Clinical Vitreoretinal Fellowship Program

Overview of Fellowship

Dr. James Kempton and Dr. John J. Huang consulting on a patient with traumatic eye injury.

The Vitreoretinal Fellowship at Yale is a two year program devoted to clinical training in the evaluation, diagnosis, and medical and surgical management of vitreoretinal diseases in state-of-the-art facilities at the Yale Eye Center and the West Haven Veterans Administration Medical Center (VAMC).

Training in clinical evaluation of vitreoretinal disease includes proficiency in indirect ophthalmoscopy, slit lamp fundus biomicroscopy, and interpretation of diagnostic tests including high-speed digital fluorescein angiography, indocynanine green (ICG) angiography, retinal autofluorescence, optical coherence tomography (Stratus OCT and Cirrus OCT), B-scan ultrasonography, and electrophysiology (electroretinogram (ERG) and electrooculogram (EOG)), at the Yale Eye Center.

The diagnostic tests for the Retina Section are performed by one of three full-time ophthalmic photographers in two separate photography suites; there is a separate room for electrophysiology. At the VAMC, there is a full time ophthalmic photographer with all the above diagnostic tests except electrophysiology.

There is also an ophthalmic photographer at the Hill Health Center (HHC), a community health center in New Haven where the first year Retina Fellow evaluates patients two half days a month.

The Retina Fellows work closely with the Retina Faculty and retina resident as part of the ?Retina Team? in the medical and surgical management of our patients who have a wide range of vitreoretinal diseases from retinopathy of prematurity (ROP) to diabetic and other vascular retinopathies and hamartomas, to inflammatory and infectious vitreoretinal disorders, age-related macular degeneration, retinal dystrophies, ocular tumors, retinal tears and detachments, proliferative vitreoretinopathies, ocular trauma, intraocular foreign bodies and others.

Clinical Training in Medical and Surgical Vitreoretinal Treatments

Is done with the individual retina faculty on a schedule that allows the first year fellow to begin all aspects of medical/surgical procedures, and gives a more intense surgical experience in the second fellowship year. Retinal procedures include panretinal laser photocoagulation via slit lamp and laser indirect ophthalmoscope, focal laser photocoagulation, laser retinopexy of retinal breaks, photodynamic therapy, trans-scleral cryopexy, subtenon and intravitreal injections of therapeutic drugs, retinal detachment surgery with scleral buckling, pars plana vitrectomy, membrane peeling, gas-fluid exchange, intra-ocular gas or silicone, and removal of intraocular foreign bodies.

The retinal surgeries are performed at either the Yale-New Haven Hospital (YNHH) in one of two dedicated retina rooms with ceiling-mounted operating microscopes, or at the West Haven VAMC with a state-of-the-art retina suite. An indirect diode laser is used for treatment of Type 1 ROP in the Newborn Special Care unit at YNHH.

The Retina Fellows also have other responsibilities in the Retina Section and Yale Eye Center.

1. They are considered as attending physicians and as such take part in the general on-call attending schedule with the other Yale faculty to support the on-call resident and sometimes perform emergency surgery.
2. The Retina Fellow is the attending in the YNHH hospital based eye clinic for inpatient consults one half day a week.
3. The Retina Fellows act as consult attending for inpatient YNHH ophthalmology consults for one week, about every 5 weeks. Consults are seen with the consult resident at the YNHH, after the Retina Office concludes.
4. The first year Retina Fellow conducts the Fluorescein Conference for all the ophthalmology residents and with retina faculty and 2nd year fellow once a month.
   
5. The Retina Fellows regularly teach the ophthalmology residents and medical students.
   
6. The second year Fellow sees retina patients in the Retina Fellows Clinic on Friday mornings and performs laser treatments and intravitreal injections.
   
7. The first year Fellow sees patients at the Hill Health Center two half days a month.

Clinical Research in Yale Vitreoretinal Fellowship

• A clinical research project is strongly encouraged for each year of the fellowship, with the goal of submitting the research for publication in a peer reviewed journal at the end of the fellowship year. Clinical research is mainly through participation in clinical trials (usually NIH and/or industry sponsored ophthalmic drug trials). Retrospective reviews and prospective studies of certain retinal disorders are also available.
• Basic research is NOT required, but there is exposure to the work of our Retina Research Scientists in basic and translational research. (There is no specific research time block in the fellowship).
• The Retina Fellows meet with all the Retina Faculty on a Wednesday at 7 AM every six weeks to evaluate progress on the Fellows? Clinical Research projects, and to discuss specific journal articles on current vitreoretinal issues.

Conferences

The first year Fellow attends the Annual Atlantic Coast Fluorescein Conference and the Fellows Forum, and theAssociation for Research in Vision and Ophthalmology (ARVO) dependent on presentation of a research project.

The second year Fellow attends the American Academy of Ophthalmology Annual Meeting, and ARVO dependent on research presentation.

Other Retina meetings and conferences are attended if presenting a clinical research paper.

About our present Fellows:

• Rajeev Seth, M.D. did his ophthalmology residency at Yale, and has been in our Vitreoretinal fellowship since July 2008. Rajeev is now our 2nd year fellow.
• Shelly Lee, M.D. did her ophthalmology residency at University of Texas Health Science Center, San Antonio and just completed a Uveitis fellowship at Casey Eye Institute in Portland, Oregon. Shelly is now our 1st year fellow.
  

Thank you for your interest in the Yale Vitreoretinal Fellowship. If you would like an application or have questions about the Fellowship, please contact Paula Carney at (203) 785-6444.

Faculty

• Ron A. Adelman, MD, MPH
• John J. Huang, MD
  
• James E. Kempton, MD
  
• Miguel A. Materin, MD
  
• Kathleen M. Stoessel, MD
  

Clinical Fellows

• Rajeev Seth,MD - 2nd Year
• Shelly Lee, MD - 1st Year
  

How to Apply

Anyone wishing to apply for a Clinical Vitreoretinal Fellowship at Yale, or to learn more about the Program should contact Paula Carney at 203.785.6444.

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