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
- 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 10-12 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.
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.
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.
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.
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 10-12 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 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.
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, 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.
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.
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.
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 basis elements of the vision rehabilitation evaluation. Following this rotation the resident will be able to evaluate the needs of individuals who are visually impaired.
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 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 third-year 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.
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.