Rotations in Ophthalmology are 8 to 9 weeks in length. Most are located at UI Health Care Medical Center University, with an annual rotation a the Iowa City VA.
- 1st year: 5 rotations at UIHC, 1 rotation at VA Iowa City
- 2nd year: 5 rotations at UIHC, 1 rotation at VA Iowa City
- 3rd year: 4 rotations at UIHC, 1 rotation at Iowa City VA, 1 rotation at Des Moines VA.
The Comprehensive Ophthalmology Clinic and Cataract Service
The Comprehensive Ophthalmology Service examines patients desiring a general eye examination, cataract surgery, as well as those referred to the hospital because of vision problems. 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 contributes to 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 refraction, slit lamp biomicroscopy, gonioscopy when indicated, and indirect ophthalmoscopy of the retina. Residents are expected to become thoroughly familiar with all techniques and methods of the ocular examination.
Patient Visits
The Comprehensive Ophthalmology Clinic provides general ophthalmic care for more than 16,000 patient visits annually.
Cataract Service
Once a week during the 8-9 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 8-9 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 contact lens 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 a day each week learning the basics on contact lens and refractive surgery. The third-year resident has greater responsibility in the management of patients with cornea and external diseases. They participate in cornea and refractive surgery under experienced faculty supervision. There is a one-year cornea fellow working supportively with residents.
Contact Lens Service
Residents will enhance their knowledge of optics and develop an understanding of basic contact lens design and materials. The first year resident will experience fitting uncomplicated and cosmetic-type contact lenses, as well as observe more complicated medical contact lens fittings.
In the first year, the resident spends one-half day per week in the Contact Lens Service under the guidance of a full-time optometrist. During this time, the resident studies the specialty of contact lens fitting and problem solving, evaluation, and dispensing of contact lenses.
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 two full days and two half days a week for 8-9 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 third-year resident spends 8-9 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 selective 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. 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 8-9 weeks on this rotation. In the second year, the resident is in clinic 4 days and cataract surgery 1 day a week throughout the 8-9 weeks. The second-year resident on the Neuro-op Service is 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 during the pediatric rotation. The resident is instructed on the techniques in the evaluation of patients with oculoplastics issues, including exposure to the interpretation of radiologic studies of the orbit. The resident will spend time in the operating room for some of these cases.
A third-year resident spends 8-9 weeks on this service. The clinic is usually 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 post-operative 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 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, two 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. Residents are also responsible for inpatient consultations during the work week.
Pediatric Ophthalmology and Adult Strabismus Service
All pediatric eye problems are directed to Pediatric Ophthalmology and Adult Strabismus. Faculty, fellows, residents, and orthoptists examine and evaluate children and adults with motility problems. Certified orthoptists and student orthoptists also participate in the clinic. Depending on the year there could be 1-2 fellows on the service as well.
First-year residents spend most days of the week during the 8-9 week rotation in this clinic. Most of the first-year rotation time is spent learning the basic pediatric eye exam and routine pediatric diseases.
An additional rotation on this service occurs full time in the second year. The second-year residents on the Pediatric Ophthalmology and Adult Strabismus Service work up patients referred to the service. Surgical cases are supervised and handled by the senior attending staff, fellows, and the residents on the service.
Retina
The 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 ophthalmoscopy, slit lamp biomicroscopy, and diagnostic contact lens examination, and other techniques for the diagnosis of diseases of the retina and vitreous.
The second year experience on the Retina service provides an 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 under faculty and fellow supervision. Additionally, they will receive education and training in intravitreal injections and anti-VEGF medicaions
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. 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 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.
Uveitis Clinic
Exposure to the Uveitis Clinic takes place during the retina experience. 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.
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 third-year resident. The first-year resident begins their surgical skill training starting with dedicated wet lab curriculum and time to develop the basic techniques of ophthalmic surgery. Wet lab occurs on a weekly basis throughout VA rotation. Faculty supervise the clinic and assist the second-year residents in cataract surgery. All pre-operative patients will be examined and approved by a faculty member. Clinics are divided into subspecialties and each clinic 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. Third-year residents spend a 8-9 week block at the Des Moines VAMC and another block at the Iowa City VA.
Elective Rotation
In the PGY-4 year, residents will have the opportunity to customize their learning experience for an 8-9 week block. This experience will be geared toward the resident's future career goals. The resident would have opportunities to participate in global ophthalmology, research, cataract surgeries, specialty care, acute ophthalmologic emergency management, and other health care opportunities depending on interests.