 |
 |
|
|
The Cornea Service of the Massachusetts Eye and Ear Infirmary was founded in 1958 by Dr. Claes Dohlman. Our goal, simply stated, is to train the future leaders of the Cornea/External Disease and Corneal Surgery. Currently, numerous graduates of this fellowship are serving in positions of academic leadership throughout the world. At last count, over 50 Professors of Ophthalmology and Department Chairs are graduates of the MEEI Cornea Fellowship, an unparalleled history in training and mentoring the leaders of our field.
During the fellowship, fellows will care for a wide variety of patients with complex disorders of the anterior segment, which will enable them to develop advanced diagnostic and surgical skills for the entire spectrum of corneal and external disorders. Fellows participate in routine keratoplasties as well as cutting-edge surgeries, including ocular surface reconstruction, lamellar and selective endothelial transplantation, and keratoprostheses, to name a few. Fellows are exposed to the entire spectrum of refractive surgery technologies. The Refractive Surgery Service currently has 3 excimer lasers (Visx S4, B & L 217Z, Alcon Ladarwave) and an Intralase femtosecond laser. Additional procedures performed include: Intacs, Conductive keratoplasty, and astigmatic keratotomy.
The Cornea Fellowship is an intensive one-year program, during which approximately 85% of the time is spent doing clinical care; the remaining time is available for research. Most fellows will spend this time performing clinically-oriented research including reviews, case series, and book chapters. The Fellowship Match # for this 1-year program is 728.16.
Fellows with a serious interest in research (basic or clinical) can elect to take an additional ‘customized’ year to dedicate primarily to their research and academic development for completion of our two-year Advanced Fellowship Program. The Fellowship Match # for this 2-year program is 727.81. Prospective fellows wishing to pursue a research year are encouraged to contact Dr. Dana, Director of the Service, at their earliest convenience.
The fellow’s responsibilities include examining patients in the Cornea Service, taking call, providing consults to Massachusetts General Hospital inpatients, responding to patient requests for information or assistance with medical needs, being available for emergency visits, assisting in corneal and refractive surgery, and other tasks as required to provide comprehensive corneal care. The fellows are also required to attend lectures and prepare and deliver case presentations in Cornea Rounds or Department-wide Grand Rounds as needed.
The Cornea and Refractive Surgery Services are located on the first floor of the Massachusetts Eye and Ear Infirmary. The current facility is fully equipped with examination lanes, procedure rooms, and state of the art laser vision diagnostic technologies. An in vivo confocal microscope has recently been added.
One of the major strengths of our fellowship is the size and diversity of its faculty. All full-time faculty members hold joint appointments with Harvard Medical School and the Massachusetts Eye and Ear Infirmary. The following full-time faculty participates in the corneal fellowship training:
In addition to expertise in corneal transplantation and the medical management of corneal disorders, the faculty members, listed alphabetically, have subspecialty interests as described below:
Kathryn Colby, M.D., Ph.D. completed her ophthalmology residency, chief residency and corneal fellowship at the Massachusetts Eye & Ear Infirmary. She is the Director of the Cornea Fellowship and Medical Education in Cornea. Her specific interests include Fuchs’ dystrophy, the subject of her research, and ocular surface tumors. Dr. Colby is also the Director of the Clinical Research Center, a joint venture between the Massachusetts Eye & Ear Infirmary and the Schepens Eye Research Institute. Dr. Colby is Assistant Professor of Ophthalmology at Harvard Medical School.
Reza Dana, M.D., M.P.H., M.Sc. is Director of the Cornea, Refractive and External Disease Services at MEEI and oversees the educational, operational, and administrative dimensions of the Service. He received his undergraduate, MPH and MD degrees from Johns Hopkins, and his MSc degree from Harvard. After residency training at the Illinois Eye and Ear Infirmary, he performed his Cornea and External Disease training at the Wills Eye Hospital, his Uveitis training at the Massachusetts Eye and Ear Infirmary, and his Ocular and Transplantation Immunology training at the Schepens Eye Research Institute, Harvard Medical School. Dr. Dana directs the Corneal Immunology Lab and is a Senior Scientist and Clement Stone Scholar at the Schepens Eye Research Institute. He also directs the NIH-supported K12 Harvard-Vision Clinical Scientist Development Program. He is an Associate Professor at Harvard Medical School. Dr. Dana has published over 170 scientific papers, chapters, and reviews. His main areas of interest include corneal transplant immunology and ocular surface disease and reconstruction.
Claes H. Dohlman, M.D. is the founder of the MEEI Cornea Service and the Cornea Fellowship. His accomplishments are too numerous to list. He was Chair of the Department of Ophthalmology from 1974-89. Since 1989, he has focused on the Boston Keratoprosthesis, which offers hope for the many patients for whom a standard corneal transplant is not a viable option. He is Professor Emeritus of Ophthalmology at Harvard Medical School.
Ula Jurkunas, M.D. completed her MEEI Cornea fellowship in 2006, after which she joined the Cornea Service as part of the Harvard-Vision Clinical Scientist Development Program. As part of this program, she collaborates with Dr. Colby, and conducts her research in the laboratory of Dr. Nancy Joyce at the Schepens Eye Research Institute. Dr. Jurkunas is Instructor of Ophthalmology at Harvard Medical School. Her clinical interests include ocular surface reconstruction and refractive surgery.
Deborah Pavan Langston, M.D. has been an Attending on the Cornea Service since the 1970s and is an Associate Professor of Ophthalmology at Harvard Medical School. Her primary clinical interest is infectious disease of the anterior segment with particular emphasis on viral infections, in particular Herpes Simplex and Zoster. She has published more than 200 original reports and chapters, and many books.
Roberto Pineda II, M.D., former resident, Chief Resident and Cornea Fellow at the Massachusetts Eye & Ear Infirmary, he is the Director of the Refractive Surgery Service. His primary interest is in refractive surgery, anterior segment reconstruction, and complex cataract extractions. He regularly participates in ORBIS International and has authored several ophthalmology textbooks. He is an Assistant Professor of Ophthalmology at Harvard Medical School.
In the one-year fellowship, approximately 85% of the clinical fellow’s time is committed to direct patient care on the Cornea Service; the proportion is less and tailored to the individual fellow’s needs/interests in case of the advanced two-year fellowship. Clinical activities include the following:
The medical management of refractive, corneal, and external disorders, as well as the preoperative evaluation and postoperative care of surgical cases, are considered the cornerstones of the Cornea Fellowship training at MEEI. Accordingly, extensive exposure to the patients of the full-time staff is required of all fellows. Fellows will examine patients in the Cornea Service of the Massachusetts Eye & Ear Infirmary (MEEI), where he/she will perform the initial examination, form a tentative diagnosis and therapeutic plan, and then present the patient to the attending physician for discussion and final disposition.
Morning Clinics generally begin at 8:30 am, although particular attendings may start at 8 am (Dr. Pineda) or 9 am (Dr. Langston). Afternoon clinics begin at 1:00 pm. Fellows are expected to begin seeing patients at this time. If you are unable to arrive on time for clinic, advance notice must be given to the Service Manager and your Attending.
The surgical experience of the cornea fellow is derived primarily from first assisting on the large surgical volume of the Cornea Service faculty. Generally, fellows will assist on all major and minor corneal and complicated anterior segment procedures performed by Cornea Service faculty. Assisting on routine cataract surgery is not a requirement of the fellowship, although there is ample opportunity to be involved in phaco/IOL surgery on select cases. Nurse assistants or residents are utilized for the majority of cataract surgical assisting.
Please refer to the section in this package with respect to the Fellow’s preoperative and postoperative surgical responsibilities.
The cornea fellows actively participate in the refractive surgery service. Fellows are responsible for evaluating refractive candidates, and presenting their findings to the appropriate Attending. Fellows play an active role in the intraoperative and post-operative care of refractive patients. Refractive clinics may occasionally be held on Saturday AM (not more than 6x/year) and fellows (one per session) will participate in these.
Each fellow is required to provide 24 half-day sessions per year of coverage in the MEEI EW, during which they see patients and teach residents and medical students.
One fellow is assigned to be “on-call” for the service each week. This fellow is responsible for all emergency medical and surgical admissions to the Cornea Service faculty during weeknights and on the weekend. An assigned attending will be on call with the fellow and is available for complicated cases, admissions, or surgical procedures. Any changes to the on-call schedule must be processed through the Cornea Service Manager. If the fellow is unable to provide on-call coverage on any given pre-assigned week, it is the fellow’s responsibility to find coverage amongst the other fellows and inform the Manager.
The cornea fellow on-call is also responsible for providing consultation services to patients at the Shriners Burn Institute and Massachusetts General Hospital. A
log of all burn consult requests are kept in a binder at the Cornea front desk. Billing forms are available at the front desk and must be completed and returned to the
front desk staff immediately after the consult. The following is the official policy regarding burn consults:
During business hours, consults are called to the Cornea Service (617-573-4443). The fellow on the Burn rotation will then be notified. By communicating with the Burn Service at MGH or Shriner’s, the fellow will determine if a consult can wait until after 5 pm. If it is absolutely necessary to see the patient before 5 pm, and the fellow is unable to attend to it, the junior resident on the Cornea rotation will be contacted by the fellow. If unavailable, the EW junior resident will then be notified.
Consults called in after business hours and on weekends should be called to the MEEI EW. They will be seen by the EW junior resident. Burn consults need to be seen the same day they are called in and the Burn fellow should be informed of the need to follow-up on any case seen by the EW resident. It is the Cornea/Burn Consult Fellows’ responsibility to make all the necessary communication and follow-up regarding each consult request.
In addition to clinical activities, the following educational activities are also included in the fellow’s curriculum:
Cornea Club, an informal session in which fellows and attendings meet to discuss interesting cases, is held monthly in the early evening, while dinner is served. The attending assigned to lead each session typically picks a topic for discussion and the fellows prepare and present interesting cases during the session. Dinner is provided. The Cornea Service also hosts a visiting professor lecture series (typically 4-6 individuals are invited each year), for lectures and case presentations. Fellows prepare and present interesting cases within the visiting professors’ areas of expertise, occasionally supplemented by live patient examinations. Finally, MEEI has extensive formal didactics including weekly Grand Rounds.
The cornea fellows are an important resource for the education of the medical students and residents. They have direct interactions in Cornea Clinic, as attendings in the EW, and for emergency cornea cases in the EW. The fellow may provide this service independently, or in collaboration with a Cornea Service faculty member, depending upon the complexity of the case and fellow’s level of expertise.
Please note: Clinical fellows must meet the requirements for full (unlimited) licensure in Massachusetts.
Currently $40,000/1st year; $45,000/2nd year (for 2-year fellows).
Malpractice premiums, through the Harvard CRICO program, are paid for by the Cornea Service.
Family health insurance will be provided through the benefits program of Massachusetts Eye and Ear Associates. The fellow will need to contribute to this benefit as well, according to the guidelines of the Infirmary.
Each fellow is allowed 3 weeks (15 work days) of combined vacation/meeting time and (1) personal day per year (vacation does not accrue year to year). Requests for time away from the Service must be submitted in written form 60 days in advance for pre-approved by the Fellowship Director or the Service Director. Up to (5) additional days may be taken with the approval of the Fellowship or Service Director for a major ophthalmology conference or academic meeting at which the fellow is a first author presenting original research (i.e., the fellow has not presented the data before.) The Infirmary’s calendar also includes 9 legal holidays per year. Vacation request forms can be obtained from the Cornea Manager. Vacation should only be requested one week at a time and must not coincide with the vacation of another cornea fellow. The vacation must not be taken at the beginning or end two-week periods of the fellowship. The formal vacation policy will be given to incoming fellows during their orientation.
Attendance and participation at appropriate professional meetings is encouraged. Up to (5) days may be taken with the approval of the fellowship or service director for a major ophthalmology conference or academic meeting at which the fellow is a first author presenting original research (i.e., the fellow has not presented the data before.). If the fellow does not meet these criteria, then vacation time may be used. Fellows will be reimbursed for travel to meetings up to a maximum of $1,500 per academic year upon timely submission of the appropriate paperwork.
If you have a cellular phone, the service will reimburse you for calls made that are directly related to patient care (i.e. when on-call). Please submit original receipts for reimbursement. The service does not supply a cellular phone nor pay for the monthly service charge.
A room has been provided for you to secure your coat and belongings. A PC and printer are in the room. All Cornea Clinic exam lanes are also equipped with
networked computers, to be used for clinical and academic purposes. The manager will provide you with a key to the Fellows’ room. Please remember that the Infirmary
An in-box for your mail and/or important messages has been placed directly behind the Cornea Service front desk. This is an important venue for staff members to send
fellows important messages. Fellows are urged to check their mailbox frequently for patient telephone call messages, dictations and important mail and memos. You are supplied with a pager that you must wear during business hours and also at all times when on-call. Please respond to your pages promptly. If you change the
status of your beeper for any reason (i.e. in surgery, not available), please make sure you promptly reverse the status on your return to clinical duty. Paychecks may be picked up on the 25th of each month in the Cornea Manager’s office. You are provided up a maximum of $1500 per year for travel/meetings. On your return, please complete a “travel reimbursement form” and submit to the cornea manager with
original receipts. Forms can be obtained from the cornea manager. For all patients requiring surgery, it is the fellow’s responsibility on that particular attending’s rotation to ensure that all orders for lens implants, corneal or
amniotic tissue, and other special requests, are submitted in a timely manner so that the surgical scheduler can forward all appropriate completed forms to Preoperative
Review (8th Floor) a minimum of 48 hours in advance of surgery. Please note that cases that do not meet this deadline are cancelled; therefore, if possible, all paperwork
should be done one week prior to surgery to avoid any problems. Consent forms are signed while the patient is the clinic (forms are filed in the drawers of each exam room). While in the exam room, the patient should meet the
appropriate surgical scheduler regarding preoperative medical clearance, consent signing, etc. All patients should have A’s and K’s performed for cataract surgery
on the same day of their visit to the clinic unless other issues preclude this testing on that day (in which case the scheduler will have to coordinate another visit
to the MEEI for this purpose). The surgical scheduler will hold the chart(s) until all appropriate paperwork has been completed prior to forwarding to Preoperative Review. However, on the morning of
surgery, it is the fellow’s responsibility to transport the charts to the operating room. Following surgery, fellows are also responsible for dictating operative notes
immediately prior to leaving the operating room area, and for transporting the charts and billing forms back from the OR to the appropriate surgical scheduler.
Mail
Paging
Paychecks
Travel Reimbursement
Surgery
page updated: 7/16/07