For students interested in applying to a cornea and contact lens residency program, what are some characteristics that make a high-quality candidate?
Dr. Killen: High quality candidates are motivated, hard-working, and are active problem solvers. The patient population at our clinic has unique pathology, complex medical histories, and oftentimes requires interdisciplinary care/management, and thus we look for candidates that we feel will take an active role in their learning and push themselves clinically. Our residency program has 12 on-campus residents, and we look for candidates that are team players, leaders, and those with teaching experience/a strong desire to teach our students.
Dr. Kornaus: Strong candidates for our residency are self-driven, motivated, open to constructive criticism, and enjoy working in a team of eye subspecialists.
Dr. Kovacich: We look for candidates who have the proper motivation to pursue a cornea and contact lens residency, which is the desire to obtain advanced competency in fitting specialty lenses. A candidate who is teachable and able to work well with others makes the best candidate. A self-starter who does not require constant supervision and who is able to incorporate and apply new information will do well in our program. A good work ethic is also important to carry the resident through the residency (and life).
Dr. Fuller: Great candidates typically have a GPA > 3.0, and the higher the NBEO scores the more competitive. Great candidates are intellectually curious, have strong work ethic, are self-motivated, take initiative, attention to detail, and accept instruction well. I look for scholars, clinically proficient individuals who want to take on leadership roles.
What specific advantages will residents take away from their training? What clinical/professional expertise will they be able to carry forward into their careers?
Dr. Killen: Our program is unique in that our cornea and contact lens/anterior segment resident works in two clinical settings. The first is within the specialty contact lens department at PCO’s clinic, The Eye Institute, where they have access to the latest in advanced testing equipment and contact lens fitting sets.
Secondly, they spend about half of their time working with James Lewis, MD, who is an anterior segment specialist performing cataract, corneal, and refractive surgeries. With such a diversified experience, the resident develops advanced competencies in contact lens management of basic refractive error, keratoconus, corneal dystrophies, myopia reduction, post-surgical contact lens care, and therapeutic contact lens management as well as pre- and post-operative care of anterior segment surgical cases.
Dr. Kornaus: Residents will achieve excellence in medical contact lens management as well as confidence in managing anterior segment/corneal disease and surgical co-management. One trait of the residency setup is continuity of care between corneal specialist care directly into the resident’s medical contact lens clinic.
Dr. Kovacich: I have always heard that a residency gives 5-6 years of experience (that would be obtained in practice) from the advanced training received during the residency. For cornea and contact lens residents, advanced competency in specialty contact lens includes fitting scleral lenses and diagnosing and managing anterior segment problems, such as dry eye. A career in education usually requires a residency or equivalent experience, and having completed a cornea and contact lens residency can give a candidate an advantage when applying for a job, especially an OD/MD practice.
Dr. Fuller: This program is designed to bridge the gap between surgical care of the anterior segment and the visual rehabilitation by specialty contact lenses. Those who successfully complete the program will be able to work in high volume medical practices, OD-MD settings, or become the local expert on specialty contact lenses.
What is a typical “day in the life” of residents?
Dr. Killen: Since the resident rotates between the two clinical practices, their schedules vary from day to day. Typically, half of their week is spent precepting 3rd and 4th-year optometry students in the specialty contact lens department, where they see cases ranging from routine soft contact lens fits, specialty RGP, and scleral fits for a variety of corneal diseases to patients enrolled in orthokeratology programs. Demographics range from children, teenagers, to adults with various ocular conditions and keratorefractive status.
When working in the Anterior Segment Service with Dr. James Lewis the resident sees patients primarily in a direct-care role but does also work with 4th-year students who are performing clinical externships as well. The Anterior Segment Service is fast-paced, high volume patient care that includes pre- and post-op cataract surgery, refractive surgery, MIGS surgery, corneal assessment, and surgical cases as well as specialty dry eye.
In addition the resident spends one shift per week (for the first half of the residency) in our emergency services to grow their skillset in triaging, diagnosing, and providing care/referral for walk-in ocular emergency cases. Outside of clinical patient care, all of our residents participate in academic conferences, which include a variety of topics and hands-on workshops provided by PCO faculty as well as outside specialists.
Throughout the residency year, each of our residents presents a 30-minute COPE-approved grand rounds presentation, submits a poster for the AAO meeting, produces a publishable quality paper, and has the opportunity to travel to optometric conferences in their specialty.
Dr. Kornaus: Each day is generally split into morning and afternoon shifts, with either four to six patients in the resident’s own clinic as a mix of comprehensive optometry and medical contact lens consultations and follow-up care. Time spent with the cornea subspecialist typically involves seeing at least 12 patients within the cornea subspecialist’s schedule and discussing cases as needed throughout the day.
A few hours per week are set for independent research intended to generate a publishable-quality article that may be used for AAO fellowship. There is also an opportunity to give CE lectures at Illinois College of Optometry in the fall, Madison, WI in the spring, and a lecture to staff in the winter.
Dr. Kovacich: Our residents are expected to put in 50 hours of work a week, which includes patient care and consulting with third and fourth year optometry students (80%) in the Cornea and Contact Lens Service, on-call, and 4-year case conference. Residents are also encouraged to work on scientific presentations for the American Academy of Optometry, American Optometric Association, and the Global Specialty Lens Symposium. There are opportunities to present CE lectures, which give the resident experience in speaking in front of an audience, and there are some service experiences also.
Dr. Fuller: Residents share time between The Eye Center, Cornea Contact Lens Service at SCO, and Eye Specialty Group, a surgical practice with all specialties and a Bascom Palmer-trained corneal fellow. The resident must complete a number of specialty encounters—contact lens fits, anterior segment disease, pre-/post-op examinations, and surgical observations. They must see a minimum of 1500 patients.
Their experience includes guest lectures, assisting in lab, and precepting 4th year interns to expose them to a career in academia. They will make several formal presentations to fellow residents, interns, faculty, and a COPE-approved CE during the spring. They must complete a capstone project and produce a publishable caliber peer-reviewed article.
They meet every Thursday morning in a conference where they review literature, discuss cases, and listen to a program of guest speakers. This is followed by a meeting with me to review their clinical cases that week, review charts, discuss seminal articles and contemporary literature, and work on career planning. They are on-call approximately every 5 to 7 weeks for one week.
What is one of the biggest challenges residents may face during their time here?
Dr. Killen: One of the biggest challenges a resident may face would be adapting to the high volume of disease seen within the specialty contact lens and anterior segment services. Managing these complex cases can sometimes be stressful and beyond what the resident has seen in their optometric training (depending on their clinical rotations and the patient population they are used to).
However, it is this challenge that pushes residents out of their comfort zone, and having the plethora of mentors within the program to learn from allows them to gain these advanced competencies by the end of the year, preparing them for any job after.
Dr. Kornaus: One of the biggest challenges noted by residents over the years is continually improving efficiency at a busy medical practice.
Dr. Kovacich: The biggest challenge is to keep the original enthusiasm for the residency constant at the end of the year. Once a resident has a job offer, the mindset can switch over to the future, and it gets harder to keep up with charting and the challenging work hours. That is why proper motivation and a good work ethic are so important.
Dr. Fuller: Most find the experience with the surgeon eye opening, when they see 40 to 80 patients in a day. Time management skills are vital. They learn to research cases seen during the day during the evening to lift their game.
Is there a specific practice setting/modality that residents commonly pursue after training?
Dr. Killen: Our residents end up in a variety of clinical settings after their graduation from our program. Past residents have gone on to work for academic institutions, hospital clinical settings, MD/OD practices, private practice optometry, and even industry positions. The alumni at Salus/PCO includes a large network of clinicians spread across the US that are always looking for residency-trained optometrists to fill roles in a variety of practice modalities.
Dr. Kornaus: Typically, residents join a group MD/OD medical setting after completion of this program.
Dr. Kovacich: Most (80%) of our contact lens residents are fitting specialty contact lenses in private optometric or OD/MD practices. Some have gone into education, and a few are working for the government (in the VA or Indian Health Service).
Dr. Fuller: Matriculants typically end up in larger urban areas, large practices or OD-MD settings, and about 30% end up in academia, either OD or MD programs.