Top 10 Surgical Retina Fellowships

[antiVEGF]

Things change fast. A decade or two ago, residents were advised that only a smattering of 10 vitreoretinal surgery fellowship programs were considered worth going to. More recently, a more palatable truth seems to have emerged: there are so many amazing programs, each with their own advantages and disadvantages.

That being said, the last thread that attempted to rank surgical retina programs was started in 2014. We all need an update. After heavy editing of this list along with several faculty, fellows, and fellowship applicants, I present to you... the 2022 Top Surgical Retina Fellowship Program Rankings!!! These reflect more recent changes such as Beaumont / ARC acquisition by PE and turnover, the dissolution of MEETH, etc. The order is obviously loose and not definitive, though the consensus seems to be that Wills is deserving of the #1 spot. Obviously, take anything on the internet with a grain of salt, guys. Healthy discussion expected and encouraged.

Top Retina Programs by Reputation
1. Wills Eye / MAR
2. Bascom Palmer (internal chief track)
3. Cleveland Clinic (Cole)
4. Duke
5. Oakland University William Beaumont / ARC
6. Mass Eye and Ear
7. Stanford (Byers)
8. Tufts / OCB
9. UCLA (Stein)
10. Michigan (Kellogg)

Other excellent programs / honorable mentions in no particular order:
- Emory
- Bascom Palmer (external track)
- Johns Hopkins (Wilmer)
- Iowa
- Illinois Eye and Ear / UIC
- OHSU (Casey)
- USC (Roski)
- NYU (Langone)
- Vanderbilt
- RGW

---

Members don't see this ad.

 

[docdoc2012]

Umm..
U kentucky
Cincinnati Eye
UAB

The surgical experience and mentor diversity you get at these places is much better than atleast half of those programs. There's a difference between being able to talk about surgery and actually have the experience to perform it/ master new techniques. Volume of high quality cases is important

 

[eyeeye_captain]

Umm..
U kentucky
Cincinnati Eye
UAB

The surgical experience and mentor diversity you get at these places is much better than atleast half of those programs. There's a difference between being able to talk about surgery and actually have the experience to perform it/ master new techniques. Volume of high quality cases is important

Couldn’t echo this enough.

Would also add spots like TRI, Colorado, and Moran for people not afraid of the middle/west of the country. MCW is also solid if you like the cold. UAB is 2 programs, RCA is the better one.

I don’t want to be mean, but can we agree that Bascom’s external track is at least a little overrated? I’d rather hang out in the OR with Dr. Kitchens in Kentucky than the senior internal fellow at Bascom, nothing against those fellows.

 

[antiVEGF]

Thanks for the input and discussion, both of you. I think continued discussion is a great way to highlight some other fantastic programs I might've missed! I admit that the "honorable mentions" list was by no means meant to be comprehensive. While I agree that the sheer volume of high quality cases is quite important, the top 10 list also takes into account other less tangible factors beyond the ever-quoted "vitrectomy numbers." The institutions represented here provide access to a diverse surgical style and teaching philosophy, are made up of leaders in the field who preside over meetings / head trials / decide the direction of vision research, and ultimately provide a network of retina specialists who will act to propel a trainee into the career of their choice, be it academics or a coveted private practice (in the location they desire). Please note that this list was not meant to be coast-centric, as you'll find the likes of Cole, Duke, Beaumont, and UMich represented, and Iowa, Emory, and Vanderbilt mentioned.

Attempting to rank retina fellowships, just like ranking any program or school, is fraught with difficulty. To a previous point, a college student may feel that they would rather attend U Kentucky, rather than a university like Harvard or Princeton, because they are considering many factors (cost, the excitement of cheering for your school's basketball team, or the overwhelming kind and supportive culture UK is known for). Many would argue that UK would indeed be a better match for this student, and might lead to greater success than if they had attended Harvard. Yet, Harvard and Princeton will regularly top any list that attempts to rank colleges. The goal of this thread is simply to do what the US News World Report and Ophthalmology Times do and rank retinal fellowships based largely on current reputation among the community. (By the way, the Ophthalmology Times 2022 rankings are out here: Ophthalmology Times 2022).

This updated list was meant moreso to highlight some recent changes and trends among the top 10 programs that are widely regarded as the best. The honorable mentions was a fun addition meant to be brief and by no means comprehensive. I do apologize as this means inherently there will always be several wonderful programs left out. The other programs mentioned above are definitely excellent (Moran, TRI, Cincinnati, MCW, etc). Other programs that come to mind include CPMC and Rush.

 

[antiVEGF]

Couldn’t echo this enough.

Would also add spots like TRI, Colorado, and Moran for people not afraid of the middle/west of the country. MCW is also solid if you like the cold. UAB is 2 programs, RCA is the better one.

I don’t want to be mean, but can we agree that Bascom’s external track is at least a little overrated? I’d rather hang out in the OR with Dr. Kitchens in Kentucky than the senior internal fellow at Bascom, nothing against those fellows.

It is true that the external track at Bascom has that reputation - 10 years ago, many might've agreed that the fellowship experience was sub-par due to the dichotomy between external and internal trainees. However, recent changes have allowed the external-track trainees to spend a large amount of time in the OR with some fantastic surgeons (non-trainees) both at the main campus and satellite sites. The pathology and clinical experience has always been and still is top-notch. Bascom external graduates have gone on to do some great things in the field of retina and remain highly regarded - the gap in distinction between "external" and "internal" in that regard is closing..

Funny you bring up Dr. Kitchens. If you are talking about John, he is coincidentally an example of someone who is an "external" Bascom track graduate!

 

[eyeeye_captain]

It is true that the external track at Bascom has that reputation - 10 years ago, many might've agreed that the fellowship experience was sub-par due to the dichotomy between external and internal trainees. However, recent changes have allowed the external-track trainees to spend a large amount of time in the OR with some fantastic surgeons (non-trainees) both at the main campus and satellite sites. The pathology and clinical experience has always been and still is top-notch. Bascom external graduates have gone on to do some great things in the field of retina and remain highly regarded - the gap in distinction between "external" and "internal" in that regard is closing..

Funny you bring up Dr. Kitchens. If you are talking about John, he is coincidentally an example of someone who is an "external" Bascom track graduate!

I think some of the point @docdoc2012 are making is a little lost here. I really hope you’re correct and that the external track is closer to the internal than it used to be, which is excellent. I merely said overrated for the external, not bad. You get good training and Bascom on your CV, which opens doors.

The point is that actually sitting in the chair with the cutter in your hand, with a variety of perspectives at the side scope, is massive. You’ve somewhat downplayed surgical volume, and I couldn’t disagree more. Numbers shouldn’t be the biggest priority, but if I’m hiring a fresh fellow, I want to know they’ve been hands-on for a bunch of cases. I agree that variety is big, but how many IOFBs or plaques are you doing in private practice?

I brought up John Kitchens for 2 reasons - 1. Kentucky was mentioned. 2. As a former Bascom fellow, he may have managed to create a similar, if not better, level of surgical competency in fellows from his program since they get to hang out with the heavy hitters. He’s a brilliant (and cool) guy who would have done well no matter where he trained. Hopefully you’re correct and the external folks aren’t stuck on the sidelines like in my day, I want everyone to get good training.

 

[docdoc2012]

It is true that the external track at Bascom has that reputation - 10 years ago, many might've agreed that the fellowship experience was sub-par due to the dichotomy between external and internal trainees. However, recent changes have allowed the external-track trainees to spend a large amount of time in the OR with some fantastic surgeons (non-trainees) both at the main campus and satellite sites. The pathology and clinical experience has always been and still is top-notch. Bascom external graduates have gone on to do some great things in the field of retina and remain highly regarded - the gap in distinction between "external" and "internal" in that regard is closing..

Funny you bring up Dr. Kitchens. If you are talking about John, he is coincidentally an example of someone who is an "external" Bascom track graduate!

Kitchens actually isn't an external fellow. His year they had a chief track opening because they lost their candidate to a medical issue I believe. Kitchens ended up doing the chief track

 

[docdoc2012]

Thanks for the input and discussion, both of you. I think continued discussion is a great way to highlight some other fantastic programs I might've missed! I admit that the "honorable mentions" list was by no means meant to be comprehensive. While I agree that the sheer volume of high quality cases is quite important, the top 10 list also takes into account other less tangible factors beyond the ever-quoted "vitrectomy numbers." The institutions represented here provide access to a diverse surgical style and teaching philosophy, are made up of leaders in the field who preside over meetings / head trials / decide the direction of vision research, and ultimately provide a network of retina specialists who will act to propel a trainee into the career of their choice, be it academics or a coveted private practice (in the location they desire). Please note that this list was not meant to be coast-centric, as you'll find the likes of Cole, Duke, Beaumont, and UMich represented, and Iowa, Emory, and Vanderbilt mentioned.

Attempting to rank retina fellowships, just like ranking any program or school, is fraught with difficulty. To a previous point, a college student may feel that they would rather attend U Kentucky, rather than a university like Harvard or Princeton, because they are considering many factors (cost, the excitement of cheering for your school's basketball team, or the overwhelming kind and supportive culture UK is known for). Many would argue that UK would indeed be a better match for this student, and might lead to greater success than if they had attended Harvard. Yet, Harvard and Princeton will regularly top any list that attempts to rank colleges. The goal of this thread is simply to do what the US News World Report and Ophthalmology Times do and rank retinal fellowships based largely on current reputation among the community. (By the way, the Ophthalmology Times 2022 rankings are out here: Ophthalmology Times 2022).

This updated list was meant moreso to highlight some recent changes and trends among the top 10 programs that are widely regarded as the best. The honorable mentions was a fun addition meant to be brief and by no means comprehensive. I do apologize as this means inherently there will always be several wonderful programs left out. The other programs mentioned above are definitely excellent (Moran, TRI, Cincinnati, MCW, etc). Other programs that come to mind include CPMC and Rush.

Vitrectomy numbers are exactly those. 'Vitrectomy numbers'. They don't highlight the complexity of the cases or the surgical diversity of them. I know for a fact that some of the programs you mentioned, the fellows only do the core vit and log it as a full case.

Being able to operate with whatever instrument you have at hand in whatever setting is priceless. Not to knock the top programs. You go to these programs with a very specific goal of wanting to make yourself a name in the academic sphere or go to the podium. I don't buy that they give you more access to private practice jobs anymore, especially in the PE era.

Be careful who you emulate. You will find as you move through retina that some of the loudest ones on the podium 1. Only show you their amazing surgical successes and 2. Take 2 hrs to do an erm peel. Few are actually brilliant like Kitchens or basil williams or yoshi yonekawa

Go to a program that will make you a top notch confident surgeon with mentor diversity and true case numbers.because at the end of the day in the OR its just you and your decision making. Being so and so's fellow won't bail you out.

The programs above have an advantage in that you do see a lot of interesting medical retina, but many times the surgical fellows aren't necessarily in these clinics.

 

[antiVEGF]

Vitrectomy numbers are exactly those. 'Vitrectomy numbers'. They don't highlight the complexity of the cases or the surgical diversity of them. I know for a fact that some of the programs you mentioned, the fellows only do the core vit and log it as a full case.

Being able to operate with whatever instrument you have at hand in whatever setting is priceless. Not to knock the top programs. You go to these programs with a very specific goal of wanting to make yourself a name in the academic sphere or go to the podium. I don't buy that they give you more access to private practice jobs anymore, especially in the PE era.

Be careful who you emulate. You will find as you move through retina that some of the loudest ones on the podium 1. Only show you their amazing surgical successes and 2. Take 2 hrs to do an erm peel. Few are actually brilliant like Kitchens or basil williams or yoshi yonekawa

Go to a program that will make you a top notch confident surgeon with mentor diversity and true case numbers.because at the end of the day in the OR its just you and your decision making. Being so and so's fellow won't bail you out.

The programs above have an advantage in that you do see a lot of interesting medical retina, but many times the surgical fellows aren't necessarily in these clinics.

I couldn't agree more regarding the issue with vitrectomy numbers. There is quite a wide range of OR experience that trainees and programs will claim as counting towards their case log. However, I'll have to disagree with the implication that the top retina fellowship are more susceptible to PPV number-inflating than others. Even if you ignore everything else entirely, the surgical experience at these top programs speak for themselves. If you look at the top 5 retina programs in particular, the combination of surgical volume and complexity is unmatched. Wills trainees function as the primary surgeon the vast majority of their surgical experience which includes a full day of OR 5 days a week, every week, in their second year of fellowship. The Bascom chiefs are handling everything from the complex (end-stage TRDs, post-globe RD's, and PVR cases) while peeling ERMs on the private side for quite an unforgiving population. Cole trainees start as primary surgeon on peels and secondary IOLs within their first few weeks of fellowship and by second year are tackling complex uveitic cases that many surgeons in the community wouldn't dare touch. Duke fellows are quite literally training with Machemer's closest colleagues.. enough said. Beaumont (though with some tough losses recently) has a one-of-a-kind pediatric experience that allows future specialists to feel comfortable operating on some of the most challenging surgeries for our most vulnerable population.

Every single retina fellowship in the top 5 listed above has vitrectomy numbers that surpass 500 comfortably, with some reaching 1000. But more importantly, the complexity, variety, and autonomy that these vitrectomy numbers represent make these programs the best vitreoretinal surgical training you can find. This is ignoring the plethora of other well-rounded opportunities that a top 10 fellowship affords, especially for those who may not hate the idea of speaking on a podium or become the next yoshi or basil themselves. I wouldn't want readers receiving the impression that choosing a top 10 program means sacrificing the quality of surgical training. In fact, I agree with the both of you that this is the most important aspect of the two-year fellowship, and contributed the most to this ranking.

 

[eyeeye_captain]

I couldn't agree more regarding the issue with vitrectomy numbers. There is quite a wide range of OR experience that trainees and programs will claim as counting towards their case log. However, I'll have to disagree with the implication that the top retina fellowship are more susceptible to PPV number-inflating than others. Even if you ignore everything else entirely, the surgical experience at these top programs speak for themselves. If you look at the top 5 retina programs in particular, the combination of surgical volume and complexity is unmatched. Wills trainees function as the primary surgeon the vast majority of their surgical experience which includes a full day of OR 5 days a week, every week, in their second year of fellowship. The Bascom chiefs are handling everything from the complex (end-stage TRDs, post-globe RD's, and PVR cases) while peeling ERMs on the private side for quite an unforgiving population. Cole trainees start as primary surgeon on peels and secondary IOLs within their first few weeks of fellowship and by second year are tackling complex uveitic cases that many surgeons in the community wouldn't dare touch. Duke fellows are quite literally training with Machemer's closest colleagues.. enough said. Beaumont (though with some tough losses recently) has a one-of-a-kind pediatric experience that allows future specialists to feel comfortable operating on some of the most challenging surgeries for our most vulnerable population.

Every single retina fellowship in the top 5 listed above has vitrectomy numbers that surpass 500 comfortably, with some reaching 1000. But more importantly, the complexity, variety, and autonomy that these vitrectomy numbers represent make these programs the best vitreoretinal surgical training you can find. This is ignoring the plethora of other well-rounded opportunities that a top 10 fellowship affords, especially for those who may not hate the idea of speaking on a podium or become the next yoshi or basil themselves. I wouldn't want readers receiving the impression that choosing a top 10 program means sacrificing the quality of surgical training. In fact, I agree with the both of you that this is the most important aspect of the two-year fellowship, and contributed the most to this ranking.

I think we’re all making the same point from slightly different angles, which is a good thing as we all seem to agree on priorities. The aside was more that there are some lesser “name brand” programs than the obvious top 5 you mention that can likely get you equal, to possibly better, surgical training than the list you provided. A significant factor is culture as well. Stein and Casey couldn’t be much more different there, for example.

 

[antiVEGF]

I think we’re all making the same point from slightly different angles, which is a good thing as we all seem to agree on priorities. The aside was more that there are some lesser “name brand” programs than the obvious top 5 you mention that can likely get you equal, to possibly better, surgical training than the list you provided. A significant factor is culture as well. Stein and Casey couldn’t be much more different there, for example.

Agreed. The honorable mentions list, and even the programs ranked #6-10 are not obvious winners against the likes of UAB RCA, Cincinnati, Moran, etc. For each individual, specific factors such as culture, location, and as mentioned, surgical numbers, might sway someone one way or another.

You do bring up an interesting point. It seems that lately there is a large focus on improving the culture of residency programs, and this shift seems to be happening in surgical retina fellowships as well. Programs known for their attention to this intangible factor - Cole, Byers, Casey, etc - have been attracting some of the best applicants and have quite the optimistic future. On the flipside, Stein (despite its reputation as a former top 5 fellowship) has had some recent issues recruiting trainees. It does make me wonder whether this represents a simple ebb and flow, or whether a fundamental shift is taking place in retina and medicine as a whole.

 

[Dusn]

How's Wilmer these days? It used to have a bad reputation for being very malignant with poor surgical training and back, I think, in 2012 the surgical retina spot didn't fill in the initial match. Obviously a lot might have changed over the past decade.

 

[i-doctor]

Another factor is that fellowship applications are down a bit overall. With the general ophthalmologists having the extra income from premium IOL’s, many are making higher incomes than the other subspecialists, except for retina. So—from an income perspective— why do a fellowship? Also, many of today’s residents are lifestyle-oriented, and therefore shy away from retina also.

 

[docdoc2012]

I couldn't agree more regarding the issue with vitrectomy numbers. There is quite a wide range of OR experience that trainees and programs will claim as counting towards their case log. However, I'll have to disagree with the implication that the top retina fellowship are more susceptible to PPV number-inflating than others. Even if you ignore everything else entirely, the surgical experience at these top programs speak for themselves. If you look at the top 5 retina programs in particular, the combination of surgical volume and complexity is unmatched. Wills trainees function as the primary surgeon the vast majority of their surgical experience which includes a full day of OR 5 days a week, every week, in their second year of fellowship. The Bascom chiefs are handling everything from the complex (end-stage TRDs, post-globe RD's, and PVR cases) while peeling ERMs on the private side for quite an unforgiving population. Cole trainees start as primary surgeon on peels and secondary IOLs within their first few weeks of fellowship and by second year are tackling complex uveitic cases that many surgeons in the community wouldn't dare touch. Duke fellows are quite literally training with Machemer's closest colleagues.. enough said. Beaumont (though with some tough losses recently) has a one-of-a-kind pediatric experience that allows future specialists to feel comfortable operating on some of the most challenging surgeries for our most vulnerable population.

Every single retina fellowship in the top 5 listed above has vitrectomy numbers that surpass 500 comfortably, with some reaching 1000. But more importantly, the complexity, variety, and autonomy that these vitrectomy numbers represent make these programs the best vitreoretinal surgical training you can find. This is ignoring the plethora of other well-rounded opportunities that a top 10 fellowship affords, especially for those who may not hate the idea of speaking on a podium or become the next yoshi or basil themselves. I wouldn't want readers receiving the impression that choosing a top 10 program means sacrificing the quality of surgical training. In fact, I agree with the both of you that this is the most important aspect of the two-year fellowship, and contributed the most to this ranking.

I have no issue with your top 5 selections. Those are indeed incredibly well rounded programs and some of my closest retina friends have graduated from these programs. They do indeed offer the diversity of experience and connections that those who want to go to podium would benefit from Beyond this, your list is murky I would say in terms of surgical experience. As far as disagreeing with the implications, its not about implication. Inflation of surgical numbers is a known fact.

What we need to acknowledge is that most of the time retina is attracting top caliber surgeons period. They are the type of people who would flourish in most environments they are placed in. What we are judging is the environment itself.

Doing a PVR/TRD/uveitis case start to finish and "participating in" these cases are very different things. Watching decion making and actually decision making in real time with your own patients are 2 very different things. The latter is what you go to fellowship training for - so that you don't harm and do the best for the patient infront of you preferably without having a post-fellowship complication based learning curve

 

[docdoc2012]

Another factor is that fellowship applications are down a bit overall. With the general ophthalmologists having the extra income from premium IOL’s, many are making higher incomes than the other subspecialists, except for retina. So—from an income perspective— why do a fellowship? Also, many of today’s residents are lifestyle-oriented, and therefore shy away from retina also.

I think residents often underestimate how hard it is to actually continuously upsell premium IOLs in practice. I've always contended that a refractive surgeons and retina surgeons are both highly gifted, highly ambitious and very detailed oriented but with vastly different outlooks on life, medicine and patient care

 

[antiVEGF]

How's Wilmer these days? It used to have a bad reputation for being very malignant with poor surgical training and back, I think, in 2012 the surgical retina spot didn't fill in the initial match. Obviously a lot might have changed over the past decade.

I believe they've made some impressive strides in addressing the surgical training issues as well as the culture. Along with the rest of the residency program, Wilmer's retina program graduates seem quite happy. Wilmer has been at the forefront of emphasizing trainee wellness with attention to things like parental leave. Surgical numbers are now quoted at the 600's range, though as we've discussed at length these numbers shouldn't necessarily be regarded as complete truths. They definitely have a research-heavy reputation but it seems a good proportion of graduates are successful in acquiring good private practice jobs. While it doesn't belong in the top 10, I do believe it's an excellent program, especially for those with aspirations in some more rigorous academic pursuits.

 

[antiVEGF]

I think residents often underestimate how hard it is to actually continuously upsell premium IOLs in practice. I've always contended that a refractive surgeons and retina surgeons are both highly gifted, highly ambitious and very detailed oriented but with vastly different outlooks on life, medicine and patient care

Nailed it. Similar candidates on paper, but quite different reasons for pursuing ophthalmology and medicine. The opportunity to help those at most risk of impending vision loss, with surgery that feels like a mix between laparoscopic surgery and neurosurgery, with anti-VEGF, gene therapy, and other miracle therapies on the way, in a field where you are surrounded by truly, some of the very best minds in the world .. what a truly special career we are blessed to be a part of. Cataract surgery is fun, but nothing comes quite close to the feeling of accomplishment after draining subretinal fluid and flattening that RD.

 

[i-doctor]

I've always contended that a refractive surgeons and retina surgeons are both highly gifted, highly ambitious and very detailed oriented but with vastly different outlooks on life, medicine and patient care

Very true. In fact, I know a few high volume refractive surgeons who perform both cataract surgery and LASIK who have actually convinced themselves that refractive errors are pathology. I mean TRUE pathology, like diabetic retinopathy and glaucoma…And thus they have also convinced themselves that their upselling premium lenses is giving their patients optimal medical care. And they view those conservative surgeons who don’t implant many premium lenses as being subpar, almost bordering on negligent. Completely different mindset than retinal surgeons.

 

[TheLesPaul]

I am not a refractive surgeon but that mindset actually makes sense to me. If you have a cure for something (i.e., refractive error) -- would you not want to offer this, especially considering the patient's best chance of glasses-free vision is at the time of the cataract surgery?

What might be subpar medicine is when 'conservative' surgeons don't offer all available technologies due to lack of training or interest, not the actual numbers implanted.

surgery that feels like a mix between laparoscopic surgery and neurosurgery

btw...nothing is closer to laparoscopy and neurosurgery than oculoplastics where we use endoscopy and you can actually touch the brain every OR day

 

[i-doctor]

Yes, I agree that to not offer eligible patients the option is subpar medicine. I am just pointing out the vast difference in perspective of patient care between the retinal surgeon and refractive surgeon.

 

[Dusn]

I’d argue that the majority of multifocal IOLs are sold to patients in an unethical manner by making them sound “superior” to monofocal IOLs and by not informing patients of the high likelihood of developing other ocular issues as they age that will not be compatible with the multifocal IOL. To each their own.

 

[mjohnsonets]

Might I suggest some discussion about femto-assisted cataract surgery? That should be interesting here...

I do have a question for everyone on private practice retina fellowships and wanted to hear some opinions. While I'm not a surgeon, I do notice a bit of a difference in the perspectives of fellows out of these fellowships vs. purely academic centers. I've tended to hear good things about these fellows after they join a practice and like them due to volume and the experience of years in a private practice (considering the fellow is looking for a private practice career track). I didn't see Barnes Retina, Charles Retina, or Wolfe Eye(newer) on any of the above lists. These fellows get about 1,000 primary cases during training and these practices do see challenging pathology. In general, what are the pros and cons of these vs. more academic centers for a doc looking for a private practice career?

 

[eyeeye_captain]

I’d argue that the majority of multifocal IOLs are sold to patients in an unethical manner by making them sound “superior” to monofocal IOLs and by not informing patients of the high likelihood of developing other ocular issues as they age that will not be compatible with the multifocal IOL. To each their own.

I hate them as well. Another poster stated they do 35-40% premium lenses, seems like a very high percentage. Great peeling their 20/80 pucker through one.

 

[eyeeye_captain]

Might I suggest some discussion about femto-assisted cataract surgery? That should be interesting here...

I do have a question for everyone on private practice retina fellowships and wanted to hear some opinions. While I'm not a surgeon, I do notice a bit of a difference in the perspectives of fellows out of these fellowships vs. purely academic centers. I've tended to hear good things about these fellows after they join a practice and like them due to volume and the experience of years in a private practice (considering the fellow is looking for a private practice career track). I didn't see Barnes Retina, Charles Retina, or Wolfe Eye(newer) on any of the above lists. These fellows get about 1,000 primary cases during training and these practices do see challenging pathology. In general, what are the pros and cons of these vs. more academic centers for a doc looking for a private practice career?

Barnes split years ago into WashU and The Retina Institute, which I mentioned above as a very good program. Dr. Shah leaving hurts, but it’s a well-respected spot. I’d put it above the more academic WashU for sure.

Dr. Charles’ fellowship is an interesting beast. He’s a huge name, but you have to subscribe to his strong opinions. Also, his other faculty only trained under him, which limits your breadth of ideas in training.

Wolfe is too young for me to know anything about it.

The private fellows often get more cases and that’s great. When I’m hiring in my private practice job, it’s nice to know they’ve been operating a ton and probably at least some without an attending scrubbed so they’re comfortable starting out. The downside is that they almost certainly won’t have had the crazy difficult cases you get at an academic center, and will have had less exposure to zebra cases in clinic. Is that the end of the world? No, you’re mostly going to do bread and butter retina, and these fellows generally do great. Is it helpful to have a little more breadth in your training? It never hurts.

 

[Trefoil]

Just tossing in some love in for refractive surgery. As a surgeon who currently does refractive surgery and has benefited from it myself, these are some of the happiest patients in the world. They also tend to be on the younger side of the patient population. Which means more years of benefit from a utilitarian perspective. Often you are buying them many years of improved quality of life.

Refractive error is a pathology in that without glasses our population would be far less functional. Indeed, in many developing countries, a lack of access to prescription glasses is a common cause of visual impairment.

I’ll be heading to a fellowship in a year, but I’ll probably continue refractive as a part of my practice. Seeing patients cry out in joy after sitting up in the refractive suite never gets old.

I think overall this falls into the “don’t yuck someone else’s yum.” Sure, retina is cool, but so is every other subfield of ophthalmology. This is a reminder that we are all lucky people to be in an awesome field that reimburses us well. You can’t really go wrong in ophthalmology generally; there is something cool about every subfield. For me, that is why comprehensive is becoming more appealing. There are a wide variety of procedures that a comprehensive ophthalmologist can do, and the need for comprehensive ophthalmologists is increasing exponentially. One day I might be doing a lid biopsy and a bunch of cataracts, the next an MMCR or a bleph, the next day refractive, the next an injection for DME, and the day after that might be a pterygium, or this might all be the same OR day.

As an aside, I’m kind of meh on multifocals. I have some patients that come in asking for them, so I’ll put them in those patients, but it’s a pretty small pool of people that really derives a benefit. I don’t plan on keeping them as a huge part of my practice in the future. Certain people really like them, but it’s definitely not for everyone. Premium lenses can include toric lenses, and I do think a lot of patients benefit from toric lenses, so it wouldn’t surprise me if “40% premium” means toric lenses.

Anyway, good luck to anyone reading this and best wishes to everyone.

 

[antiVEGF]

The private fellows often get more cases and that’s great. When I’m hiring in my private practice job, it’s nice to know they’ve been operating a ton and probably at least some without an attending scrubbed so they’re comfortable starting out. The downside is that they almost certainly won’t have had the crazy difficult cases you get at an academic center, and will have had less exposure to zebra cases in clinic. Is that the end of the world? No, you’re mostly going to do bread and butter retina, and these fellows generally do great. Is it helpful to have a little more breadth in your training? It never hurts.

Wonderful answer. I agree that Wolfe is too new to form an opinion. In terms of TRI St. Louis, a few years ago it was considered a premier fellowship program, and probably one of if not the best of the fully private fellowships. In recent years they seem to not be regarded as highly, though I have met some recent trainees / grads who are excellent.

I agree with eyeeye_captain wholeheartedly when it comes to hiring fresh grads from a private-only fellowship. For those that are dead-set on private practice I would still push them to consider the hybrid setups. When so many great fellowships offer trainees the chance to work in the private practice setting for a significant portion of their training (Mid-atlantic retina, OCB, ARC, RGW, etc..), one has to wonder what there is to gain by investing 100% of your two-year fellowship in that environment. Yes, reps are important. But I would argue that instead of going after that 300th ERM peel, a fellow's time is much better spent learning from a diverse faculty's individual styles of preop/intraop/postop management, wrestling with those difficult thrice-referred cases that academic centers attract, and see interesting med retina/uveitis/onc to establish a strong foundation of knowledge before they go out into the world to practice their own flavor of retina as a surgeon and clinician.

 

[antiVEGF]

Just tossing in some love in for refractive surgery. As a surgeon who currently does refractive surgery and has benefited from it myself, these are some of the happiest patients in the world. They also tend to be on the younger side of the patient population. Which means more years of benefit from a utilitarian perspective. Often you are buying them many years of improved quality of life.

Refractive error is a pathology in that without glasses our population would be far less functional. Indeed, in many developing countries, a lack of access to prescription glasses is a common cause of visual impairment.

I’ll be heading to a fellowship in a year, but I’ll probably continue refractive as a part of my practice. Seeing patients cry out in joy after sitting up in the refractive suite never gets old.

I think overall this falls into the “don’t yuck someone else’s yum.” Sure, retina is cool, but so is every other subfield of ophthalmology. This is a reminder that we are all lucky people to be in an awesome field that reimburses us well. You can’t really go wrong in ophthalmology generally; there is something cool about every subfield. For me, that is why comprehensive is becoming more appealing. There are a wide variety of procedures that a comprehensive ophthalmologist can do, and the need for comprehensive ophthalmologists is increasing exponentially. One day I might be doing a lid biopsy and a bunch of cataracts, the next an MMCR or a bleph, the next day refractive, the next an injection for DME, and the day after that might be a pterygium, or this might all be the same OR day.

As an aside, I’m kind of meh on multifocals. I have some patients that come in asking for them, so I’ll put them in those patients, but it’s a pretty small pool of people that really derives a benefit. I don’t plan on keeping them as a huge part of my practice in the future. Certain people really like them, but it’s definitely not for everyone. Premium lenses can include toric lenses, and I do think a lot of patients benefit from toric lenses, so it wouldn’t surprise me if “40% premium” means toric lenses.

Anyway, good luck to anyone reading this and best wishes to everyone.

Retina is awesome, and so is ophthalmology. I have respect for all of our colleagues who make it a mission to treat patients and take care of our most precious sense.

I'm curious to know what fellowship you are headed to. Congratulations! It sounds like you've been practicing for some time now? What's the reason you are giving up the primarily refractive practice?

 

[VikingFavre]

The BPEI shade being thrown around reflects how reputation lags behind reality.

One of my good family friends recently completed the external VR fellowship there and could not have been happier. There was certainly a dry spell for that fellowship after Tim Murray left and with volume primarily going to the chief track fellows (early 2010s). In recent years, however, they have added rotations at their palm beach satellite, 3 excellent VR surgeons and instructors (aforementioned Basil Williams, the younger Yannuzzi, and Jay Sridhar), and surgical volume and autonomy are apparently through the roof due to population growth and PE dynamics forcing more and more volume to the academic hospital.

My friend graduated with over 400 true primary cases across the whole spectrum of retinal surgery. I think it will probably take a couple of years for rep to catch up but this reminds me of Cleveland Clinic a few years ago.

The truth is there are a ton of really good VR fellowships. The biggest differentiators in my mind as a hiring surgeon are a) do you get to operate as primary surgeon b) do they teach good surgical principles c) do you learn to manage postop complications d) do you learn multiple IOL techniques e) do you learn to do a primary scleral buckle and f) do you at least learn to recognize and refer onc, uveitis, and IRD cases. Unfortunately, fewer and fewer programs check off those boxes….

 

[i-doctor]

You are exactly right about one thing: where P.E. takes over the market, more and more retinal surgeries get spun off to the academic institutions. Definitely occurring in my area as well. Various factors, which most of you can figure out.

 

[owleye]

I think residents often underestimate how hard it is to actually continuously upsell premium IOLs in practice. I've always contended that a refractive surgeons and retina surgeons are both highly gifted, highly ambitious and very detailed oriented but with vastly different outlooks on life, medicine and patient care

Could you unpack what you mean by this?

 

[docdoc2012]

Just tossing in some love in for refractive surgery. As a surgeon who currently does refractive surgery and has benefited from it myself, these are some of the happiest patients in the world. They also tend to be on the younger side of the patient population. Which means more years of benefit from a utilitarian perspective. Often you are buying them many years of improved quality of life.

Refractive error is a pathology in that without glasses our population would be far less functional. Indeed, in many developing countries, a lack of access to prescription glasses is a common cause of visual impairment.

I’ll be heading to a fellowship in a year, but I’ll probably continue refractive as a part of my practice. Seeing patients cry out in joy after sitting up in the refractive suite never gets old.

I think overall this falls into the “don’t yuck someone else’s yum.” Sure, retina is cool, but so is every other subfield of ophthalmology. This is a reminder that we are all lucky people to be in an awesome field that reimburses us well. You can’t really go wrong in ophthalmology generally; there is something cool about every subfield. For me, that is why comprehensive is becoming more appealing. There are a wide variety of procedures that a comprehensive ophthalmologist can do, and the need for comprehensive ophthalmologists is increasing exponentially. One day I might be doing a lid biopsy and a bunch of cataracts, the next an MMCR or a bleph, the next day refractive, the next an injection for DME, and the day after that might be a pterygium, or this might all be the same OR day.

As an aside, I’m kind of meh on multifocals. I have some patients that come in asking for them, so I’ll put them in those patients, but it’s a pretty small pool of people that really derives a benefit. I don’t plan on keeping them as a huge part of my practice in the future. Certain people really like them, but it’s definitely not for everyone. Premium lenses can include toric lenses, and I do think a lot of patients benefit from toric lenses, so it wouldn’t surprise me if “40% premium” means toric lenses.

Anyway, good luck to anyone reading this and best wishes to everyone.

I don't think anyone is yucking someone else's yum. But as retina surgeons, our practices are filled with unhappy post-premium IOL patients who come in with decreased contrast sensitivity, ERMs or advancing AMD that would have been better off with monofocal IOLs and were improperly counseled. Operating through these IOLs is once again it's own beast.

I personally think refractive surgery is great. The discussion was about residents going directly into practice thinking they'll make bank on premium IOLs and forego doing fellowships.

 

[docdoc2012]

Could you unpack what you mean by this?

Retina surgeons look at a sick eye and say 'I can make this better' or 'I am going to try to keep your eye in your head'. The pathology retina deals with is not something that can be solved my more conservative means. In other words, we like operating when something definitely needs fixing. Other than floaterectomies a majority of retina cases are not elective. We are detail oriented and obsessive but also like unpredictability and being creative in the OR. A retina surgeons creativity blossoms intraoperatively as retinal tissue is highly unpredictable especially in sick eyes, and many times we have no idea how it will behave until we feel it out in the OR. We are very often trying to keep people from going blind.

Refractive/ant seg surgeons are also obsessive and detail oriented. But they deal with primarily healthy eyes and patients who have an inconvenience that needs fixing. Don't get me wrong. As a -7.00 myope who's been in contact lenses forever I understand the inconvenience. But it's different. And as the above comments have stated, many refractive surgeons will call refractive error pathology. To retina people who are dealing with sick eyes, you can see how this seems. Refractive surgery is dependant on rhythm and predictability. It is the fixing of imperfections that their patients deem unmanageable. Of course all surgery has variations. But most of the creativity is happening in preop planning, with the surgical steps having to have military precision.

Atleast my 2 cents. 2 of my best friends are refractive surgeons at high power practices. I absolutely respect their skill and there is 100% a difference in our perspectives.

 

[owleye]

Retina surgeons look at a sick eye and say 'I can make this better' or 'I am going to try to keep your eye in your head'. The pathology retina deals with is not something that can be solved my more conservative means. In other words, we like operating when something definitely needs fixing. Other than floaterectomies a majority of retina cases are not elective. We are detail oriented and obsessive but also like unpredictability and being creative in the OR. A retina surgeons creativity blossoms intraoperatively as retinal tissue is highly unpredictable especially in sick eyes, and many times we have no idea how it will behave until we feel it out in the OR. We are very often trying to keep people from going blind.

Refractive/ant seg surgeons are also obsessive and detail oriented. But they deal with primarily healthy eyes and patients who have an inconvenience that needs fixing. Don't get me wrong. As a -7.00 myope who's been in contact lenses forever I understand the inconvenience. But it's different. And as the above comments have stated, many refractive surgeons will call refractive error pathology. To retina people who are dealing with sick eyes, you can see how this seems. Refractive surgery is dependant on rhythm and predictability. It is the fixing of imperfections that their patients deem unmanageable. Of course all surgery has variations. But most of the creativity is happening in preop planning, with the surgical steps having to have military precision.

Atleast my 2 cents. 2 of my best friends are refractive surgeons at high power practices. I absolutely respect their skill and there is 100% a difference in our perspectives.

Thanks, that’s really helpful.

 

[MstaKing10]

Wonderful answer. I agree that Wolfe is too new to form an opinion. In terms of TRI St. Louis, a few years ago it was considered a premier fellowship program, and probably one of if not the best of the fully private fellowships. In recent years they seem to not be regarded as highly, though I have met some recent trainees / grads who are excellent.

I agree with eyeeye_captain wholeheartedly when it comes to hiring fresh grads from a private-only fellowship. For those that are dead-set on private practice I would still push them to consider the hybrid setups. When so many great fellowships offer trainees the chance to work in the private practice setting for a significant portion of their training (Mid-atlantic retina, OCB, ARC, RGW, etc..), one has to wonder what there is to gain by investing 100% of your two-year fellowship in that environment. Yes, reps are important. But I would argue that instead of going after that 300th ERM peel, a fellow's time is much better spent learning from a diverse faculty's individual styles of preop/intraop/postop management, wrestling with those difficult thrice-referred cases that academic centers attract, and see interesting med retina/uveitis/onc to establish a strong foundation of knowledge before they go out into the world to practice their own flavor of retina as a surgeon and clinician.

I agree with this. An ideal fellowship blends private and academics (Privademic). Best of both worlds. I would argue that some of these fellowship that lean harder on academics/research are great if pursuing an academic track due to pedigree but not so great if pursuing private practice. Some of the most questionable surgeons I know in our community graduated from these academic fellowships (and one is on the "top 10 list"). OCB, ARC, CEI (Cincinnati), RGW, Rush, CPMC, etc all come to mind as examples of excellent blended fellowships. There are several others of course.

 

[VR.]

Hi all,

Any insight on how Canadian retinal fellowships perform compared to these programmed ranked?
- University of Montreal was quoted to have unbelievably high surgical numbers (1500 cases as a primary surgeon!)
- Ottawa, Toronto & British Columbia also have good numbers.
Does this translate into good training quality?
What about other fellowships, like McGill, Alberta & Calgary?

Thanks a lot for your input.

 

[linevasel]

Late comment here, but one of my best friends went to Wolfe. Its a sleeper when it comes to PP VR fellowships. Lot of truth in some of the comments. If you are looking for an "alternate" pathway... hard to beat PP fellowships with Bascom res/vr grads.

 

[DrZeke]

I think trying to go to a highly ranked fellowship with a minimum cut off for numbers is helpful. Big privademic retina only practices seem to be impressed by pedigree and connections.

 

[docdoc2012]

I think trying to go to a highly ranked fellowship with a minimum cut off for numbers is helpful. Big privademic retina only practices seem to be impressed by pedigree and connections.

I think this made a difference before most of them sold to PE. I think they're going to have to take what they get in a couple years especially after the second sale go through

 

[MstaKing10]

I think this made a difference before most of them sold to PE. I think they're going to have to take what they get in a couple years especially after the second sale go through

Why do you say that? Curious

 

[docdoc2012]

Why do you say that? Curious

I think owners at these privademic groups underestimate how much respect they've lost in the eyes of new grads. If it's all about the money for them, why wouldn't it be for new grads, especially those who worked hard to get top fellowships? Unless geographically restricted or they don't care about money there is really no upside for a young person to join a PE situation.
Privademic groups used to be places to flourish and thrive, the meccas of private retina where you made money, took care of patients without a lot of interference and could contribute academically. I think other than robust research departments, new grads see the writing on the wall when it comes to what will happen to them and their patients down the line. Most highly qualified grads are looking for small group retina or staying in academics. The ones who aren't will probably exit the groups they are in in a few years, once again unless geographically restricted or set on a location

 

[knitesonee13]

Would someone mind explaining the internal vs external track for Bascom Palmer? Ill be starting M1 this fall and Ophthalmology is what I'm most interested in heading in so trying to learn more about fellowships in the specialty.