Optics, Refraction, Contact Lenses, Low Vision
The faculty for this material includes Drs. Wilson, Egan, and Ingraham. The curriculum includes an introduction to refraction early in the first year by Dr. Ingraham and yearly ophthalmic board review on optics by Dr. Wilson. Primarily Dr. Wilson and the Optometric staff on assorted topics in refraction, optics, contact lens, and low vision give the didactic series of lectures. Dr. Wilson presents a monthly optics club, teaching the fundamentals of clinical optics and their applications. He has prepared an extensive text on this topic. Informal teaching occurs daily in the clinic as well as appropriate supervision as previously described. First year residents begin simple refractions in August of their first year and in January begin doing approximately six to eight refractions daily for the remainder of their time in the clinic. These include essentially all new patients, designed refraction slots in the schedule, postoperative patients, and any other patient requiring a change in the refractive correction. As previously stated the contact lens and low vision experience is derived both from the general clinic as well as through the second and third rotations. Overall approximately 3,500 refractions are performed by each resident over the three year period in the daily schedule.

Additionally, the residents see approximately 30 to 50 patients per year with contact lens related problems and during the course of their residency fit contact lenses on between 20-25 patients. It is expected that the residents should become facile at most contact lens fittings, at basic and advanced refraction, and are aware of the basics, availability, and application of various low vision aids. They also become facile at retinoscopy through rotations with Dr. Wilson and the Lancaster Course.

Uveitis and Ocular Tumors
Faculty include Dr. Ingraham, who primarily instructs in anterior and diffuse or intermediate Uveitis; Dr. Marks, who is predominantly responsible for posterior Uveitis, inflammation and intraocular tumors; and Dr. Wilkinson, who instructs in inflammation and ocular tumors of the lid, orbit, and ocular adnexa. The curriculum includes didactic lectures as outlines and these are supplemented by outside speakers as needed. Emphasis in this area is on learning the differential, appropriate workup, and treatment of inflammation and mass lesions. Other services are involved as indicated particularly the departments of Rheumatology and Oncology.

The numbers of patient in this area are relatively small, as particularly ocular tumors and posterior Uveitis are relatively rare. Attends and residents share cases found in the clinic both at the time of diagnosis and from case presentations as previously noted. Consultation services are available as needed, either at the Wills Eye Hospital in Philadelphia or the Wilmer Institute at John Hopkins in Baltimore, Maryland. The residents manage approximately 30 to 50 cases over the course of their residency, predominately of anterior uveitis and approximately 5 to 10 cases of intraocular tumors during this time. Significant numbers of these cases are seen on the inpatient consult service.

Retina and Vitreous
Faculty for this area is Dr. Marks. The Curriculum includes didactic lectures, case presentation conferences and fluorescein angiogram conferences. There is an emphasis placed on diagnosis, appropriate treatment, and management particularly in diabetic retinopathy, rhegmatogenous retinal detachments, and accurate drawing of retinal lesions. The resident is expected to become facile with laser photocoagulation, both panretinal photocoagulation and focal. They are also exposed to cryoablation and indirect laser to peripheral lesions. On average the residents will perform approximately 40 to 50 laser procedures over the course of their residency. Primary surgical experience varies with the skill and interest of the resident, but the residents are all exposed to vitrectomy, repair of retinal detachment, and membrane peels with the majority of the cases done as a first assistant. In this capacity they are exposed to approximately 30 to 40 cases over the course of the residency and act as the primary surgeon in 15-20. The residents also become expert at isolating muscles and localizing lesions as well as management of penetrating trauma. There is also the opportunity to co-schedule patients several times a week with the retina attending for particularly difficult or complicated retinal cases.

Neuro-ophthalmology
The current faculty is Dr. Guruswami Arunagiri, who joined our staff in July 2002, having completed his residency and fellowship in Neuro-Ophthalmology. The curriculum consists of a mixture of case presentation conferences and didactic lectures delivered as part of the lecture series and supplemented by the Neuro-Ophthalmology rotation in the second and third years. This experience is also supplemented by the third year inpatient consult service. Emphasis is placed on the history taking and examination skills required for accurate diagnosis and the appropriate workup and treatment of Neuro-Ophthalmic lesions. Knowledge of the literature is also encouraged through periodic Neuro-Ophthalmic journal club. Residents are encouraged to perform their own Goldman visual fields and the residents receive extensive exposure to patients with myasthenia gravis, thyroid disease and the neurologic manifestations of ischemic and compressive lesions.

Pediatric Ophthalmology and Strabismus
This area is represented by Dr. Wilson. The residents rotate for one month during their first year with Dr. Wilson and assist him throughout the year in the operating room. Residents rotate with Dr. Wilson one half day every week in the their second year to develop their skills in examining the pediatric patient and receive immediate supervision and feedback. This experience is also supplemented by patients seen in the regular course of the Ophthalmology clinic. The residents enjoy an extensive experience in strabismus surgery with cases generated both by Dr. Wilson and by the residents themselves. Each resident performs approximately 40 strabismus procedures during the course of their residency and many more as first assist to Dr. Wilson. There is a significant exposure to neonatology and retinopathy of prematurity and these patients are seen in conjunction with Dr. Wilson. These patients are seen as inpatients and then followed in the Wednesday morning retinopathy of prematurity clinic. This duty is performed predominantly by the second year residents, and inpatient pediatric consultations which number perhaps two to three per week are seen by the third year residents. It is expected that during the residency the physician should become quite comfortable and expert with the examination, diagnosis, and operative management of entities in pediatric Ophthalmology and strabismus.

Corneal and External Diseases
Drs. Notz and Ingraham are responsible for this area of training. The curriculum consists of a series of didactic lectures coordinated between the two instructors. These are given on an approximately 16 to 18 months rotation to ensure coverage of all topics thoroughly and several times prior to graduation. The residents as a group see 30-40 patients/week with cornea and external disease problems in the general clinic and these are usually seen in consultation either with the attending on call or more often with Drs. Notz and Ingraham. The department of Ophthalmology performs approximately 70-80 corneal transplants per year with approximately 4-5 being performed by each third year resident and nearly all of the remainder with the residents as first assistant. It is expected that the residents should become comfortable with the management of common corneal and external disease problems as well as more complicated viral and bacterial keratitis and congential lesions. Corneal dystrophies and degenerations, which are relatively rare, are covered thoroughly in the didactive lecture series.

Glaucoma
Dr. Shareef is responsible for this area of the resident training. The curriculum consists of a series of didactic lectures and case presentation conferences with an emphasis on diagnosis, and the medical and surgical management of Glaucoma. The department of Ophthalmology tends to be somewhat conservative in the management of Glaucoma and serves a population, which less frequently requires surgery than most inner city populations. Regardless, the resident typically perform between five and six Trabeculectomies or combined procedures and assists at 15 - 20. The residents also have extensive experience in argon laser, trabeculoplasty and laser iridotomy. Performing 60-70 laser and cryo procedures per year as a group. The experience is monitored closely through the log books kept for every laser procedure performed in the department, as well as the Residents own log books, cryo procedures per year as a group.

Lens and Related Anterior Segment Surgery
The faculty for this topic is broad and includes Drs. Wilkinson, Derck, Ingraham, Dobbins, Guibord and Notz. Didactic lectures are presented on cataract surgery. Combined procedures with Glaucoma or Cornea, congenital malformations, dystrophies, and degenerations in the anterior segment. Refractive, medical and surgical management of these issues is emphasized. A wide range of pathology is seen through the general clinic and the residents also have the opportunity to view extensive collection of videotapes in the resident library. Each resident performs between 120-140 cataract procedures as the primary surgeon prior to graduation and over 300 as the first assistant. Some of these will also be performed as combined with either a cornea transplant or trabeculectomy or phacoemulsification techniques and the recognition and appropriate treatment of other anterior segment anomalies is emphasized.

Oculoplastics including Orbit, Eyelids, and Adnexa
This area is taught by Dr. Wilkinson. The curriculum consists of a series f didactic lectures as outlined in the curriculum section and surgical cases are co-managed with the attending physician. The diagnosis, medical and surgical management of ptosis, thyroid disease, lid tumors, and nasolacrimal duct obstruction are emphasized and the resident is expected to become facile in the surgical management of these as well as lacerations, other trauma and blepharoplasty. Each resident performs approximately 40 major cases during the course of their residency with additional experience in temporal artery biopsy, chalazion and other minor procedures. Orbital cases number approximately 5-10 per year and are relatively rare and shared with all the residents in the clinic when they occur. The residents are also expected to become expert in the management of trauma including ruptured globes and will be acting as the primary surgeon when appropriate in these cases and always under direct attending supervision.

Electrophysiology
Residents are exposed to principles of electrophysiology during their didactic lectures in Retina by Dr. Marks, Neuro-Ophthalmology by Dr. Arunagiri, and while at the Lancaster Course at Colby College in Maine. Services such as EOG, VEP and ERG are available through the Neuro-Physiology dept. At Geisinger or in unusual cases at the affiliated Medical School at Jefferson and its Dept. of Ophthalmology at Wills Eye. Patients requiring this technology tend to be rare, and are thus shared with residents and attendings in the clinic through grand rounds presentations.

Ophthalmic Pathology
Residents in the department of Ophthalmology perform an extramural nine-week rotation at the Wills Eye Hospital in Philadelphia. Time is spent in this rotation in the gross and microscopic examination of specimens under the supervision of two Ophthalmic Pathologists (Drs. Eagle and Bernardino). The residents benefit from a wealth of pathologic material derived from the participating hospitals in the Thomas Jefferson University system and the Philadelphia region as well as unusual material sent from the home campus at GMC to Dr. Eagle�s lab. Clinic pathologic conferences, Oncology pathology reviews and didactic lectures in pathology are provided while at Wills. Funds are provided, by Geisinger�s Dept. of Ophthalmology, in addition to usual salary and benefits, to support the residents during this extramural rotation.

Routine pathologic material can also be reviewed with physicians in the Pathology dept. at Geisinger at any time. Twelve slide carousels on Ocular Pathology from the Lancaster Course and numerous texts are also available for review in the Resident Library.

Refractive Surgery
The faculty for this area includes Drs. Dobbins and Guibord. Didactic lectures cover such topics as basic refraction, topography and the history of Refractive Surgery, as well as Lasik, PRK and new, emerging technologies. Third-year residents rotate several days per month with Drs. Dobbins and Guibord to observe pre-op, intra-operative and postoperative issues and management in refractive surgery. Residents are also exposed to the refractive issues of astigmatism management and cataract surgical and post-corneal transplant patients through their other clinical experiences. The numbers of Lasik pts. seen by the residents in their own clinic is small, but this larger group of patients potentially requiring refractive surgical services totals approximately 50-100 per resident over the course of their training. By the end of their residency, the graduate will be facile in the refractive issues of cataract and other anterior segment surgery, and will be skilled in assessing and managing the Refractive Surgery patient, including excimer PRK, Lasik and other technologies.

Ethical Issues, Socioeconomics of Healthcare, Cost-Effective Medical Practice
Describe how ongoing instruction in ethical issues, in the socioeconomics of health care, and in the importance of medical practice is provided in the program. Some formal presentations are expected, in addition to teaching through discussions and by example.

Education in these issues occurs at both the formal and informal level. At the informal level there are discussions of individual cases and the overall approach to patient management. There is also an important aspect of the example provided to the residents by the attendings in the Department of Ophthalmology. Residents in their PGY-4 year are invited to and expected to attend Monthly QI and Administrative meetings when social economic and cost effectiveness issues are discussed, as well as practice management issues. Formal lectures consist of a series of scheduled discussions in ethics based on the American Academy of Ophthalmology curriculum.

Additionally, lectures are held on managed care issues, coding, medical-legal issues and other topics within the dept. of Ophthalmology. There is also an extensive Institutional Curriculum on subjects such as Ethics, Practice Management, Teaching Skills, Service Excellence, Care Management and Clinical Guidelines at the time of orientation and throughout the calendar year.