Jul 15, 2019
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We are the immediate past cornea fellows at Washington University in St. Louis, MO. We had a really great experience and wanted to bring attention to this fellowship on SDN for potential applicants. Our program did not ask us to do this, but it was such a great year that we want to get the word out about the program before the next application cycle.

The Washington University cornea fellowship is a strong academic program that provides an excellent foundation in traditional corneal surgery (penetrating keratoplasty, DSEK, pterygium and ocular surface neoplasia) as well as newer and subspecialized techniques (DMEK, ocular surface reconstruction, limbal stem cell transplantation), while maintaining and further refining cataract surgery skills. The fellows average about 100 keratoplasties (all types) as primary surgeon over the year, which is well over the national average reported by AUPO FCC. Fellows receive instruction in and perform several primary keratorefractive procedures, but this topic is explicitly not emphasized in this fellowship. A core of 5 dedicated faculty provide longitudinal mentorship and graded surgical supervision. One of the strengths of this program is that each attending does things completely differently than the other one, so you get multiple perspectives of how to approach the same problem both clinically and surgically. This exposure to diverse treatment approaches enables the fellow to parse out his/her own management strategies for future independent practice. For example, you will learn to do phaco not just by clear cornea incisions, but via scleral tunnels and open-sky combined with PKP, as well as multiple opportunities to do extracap cataract surgery. If you are interested, you can work with attendings in other subspecialties too including anterior segment/glaucoma/MIGS and pediatrics.

Our averaged PRIMARY surgical numbers by the end of the fellowship year:
PKP: 50
DSEK: 28
DMEK: 19
DALK: 4
Cataract: 85
Pterygium: 8
Ocular surface neoplasia surgery: 10
IOL exchange/scleral-sutured TSSIOL/iris fixated IOLs: 7
KLAL/SLET (limbal stem cell transplantation): 5
LASIK/PRK: 8 (again, keratorefractive #s are not emphasized in this program but you get plenty of teaching on how-to and patient selection! If you want, you could advertise and probably do more than we did)

Another strength is that the fellows have a lot of autonomy in their own clinic at the VA and the resident/fellow clinic, but get sufficient supervision in the attendings’ specialty clinics. Instead of just shadowing and then going over cases at the very end of the day, attendings will pull you into the room and make sure that you see the exact finding that you’re supposed to see at the slit lamp. You also keep up your comprehensive skills at the VA with glaucoma and retina staffing in addition to minor plastics procedures which will aid anyone looking to practice at least part-time comprehensive ophthalmology, as well as prepping for boards.

Fellows have access to a wet lab equipped with operating microscopes and cadaveric human eyes for practice, as well as educational resources from the local Eye Bank. Research by fellows is encouraged and supported with protected time / funds for travel to conferences to present research. There are weekly cornea conferences ranging from case-based to topic-based, and a monthly cornea-specific pathology conference with the ophthalmic pathologist. Fellows are expected to teach residents and medical students, as well as to share on-call responsibilities with a co-fellow for cornea call and a pool for trauma call. The residency program is very strong with a PGY5 chief resident handling most of the weekday/weeknight trauma, so call is actually very manageable and you will have a good quality of life. Fellows are paid on PGY scale at the University plus hourly as a staff physician at the VA, so combined with the affordable cost of living in St. Louis, the take home pay is very reasonable compared with many other metropolitan areas. Graduates have gone on to both academic and private practices.

In summary: This cornea fellowship is truly amazing and we would do it again in a heartbeat. It is well-rounded with both diverse and in-depth exposure to anterior segment disease and surgery, and we would venture that there are few other programs in the country that offer as much of an experience.
 
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Bronze Medal

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Thanks for posting! It's really helpful when residents and fellows post program reviews.
 
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LightBox

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Average numbers for a cornea fellowship. Not terrible, but not great. Lack of refractive is a significant weakness. I don't care what people say -- you only learn by doing, not just reading. You wont feel comfortable with flap lifts and scraping out epi ingrowth without real life experience. Your cataract skills wont evolve significantly with 2 cats/week. I'd rather do that Cleveland private practice fellowship (which has it's own faults too). At least most of your skills would be significantly honed with >1000 cases. In the "real world" PKPs and DALKs are pretty scarce and are a money loser. Better to learn how to be good at EK. I think maybe the only advantage of this fellowship versus a private practice one, is exposure to clinic pathology and great clinicians who actually know what they are seeing.
 
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dantt

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Those are actually very good numbers. There are only a handful of fellowships in the country with better numbers.
Median primary surgery PKPs is about mid 20, endothelial keratoplasties is high 10s,.
 

LightBox

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Ok agree... the PKP and EK numbers are reasonable. Is that Eye Associates of Atlanta fellowship still out there? I remember that one being the highest volume fellowship.
 
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