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Young Ophthalmologists
Five Pearls for the New Year: Advice for 2011 from YO Info’s Editorial Board
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Pearl #1: Membership in the American Academy of Ophthalmology is an integral component in the success of both our individual careers as well as our shared profession. The Academy is the single greatest advocacy organization for ophthalmology.

It is particularly instrumental in the effort to protect the welfare of patients by leading the fight to prevent the expansion of optometric scope of practice. The Academy also serves a critical role in efforts to preserve and expand physician reimbursement.

Participation in the Academy allows us to work together on these and other important issues. Membership focuses our energies. It allows us to move and act in a coordinated effort, and it enables us to speak with a single, more powerful voice. Serving on the YO Info editorial board has enabled me to personally support the mission and advocacy of the Academy.

Lauren Eckstein, MDLauren Eckstein, MD, PhD, is an assistant professor of ophthalmic plastic and reconstructive surgery at the Scheie Eye Institute at the University of Pennsylvania. She completed her undergraduate training at the California Institute of Technology and later matriculated in the Medical Scientist Training Program at the University of California, San Francisco, where she completed her graduate dissertation in the biomedical sciences. Thereafter, she received her residency training at the Jules Stein Eye Institute and completed her fellowship training in oculofacial and orbital surgery at the Scheie Eye Institute.

In addition to her active clinical practice, as a member of the University of Pennsylvania faculty, Dr. Eckstein is also engaged in translational biomedical research as well as fellow, resident and medical student education. Her research interests include studies of structural and inflammatory abnormalities of the orbital soft tissues.

Writing in YO Info:

Pearl #2: My pearl for those of you still in training and for those who are just starting their careers is to speak with ophthalmologists in different types of practice settings and try to determine the one in which one you will be the happiest. Decide if you want to be involved in teaching at some level and try to incorporate that into your career decision. Because once you are done with your training, your career path is what you make it and success is what you define it to be.

Natasha Herz, MDNatasha Herz, MD, completed her residency and fellowship in cataract, refractive and anterior segment surgery at Baylor Ophthalmology in Houston. At the conclusion of her training, she bought a practice from a retiring cataract specialist in the Washington, D.C., area, and since then has discovered both the joys and challenges of running a business. She joined the YO Info editorial board out of a desire to share her experiences with others and hopefully help them through the tough and disorienting transition from training to the real world.

Writing in YO Info:

Pearl #3: In today's turbulent environment of health care reform, my advice to beginning ophthalmologists is to keep some perspective. You have chosen a wonderful profession that allows you to make tangible differences in the lives of your patients using cutting-edge science and technology. As you are inserting an accommodative IOL or repairing a retina with a laser, take a moment to reflect on the privilege of doing so. The Academy and the YO committee are working hard to develop the next generation of leaders to help navigate these turbulent times, but it is important to remain grounded in what makes our profession so great.

Lance Kugler, MDLance Kugler, MD, spent four years in private practice as a comprehensive ophthalmologist before leaving his practice to pursue fellowship training in refractive surgery so he could be at the forefront of the merger between refractive surgery and cataract surgery. After completing his training, he joined a refractive surgeon who is transitioning to retirement over the next few years. He also serves as the director of refractive surgery at the University of Nebraska. As a graduate of the Academy’s Leadership Development Program, he says he has enjoyed his involvement with the YO Info editorial board. “The future of ophthalmology is in the hands of young ophthalmologists, and strengthening their involvement in the Academy will lead to a stronger future.”

Writing in YO Info:

Pearl #4: Two pearls: First, I would strongly advise young ophthalmologists to take a few coding courses at the Academy during your last year of residency or fellowship (while you also still receive a 50 percent discount on courses!). Though most of us learn basic coding in training, there are still many nuances that may not be of importance to you until you begin practice. Second, I would suggest constructing a learning plan (CME courses, grand rounds, meetings, journals) to stay up to date on the latest techniques, discoveries and innovations in ophthalmology. As a resident, your professors pass on most of this information to you, but as you enter practice, this responsibility falls on your shoulders. Having an active plan in place will help you stay abreast of the most important breakthroughs in ophthalmology.

Lisa Nijm, MD, JDLisa M. Nijm, MD, JD, recently relocated back to the Midwest to work at The Eye Institute at Springfield Clinic in Springfield, Ill., as a corneal and refractive surgeon. She’s very excited to be in the capitol, as she will also be working at her alma mater, Southern Illinois University School of Medicine and School of Law, teaching medical students and conducting research in health care policy. Dr. Nijm completed her residency at the University of Illinois Eye and Ear Infirmary and her corneal fellowship at the University of California at Davis. She is eager to use her skills and knowledge to help care for patients in an underserved region of Illinois.

She joined the Academy to serve as an advocate for her patients and the profession for improvement of eye health care. “I have been privileged to work as part of the editorial board of YO Info this past year. I believe it is a great opportunity to help serve the needs of young ophthalmologists as they transition from residency to practice. I look forward to continued interaction with other YO members to make YO Info an invaluable resource for future leaders in ophthalmology.”

Writing in YO Info:

Pearl #5: As the baby boomers reach their mid-60s, one thing YOs can do this, even those not specializing in the retina, is to become well acquainted with the many treatments for macular degeneration.

Over the last 20 to 30 years, there have been several therapies that have become available for the treatment of age-related macular degeneration (AMD). For exudative (or wet) AMD, these include laser photocoagulation, photodynamic therapy and, more recently, anti-angiogenesis treatments such as pegaptanib sodium (Macugen, Eyetech, Inc), bevacizumab (Avastin, Genentech, Inc.) and ranibizumab (Lucentis, Genentech, Inc).

Laser photocoagulation was effective, but would unfortunately leave a scotoma in the vision corresponding to the treatment location, so it was suboptimal for treatment of subfoveal lesions. I still occasionally use laser photocoagulation today for extrafoveal lesions.

Photodynamic therapy was helpful for patients with subfoveal lesions, however, the best one could hope for was stabilization of vision. Since 2004, more recent therapies, such as bevacizumab and ranibizumab, have revolutionized the treatment of AMD, as they have offered patients the hope of visual improvement for this once-blinding disorder.

For nonexudative (or dry) AMD, while it is often less visually devastating in its clinical course and progression, there has been comparatively little progress for prevention and treatment of the disorder. The age-related eye disease study has offered patients the chance of lessened progression with use of a vitamin formulation.

As always, visual screening with an amsler grid is essential. I have now started asking my patients to screen their vision daily, as I have found that patients tend to be less compliant with weekly or bi-weekly screening instructions. Patients should be encouraged to report all changes in amsler grid immediately to their ophthalmologist.

Manju Subramanian, MDManju Subramanian, MD, completed her residency at the University of Kansas Medical Center, followed by a vitreoretinal fellowship at Tufts University/Ophthalmic Consultants of Boston, which she completed in 2004. She is currently an assistant professor at Boston University School of Medicine and vice-chairman of clinical operations at Boston University Eye Associates. She serves on the medical school admissions committee and is involved in clinical research focused on macular degeneration and diabetic retinopathy.

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