Vitreoretinal Surgery

Delivering outstanding surgical training is a key focus of this fellowship. To that end, the fellow is expected to actively participate in surgical cases starting on day one, being trained on ReSIGHT, BIOM, Constellation and Stellaris. Fellows rapidly assume autonomy in the operating room and benefit from the diversity of surgical sites including an ambulatory surgery center (Byers Eye Institute), a level 1 trauma center (Stanford Hospital), a large children’s hospital (Lucile Packard Children’s Hospital), a flagship veterans hospital (Palo Alto VA Medical Center), a major county hospital (Santa Clara Valley Medical Center), and a high volume vitreoretinal service site (Palo Alto Medical Foundation). Our surgical volume is among the highest for academic fellowships, and our fellows have extensive exposure as primary surgeon to the most complicated cases. One of our key strengths is the breadth of training and experience of our faculty, which provides the fellows with a unique opportunity to learn a variety of surgical techniques and approaches. Our faculty have trained at some of the top programs in this country and around the world, including Bascom Palmer, Cole, Duke, Iowa, Jules Stein, Mass Eye & Ear, Moorfields, Stanford, and Wilmer. Our fellows graduate well-rounded, confident, and ready to handle the most challenging surgical cases that they will encounter during their careers.

Additional highlights of our surgical training include:    
· Complex tractional retinal detachments from numerous diseases such as diabetes and inherited dystrophies
· Intensive implementation of scleral buckling techniques, including placement of primary
· Surgical approaches to pediatric retinal diseases
· Treatment of intraocular tumors utilizing techniques such as brachytherapy as well as collaborations with Radiation Oncology for team-based approaches
· Surgical approaches to diagnosing and treating complex uveitis patients
· Scleral fixated intraocular lens techniques   
· Significant opportunities to perform complex cataract and combined cataract/vitrectomy surgeries
· Utilization of cutting-edge surgical technology including intraoperative OCT and 3-D heads up display viewing systems
· Translational research opportunities bridging the operating room and the laboratory bench    
· Numerous brands of surgical microscopes from Zeiss and Leica
· Alcon constellation vitrectomy systems across all surgical sites
 

Medical Retina and Specialty Clinics

Outside of the operating room, a key strength of our fellowship program is the comprehensive and extensive training that fellows are provided in all aspects of clinic-based retina, ranging from complex medical retina to intraocular tumors to uveitis. We are fortunate to have some of the world’s foremost authorities leading these sub-specialty clinics. This access for the fellows is a unique opportunity to further explore individual academic interests, refine clinical practice, and delve deeper into individual passions through clinical and basic science research opportunities.

· Medical Retina – fellows have extensive exposure to the medical management of some of the most complex and prevalent retinal diseases in our society including diabetic retinopathy, age-related macular degeneration, and retinal tears and detachments. Clinical training will include numerous opportunities to master laser retinopexy techniques including slit lamp biomicroscopy and indirect ophthalmoscopy lasers as well as the photodynamic therapy (PDT) laser. Fellows will also receive extensive training in performing intravitreal biopsies and injections of medications and clinic-based pneumatic retinopexy. Finally, fellows will learn to interpret imaging data from all the major modalities including angiographies with fluorescein and/or indocyanine green utilizing the Optos ultra-widefield viewing system, spectral-domain optical coherence tomography (OCT), and OCT angiography utilizing all current major commercial platforms.

· Inherited Retinal Dystrophies – as a tertiary referral center for the region as well as abroad, numerous patients with extremely rare inherited retinal diseases present to our clinic for further evaluation and care. This gives the fellows a rare opportunity for hands-on experience with some of the most unique and perplexing retinal diseases that others have only encountered in journals or textbooks. Fellows will gain experience in the nuances of genetic testing and interpretation of results from multiple imaging modalities and functional tests such as electroretinography, as well as management with subretinal gene therapy.

· Ocular Oncology – a unique opportunity is available for fellows to partake in the management and care of patients with ocular malignancies, including both anterior and posterior segment lesions. Fellows will learn techniques to monitor intraocular lesions as well as treatment modalities both within the clinic as well as within the operating room. Clinic-based therapies include intravitreal injections of chemotherapy and lasers including PDT. Furthermore, fellows will be trained to approach intraocular biopsies of lesions through a vitreoretinal surgical approach as well as implementing brachytherapy and other treatment modalities as part of a team-based approach with our counterparts in Radiation Oncology.

· Pediatric Retina – fellows will have exposure to and gain experience with numerous aspects of pediatric retinal diseases such as retinopathy of prematurity (ROP), inherited dystrophies, and pediatric retinal detachments. There will be ample opportunity to learn staging of ROP as well as treating this disease using intravitreal bevacizumab as well as indirect ophthalmoscopic laser retinopexy. Our fellows operate in complex pediatric vitreoretinal disorders including Stage V ROP detachments, FEVR, and Coloboma detachments. Furthermore, fellows will learn to operate the RetCam imaging system for fundus photos as well as fluorescein angiography as part of the examination under anesthesia.

· Uveitis – intraocular inflammatory diseases pose a unique challenge to retinal specialists as they can represent the initial manifestations of serious systemic diseases that can lead to detrimental effects if not treated in an effective and timely manner. Fellows will gain extensive experience in the identification, diagnosis, and management of complex ocular inflammatory diseases including management with medications such as topical and systemic steroids as well as immune-modulatory therapies. The uveitis clinic self-manages the IMT / immunosuppression. Furthermore, fellows will be comfortable with diagnosis utilizing laboratory studies, intraocular biopsies, and surgical-based diagnostic vitrectomies.
 

Educational Conferences

· Retinal Imaging Conference: this fellow-run conference is aimed at teaching residents the essentials of retinal imaging techniques to help diagnose and manage a variety of disorders. Didactic pearls are reinforced in a case-based format. Retina faculty attendance will help guide discussion and evaluate fellow teaching skills.

· Vitreoretinal Surgical Rounds: this fellow-focused conference is aimed at teaching fellows the nuances of surgical retina techniques and management of intraoperative complications. Fellows edit surgical videos and present them to the retina faculty for feedback. This interactive conference helps fellows develop the skills needed to approach simple and complex retinal cases, refining their approach to vitreoretinal surgery. Fellows are expected to present surgical cases at national meetings as well, and this conference helps prepare them for this exercise.
 

Research Opportunities

A unique aspect of our program is a weekly dedicated research day which enables the fellow to pursue meaningful research projects. The breadth of our retina faculty provides a wide array of potential research avenues for the fellows to pursue, spanning clinical, basic science, and entrepreneurial endeavors. Faculty have expertise across multiple subspecialities, and fellows can take an active part in clinical trials across the field. There are ample opportunities to explore basic science research projects for fellows planning to submit for grant funding to start their own laboratories upon completion of fellowship.
In addition, our fellows are invited to take advantage of incredible resources at Stanford University and collaborate across different departments. Stanford is a hub of innovation and is located in the heart of Silicon Valley. Several faculty, including Drs. Mark Blumenkranz, Daniel Palanker, and Darius Moshfeghi, are recognized as leaders in ophthalmic innovation, having overseen the commercialization of a number of technologies that impact current retinal practice.
We support our fellows to submit their research for presentation to national and international conferences throughout the year as these are fantastic opportunities to learn more about the field, network with those around the world, and develop depth within one’s skillset. Our expectation is for the fellows to pursue meaningful research projects and develop the skills needed to have dynamic careers as leaders in the field of retina. 
 

Teaching

Our fellows are given the title of Clinical Instructor in Ophthalmology within the department. As such, fellows are part of the teaching staff and are expected to take an active role in teaching the residents and medical students who rotate through our service. Our fellows have the opportunity to teach residents in the urgent care clinic as well as via ocular trauma (globe call). Furthermore, we hope that the fellows act as mentors for the residents and medical students, guiding them through their learning of ophthalmology and inspiring the next generation of leaders within our field. Applicants who are not interested in sharing our educational goals would not be a good fit for our fellowship.
 

Salary & Benefits

As fellows are considered house staff as part of the General Medical Education (GME) office at Stanford University School of Medicine, you are entitled to numerous benefits and stipends as well as annual pay according to the PGY scale. For more information, please visit the Stanford GME webpage.