Training in cornea and external disease is generally a main campus experience though some additional training occurs at the VAMC and in our West Augusta office. Dr. Amy Estes is chief of this service and she came to us from Wake Forest in 2013. Basic and advanced corneal pathologies are managed together with the resident with ready access to a procedure room for minor immediate interventions. Typical surgeries the resident will have exposure to include, DSAEK, penetrating keratoplasty, lamellar keratoplasty, and the keratoprosthesis. We have an award winning ophthalmic photography team on staff. Modalities we currently employ include ultrasound biomicroscopy, corneal topography, Pentacam, and the anterior segment module for the HRT.
While refractive surgery is generally performed by Dr. Bogorad there can be opportunity for resident performed surgery depending upon how these patients are identified and patient consent. Our LASIK center is run together with Eye Care One (ECO). This privately owned corportation has its office about 15 minutes from the main campus. One of ECO's optometrists oversees the pre-operative assessment phase and the coordinates with Dr. Bogorad for the days of surgery.
Dr. Zach Lukowski is the director of our retina service. During the retina blocks the resident will chiefly work alongside him, but also will be periodically assigned to Dr. Julian Nussbaum's (chairman) clinic. The retina practice is mature with great breadth of pathology from standard and unusual diagnoses. Laser treatments and injections are done in our clinics and procedure rooms. Residents are heavily involved in these procedures. Historically, there has been resident involvement with a set of retina clinics at ASMP, but that is less consistent at this point.
A full array of imaging systems are available. Included are standard retinal imaging platforms. We have Optos, Spectral domain OCT, standard retinl photography, fluorescein and even indocyanin green angiography remains available. Progress is being made toward acquistion of the OCT-A platform. Two full-time ophthalmic photographers orchestrate this and other clinical imaging events. Our senior photographer, Mike Stanley, has won a number of national level awards for some of his work. Electrophysiology is also routinely available being administered by Dr. Alan Saul. The resident is expected to understand the indications for these and other studies as well as the interpretation of them. Approximately once per month an imaging conference is held presented by a resident and moderated by one of the retina faculty. While non-laser, non-injection based retinal procedures are generally performed by faculty there are some which may be done partially or entirely by the resident. Dr. Sohail Khan (private retina specialist, and Class of 2010 alumnus) does retina at the VAMC and ASMP.
There is a uveitis clinic that runs monthly on this service as well. Dr. Nussbaum and an Augusta University rheumatologist make up the attending staff for this clinic. This service was established in academic year 2010 and provides a valuable service to our patients and experience for the residents.
The glaucoma service is managed by Dr. Katie Bollinger. She works closely with her own clinic as well as the pediatric, retina and uveitis services. Being a referral service there will be much advanced glaucoma exposure to the resident staff. The resident will be able to perform tube shunts and trabeculotomies on Dr. Bollinger's service as well as learn the post-operative management of these procedures. OCT and HRT are readily available to enhance the diagnostic abilities. Humphrey and Octopus visual field systems are in place as well. At the VAMC Drs. Killingsworth and Brinsko both perform glaucoma surgery as well. At the Augusta State Medical Prison there is an extensive population of glaucoma patients. While Dr. Ulrich does not perform trabs/tube shunts he has a large medical glaucoma practice both there and on the main campus. Finally Dr. Sumner Fishbein practice as a glaucoma specialist in private practice for many years in Augusta. He is on staff in our hospital providing additional medical glaucoma care. The graduating resident should be well trained in tube-shunts, trabs, SLT, LPI, and cyclophotocoagulation.
Pediatric ophthalmology is a specialty unto itself, but ophthalmologists still need to be able to lend expertise to the little people among us. We have two pediatric ophthalmologists on our staff who routinely work with our residents. Dr. Stephanie Goei joined our faculty in 1999 after completing her fellowship at The Hospital for Sick Kids in Toronto.Dr. Andrea Prosser joined our faculty immediately upon conclusion of her residency and then practiced pediatric ophthalmology in the midwest for two years before returning to our department in 2015. The clinical pediatric ophthalmology experience is comprehensive providing a sufficient base in bread-and-butter type diagnoses like vision screenings, refractions, strabismus, amblyopia, nasolacrimal obstructions, etc. As we are connected with a full-service adjacent children's hospital the residency training will include ROP screening and treatment, genetic, craniofacial disorders, metabolic problems and other less typical processes.
The clinical experience is divided between the main campus and a satellite office in West Augusta (about 25 minutes from the main campus. The Children's Hospital of Georgia (CHOG) is an adjoining hospital which is entirely devoted to primary and subspecialty pediatric care. The pediatric surgical experience occurs in that facility. In the operating room the resident will be assisting on pediatric cataract surgeries and will be primary surgeon on cases such as strabismus, nasolacrimal duct obstructions, ptosis repair, examinations under anesthesia, etc. As we have no fellows there is opportunity to perform re-operations and vertical muscles. There is an accompanying adult strabismus clinic with surgical involvement. While the graduating resident will not function at the level of a pediatric trained ophthalmologist they should feel very comfortable examining children and doing horizontal muscle surgery.
Dr. Dilip Thomas has been involved in resident training for nearly 20 years and he coordinates the oculoplastics rotation. During the months you are with Dr. Thomas the time will chiefly be at Augusta University, though the VA and the Augusta State Medical Prison do provide significant additional pathology with accompanying surgical exposure. Most of the time with Dr. Thomas deals with functional oculoplastic issues, e.g. nasolacrimal duct obstruction, ptosis, facial and eyelid reconstruction, nerve palsies, enucleation and exenteration, blow out fracture repair and thyroid eye disease. While there is an emphasis on functional oculoplastics the cosmetic vantage point, e.g. Botox injection, is a growing venue. He typically will perform surgery on one side while the resident does on the other. Our plastics case volume is in the highest quartile in the nation.
Dr. Thomas is also an outstanding neuro-ophthalmologist and manages this service for us. I do not put neuro-ophthalmology as a separate heading on our website for it is an Augusta University, referral only, service and while provides suitable educational exposure is not a clinical emphasis in our department. That being said there is most-definitely training in this arena. Coupled to it is also an offered elective to New York City with Dr. Jeff Odel as mentioned in the PGY-3 residency year overview.
The service at the VA hospital is widely scoped and provides extensive surgical exposure. There is a close team of physician and resident staff in these clinics. Dr. Killingsworth is cornea trained and additionally has wide experience in glaucoma surgical management. Dr. Brinsko manages many VAMC clinics and ORs including a number of glaucoma surgeries. Dr. Amie Squires assists seniors in the operating room mostly on cataracts. Dr. Thomas provides oculoplastics and neuro-ophthalmology consultant services in that arena as well. A considerable number of the resident cataracts are done at this facility. The senior cataract experience with Dr. Squires is chiefly clear cornea, topical. She does teach a vertical chopping technique in some situations.
Dr. Margaret Green was in private practice in Augusta for many years. She works with our first year residents at the VA. A great advantage for first years at the VA is exposure to YAG lasers and minor procedures which she staffs.
While the structure of our residency does not have resident continuity clinics throughout the residency general ophthalmic experiences are provided. The on-call emergency clinic has much of these types events as do the times when one is with Dr. Bogorad or our optometric partners. The VAMC has subspecialty clinics, but also provides much general ophthalmology.
Generally only seniors are on rotation with Dr. Ulrich. One "problem" one gets in subspecialty clinics is the tendency to become very drilled down. Dr. Ulrich's approach is that of providing comprehensive care of the eye patient. One of the key aims in Dr. Ulrich's clinic is to make sure all the various aspects of a patient's eye care are coordinated being careful to try to avoid overlooking specific issues. Having these months with Ulrich at ASMP and Augusta University it helps the resident to step back and get their focused a bit more broadly. That way pressures are being managed in the glaucoma/retina patient. One also learns how to remember to not overlook dry eye in a patient who you might think was only needing their hydroxychloroquine screening.
The bulk of your senior year Augusta University cataracts are done with Dr. Ulrich. His cases are nearly entirely topical and clear corneal. Most residents are capable of the horizontal chop techniques. Limbal relaxing incisions (considered by the ACGME to be a refractive procedure) also are routinely taught and done by the residents. The rotation involves weekly visits to the Augusta State Medical Prison where the diversity of pathology is considerable and the resident experience enhanced. There are a number of traumatic cataract cases in this venue and the resident may have opportunity to place capsular tension rings. In AY2018 Dr. Ulrich began taking the resident surgery videos back to his office watching them and then typing up a narrative of his thoughts and notions. He uploads the videos to a private YouTube channel and gives a link to the written critiques. Some of these videos will be crafted into public training videos on YouTube. Once per month cases will be taken to the resident lectures and watched/paused/taught through.