Ophthalmology

The residency program in Ophthalmology at the Ohio State University provides advanced clinical training and specialization in the diagnosis and treatment of ophthalmic diseases of small and large animals under the supervision of 2-3 board-certified specialists. Faculty members are nationally and internationally recognized leaders in their respective fields. The residency is a 3-year combined residency and graduate studies program leading to a Certificate of Residency and Master of Science degree.

Training is designed to insure development of clinical competence in ophthalmology by facilitating development of clinical proficiency, clinical skills, and knowledge of ophthalmology through exposure to a wide variety of cases at all levels of complexity. This goal is facilitated by location of the Veterinary Medical Center in a large metropolitan area (population over 1.5 million) that provides a rich variety of case material as well as a referral base that includes Ohio, Indiana, Pennsylvania, Kentucky, West Virginia and Michigan. Case management is carried out with the guidance and collaboration of experienced faculty who are recognized experts in their respective fields. State-of-the-art diagnostic and surgical equipment and facilities are available to develop technical expertise in diagnostic and therapeutic procedures.

All residents at The Ohio State University must complete a significant piece of original research that forms the basis of a thesis to meet requirements for obtaining a Master’s of Science (MS) degree. The research thesis must be completed and defended prior to completion of the 3-year training program. We believe that completion of the MS degree provides significant advantages to the resident in his/her maturation and development as an ophthalmologist. Regardless of the resident’s anticipated career (private practice, academia, research, or industry), the completion of advanced didactic courses (for example, biostatistics, immunology, pharmacology) and significant research as a principal investigator provide insight and understanding that are rarely achieved in clinical residency programs.

Objectives

The objectives of the program are for the resident to accomplish the following:

Develop comprehensive, state-of-the-art expertise and clinical and surgical proficiency in ophthalmology;
Satisfy the criteria necessary to qualify for Board Certification, and to prepare the resident for successful completion of the American College of Veterinary Ophthalmologists Certification Examination;
Prepare for future career goals of teaching, clinical research, scientific publication, or specialized practice; and
Complete a Master of Science or PhD degree in a specific area of research endeavor related to ophthalmology.

General goals of the residency program:

First year: 80-100% direct supervision. Goals are to develop a thorough understanding of the normal eye and establish the diagnostic/therapeutic foundation for clinical veterinary ophthalmology and to initiate the Master’s degree program by enrolling in classes in the Fall quarter and beginning a research project by the Winter quarter. The resident should also begin preparation for the ACVO application including establishing a case and surgical log.

Second year: 75-90% direct supervision. Goals are to develop a thorough understanding of comparative ophthalmology and ophthalmic pathology, refine clinical and surgical skills, complete master’s degree research project, continue preparation of the ACVO application and to develop competence in ophthalmic photography and microsurgery.

Third year: 75-80% direct supervision. Goals are to develop familiarity with current ophthalmic research, refine abilities in laboratory and exotic animal ophthalmology, to refine techniques in ophthalmic microsurgery and to finalize Master’s degree (thesis and defense) and application and preparation for the ACVO examination.

Faculty and staff

Faculty:

Dr. Anne Gemensky-Metzler (Ophthalmology Service Chief)
Dr. David A Wilkie (Tenured faculty)

Current residents:

Dr. Elizabeth Lutz DVM (residency July 2010- July 2013)

Ophthalmology staff:

Ms. Kelley Norris (Ophthalmology technician)
Ms. Chris Basham (Ophthalmology technician)

Prerequisites and application

All potential residents in ophthalmology must meet the minimum requirements and qualifications (see Residency Program Handbook, CVM Graduate Program Handbook and Graduate School Handbook).
- The residency in ophthalmology is a formalized program approved by the American College of Veterinary Ophthalmologists (ACVO).
Residents who are foreign nationals (non-US citizens) must be in possession of the appropriate visas and work authorization as outlined in the Department of Veterinary Clinical Sciences Residency Program Handbook (link). In addition, foreign nationals must also meet the requirements of the university Graduate school for the Test of English as a Foreign Languages (TOEFL) or Michigan Test of English Proficiency (MTELP) – see Graduate Program Handbook.

Employment and benefits

Residency Program Handbook

Salary
Health insurance
Book/travel allowance
Personal + Professional days leave (from policy)
External consultation and employment
Licensure

Orientation

During the first few days at the commencement of the residency program, all incoming residents participate in a comprehensive orientation program (link to Residency Program handbook) to introduce them to the department, college and university, complete necessary documentation, and to facilitate integration into our program and activities.
Following the general orientation program for all residents, new ophthalmology residents will meet with the faculty to discuss and plan the initial few weeks and months of the first year of the residency.
Typically, new residents will spend the first few days or weeks on clinical duty in an observatory capacity. Thereafter, new residents will take primary case responsibility and discuss each and every case with the faculty clinician before deciding on diagnostic approach and therapeutic management of the case. This period is variable dependent on the clinical knowledge and skills of the resident.

Advisors and mentoring

Clinical advisors: Each of the ophthalmology faculty members will serve in an equal capacity as clinical advisors. Residents will take advice and input from the on-clinic ophthalmologist.
Academic advisor: The principal academic advisor is decided once the area of research is decided. Until that time, all faculty are involved in initial discussions and planning of the direction of the resident’s research. The ophthalmologist who is not the academic advisor to the resident will always serve on the advisory and examination committees for the MS degree.
Thesis committee: Once the specific area of research is selected, an Advisory committee will be formed that will consist of the academic advisor, the ophthalmology faculty and any other faculty members who may be able to provide advice in the development of a specific research project, during the project and to completion of the study. Typically, the Advisory committee serves as the Examination committee for the thesis defense. These committees must consist of at least 3 graduate faculty members.
Mentoring: The ophthalmology faculty members serve as mentors throughout the course of the residency, graduate course program and research project. We regard mentoring of our residents as one of our most important, and most enjoyable, duties. We are committed to providing support, guidance and help in all aspects of their professional lives during the course of the residency. We care about our residents’ professional and personal development and aim to assist our residents in being the best that they can possibly be and to prepare them for successful careers in ophthalmology.

Clinical Service responsibilities

Residents are expected to participate in all small and large animal clinics, emergencies and all in-house consultations.
When possible, residents should examine all outpatients and hospitalized patients.
Residents should assist in and perform ophthalmic procedures

DIAGNOSTIC/THERAPEUTIC PROCEDURES

The resident is expected to be competent to set up and perform the following diagnostic/therapeutic procedures (this is not an all-inclusive list):

Biomicroscopy
Indirect Ophthalmoscopy
Direct Ophthalmoscopy
Tonometry
Ocular Photography
Equine nerve blocks
Gonioscopy
Ocular ultrasonography
Electroretinography
Visual evoked potentials
Radiation therapy using the SR90 probe (resident must complete OSU radiation safety training)
Aqueocentisis/Intracameral injection

SURGICAL PROCEDURES

Cadaver Surgery

1. The resident is expected to perform the following surgeries on cadaver eyes and submit videotapes of them to the mentors for evaluation prior to performing these surgeries on live animals:

Eyelid wedge resection
Entropion repair
Corneal laceration repair
Keratectomy
Conjunctival pedicle graft
Corneoscleral transposition
Penetrating keratoplasty
Corneal limbal incision and closure
Capsulorhexis
Phacoemulsification
Intraocular lens implantation
Extracapsular cataract extraction

2. The surgery room and equipment must be thoroughly cleaned following cadaver surgery.

Surgery Set Up and Clean Up

Residents are expected to set up the operating microscope, television monitor and phacoemulsification machine prior to surgery and to put away all equipment at the conclusion of the surgery day.
Residents are responsible for cleaning the micro surgical packs and the eyepacks and for flushing the irrigation/aspiration and phacoemulsification handpieces.
Residents are expected to develop an understanding of the mechanics of the phacoemulsification machine.

Surgical Procedure Timeline

First year: Residents are expected to become proficient in extraocular procedures such as entropion correction, eyelid tumor excision, enucleation and evisceration and intrascleral prosthesis. Depending on ability, residents may also primarily perform keratectomy and conjunctival graft placement and may begin to master the approach to cataract surgery (stay suture placement, corneal groove, corneal incision, beginning +/- completion of continuous tear circular capsulorhexis, +/- begin phacoemulsification, +/- closure of corneal incision. The resident is expected to be familiar with the use of magnificaton using both surgical loupes and operating microscopes and to be able to set these up and use them appropriately. The resident is expected to be familiar with microsurgical instruments, their names, use and care.

Second year: Residents are expected to become proficient in corneal surgery such as laceration repair, keratectomy, conjunctival graft placement. Major blepharoplasty and orbital procedures should become familiar. Depending on the resident’s abilities, he/she will assisted by a faculty member to perform intraocular surgery including phacoemulsification, irrigation/aspiration, implantation of intraocular lens implants, closure of corneal incision and lensectomy.

Third year: Residents are expected to refine microsurgical skills particularly in intraocular surgery as listed under the second year.

Medical Records

Medical records should be completed in a timely fashion and should include the following:

Chart diagnosis and signature
Ophthalmic examination sheet completed and department copy filed
Referral letter copy sent with a copy of ophthalmic exam sheet and bloodwork
In-patients’ SOAPs should be read at least once and comments made in the chart during the hospitalization of the pet to ensure that the patient is being properly cared for and that the student understands the diagnosis, treatment plan and prognosis.
Surgery reports should be reviewed, corrected and final copies approved, printed and filed within 24 hours of the surgery. It is the responsibility of the primary clinician on the case to make sure that the surgery reports are complete.
Follow up on laboratory tests and call owners and referring veterinarians with results. It is acceptable for the student on the case to call owners with results.
Follow up on pathology reports and call owners and referring veterinarians with results.

Telephone Consultations

Residents are responsible for promptly attending to all potential emergency calls.
For non-emergency calls, the calls should be returned the same day if possible, but must be returned by the following day.

After-hours Emergencies

Residents should arrange a schedule for emergency coverage and the schedule must be approved by the faculty.
The resident on call must be reachable by pager or phone at all times.
The resident on call should examine all cases referred for evaluation by an ophthalmologist and most current patients of ophthalmology that present with problems.
The resident on call can use personal judgment after consultation with the emergency clinician on duty to determine if it is necessary to examine non-referred patients with ocular problems.
The resident on call is responsible for telephone consultation with the emergency clinician to assist in diagnosis and treatment of ophthalmic cases.
The resident on call is responsible for locking up all equipment after finished with an emergency.
The resident is responsible for entering charges on the computer for all emergency patients before the patient is discharged.
The resident is expected to consult with the faculty member on back-up for all equine emergencies and any complex cases or for any questions.

Hospitalized Patients

Residents are expected to complete at least a penlight examination on all hospitalized patients prior to attending morning rounds. Depending on the ophthalmic condition, a more complete examination may be required.
Residents are responsible for checking ICU orders to ensure accurate treatment of the patients.
The resident or the student on the case should update owners on the condition of the patient each morning after evaluation.
Residents are responsible for assisting the senior students in determining daily insulin doses based on morning and evening blood glucose levels.

Patient Log and Surgery Log

1. Residents are responsible for maintaining a patient log per ACVO biannual requirements.

2. Residents are responsible for maintaining a surgery log per ACVO biannual requirements. Each surgery should be coded as follows: 3=resident is the primary surgeon without a diplomate assisting, 2=resident is the primary surgeon with the diplomate assisting, 1=resident is the assistant surgeon to a diplomate or senior resident as the primary surgeon.

Teaching responsibilities

DIDACTIC REQUIREMENTS

Residents are expected to assist in student instruction/supervision/evaluation in clinical rotations for seniors
Residents are responsible for leading rounds discussions on daily cases and sample cases on projected slides.
Residents are required to assist in Operative Practice surgical laboratories and techniques laboratories for the “Introduction to Veterinary Ophthalmology” core course for juniors.
Residents may be required to assist in lectures for the “Introduction to Veterinary Ophthalmology” core course for juniors.

ACADEMIC REQUIREMENTS

Rounds

Residents are responsible for creating a schedule for rounds each month and distributing it to all participants one week prior to the end of the month.
Residents are expected to attend all rounds and to be prepared and punctual.
Rounds schedules will include journal club, histopathology, 2x2 slide rounds, morbidity and mortality rounds and residents’ organizational meetings.
Residents are expected to pick up slides for histopathology from the library in Goss Lab and to return them after rounds.
Residents are responsible for making sure that rooms and the microscope are reserved for rounds each quarter.
Residents are encouraged to maintain the pathology report filing system.

Educational opportunities

Basic Science Course

All residents are required to attend one Basic Science Course, a four-week intensive comparative ophthalmology and histopathology course offered every second year in the late Spring/early Summer.

ACVO Credentialing Process

Residents must complete the credentials process as outlined by the requirements of the ACVO.

ACVO Board Examination

The resident is responsible for reviewing journals at least on a monthly basis for literature required to read for boards.
The resident is expected to read Gelatt’s Veterinary Ophthalmology prior to starting the residency and to re-read and outline the book in preparation for the examination.
The resident is expected to read and outline Adler’s Physiology of the Eye in preparation for the residency and for the examination.
The resident is expected to read Havener’s Ocular Pharmacology in preparation for the residency and for the examination.
The resident is expected to read Veterinary Clinics of North America 1997 Surgical Management of Ocular Disease in preparation for the residency and for the examination.
The resident is expected to subscribe to the journal of Veterinary Ophthalmology throughout the residency.

ACVO MEETING

The resident is expected to attend a minimum of 2 ACVO meetings during the 3-year program and to present a paper/poster at one or more ACVO meetings.

Graduate program

As part of the MS degree program, residents must complete 30 hours of didactic coursework. Courses are offered at the College of Veterinary Medicine (a full curriculum of graduate courses on a range of topics is offered within the Department of Veterinary Clinical Sciences) as well as by other colleges at The Ohio State University. Typically, courses that are taken include immunology, research methods, statistics, advanced ophthalmology, and courses in cardiology, amongst others. In the past, ophthalmology residents have fulfilled their didactic coursework requirements by early in the 3^rd year of their programs.

Research and scholarly activity

Research Project and Master’s Degree

Residents are responsible for developing, with the assistance of the graduate mentor, a research project suitable for use for a Master’s thesis and publication.
Residents are expected to write a grant and to successfully acquire funding for their projects.
Residents are expected to present the results of the research project at the ACVO meeting.
Residents are expected to successfully complete a Master’s thesis defense.
Residents are expected to complete the Master’s thesis and submit it to the library.
Residents are expected to submit the Master’s project for publication within 1 year after completion of the project.
Residents are expected to complete the coursework required to obtain the Master’s degree with the guidance of the mentors.

Evaluations

Department of Veterinary Clinical Sciences: Formal Resident Performance Evaluations are completed by December 1^st and June 1^st each year. Details of the nature and structure of these evaluations can be found in the Residency Handbook (link)
ACVO evaluations: The ACVO requires that residents are evaluated by their mentors every 6 months. In addition, the resident is responsible for completing an ACVO Residency Evaluation every 6 months throughout their program.

Specialty college requirements

Additional requirements for successful completion of the residency as mandated by the ACVO may be found at www.acvo.org

Board certification

We offer a comprehensive didactic and clinical training program that we believe provides excellent preparation for successful completion of the ACVO board certifying examinations. Since 1980, all of the ophthalmology residents at OSU have obtained their MS degree and all but one have passed the board certifying examinations on the 1^st attempt.

Vacation/Illness/Off Clinic Time

Off Clinics Time

26 weeks/3yr residency are provided for academic work primarily on the Master’s degree research project, Master’s thesis defense, thesis publication, and attendance of the Basic Science course (3-4 weeks). Off clinics time may be used for preparation of credentials and for preparation for the ACVO examination as long as the Master’s degree requirements are fulfilled.
Off clinics time is scheduled at the discretion of the mentors and the resident is responsible for keeping track of time used and time remaining.

Vacation Time

Ten days of vacation are provided each year. Vacation time will come from the 26 weeks off clinic time (see the Resident leave policy).
The resident may only schedule vacation time after the approval of all faculty members.
Leave slips must be filed with the Department prior to vacation days and the small and large animal reception desks must be informed in advance.

Illness

The graduate school does not provide paid sick leave.
In the event of illness, the resident should notify a technician and the faculty member on clinical service as early as possible.

Appendices

Draft biweekly schedule

Appendix 1: Weekly schedule

	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY
	Activity	Activity	Activity	Activity	Activity

8:00 – 9:00AM		Resident Rounds			Resident Rounds
9:00 AM – Noon	CERF Clinics and Resident Small Animal Surgery	SA Receiving	SA Surgery	SA Receiving and Post Patient Evaluation	SA Receiving
12:1 100 PM - 5PM	SA Receiving	SA Surgery Patient Workup	SA Surgery	LA Receiving	LA Surgery

Emergencies – Large and Small Animal are accepted everyday throughout the day

In-House Consultations - Large and Small Animal are accepted everyday (Mon-Fri) throughout the day

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