Through much of medical school and residency, trainees face a series of forks in the road. Do you want to practice clinical medicine or work in a non-clinical capacity? Patient-facing interactions or not? Medical or surgical? Adults or pediatric population?
This continues in residency, with exposure to various subspecialties within ophthalmology. Residents begin to think about fellowship and career options early in training and often have opportunities to tailor their rotations, mentors, and research focus to their anticipated path.
If you are considering which career path to follow after residency, let’s talk about what makes comprehensive practices great. A comprehensive ophthalmologist can design their career to highlight whatever brings them the greatest satisfaction and affords the opportunity to maintain long-term relationships with their patients by providing longitudinal care.
The true variety of comprehensive ophthalmology
For many, the draw of changing your patients’ lives with a 10 to 15 minute cataract surgery is very alluring. Cataract surgery is the “bread and butter” of many comprehensive ophthalmologists’ careers. With continued advances in surgical techniques and technology, it is a fast-paced field with many exciting innovations on the horizon.
The demand for cataract surgery will continue to increase as the population ages, and as intraocular lens (IOL) technology improves, the market for refractive lens exchange in the presbyopic population will likely grow as well.
“While practice patterns do vary between individuals, a comprehensive ophthalmologist may care for patients in all stages of life, from refractive correction to medical and surgical care.”
Comprehensive doctors may prescribe glasses and contacts; perform laser vision correction surgeries such as LASIK and PRK; evaluate and treat patients with various medical diseases; manage glaucoma, diabetes, and macular degeneration; and perform interventional lasers or injections for various disease processes.
While cataract surgery is often the bulk of a comprehensive ophthalmologist’s surgical volume, we may also perform surgeries such as pterygium excision, superficial keratectomy, minimally invasive glaucoma surgery, complex or secondary IOL revisions, and some even do eyelid surgery, intravitreal injections, or other subspecialized services.
The skillset of a comprehensive ophthalmologist
For an ophthalmologist who truly enjoys being a diagnostician and thorough historian, comprehensive ophthalmology clinics might see just about anything that comes through the door. I work closely with specialists in many other disciplines, such as primary care, rheumatology, cardiology, neurosurgery, etc.
In 4 years of practice, I have been able to diagnose conditions such as pituitary masses, carotid arterial disease, cardiac arrhythmias, trigeminal neuralgia, giant cell arteritis, connective tissue disorders, and more.
As a comprehensive ophthalmologist, I feel that I can practice medicine and can counsel my patients on metabolic disease management, smoking cessation, and other lifestyle changes that may protect their eyesight. At the same time, I can perform a 10 minute surgery that will dramatically improve a person’s quality of life by restoring their clear vision! What could be better?
A day in the life of a comprehensive ophthalmologist
A typical office day for me will include a variety of clinical and surgical appointments. Many of my patients are referred by their optometrist for cataract surgical consultation, which begins with a complete eye examination and detailed medical and ocular history.
Often, the onset of vision changes related to cataract formation is the first time a patient will interface with an ophthalmologist. I view it as a very important part of my role to provide a detailed examination and discussion, especially if any unexpected diagnoses are made. I perform many diabetic exams and also care for a large number of patients with glaucoma.
“As continued innovations in intraocular pressure management occur, cataract surgeons and comprehensive ophthalmologists have more and more tools to choose from, such as minimally invasive glaucoma surgery (MIGS) or long-acting drug depot implants.”
I also offer several laser surgeries, including YAG capsulotomy, laser peripheral iridotomy, and selective laser trabeculoplasty, in addition to cataract and refractive surgery.
Figure 1 shows Dr. Early performing cataract surgery.
Figure 1
The cutting edge of comprehensive ophthalmology
While not all comprehensive ophthalmologists prefer to perform surgery in the operating room, there are many office-based procedures for both medical and cosmetic treatments that can be performed.
It is quite common for practices to have comprehensive doctors performing intravitreal injections, retina and glaucoma lasers, biopsies, eyelid procedures, or aesthetic treatments such as injectables and skin resurfacing lasers.
Another exciting frontier and newer niche in the field of eyecare is dry eye treatment, with a number of procedural options including in-office meibomian gland expression and intense pulsed light therapy.
One of the most exciting aspects of current ophthalmology is innovations in intraocular lens implant technology, presbyopia reduction, and refractive surgery. Patients of all ages are increasingly motivated toward spectacle independence.
For pre-presbyopic patients, new technologies include customized LASIK or SMILE, and the EVO Visian implantable collamer lens (ICL), which no longer requires a laser iridotomy as earlier generation phakic IOLs needed.
Performing refractive lens exchanges or ICL surgery is a skill that a cataract surgeon may add to their existing repertoire with ease. For patients requiring cataract extraction, new IOL technology is continually moving toward more perfect astigmatic and presbyopic reduction, allowing for a full range of uncorrected vision in many patients.
The landscape of comprehensive ophthalmology
There are a number of potential employment situations for a comprehensive ophthalmologist, ranging from a solo practice to group, private, academic, hospital-employed, and private equity practices.
For those who desire a large degree of autonomy and a broader scope of practice, a small group or solo practice in a rural or underserved area would be an excellent way to maintain a variety of skills.
“Most academic centers have comprehensive ophthalmologists in their departments, and even community hospitals may have the need for an employed ophthalmologist.”
The practice landscape has experienced a shift in recent years with many formerly private, physician-owned practices being acquired by private equity firms. For those who are more oriented toward a large, multispecialty clinic with collaboration and fast access to subspecialists, larger groups can be a great fit.
Conclusion
If you like a little bit of everything, comprehensive ophthalmology just might be the right fit for you!
