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.

Comprehensive Ophthalmology and Trauma Service rotation

Supervising Attendings
Carolyn E. Kloek, M.D., Matthew Gardiner, M.D. Ankoor Shah, M.D., Ph.D. (Chief Resident)

Clinical Experience
Residents work closely with Drs. Kloek and Gardiner in the Comprehensive Ophthalmology clinic where they evaluate and manage patients with a wide spectrum of eye disease. An emphasis is placed on the pre-operative, intra-operative, and post-operative management of patients requiring cataract surgery. In addition, one half day is spent in the Eye Trauma clinic, attended by the Chief Resident, where the residents evaluate and manage the eye trauma patient.

Surgical Experience
One full day every other week and one half day each week is spent in the OR with Drs. Kloek and Gardiner respectively during which time the resident serves as primary cataract surgeon.

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 and Uveitis Service rotation 

Supervising Attendings
Sherleen Chen, M.D., George Papaliodis, M.D., Ankoor Shah, M.D., Ph.D. (Chief Resident)

Clinical Experience
Residents divide their time on this rotation between Dr. Sherleen Chen in the Comprehensive Ophthalmology Clinic and Dr. George Papaliodis in the Uveitis Clinic.  While on the Uveitis Service the residents learn the work-up and management of complex patients with a variety of inflammatory and infectious eye conditions.

Surgical Experience
One full day every week and one half day every other week are spent in the OR with Drs. Chen and Papaliodis respectively serving as primary surgeon for cataract surgeries and participating in complex eye surgeries in the uveitic patient.   

Call Responsibilities
Refer to the section under Comprehensive Ophthalmology at MEEI[HS1] for details of the call responsibility. 

Comprehensive Ophthalmology and Cornea Service rotation

Supervising Attendings
Scott H. Greenstein, M.D., Roberto Pineda II, M.D., Kathryn A. Colby, M.D., Ph.D.

Clinical Experience
The senior resident’s time is divided between Dr. Scott Greenstein in the Comprehensive Ophthalmology Clinic and Drs. Colby and Pineda in the Cornea Clinic. In the Cornea Clinic residents refine their clinical skills in the management of patients with complex corneal disease as well as ocular surface disease including ocular surface tumors.

Surgical Experience
Residents serve as primary surgeon for cataract surgeries performed with Drs. Greenstein and Pineda. In addition, residents participate in cornea and ocular surface surgeries with Drs. Pineda and Colby. Residents also participate in the care of Dr. Pineda’s refractive surgery patients one half day every other week.

Call responsibilities
Refer to the section under Comprehensive Ophthalmology at MEEI[HS2] for details of the call responsibility.

Retina Service rotation

Supervising Attendings
Evangelos Gragoudas, M.D., John I. Loewenstein, M.D., M.P.H., Lucy H. Young, M.D., Ph.D., Shizuo Mukai, M.D., Ivana Kim, M.D., Demetrios Vavvas, M.D., Ph.D.

Clinical Experience
Two half days each week are spent in Dr. Gragoudas’s ocular tumor clinic during which the residents will see between 60-80 patients with ocular tumors each week and learn the management and treatment options for intra-ocular tumors. Additional time is spent in the retina clinics of Drs. Loewenstein, Kim, and Young where the resident participates in the evaluation and management of patients with a wide spectrum of retinal disease.

Surgical Experience
The residents operate with Dr. Gragoudas, performing enucleations and assisting in the placement of tantalum scleral rings for targeted proton beam therapy for treatment of ocular tumors. Additional time is spent in the OR with Drs. Vavvas and Mukai performing primary scleral buckles, core vitrectomies, and assisting in other retinal procedures.

Call Responsibilities
Refer to the section under Comprehensive Ophthalmology  for details of the call responsibility.  

Glaucoma Service rotation

Supervising Attendings
Teresa C. Chen, M.D., Cynthia L. Grosskreutz, M.D., Ph.D., Louis R. Pasquale, M.D., Douglas J. Rhee, M.D., Lucy Shen, M.D.

Clinical Experience
The residents enhance their experience in the management of the glaucoma patient during this rotation. A particular focus is placed on the management of the complex glaucoma patient including training in the various modalities of monitoring and testing for glaucoma, as well as management of the post-operative glaucoma patient.

Surgical Experience
The residents work with all members of the glaucoma faculty in the OR and serve as primary surgeon for cataract surgeries, trabeculectomies, and glaucoma tube shunt procedures. They also assist in performing trabectome surgeries and pediatric glaucoma cases. There is also ample opportunity for performing glaucoma laser procedures.

Call Responsibilities
In addition to the back-up coverage of the MEEI ED, residents are on home call for the Glaucoma Service 2 weeks during the rotation. 

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.

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 full day 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. 

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 (both extra-capsular and phaco-emulsification).

 Page updated March 26, 2010

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