Ophthalmology Residency. About the Program. Ophthalmology Residency at the University of Iowa. Committed to Education

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1 Ophthalmology Residency Welcome to the Department of Ophthalmology & Visual Sciences at the University of Iowa Hospitals and Clinics and thank you for your interest in our residency program. We offer a three-year ACGME-accredited program with a tradition of excellence. Our program is recognized as one of the finest ophthalmology training centers in the world and our clinical and research programs are consistently ranked among the best in Ophthalmology Times and U.S. News & World Report. Our department provides an environment that fosters not only intellectual curiosity and collaboration but also a commitment to teaching and patient care. Our facility covers over 56,000 square feet on two floors of the Pomerantz Family Pavilion as well as multiple off-site clinic and laboratory locations. With over 65,000 patient visits per year we are constantly striving to provide first class patient care. Our residency program seeks to give residents a broad general ophthalmology background with the opportunity to gain experience in all subspecialty areas. Please take this chance to explore the possibilities you will find at The University of Iowa. About the Program Ophthalmology Residency at the University of Iowa We invite you to consider the advantages of a program that will expose you to: high-powered faculty members dedicated to your success comprehensive exposure to all subspecialties state-of-the-art clinical facilities The accomplishments of our residency graduates demonstrate our commitment to help you develop necessary medical judgment to succeed in your career endeavors. The ophthalmology resident training program gives residents a broad comprehensive ophthalmology background and opportunities to gain experience subspecialties as well. Thomas A. Oetting, MD, Director, Ophthalmology Residency Program Photo by University Relations Photography/University of Iowa In training residents, the Department strives to produce excellent practitioners. We also want our residents to learn to be good teachers and to acquire a critical and inquiring approach to investigating the unsolved problems of ophthalmology. Residents rotate through every service, work closely with faculty and fellows, and participate fully in surgery under the expert guidance of faculty. Residents are required to actively participate in clinical or basic research during their training. Committed to Education The ophthalmology resident training program lasts three years with five residents appointed annually. Our program is poised to meet the needs of the changing face of today s health care. We aim to assure that residents receive a broad comprehensive background in ophthalmology and develop research skills to make them better clinicians. We want to assure our graduates are completely ready for whatever they may encounter in private practice or in further training in a

2 subspecialty. We are committed to providing all our trainees with an appropriate and varied surgical experience to achieve competence as ophthalmic surgeons. With this commitment, we feel we have a moral obligation to our patients and the public to foster the highest moral and ethical behavior. Approximately half of our graduates enter private practice immediately upon completion of the 3-year residency. Others pursue fellowship training before going into practice or entering an academic career. Regardless of a resident or fellow's choice of career path, he or she should feel fully confident of having received the best possible training in ophthalmology. As part of the Iowa Ophthalmology Family, they have worked with dedicated and experienced faculty in a contemporary and world-renowned program. We believe at the completion of training, graduates of the University of Iowa Department of Ophthalmology and Visual Sciences are prepared for the challenges ahead and can look forward to the fulfillment that comes from pursuing a career that fosters life-long education. Accreditation and Board Certification Accreditation of Ophthalmology training PROGRAMS is provided by the Accreditation Council for Graduate Medical Education (ACGME). The ACGME sets general requirements for all residency training programs as well as special requirement and prerequisite information for each specialty. These requirements are enforced by the various Residency Review Committees (RRC). For additional information visit ACGME-accredited programs in ophthalmology must be 36 months in length. Certification of INDIVIDUALS trained in Ophthalmology is provided by the American Board of Ophthalmology (ABO). To be eligible for examination you must have satisfactorily completed 12 months of broad clinical training (PGY-1) and a formal residency training program in Ophthalmology of at least 36 months (some programs require 48 months). All training must be in accredited programs in the U.S. or in Canada. It is possible that a State Licensing Board will give you credit for foreign training, whereas the ABO will not. You should check with the ABO about this before you enter the match or start your training. The Board Certification process must be completed not more than 6 years after your training. All Certificates require completion of a designated renewal program every 10 years. For more detailed information visit the American Board of Ophthalmology's website at Quick Facts By the Numbers Number of residents accepted each year: 5 ACGME approved residents for our training program: 15 Length of Residency: 3 years Graduates who go on to fellowships: 54% Faculty Members who train Ophthalmology residents: 28 Required rotations 1st and 2nd year: four of five week rotations are scheduled at University of Iowa Hospital One rotation annually is at the VAMC, Iowa City 3rd year: one of five rotations is in Des Moines and is split between the VA Medical Center and Broadlawn Hospital Page 2

3 Benefits Department of Ophthalmology & Visual Sciences Competitive Stipends Comprehensive medical, dental, hospitalization and pharmacy benefits for residents/fellows and their dependents Vacation each year: 3 weeks, for specific information Paid Time Off and Leave Information Board Certification Requirements Visit the American Board of Ophthalmology for specifics on board certification requirements Stipends Our stipend schedule is designed to provide each house staff member with income to maintain a comfortable standard of living in Iowa City and surrounding communities. Annual stipends for the fiscal year are as follows: Pay Grade Levels Stipends Stipends PGY-1 $52,200 $53,300 PGY-2 $54,100 $55,100 PGY-3 $56,200 $57,100 PGY-4 $58,300 $59,100 PGY-5 $60,400 $60,800 PGY-6 $62,900 $63,300 PGY-7 $64,900 $65,300 UI Hospitals and Clinics pays stipends monthly, usually on the first day of the month. For appointments that begin July 1, the first stipend will be paid August 1. Benefits Our salary and benefits compare with the top training programs in the country. We are committed through our benefits programs to protect trainees and their families and to offer them a wealth of services. Read more at Here you will find information about Medical, Dental, Hospitalization and Pharmacy Coverage Counseling and Crisis Management Services Life, Disability, and Malpractice Coverage Computer and Software Purchases GI Bill Paid Time Off and Leave Information Reduced UI Tuition Retirement Savings GME Policies We have indexed our policies and procedures in a document clearinghouse as a means of keeping items there as up to date as possible. Each of the documents listed on the clearinghouse page is in pdf format and will be downloaded to your computer. All policies are subject to change. See Page 3

4 Frequently Asked Questions Where is Iowa City? Iowa City ( is 220 miles directly west of Chicago on Interstate 80. It's also within a 4 to 5 hour drive to Milwaukee, Madison, Minneapolis, Omaha, Kansas City and St. Louis. It has the cultural, educational, social and political opportunities of a bigger city with the values and ambiance of a midwestern town. It's clean, safe, nothing is farther than a 20 minute car ride, it has a great city bus system (with bike racks!), wonderful parks, bike and hiking trails, sports, schools and even sailing. Those who have lived here and left, frequently return because what they were looking for was in their own back yard. What's the weather like in Iowa City? It depends on what you like. Our weather was a lot better than the East Coast this year! For about two weeks every winter it's very cold and windy and for two weeks every summer it's really hot and humid. For the rest of the time it's pretty nice. We consider our weather character building. The average warmest month is July and the coolest month is January. High temperatures between May and September are between 73 and 87 degrees (Yearly Avg. 60.9). The average low temperatures between October and April range from 15 degrees to 42 degrees (Yearly Avg. 39.8). Average number of sunny days is 166. The highest recorded temperature was 104 F in The lowest recorded temperature was -26 F in The maximum average precipitation occurs in June, average annual rainfall is 35.2". Average snowfall is 28" (with an average of 16 days of measurable snowfall per winter). What is there to do in Iowa City when you're not working? There are 15 different festivals and art fairs, plus concerts and race events. There are many music venues, sports events and neighborhood street fairs and garden walks. We also have a really big mall and several smaller ones, 50 parks, 9 golf courses, 6 public tennis courts, 6 public pools, some lakes and a reservoir with trails, camping & boating. There are hiking and bike trails, some famous bookstores, a ton of galleries and excellent museums. There are half a dozen or more performing arts venues. There's always something going on. University of Iowa Events: List What's happening in Iowa City/Coralville? What's Iowa City like for kids and families? There's ice skating, bowling, organized sports, public parks, miniature golf, a great public library, a toy library, fun centers, swimming pools and 3 beaches, 9 museums including a children's museum, dance companies and public recreation centers that feature many activities for kids and families at little or no cost. We also have 20 movie screens and 50-licensed daycare providers. The Iowa City schools are perennially ranked among the top schools in the nation. Iowa City is unique in the facilities and services available for individuals with disabilities. Many families who have a Page 4

5 family member with a disability are reluctant to leave Iowa City because they cannot duplicate those services in another location. It's a great place to live, but don't just take our word for it, see what others are saying: 30 things you need to know about Iowa City Iowa's Creative Corridor: Pick Your Pace: Iowa City Area Development: About living here: Are there any job opportunities for my spouse/significant other? Yes, in July 2014, Iowa City had an average of 3.2% unemployment (compared to 4.5% in the state of Iowa and 6.2% nationwide). Also check out The University of Iowa's Dual Career Network: How ethnically diverse are the patients? Like a lot of university towns, we have a large international community. Growing cultural diversity is another reason Iowa City is an interesting place to live. Diversity is embraced and celebrated with city and university events, festivals, clubs and programs. The University works hard to recruit and retain minorities with its affirmative action policies. About 15% of Iowa Citians are non-white, this percentage is paralleled in our clinics. What are the fellowship opportunities available? Ten to 12 fellows train in our accredited fellowship programs each year. We have fellowships in all of our sub-specialty areas. Most are one-year fellowships but 2-year fellowship opportunities are available as well. About half of our residents enter fellowships immediately after graduation. Is this a family friendly program? We love children and support residents in their efforts to balance work with family life. We have several dual physician resident and faculty families and understand the stresses. Women residents receive up to 6 weeks of paid maternity leave after delivery. Men get 5 working days off for paternity leave. The house staff health insurance policy provides full coverage for spouses and children. There are several childcare facilities near the hospital and one on-site. The training program also has activities during the year where all family members are invited. Is there sufficient patient volume so that I can have multiple exposures to a variety of eye diseases and conditions? Our patients represent all age groups and all socioeconomic strata and they present with virtually all acute and chronic conditions of the eye. With nearly 64,000 annual patient visits you will see plenty of the most common eye conditions and many of the less common ones as well. Our clinical practice serves the general eye care needs of the local community and the subspecialty needs of the region. The UIHC is a tertiary care center and our department receives referrals for specialized services from Iowa and neighboring states. Some patients travel from outside the continent to be seen by our physicians. In an average year, patient visits per sub-specialty are approximately: Cornea: 7,000 Comprehensive Ophthalmology: 11,500 Glaucoma: 5,800 Neuro-Ophthalmology: 3,600 Oculoplastic Surgery: 3,800 Page 5

6 Contact Lens: 4,100 Pediatric Ophthalmology: 7,800 Retina/Vitreous: 15,500 Vision Rehabilitation: 3,000 Other: 1,600 The surgical statistics for ophthalmology resident graduates will give you an idea of how many surgeries you may encounter over your three-year residency: Surgical Statistics for Ophthalmology Residency Graduates. Ophthalmology Resident Surgery Statistics Surgical Statistics for Ophthalmology Residency Graduates Required surgeries ACGME minimum Average 2014 UI Ophthalmology Graduate Cataract - Total (S) YAG (S) 5 36 Glaucoma filter/shunt (S) 5 8 Laser trabeculoplasty (S) 5 12 Laser iridotomy (S) 4 15 Strabismus - Total (S) Retina Vitreous-Total (S+A) Intravitreal Injection (S) Panretinal laser photo Keratoplasty (S+A) 5 19 Pterygium/Conjunctival & other cornea 3 7 K refractive - Total (S+A) 6 8 Plastics Total (S) Chalazion (S) 3 8 Eyelid laceration (S) 3 10 Ptosis/blepharoplasty (S) 3 43 Open Globe- Total (S) 4 9 S = Surgeon Procedures Only S+A = Surgeon and Assistant Procedures What is the program's balance between primary and specialty care? We seek to provide each resident physician with a sufficiently broad experience that he or she can choose wisely among all the options to pursue a career in ophthalmology in private practice, group practice, or an academic career. About half of our graduates go on to private practice while the remainder go on to fellowships in ophthalmic subspecialties or academic ophthalmology. What are the on-call expectations of ophthalmology residents? Call is divided into first call, backup call, and faculty call for Retina, Oculoplastics, Neuro-ophthalmology, as well as general call. Resident call schedules are prepared by the residents. The week day calls are split by the first and second year residents. Weekends and holidays are covered by first year residents. Third year residents provide back up call. Residents are not placed on the call schedule during their first 2 months in the department. At-home call must not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call are provided with one day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period. Page 6

7 What makes a great resident? As part of an interview for Pearls of Ophthalmology, our residency program director, Dr. Tom Oetting addressed this question and an excerpt from this interview follows: "A great ophthalmology resident is hard to define but when you see it, you know it. A great resident has infectious enthusiasm for our great profession and the science of the eye. He or she enjoys working with patients and wants more clinic opportunities, more surgical opportunities, and more chances to learn. A great resident makes our patients feel cared for and special. A great resident is coach-able (i.e. learns from his or her mistakes and moves on). A great resident is a great teacher and creates a sea of medical students interested in ophthalmology. A great resident gets things done when they said they would. A great resident does their dictations, notes, work hour requests, faculty evaluations, and the other important administrative jobs on time and with no fanfare. A great resident gives more than he or she takes. And like a good camper, a great resident leaves our program better than when they arrived" Is there a research requirement for graduation? Yes, participation in research is an integral part of the training experience. During the first year, residents develop a research plan for conducting at least one research project. All projects are done in collaboration with a faculty preceptor who will supervise all phases of the project. Each resident presents the results of his/her research at the department's resident and fellow research day. The initial presentation is made in the spring of the first year even when the results are in the pilot or preliminary stages. Updated presentations are made in the spring of subsequent years revealing the maturing or completed project. While some projects will not result in a published manuscript, our residents are coauthors on a number of published papers each year. What's so good about Iowa? Our faculty are really nice, and exceptionally dedicated teachers too. We have a diverse faculty with wide-ranging clinical and research interests. Some of our faculty are internationally known and have been with us for many years. We also have several bright young faculty who bring new interests and enthusiasm to the practice. You work with and learn directly from faculty on all rotations. All the subspecialties are represented in our training program. Our programs, clinical, research, and teaching are consistently ranked in the top ten nationally. The clinics, hospital, and inpatient units are located within a single hospital, with 1 rotation per year at the VAMC located just across the street. The ASC is conveniently located directly above the clinic at both locations. (No hours of commuting through traffic daily to get to work.). You have access to a locked resident room with your own desk, file, phone, internet port, and personal space. A dedicated ophthalmology library located directly below the clinic with a world-class librarian. A state-of-the art EMR system (EPIC), with the ability for both remote and mobile access Our residents are great people and they make exceptional ophthalmologists. Iowa City is a highly intellectual community (Iowa City has been named a UNESCO City of Literature) with an abundance of arts and culture events that are accessible to residents both in terms of cost and location. A competitive stipend and benefits in a region with very low cost of living We have an outstanding school system for children in grades K-12. A great training program and a high quality of life We want you to succeed. If you have additional questions please contact our program coordinator at laura-pitlick@uiowa.edu Page 7

8 Medical Licensure Residents should apply for a resident license at least three months in advance from the Iowa Board of Medicine ( Contact the Iowa Board of Medicine at Every resident is responsible for acquiring a medical license prior to practicing medicine at UI Hospitals and Clinics. State of Iowa law prohibits practice without the proper license. Contracts Each house staff member is issued a contract each year until the conclusion of training. All house staff at the University of Iowa Hospitals and Clinics (UIHC) will be promoted upon the satisfactory completion of the program year and evidence of satisfactory progressive scholarship and demonstration of clinical competence and professional growth. Each house staff member will receive regular and timely assessment of his/her overall performance and competencies (in patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism, and systems-based practice). The procedures referenced in the Policy and Procedures for the Evaluation and Advancement of House Staff are designed to ensure that all house staff members are promoted to a higher level of responsibility at the appropriate time. Those house staff members who have not satisfactorily completed the program year and who fail to show evidence of satisfactory progressive scholarship or to demonstrate clinical competence and professional growth, may be offered a remediation plan of action prior to promotion, as deemed appropriate by the Program Director and as described in the Policy and Procedures for the Evaluation and Advancement of House Staff. House staff members denied promotion or reappointment are provided due process as described in the UIHC Statement on House Staff Member Concerns and in Article IV, Section VII of the Bylaws, Rules and Regulations of the UIHC and its Clinical Staff; in the case of a denial of promotion or denial of a reappointment, the Program Director should consult with the Graduate Medical Education (GME) Director who may confer with UIHC Legal Services. Foreign Applicants For information regarding policies as well as Visa issues, please contact the UI Graduate Medical Education Office ( University of Iowa Hospitals and Clinics, C123-GH 200 Hawkins Drive, Iowa City, Iowa Phone: gmeoffice@uiowa.edu Page 8

9 Ophthalmology Training Program Duty Hours Department of Ophthalmology & Visual Sciences Duty hours are defined as all clinical and academic activities related to the program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities. Residents must be provided with one day in 7 free from all educational and clinical responsibilities, averaged over a 4- week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities. Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods. At-home call (pager call) is defined as call taken from outside the assigned institution. The frequency of at-home call is not subject to the every-third-night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call must be provided with one day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period. When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit. The program director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue. Residents should report time spent at hospital after 2:00 AM to the Program Director or Program Coordinator the next morning and will most likely be released at noon to avoid fatigue related errors. Weekend Call Duties The weekend on-call residents have the same responsibilities as weekday call. Additionally, any patient scheduled for admission or work-up on the weekend is the resident's responsibility. If an operative permit is required, it will be explained to the patient by the surgical team who will come in to the hospital to examine the patient and answer the patient's questions. Any questions about weekend patients should be directed to the senior resident on call or the appropriate service. The second call physician (a senior resident) will be available to the first call resident for consultation. In addition, he or she will decide, after clearing it with the senior staff member on call, when and if emergency operations should be done. No surgery is to be performed without approval of the senior faculty. Intraocular trauma or orbit cases may only be performed in the presence of a senior faculty member. The senior resident must be available by telephone at all times. The senior resident is required to come in to see any patient on whom the "First Call" resident requests consultation. Finally, there are four "Senior Staff Call" lists. 1) The senior staff member on general call will be consulted by the thirdyear resident and will be contacted before any patient is admitted to the hospital or before an operation is planned. 2) The senior staff retina call list is made up of members of the Vitreoretinal Service, who will assist in handling posterior segment trauma and retinal detachments. 3) The Oculoplastic Service covers the plastic call and assists in any problems involving trauma to the lids, adnexae, and orbit. 4) The Neuro-ophthalmology on call staff. The senior staff members also have pagers. Page 9

10 No operation may be performed without the consent and assistance of the senior staff member. Integrated Internship Department of Ophthalmology & Visual Sciences Our integrated internship (PGY-1 year) is in its second year with rotations in our internal medicine and ophthalmology departments. The integrated internship is required starting with interns entering July This internship will include 8 four-week rotations on the medicine service and 5 four-week rotations on ophthalmology. The interview for the internship will occur along with our ophthalmology residency interview. We hope this will make the process simpler and more economical for applicants. As an intern on the ophthalmology service, you will learn basic examination skills and be ready to take care of most simple problems and triage complex eye problems. While on the ophthalmology service, you will have no call, thus allowing you to focus on study. The intern year will be divided into thirteen 4-week rotations. Two to three 4-week ophthalmology rotations at the Iowa City VA Medical Center, caring for patients in clinic. Two to three 4-week rotations on the UIHC comprehensive ophthalmology service, caring for patients in clinic, the emergency department, and the inpatient units. Eight 4-week rotations on the medicine service, covering the wards at UIHC and the VA. Two of the eight rotations will be outpatient ambulatory medicine rotations, 1 block of rheumatology and 1 block of either general ambulatory medicine or endocrinology, during these blocks there is no call, allowing further time for study. The objective during these rotations will be to hone your basic medical skills, including the management of inpatients. Three weeks of vacation over the year, two during medicine blocks and one during ophthalmology blocks We believe there are many distinct advantages to our integrated internship program. Providing far more ophthalmology experience than would be possible at an outside preliminary or transitional year program. This added level of experience, all before taking any call, will make the transition to call responsibilities smoother and more effective. Becoming an integrated member of our ophthalmology team early in your training. Avoiding multiple interviews for other intern year positions, saving time, money and stress. Monthly lunch lectures directed towards interns on basic, commonly encountered diagnoses in ophthalmology. Moving only once during residency. Gaining familiarity with the hospital, electronic medical record, and members of other services with whom you will be working throughout the remainder of your residency. Having access to our structured wet lab and Eyesi surgical simulator. Acquiring exposure to a broad range of available research projects that can be carried forward through your ophthalmology residency. We are excited to offer this integrated opportunity that promises to make our program the best in the country. In the additional five months of ophthalmology training, our residents will learn systems-based skills, have ample time for independent study, and learn basic ophthalmology exam and assessment skills which will put them far ahead by the time they begin their PGY-2 year. Page 10

11 Questions? For questions regarding our new combined internship feel free to contact our Program Director, program coordinator, or any of our current integrated IM/Ophthalmology interns: T.J. Clark Lindsay McConnell (Lindsay- Matthew Miller Lorraine Myers or Tyler Risma First Year Residency The first year is spent in a combination of comprehensive ophthalmology service and subspecialty clinics. The year is arranged to allow the resident to acquire skills in complete ocular examination and refraction of ophthalmic patients at the UIHC Comprehensive Ophthalmology Clinic and during a 10 to 12 week rotation at the VA. In this year, Residents also rotate through subspecialty clinics with the intent of learning some of the vocabulary, examining techniques, and equipment used in each area. There are 5 rotation blocks per year, however, some of these rotations are split between two or more services. This in the first year, the resident will spend time in the following services: Comprehensive Ophthalmology Clinic Cornea/External Disease Glaucoma Neuro-Ophthalmology Oculoplastics Ocular Pathology Pediatric Ophthalmology & Adult Strabismus Retina VAMC-Iowa City Research Requirement Second Year Residency During the second year, residents begin their surgical rotations. They have five rotations spending ten to 12 weeks in pediatric ophthalmology/strabismus, glaucoma, neuro-ophthalmology, retina, and at the Veterans Affairs Medical Center in Iowa City. While on the neuro-ophthalmology rotation, residents spend one day a week on cataract surgery. They spend less time on call during this phase of the residency program and often work on their required research project and case presentations for eyerounds.org. Pediatric Ophthalmology and Adult Strabismus Service Glaucoma Service Neuro-Ophthalmology Service Vitreoretinal Service VAMC-Iowa City Page 11

12 Third Year Residency The third year the resident has increased clinical responsibility. This year is mostly spent with leadership and surgical experiences in the Iowa City and Des Moines VAMCs and University Comprehensive Service. Residents also train in Oculoplastics, office management, and Cornea. Residents have a ten-week rotation in the Des Moines VAMC that includes a clinic at the affiliated Broadlawns Hospital two afternoons a week. A rotation in office management allows the resident to begin learning the everchanging domain of billing, coding, and compliance with federal and state regulations. This rotation takes place in our departmental Billing Office to allow residents to learn the basic coding and billing principles needed for practice in today s health care environment. This is a split rotation, with oculoplastic surgery covered every other Friday. Oculoplastics/Orbital Oncology Service Cornea / External Diseases and Refractive Surgery Comprehensive Ophthalmology and Cataract Surgery Veterans Affairs Medical Centers o VAMC Des Moines o VAMC Iowa City International Ophthalmology Experience Option Research Requirement Ophthalmology Resident Call Schedule At UIHC First year residents: First call (none for the first 2 months) then every 5th weekend day and about every 10th weekday night Second year residents: First call every 5th weekend/weekday for first 3 then about every 10th weekday night Third year residents: Call backup about every 5th weekday and every 5th weekend At the VA Des Moines VA: The Third Year Resident on the Des Moines rotation takes call during the week from Monday to Thursday evening from home. (Rarely come in) Iowa City VA: First and Second Year Residents take alternate weeks of call while on the Iowa City VA rotation. (Rarely come in) Ophthalmology Residency Rotations and Services Rotations in Ophthalmology are ten to 12 weeks in length. Most are located at the University of Iowa Hospitals and Clinics (UIHC). 1st year: 4 rotations at UIHC, 1 rotation at VA Iowa City 2nd year: 4 rotations at UIHC, 1 rotation at VA Iowa City Page 12

13 3rd year: 3 rotations at UIHC, 1 rotation at VA Iowa City, 1 rotation in Des Moines (VA and Broadlawns) THE COMPREHENSIVE OPHTHALMOLOGY CLINIC AND CATARACT SERVICE The Comprehensive Ophthalmology Service examines all patients desiring a general eye examination, cataract surgery, as well as those referred to the hospital because of vision problems. The university student population of over 30,000 provides a major source for routine refractions. The Comprehensive Ophthalmology Clinic provides general ophthalmic care for more than 16,000 patient visits annually. Patients are screened for specific ocular problems and, if necessary, referred to appropriate specialty services. In addition, the Comprehensive Ophthalmology Clinic provides a daytime on-call service for emergent eye problems, diagnosis, care, and consultations. Each resident is expected to do a complete ophthalmic examination on each patient. This includes a manifest or cycloplegic refraction by retinoscopy, slit lamp biomicroscopy, gonioscopy when indicated, and direct and indirect ophthalmoscopy of the retina. Residents are expected to become thoroughly familiar with all techniques and methods of the ocular examination. CATARACT SERVICE: One day a week during the week Neuro-ophthalmology rotation in the second year will be spent in the Cataract Service. The resident on this service develops increasing responsibility for the care of patients before, during and after cataract surgery. They use deliberate practice of the capsulorhexis and post-surgical video formative feedback to hone their surgical skills. Residents on this service will hone their professional communication skills by helping with the preoperative, operative, and post-operative documentation on this busy service During the third year, the resident will rotate through the comprehensive service for a ten to 12 week continuous period. During this time, the resident develops comprehensive ophthalmologic care, evaluates and manages ophthalmic emergencies, and performs high-quality, efficient, anterior segment surgery. CORNEAL/EXTERNAL DISEASE AND REFRACTIVE SURGERY SERVICE On the Corneal/External Disease and Refractive Surgery Service, residents receive extensive training in the medical and surgical management of corneal diseases, including eye banking and refractive surgery. Each resident will rotate through this service twice during their training. The first-year resident, under the direction of the faculty, fellows, and more senior residents, are introduced to cornea and external disease examination techniques and treatment strategies, they also spend two days each week during the last five weeks of this rotation in contact lens.the third-year resident has greater responsibility in the management of patients with cornea and external diseases. In the third year, refractive surgery is done under faculty supervision. There is a one-year fellow working with residents. CONTACT LENS SERVICE A full-time optometrist supervises the Contact Lens Service. Under the supervision of the optometrist and optician, residents will enhance their knowledge of optics and develop an understanding of basic contact lens design and materials. During this time reisdents will experience fitting uncomplicated and cosmetic-type contact lenses, as well as post cataract surgical patients, infants as young as 2 weeks old, and others. In the third year, the resident spends one day per week for 5 weeks in the Contact Lens Service under the guidance of a full-time optometrist. During this time, the resident continues study in the specialty of contact lens fitting and problem solving, evaluation, and dispensing of contact lenses. Page 13

14 GLAUCOMA SERVICE The Glaucoma Service provides experience with medical and surgical decision-making in the management of these patients. The first-year resident spends time in this clinic three to five days a week for ten weeks. This initial exposure serves as the introduction to the clinical evaluation of glaucoma patients. The resident learns and performs diagnostic skills including visual fields and OCT needed for the evaluation of anterior segment disease as it pertains to glaucoma. The second-year resident spends ten weeks managing challenging glaucoma patients. The resident does complete evaluations of new glaucoma patients and provides continuing care to patients returning for follow-up care. The resident gains experience at gonioscopy, optic nerve head examination, kinetic perimetry, and static threshold perimetry. Laser therapy for glaucoma, including Argon laser trabeculoplasty and laser peripheral iridotomy, is performed by the resident under staff supervision. Glaucoma filtering surgery and cataract surgery on patients with glaucoma are performed during this rotation. There is a one-year fellow on the Glaucoma Service. NEURO-OPHTHALMOLOGY SERVICE The Neuro-ophthalmology Service is both an outpatient clinic and an inpatient consultation service. Many patients have complex problems that require extensive evaluation. Each patient is seen by a resident or fellow and staffed by faculty. Patients requiring an in-hospital work-up are admitted to Neurology but are followed by the Neuro-ophthalmology Service. Consultations for temporal artery biopsies are handled by this service. All patients are presented to staff at the time they are seen and are then discussed during daily working rounds. Residents from Neurology and Neuro-surgery may take elective rotations in the Neuro-ophthalmology Clinic. There are usually one or two fellows in the Neuro- Ophthalmology Service. First-year residents spend one day per week for 10 weeks on this rotation. In the second year, the rotation occupies weeks. The second-year resident on the Neuro-op Service is also responsible for moderating morning rounds. Residents on the Neuro-ophthalmology Service are also responsible for moderating morning rounds. OCULOPLASTICS/ORBITAL ONCOLOGY SERVICE The Oculoplastics Service is involved with the evaluation and management of patients with diseases of their eyelid and adnexa, lacrimal system, and orbit. The first-year resident spends one day per week on this service for five weeks during this rotation. (The rotation is split in the first year between Cornea, Oculoplastics, Pediatrics, and Contact Lens). The resident is instructed on the techniques in the evaluation of these patients, including exposure to the interpretation of radiologic studies of the orbit. The resident is also expected to be present in the operating room for the first case on every Wednesday morning while on this rotation. A third-year resident spends ten to 12 weeks on this service. The clinic is conducted two days per week, with the residents and fellow seeing all patients prior to examination by the staff. The third-year resident performs or assists in surgery two days per week under the direction of staff or a fellow. Faculty provide guidance in ophthalmic plastic and orbital examination techniques, diagnosis and treatment of oculoplastic/orbital disorders, pre-operative and postoperative evaluation, management of surgical patients, and surgical management of oculoplastic/orbital problems. The oculoplastics fellow spends 24 months in training. The fellowship is approved by the American Society of Ophthalmic Plastic and Reconstructive Surgery. OPHTHALMIC PATHOLOGY / CONSULTATION SERVICE While on this rotation, residents perform gross examinations on tissues passing through the laboratory including whole eyes, corneal buttons, and all varieties of biopsy material. This gross examination is entirely supervised by faculty from Page 14

15 the Division of Eye Pathology. Each resident is responsible for studying the microscopic appearances of tissues and for discussing these cases. There will be no unsupervised handling of tissues. In the first year of residency, the afternoons of the Glaucoma-Consults/Pathology rotation are spent in the ocular pathology laboratory. Each resident is responsible for studying the microscopic appearances of tissues and for discussing these cases. Each rotation includes at least two presentations in Morning Rounds of a histopathologic clinical correlation. Residents are responsible for inpatient consultations during the work week. PEDIATRIC OPHTHALMOLOGY AND ADULT STRABISMUS SERVICE All pediatric eye problems other than routine refractions are directed to Pediatric Ophthalmology and Adult Strabismus. Faculty, fellows, residents, and orthoptists examine and evaluate children and adults with motility problems. Two certified orthoptists and student orthoptists participate in the clinic. There are usually one or two postgraduate fellows on the service as well. First-year residents spend Monday, Tuesday, and Tuesday of a second 5 week block in this clinic, Most of the first-year rotation time is spent with the orthoptists learning the basic pediatric eye exam. An additional ten weeks on this service occurs full time in the second year. The second-year residents on the Pediatric Ophthalmology and Adult Strabismus Service work up all patients referred to the service. Surgical cases are supervised and handled by the senior attending staff, fellows, and the residents on the service. In advance of the rotation on the Pediatric Ophthalmology Service, a study outline with pertinent references is given to each resident. At various times, topics are discussed. Reading of the prescribed outline is essential in understanding these discussions. MEDICAL RETINA The Medical Retina rotation introduces first-year residents to medical retinal diseases. The first-year resident is not expected to be in the operating room. Emphasis is placed on vascular disorders of the eye, diabetic retinopathy, macular disease, and retinal detachment. The resident also receives instruction on fluorescein angiography, indirect and direct ophthalmoscopy, slit lamp biomicroscopy, and diagnostic contact lens examination, and other techniques for the diagnosis of diseases of the retina and vitreous. VISION REHABILITATION The medical retina rotation also involves the evaluation of patients with low vision. In the Vision Rehabilitation Service, the first-tear resident is exposed to the various vision rehabilitation aids. The work-up and rehabilitation of low vision patients is done with faculty supervision. The resident will first observe a vision rehabilitation practitioner providing vision rehabilitation services. As the rotation progresses, the resident will perform the basic elements of the vision rehabilitation evaluation. Following this rotation the resident will be able to evaluate the needs of individuals who are visually impaired. VITREORETINAL SERVICE The Vitreoretinal Service provides an opportunity for residents to gain a broad experience in disease and surgery of the retina and vitreous. The resident will be trained in the use of laser photocoagulation to treat retinal breaks and diabetic retinopathy. Residents will receive an introduction into the theory and practical application of scatter laser treatment for diabetic proliferative disease. During the second year of residency, the resident becomes skilled in the use of indirect ophthalmoscopy, scleral indentation, contact lens examination of the fundus, and fluorescein angiography. They perform laser treatment on diabetic patients under faculty or fellow supervision. The quality of the resident's work-up, skill in indirect ophthalmoscopy and Goldmann lens examination, and surgical dexterity are important factors in ascertaining the Page 15

16 resident's qualifications for this type of surgery. Faculty and fellows actively participate in resident training. Four fellows spend 24 months studying vitreoretinal diseases and surgery and ocular oncology. The vitreoretinal fellowship is staggered so that two new fellows begin each July. VETERANS ADMINISTRATION HOSPITALS Residents rotate through the Iowa City VA Medical Center in each of the three years of residency. During their first-year rotation, residents share primary patient responsibility in the VA clinic with a second-and thirdyear resident. The first-year resident begins to work in the OR starting in the simulator and wet lab. Faculty supervise the clinic and assist the second-year residents in cataract surgery. All pre-operative patients will be examined and approved by a staff member. Subspecialty surgery is supervised by members of the appropriate service. Faculty supervise the clinic and assist residents in surgery. The Veterans Administration Medical Centers in Iowa City and Des Moines allows the third-year resident to supervise and run a busy outpatient clinic, with faculty supervision available promptly on request. Third-year residents spend ten to 12 weeks at the Des Moines VAMC, which includes a clinic at the affiliated Broadlawns Hospital. UVEITIS This intensive experience in a busy Uveitis Clinic takes place on 10 half-days during a 10 week rotation during the first year. The resident develops the history-taking and examination skills to care for complex uveitis patients. The resident learns to navigate the system of care to allow for consultation with various services and laboratory assessment to properly care for uveitis patients. Rounds, Lectures, and Conferences Grand rounds are held Monday through Thursday from 8:00 to 8:45 a.m. in the Braley Auditorium. All residents and staff attend unless operating or engaged in acute medical care. During rounds, residents and fellows develop their public speaking skills by making presentations. Discussion by the faculty and house staff follows each case. The cases and discussions presented by Residents and Fellows at Grand Rounds are often further developed and published as case reports and tutorials on EyeRounds.org. Afternoons are, in general, reserved for rotation-specific conferences. Some services such as glaucoma, cornea, neuro-ophthalmology, and pediatric ophthalmology have "chart rounds". These conferences focus on interesting patients that presented that day. Discussions center on patient care but also cover other areas such as communication, ethics, and systems based care. Other services such as retina have formal conferences, such as Fluorescein conference on Monday afternoons, and Dr. Ed Stone's molecular ophthalmology rounds on Tuesday nights. Once a week during the academic year, didactic lectures on ophthalmology are presented. These two-hour lectures are organized to coincide with the American Academy of Ophthalmology s Basic and Clinical Sciences Course. Lectures cover most aspects of basic and clinical ophthalmology. Once every 10 weeks these sessions include a journal club covering recent journal articles in that subject area to help develop skills in practice based learning. Six, day-long clinical conferences are held during the academic year. Clinics are closed on these days. Ophthalmologists from throughout Iowa and Illinois attend and present challenging clinical problems for discussion by faculty and guests. These meetings feature a visiting professor who presents a lecture based on his/ her research interests. The day is Page 16

17 balanced by the presentation of a more clinically oriented topic. This conference has contributed to the excellent rapport between practicing ophthalmologists and the ophthalmology staff at the university. Each year in June, alumni and other members attend a two- to three-day Iowa Eye Association meeting with invited speakers and a focus on a specific subspecialty topic. Presentations of research are made annually during the Resident/Fellow Research Conference at the end of the academic year. Ophthalmology Upcoming Event Calendar: Relaxation and Fun It's not all about work. At Iowa you meet some great people and forge life-long relationships with your colleagues. Second Year Residents celebrate with an "End of First Call" retreat in late summer. Each Fall we attend a Phacoemulsification course in Madison; at the end of the day, there is always time to relax and have some fun. At the American Academy of Ophthalmology Annual Meeting, the Iowa Eye Alumni reception gives current residents a change to network with alumni of the program. Page 17

18 There are many other opportunities to relax and have some fun. Among the many regularly scheduled events are a monthly "Breakfast with the Head" during the first year, as well as the Annual Iowa Eye Association social events which include a golf tournament. Attending Hawkeye football games at Kinnick Stadium directly across the street from UIHC is always a blast. Our annual graduation celebration is held in Kinnick stadium's luxurious press box. International Ophthalmology Experience The University of Iowa provides a global perspective. Ophthalmology Residents have an opportunity to participate in an international training experience during their third year of training. This experience exposes residents to different health care systems around the world and helps shape practice and career choices. In some cases, residents travel with Iowa alumni on global health and mission trips. Our residents have traveled to places such as Nigeria, Philippines, India, Peru and the Dominican Republic. Research Training Each ophthalmology resident and fellow is expected to complete a research project based on clinical or laboratory experience. Research is usually performed within the department, but can take place in another department or, occasionally, at another institution. The research interests of the faculty are varied, and many projects are in progress. Presentations of research are made annually during the Resident/Fellow Research Conference at the end of the Page 18

19 academic year. The P.J. Leinfelder Award is given annually by a faculty committee to the resident and fellow who have made the most significant contributions in preparing and delivering their research. Visit our most recent Resident/Fellow Research Day program for examples of typical areas of research interest: Research in Ophthalmology and Visual Sciences Department of Ophthalmology & Visual Sciences The Carver College of Medicine is internationally recognized for its excellence and leadership in biomedical research. Among public medical schools, the College of Medicine ranks 11th in NIH funding in both the number of grants and total grant dollars per research faculty in public medical schools. In 2013, Stephen A. Wynn made a $25 million gift to the University. The Stephen A. Wynn Institute for Vision Research continues to garner funding for its ground-breaking research. Carver College of Medicine faculty have been awarded approximately half of the University's total research funding and more than 80 percent of its National Institutes of Health funding. The University of Iowa is at the forefront among research universities in this country, and its contribution has been nationally recognized by such eminent authorities as the Carnegie Foundation, which classified The University of Iowa as having "very high research activity" among research universities. The Laboratory for Disease Gene Discovery (LDGD), directed by Val C. Shefffield, MD, PhD, has as its primary goal the identification and characterization of genes involved in hereditary human disease with special emphasis placed on the study of hereditary retinopathies including agerelated macular degeneration. The main strategies used by the laboratory are the use of genetic mapping methods and genomic resources to identify disease genes based on their position within the genome and/or putative function. The LDGD has developed thousands of highly polymorphic human genetic markers and novel genetic mapping methods to aid in the efficient mapping of disease loci. In collaboration with the MOL, the LDGD has succeeded in the mapping of over thirty human disease loci, and the identification of ten disease-causing genes including genes involved in glaucoma, macular degeneration and syndromic retinopathies (Bardet-Biedl Syndrome). The Iowa Glaucoma Center, directed by Dr. Wallace L.M. Alward, researches the causes of glaucoma and develops tools to aid in diagnosis and treatment. The Glaucoma Genetics Laboratory, directed by John Fingert, MD, PhD, is dedicated to identifying these genes and investigating their role in the development of disease with the ultimate goal of preventing vision loss by improving diagnosis and treatment of glaucoma. The Glaucoma Cell Biology Laboratory, directed by Markus Kuehn, PhD, is located in the Medical Education and Research Facility. The goal of this laboratory is to determine the molecular events that lead to retinal ganglion cell death in a variety of retinal diseases. While the research focus is glaucoma, the lab is also investigating ganglion cell death in retinal ischemia and other optic neuropathies, such as idiopathic intracranial hypertension. The Chorioretinal Degenerations Laboratory is directed by Rob Mullins, PhD. The major focus of this laboratory is to understand the cellular and molecular basis of macular diseases, including age-related macular degeneration (AMD), central serous retinopathy and Best vitelliform macular degeneration. Page 19

20 o The laboratory is exploring the role of the choroid in the development of AMD and other diseases. It is also looking at the pathogenesis of other macular diseases including Best disease, Bardet-Biedl syndrome, Leber congenital amaurosis, retinitis pigmentosa, uveitis, and other acquired and inherited diseases of the retina. It utilizes animal models, human donor eyes, cell culture approaches, biochemical methods and genetic resources unique to the Carver Family Center for Macular Degeneration to approach this problem. The Iowa Visual Field Reading Center is directed by Chris A. Johnson, PhD. The University of Iowa Visual Field Reading Center was established to provide clinicians and researchers a means to quickly access and evaluate both raw and processed visual field data and to provide timely feedback to researchers, clinicians, and patients. The Center's main operations are centered around a team of visual field experts led by Director Chris A. Johnson, PhD and Assistant Director, Michael Wall, MD; faculty include: Randy Kardon, MD, PhD. The Center is located at the Oakdale Research and Technology Innovation Campus. Mahajan Laboratories: Vinit Mahajan, MD, PhD, directs a laboratory with research projects in genomics, phenomics, proteomics, and microsurgery of the retina and vitreous. Research in Gene Therapy for eye diseases is under the auspices of Stephen R. Russell, MD and Arlene V. Drack, MD. The University of Iowa is a leader in finding genetic causes of common and uncommon eye diseases such as Leber congenital amaurosis (LCA). Under the Carver Family Center for Macular Degeneration in the Department of Ophthalmology Institute for Vision Research, Drs. Russell and Drack are collaborating with pioneer gene therapists at the Children s Hospital of Philadelphia to treat children blind from birth with Leber s congenital amaurosis. In addition Drs Drack and Russell are investigating gene replacement therapies and gene directed therapies in mice for other inherited retinal conditions. Drs. Drack and Russell are assisted by Genetic Counselor, Tiffany Grider, MS, CGC. Stem Cell Research for retinal, eye and related diseases is directed by Budd Tucker, PhD. New to the UI in 2010, Dr. Tucker s research on combining state-of-the-art patient-specific stem cell and biodegradable tissue engineering technologies for the treatment of blinding retinal degenerative diseases has earned a 2010 National Institutes of Health Director's New Innovator Award. Computer-Aided Diagnosis. Dr. Michael Abramoff and coworkers have established large retinal imaging networks in the Midwest of the United States and the Netherlands, with widespread networks of retinal cameras connected through the internet to the University of Iowa, for screening of diabetic retinopathy. The research combines clinical ophthalmology, visual neuroscience and bioinformatics to study the phenotypes and genotypes of diabetic retinopathy, age related macular degeneration and glaucoma. Many of our faculty are investigators for the Center for the Prevention and Treatment of Visual Loss at the Iowa City Veterans Administration Medical Center. Investigators: Randy Kardon, MD, PhD; Michael D. Abramoff, MD, PhD; Chris A. Johnson, PhD; Markus Kuehn, PhD; Young H. Kwon, MD, PhD; Thomas A. Oetting, MD; Milan Sonka, PhD; Michael Wall, MD. See additional information at The Stephen A. Wynn Institute for Vision Research. ( The WIVR supports and coordinates the vision research activities of nine existing research units at the University of Iowa. Ophthalmology Diagnostic Laboratories The Frederick C. Blodi Ocular Pathology Laboratory occupies approximately 1,350 square feet in the Carver College of Medicine. A major renovation of this space was completed in Dr. Nasreen Syed joined the department as the laboratory director in September The lab serves as a national reference center and has up-to-date tissue processing equipment and computers to meet Page 20