In addition, the residents have an international ophthalmology elective rotation. Many residents choose to go to the Aravind Eye Hospital in India where they are exposed to an exceptional array of ocular pathology and participate in cataract surgeries on a daily basis. Some residents choose to use this block for research or set up an independent international rotation. The third year is divided into 8 different rotation blocks, each 6-7 weeks in duration.

The rotations of the third year are constructed around experiences with individual attendings.  This allows the senior ophthalmology resident to examine patients in clinic, participate in the pre-operative evaluation, perform the patients surgery and then see the patient in the immediate post operative period.  Through these experiences the resident becomes not only an excellent surgeon but also an exceptional clinician.

Call Responsibilities

Senior residents are assigned night float shifts for the first 3 months of the academic year (10-12 nights on average) during which time they supervise the junior resident in the MEEI Emergency Department (ED). Residents are free from clinic and daytime responsibilities the day before and after a night float shift.

For the remainder of the academic year, night and weekend call for the senior resident is home-call and is divided evenly amongst the senior residents to provide back-up for the junior resident working in the ED. The senior residents perform all open-globe repairs under the supervision of the chief resident and supervise the first year residents in minor procedures such as simple eyelid laceration repairs. On average, each resident performs 15 open-globe repairs in their senior year.

Comprehensive Ophthalmology Service:

Attendings: Sherleen Chen, M.D., Matthew Gardner, M.D., Carolyn E. Kloek, M.D., Scott Greenstein, M.D.

The senior residents perform cataract surgery with each of the attendings listed above.  By the time residents enter their third year they should already be experienced cataract surgeons because of the step-wise introduction received during their second year.  Senior residents gain also gain expertise in complex cataract surgery.  Techniques include: use of trypan blue, PXF cases, Flomax cases, use of iris hooks and use of Malyugin rings.

Glaucoma Service:

Attendings: Louis Pasquale, M.D., Teresa C. Chen, M.D., and Douglas Rhee, M.D.

Senior residents on the glaucoma service focus on the surgical management of glaucoma.  They perform trabeculectomies, insertion of tube shunts and other miscellaneous procedures under faculty supervision.  Time is also spent refining their skills of the medical management of glaucoma.

Boston VA Medical Center rotation:

Supervising Attendings
Mary K. Daly, M.D., Joanne Haney-Tilton, M.D., Milhim I. Aswad, M.D., Donna Siracuse-Lee, M.D., Christine S. Ament, M.D., Babak Eliassi-Rad, M.D., Li-Wei Lin, M.D., Nabil I Jarudi, M.D.

Clinical Experience
The third year rotation at the Boston VA Medical Center is a cataract intensive rotation. The senior resident plays an active role in the pre-, intra-, and post-operative management of the cataract patient. In addition, the senior residents assist in the general ophthalmology and subspecialty clinics at the Boston VA.  At the VA, residents also gain experience in the use of toric IOLs.  Senior residents are responsible for the pre-operative workup and lens calculations for patients eligible for toric lenses.  The residents then perform the patient’s surgery and place the toric lens inside the eye.  This is a unique experience as “premium IOL cases” are often reserved for attendings.

Surgical Experience

The residents are in the OR every other day where they serve as primary surgeon for cataract and glaucoma surgeries.

Call Responsibilities

The third year resident provides back-up coverage for the first year resident on home call every other day.

Togus VA Medical Center rotation

Supervising Attending
Jeffrey Dempski, M.D.

Clinical Experience

Similar to the Boston VA, the Togus VA Medical Center is a regional referral center for ophthalmology in the state of Maine. The residents are exposed to a broad range of ocular disease during their rotation in Maine. 

Surgical Experience

One or Two full days each week is spent serving as primary surgeon for cataract surgeries. One full day per week is also spent performing minor procedures including eye plastics procedures and glaucoma and retina laser procedures.

Call Responsibilities
There are no call responsibilities on this rotation.

Housing:
Residents are provided housing on the Togus VA campus.  Residents have a three bedroom house with kitchen and laundry facilities to themselves, allowing for family or spouses to join them if desired.

Retina Service:

Attendings: Evangelos Gragoudas, M.D., Ivana Kim, M.D., John I. Loewenstein, M.D.,  Joan W. Miller, M.D., Shizuo Mukai, M.D., Lucia Sobrin, M.D., Demetrios Vavvas, M.D., Ph.D, Lucy H. Young, M.D., Ph.D., and Dean Eliott, M.D.

Senior residents on the retina service gain experience in the surgical management of retinal disease.  Residents also spend two half days per week in Dr. Gragoudas’ tumor clinic and one half-day per week in Dr. Gragoudas’ OR learning the management of ocular tumors.

International Elective Rotation/Aravind Eye Hospital, India:

During the senior year, residents have an elective rotation during which time most residents choose to do an international elective at the Aravind Eye Hospital in India. Alternatively, some residents opt to stay in Boston to participate in a research project. This is a unique opportunity available to the HMS ophthalmology residents to broaden their clinical and surgical experience through the international elective or focus on a research interest.

At the Aravind Eye Hospital, residents witness an impressive international health care system that is able to deliver high quality eye care to a large volume of patients in a cost-efficient manner. Residents have the opportunity to participate in the cornea, glaucoma and uveitis clinics with exposure to end stage inflammatory and infectious diseases uncommon in the United States.    The residents also spend one half of each day in the operating room and serve as primary surgeons for cataract surgeries (extra-capsular, small incision cataract surgery and phaco-emulsification).
 

 Page updated   November 10, 2011