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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.
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. 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 experience fitting uncomplicated and cosmetic-type contact lenses, as well as post cataract surgical patients, infants as young as 2 weeks old, and others.
The Vitreoretinal Service provides an opportunity for residents to gain a broad experience in disease and surgery of the retina and vitreous. In the first year, emphasis is placed on vascular disorders of the eye, diabetic retinopathy, macular disease, and retinal detachment. Residents receive 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. First-year residents are not expected to be in the operating room. Second-year residents perform retinal reattachment procedures and retinal laser photocoagulation. The resident is trained in the use of cryopexy and laser photocoagulation to treat retinal breaks and diabetic retinopathy. They receive an introduction into the theory and practical application of scatter laser treatment for diabetic proliferative disease. They perform laser treatment on diabetic patients under faculty or fellow supervision. 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.
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 days a week for five weeks. This initial exposure serves as the introduction to the clinical evaluation of glaucoma patients. The resident learns and performs diagnostic skills 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.
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 wet lab and works into cases done by the third year. 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 weeks at the Des Moines VAMC, which includes a clinic at the affiliated Broadlawns Hospital.
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.
Residents on the Neuro-ophthalmology Service are also responsible for moderating morning rounds.
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 will spend one day per week on this service for ten weeks during Neuro-Ophthalmology/Comprehensive Service rotation. A third-year resident spends ten 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. Each rotation includes at least one presentation in Morning Rounds of a histopathologic clinical correlation. Residents are also responsible for in-patient 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 most of this rotation time 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.