CECFellow2022
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Hello Cataract, Refractive, & Anterior Segment surgery fellow applicants!
I want to provide an introduction and update for the amazing one-year cataract and refractive surgery fellowship at the Cleveland Eye Clinic and Clear Choice Custom LASIK Center with William Wiley, MD and Shamik Bafna, MD in Cleveland, OH. I am the former (recently graduated) fellow (2021-2022) and had a fantastic year in Cleveland – the fellowship was truly fulfilling and everything that I hoped it would be and more. I am obviously biased but I personally feel this is the best-in-class cataract and refractive fellowship in the country. The experience in this fellowship is unparalleled, and I hope I am able to convey its value in this post.
I perused the various threads on SDN regarding fellowships and cataract and refractive surgery during residency and personally benefitted from the various discussions and opinions voiced in this forum, so thank you to everyone here! I’ll address various comments from different threads across the years towards the end of this post.
Exposure to refractive surgery is extremely uncommon in residency, and there is no great singular resource that exists for helping applicants navigate the wide spectrum of cornea, cornea & refractive hybrid, anterior segment, and refractive & cataract fellowships. SF Match descriptions are often outdated, websites contain little to no information about fellowships, the COVID-19 pandemic ushered in an era of virtual interviews which made it difficult to feel out programs, and applicants have different aspirations and are looking for different things. What may be the perfect fellowship for one person may be non-ideal for someone else, so it is important to find a program with mentors who you trust and who can help you achieve your goals.
When I applied to fellowship, I felt implicitly pressured in the academic residency environment to pursue a cornea fellowship like my predecessors; no resident in my program before me had completed a private practice refractive and cataract fellowship, and it was implied I was wasting my potential by doing so. As a result, I ended up applying to 30+ fellowships of all kinds as I tried to feel out what path I wanted to take and what I wanted to do in my professional career. I even strongly considered doing two fellowships. I summarized my experience with the process after the cycle was complete, but in this post, I want to convey some thoughts as someone who considered refractive surgery from the start of residency and has been fortunate enough over the years to visit different private practices around the country and participate in groups and societies involved in pushing cataract and refractive surgery forward as a field.
I get a lot of questions from residents interested in refractive surgery (especially during application season) so I will update this post if any arise in this thread and am more than happy to speak offline about my experience in this fellowship.
This fellowship is geared towards someone interested in taking a deep dive in the full spectrum of refractive, cataract, and anterior segment surgery. Fellows perform some of the highest volume refractive and cataract surgery in the country, work through multiple clinics every week focused on consults and pre-operative exams for selecting the right patient and procedure, and serve as sub-investigators on clinical trials involving femtosecond/excimer lasers, MIGS devices, and IOLs that have yet to hit the commercial market. The fellow has the opportunity to present at national meetings, is exposed to healthy industry interactions, understands how the administrative and business aspects of private practice work, learns billing and coding, and emerges fully trained in cataract surgery, refractive lens exchange, EVO ICLs, SMILE, LASIK, PRK, PTK, INTACS, CXL, and MIGS.
The fellowship directors are Dr. Bill Wiley and Dr. Shamik Bafna who are both renowned in cataract and refractive surgery and are phenomenal mentors. In addition to being incredible surgeons and clinicians, they are some of the most positive, humble, and down-to-earth ophthalmologists you will have the pleasure of meeting, and they are truly invested in your success and helping you achieve your goals. You will work closely with both as they set you up with the tools and knowledge necessary to succeed.
Your time in the fellowship is split between the Cleveland Eye Clinic and Clear Choice Custom LASIK Center. Both practices are incredibly efficient and filled with knowledgeable and friendly staff. The two locations are contiguous and in the same building as the ASC, so this affords a seamless back and forth between clinic and surgery. During a typical week you will be in the OR 2-3 days (cataracts, RLE, ICL, MIGS), the laser suite 2-3 days (SMILE, LASIK, PRK, PTK, CXL), and clinic 2-3 days.
Both the Cleveland Eye Clinic and Clear Choice Custom LASIK Center are at the forefront of refractive and cataract technology and are often the first in Ohio (or the country) to starting doing new procedures. The practice set-up and volume of surgery that takes place makes it a desirable location for industry collaboration and research. Both Dr. Wiley and Dr. Bafna are heavily involved in various academic societies, are very well-connected, and regularly contribute to peer-reviewed and trade journals. In short, this fellowship is designed to train the next generation of leaders in the field of cataract and refractive surgery.
Although the primary focus of the fellowship is cataract and refractive surgery, there is a cornea subspecialist at a sister facility who loves teaching and performs PKPs, DMEK, DSEK, as well as tubes/trabs should the fellow express the desire to learn those procedures.
Your surgical time as a fellow is split between the OR and the laser vision correction suite.
Operating Room
The operating room is equipped with NGENUITY 3D Visualization systems, so all surgery is conducted as 3D heads-up surgery. I am a big believer in the ergonomic benefits of 3D heads up surgery and I found this to be a blessing as the fellow operates with both Dr. Wiley and Dr. Bafna multiple days a week, often with 40+ cases booked each day. The heads-up display technology is also an amazing didactic tool that allows you to see exactly what Dr. Wiley and Dr. Bafna are seeing and doing when you are not in the middle of a case yourself. The ORs are equipped with ORA and the fellow will see how this technology is utilized and how aphakic and pseudophakic measurements interplay with other pre-operative biometry (IOL Master 700, Pentacam, etc.). Every single IOL that exists is on consignment which allows for selecting the right lens for the right patient. Both Dr. Wiley and Dr. Bafna have different surgical techniques and different IOL preferences, so as the fellow, you get exposed to everything. I thought I had a pretty good grasp of the IOL landscape coming out of residency, but there were so many IOLs I was exposed to in fellowship that I didn’t even know existed. There were also many levels to IOL selection that I had not given much attention to as a resident (sphericity, spherical aberration, chromatic aberration, defocus curves, IOL design, monovision, etc.) that I learned.
You will learn many types of nucleofractis: how to vertical chop, horizontal chop, combo chop, phaco chop, tilt n’ tumble, flip and chop, etc. Whatever method of nucleofractis you are interested in, Dr. Wiley and Dr. Bafna will make sure you learn how to perform the technique. You will also learn how to use devices like miLoop for dense cataracts, and if you didn’t have a lot of experience in residency with iris expansion devices, capsular hooks, etc. - you will learn how to utilize those as well.
Dr. Wiley is always trying out new things and innovating, so you get a front row seat to new techniques or surgical instruments being born in real time. Unrelated, but he also once did cataract surgery on a 1.5 lb Golden Lion Tamarin Monkey at the Akron Zoo!
Since Dr. Wiley and Dr. Bafna are regarded as experts in the field, you will see a good number of unique cases and a lot of post-refractive surgery eyes for cataract surgery (s/p RK, PRK, LASIK, SMILE, KAMRA), and understand how to handle those cases.
In addition to cataract surgery, refractive cataract surgery, and refractive lens exchange, you will also learn how to do EVO ICL surgery and INTACS. The fellow also performs a fair amount of MIGS surgery and often sees the latest MIGS devices in action before they hit the market.
Surgery involves the use of compounded medications, so you will learn the process and flow behind minimizing post-operative drops. The ORs have extremely efficient turnover time, so you will passively be exposed to the streamlined process and learn how to replicate it should you decide to hang your own shingle (this holds true for clinic as well).
Laser Vision Correction suite
The suite is equipped with the Zeiss VisuMax and J&J Intralase femtosecond lasers, and the Nidek and Alcon (Allegretto and EX500) excimer lasers. You will perform hundreds of PRK, LASIK, SMILE, and PTK and CXL as the primary surgeon. In addition, you will also makes hundreds of flaps and perform various parts of all procedures as you are learning. Clear Choice Custom LASIK Center is almost always involved in multiple clinical studies, so depending on the time of year and market forces, you may be exposed to new femtosecond and excimer lasers long before they become commercially available.
The evolution of technology also means that every fellow’s experience will be slightly different. Corneal inlays are no longer being implanted, MIGS devices change, IOLs come and go, and laser vision correction trends are changing as well. The benefit of training at a place that embraces innovation and technology is that you will be trained on the latest procedures and will not be surprised by anything in practice or what is coming down the pipeline.
People often say that learning refractive surgery is easy, but that the hardest and most important part is learning the pre-operative process and proper patient selection (I’ll address this later).
As the fellow, you will be in clinic three days a week working side-by-side with a highly subspecialized refractive optometrist, Dr. Jeffrey Augustine, who has been involved in refractive surgery since the RK days. You will learn just as much from him as you will from Drs. Wiley and Bafna and will perform hundreds (maybe even thousands) of pre-operative exams and consultations. You will see every type of cornea, eye anatomy, relative and absolute contraindications and will emerge truly confident regarding the patient selection process. The latest diagnostic equipment is available so you will learn how to interpret topography, tomography, epithelial mapping, etc. You will also learn the art of talking to patients and providing a high-touch patient experience, two things often not formally taught in residency.
Additionally, just as in surgery, for every patient you are not personally seeing, you will still have the ability to see the work-up and plan, so you will learn from that as well. The value of clinic time cannot be overstated, and one of the amazing things about this fellowship is how both time in surgery and time in clinic are maximized.
Not everyone is interested in research, and that’s OK. If you are, both the Cleveland Eye Clinic and Clear Choice Custom LASIK Center are always involved in clinical studies, and former fellows were among the first to be exposed to things like SMILE laser vision correction, the Apthera IC-8 IOL, the EVO ICL, KAMRA inlay, etc. There is ample opportunity to be first author on publications, and former fellows have been published in JCRS, JRS, and various trade publications as well. There is a dedicated research department, so this makes conducting IITs or clinical studies very easy. This is also a great way to get medical students and residents involved if you enjoy that type of collaboration.
I want to provide an introduction and update for the amazing one-year cataract and refractive surgery fellowship at the Cleveland Eye Clinic and Clear Choice Custom LASIK Center with William Wiley, MD and Shamik Bafna, MD in Cleveland, OH. I am the former (recently graduated) fellow (2021-2022) and had a fantastic year in Cleveland – the fellowship was truly fulfilling and everything that I hoped it would be and more. I am obviously biased but I personally feel this is the best-in-class cataract and refractive fellowship in the country. The experience in this fellowship is unparalleled, and I hope I am able to convey its value in this post.
I perused the various threads on SDN regarding fellowships and cataract and refractive surgery during residency and personally benefitted from the various discussions and opinions voiced in this forum, so thank you to everyone here! I’ll address various comments from different threads across the years towards the end of this post.
Exposure to refractive surgery is extremely uncommon in residency, and there is no great singular resource that exists for helping applicants navigate the wide spectrum of cornea, cornea & refractive hybrid, anterior segment, and refractive & cataract fellowships. SF Match descriptions are often outdated, websites contain little to no information about fellowships, the COVID-19 pandemic ushered in an era of virtual interviews which made it difficult to feel out programs, and applicants have different aspirations and are looking for different things. What may be the perfect fellowship for one person may be non-ideal for someone else, so it is important to find a program with mentors who you trust and who can help you achieve your goals.
When I applied to fellowship, I felt implicitly pressured in the academic residency environment to pursue a cornea fellowship like my predecessors; no resident in my program before me had completed a private practice refractive and cataract fellowship, and it was implied I was wasting my potential by doing so. As a result, I ended up applying to 30+ fellowships of all kinds as I tried to feel out what path I wanted to take and what I wanted to do in my professional career. I even strongly considered doing two fellowships. I summarized my experience with the process after the cycle was complete, but in this post, I want to convey some thoughts as someone who considered refractive surgery from the start of residency and has been fortunate enough over the years to visit different private practices around the country and participate in groups and societies involved in pushing cataract and refractive surgery forward as a field.
I get a lot of questions from residents interested in refractive surgery (especially during application season) so I will update this post if any arise in this thread and am more than happy to speak offline about my experience in this fellowship.
TABLE OF CONTENTS
- Introduction
- Surgery
- Clinic
- Research
- Meetings & Teaching
- Industry
- Job Opportunities
- Frequently Asked Questions
- Surgical Numbers
- Response To Previous SDN Comments
- SDN References
INTRODUCTION
This fellowship is geared towards someone interested in taking a deep dive in the full spectrum of refractive, cataract, and anterior segment surgery. Fellows perform some of the highest volume refractive and cataract surgery in the country, work through multiple clinics every week focused on consults and pre-operative exams for selecting the right patient and procedure, and serve as sub-investigators on clinical trials involving femtosecond/excimer lasers, MIGS devices, and IOLs that have yet to hit the commercial market. The fellow has the opportunity to present at national meetings, is exposed to healthy industry interactions, understands how the administrative and business aspects of private practice work, learns billing and coding, and emerges fully trained in cataract surgery, refractive lens exchange, EVO ICLs, SMILE, LASIK, PRK, PTK, INTACS, CXL, and MIGS.
The fellowship directors are Dr. Bill Wiley and Dr. Shamik Bafna who are both renowned in cataract and refractive surgery and are phenomenal mentors. In addition to being incredible surgeons and clinicians, they are some of the most positive, humble, and down-to-earth ophthalmologists you will have the pleasure of meeting, and they are truly invested in your success and helping you achieve your goals. You will work closely with both as they set you up with the tools and knowledge necessary to succeed.
Your time in the fellowship is split between the Cleveland Eye Clinic and Clear Choice Custom LASIK Center. Both practices are incredibly efficient and filled with knowledgeable and friendly staff. The two locations are contiguous and in the same building as the ASC, so this affords a seamless back and forth between clinic and surgery. During a typical week you will be in the OR 2-3 days (cataracts, RLE, ICL, MIGS), the laser suite 2-3 days (SMILE, LASIK, PRK, PTK, CXL), and clinic 2-3 days.
Both the Cleveland Eye Clinic and Clear Choice Custom LASIK Center are at the forefront of refractive and cataract technology and are often the first in Ohio (or the country) to starting doing new procedures. The practice set-up and volume of surgery that takes place makes it a desirable location for industry collaboration and research. Both Dr. Wiley and Dr. Bafna are heavily involved in various academic societies, are very well-connected, and regularly contribute to peer-reviewed and trade journals. In short, this fellowship is designed to train the next generation of leaders in the field of cataract and refractive surgery.
Although the primary focus of the fellowship is cataract and refractive surgery, there is a cornea subspecialist at a sister facility who loves teaching and performs PKPs, DMEK, DSEK, as well as tubes/trabs should the fellow express the desire to learn those procedures.
SURGERY
Your surgical time as a fellow is split between the OR and the laser vision correction suite.
Operating Room
The operating room is equipped with NGENUITY 3D Visualization systems, so all surgery is conducted as 3D heads-up surgery. I am a big believer in the ergonomic benefits of 3D heads up surgery and I found this to be a blessing as the fellow operates with both Dr. Wiley and Dr. Bafna multiple days a week, often with 40+ cases booked each day. The heads-up display technology is also an amazing didactic tool that allows you to see exactly what Dr. Wiley and Dr. Bafna are seeing and doing when you are not in the middle of a case yourself. The ORs are equipped with ORA and the fellow will see how this technology is utilized and how aphakic and pseudophakic measurements interplay with other pre-operative biometry (IOL Master 700, Pentacam, etc.). Every single IOL that exists is on consignment which allows for selecting the right lens for the right patient. Both Dr. Wiley and Dr. Bafna have different surgical techniques and different IOL preferences, so as the fellow, you get exposed to everything. I thought I had a pretty good grasp of the IOL landscape coming out of residency, but there were so many IOLs I was exposed to in fellowship that I didn’t even know existed. There were also many levels to IOL selection that I had not given much attention to as a resident (sphericity, spherical aberration, chromatic aberration, defocus curves, IOL design, monovision, etc.) that I learned.
You will learn many types of nucleofractis: how to vertical chop, horizontal chop, combo chop, phaco chop, tilt n’ tumble, flip and chop, etc. Whatever method of nucleofractis you are interested in, Dr. Wiley and Dr. Bafna will make sure you learn how to perform the technique. You will also learn how to use devices like miLoop for dense cataracts, and if you didn’t have a lot of experience in residency with iris expansion devices, capsular hooks, etc. - you will learn how to utilize those as well.
Dr. Wiley is always trying out new things and innovating, so you get a front row seat to new techniques or surgical instruments being born in real time. Unrelated, but he also once did cataract surgery on a 1.5 lb Golden Lion Tamarin Monkey at the Akron Zoo!
Since Dr. Wiley and Dr. Bafna are regarded as experts in the field, you will see a good number of unique cases and a lot of post-refractive surgery eyes for cataract surgery (s/p RK, PRK, LASIK, SMILE, KAMRA), and understand how to handle those cases.
In addition to cataract surgery, refractive cataract surgery, and refractive lens exchange, you will also learn how to do EVO ICL surgery and INTACS. The fellow also performs a fair amount of MIGS surgery and often sees the latest MIGS devices in action before they hit the market.
Surgery involves the use of compounded medications, so you will learn the process and flow behind minimizing post-operative drops. The ORs have extremely efficient turnover time, so you will passively be exposed to the streamlined process and learn how to replicate it should you decide to hang your own shingle (this holds true for clinic as well).
Laser Vision Correction suite
The suite is equipped with the Zeiss VisuMax and J&J Intralase femtosecond lasers, and the Nidek and Alcon (Allegretto and EX500) excimer lasers. You will perform hundreds of PRK, LASIK, SMILE, and PTK and CXL as the primary surgeon. In addition, you will also makes hundreds of flaps and perform various parts of all procedures as you are learning. Clear Choice Custom LASIK Center is almost always involved in multiple clinical studies, so depending on the time of year and market forces, you may be exposed to new femtosecond and excimer lasers long before they become commercially available.
The evolution of technology also means that every fellow’s experience will be slightly different. Corneal inlays are no longer being implanted, MIGS devices change, IOLs come and go, and laser vision correction trends are changing as well. The benefit of training at a place that embraces innovation and technology is that you will be trained on the latest procedures and will not be surprised by anything in practice or what is coming down the pipeline.
CLINIC
People often say that learning refractive surgery is easy, but that the hardest and most important part is learning the pre-operative process and proper patient selection (I’ll address this later).
As the fellow, you will be in clinic three days a week working side-by-side with a highly subspecialized refractive optometrist, Dr. Jeffrey Augustine, who has been involved in refractive surgery since the RK days. You will learn just as much from him as you will from Drs. Wiley and Bafna and will perform hundreds (maybe even thousands) of pre-operative exams and consultations. You will see every type of cornea, eye anatomy, relative and absolute contraindications and will emerge truly confident regarding the patient selection process. The latest diagnostic equipment is available so you will learn how to interpret topography, tomography, epithelial mapping, etc. You will also learn the art of talking to patients and providing a high-touch patient experience, two things often not formally taught in residency.
Additionally, just as in surgery, for every patient you are not personally seeing, you will still have the ability to see the work-up and plan, so you will learn from that as well. The value of clinic time cannot be overstated, and one of the amazing things about this fellowship is how both time in surgery and time in clinic are maximized.
RESEARCH
Not everyone is interested in research, and that’s OK. If you are, both the Cleveland Eye Clinic and Clear Choice Custom LASIK Center are always involved in clinical studies, and former fellows were among the first to be exposed to things like SMILE laser vision correction, the Apthera IC-8 IOL, the EVO ICL, KAMRA inlay, etc. There is ample opportunity to be first author on publications, and former fellows have been published in JCRS, JRS, and various trade publications as well. There is a dedicated research department, so this makes conducting IITs or clinical studies very easy. This is also a great way to get medical students and residents involved if you enjoy that type of collaboration.
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