Clinical Training

The fellowship programs in retinal, vitreous and macular disease allow hands-on, in-depth experience and frequent didactic teaching in the following areas:

1. Retinal Detachments and Peripheral Degenerations

Fellows will learn the technique of indirect ophthalmoscopy, scleral indentation, examination of the vitreous by slit-lamp biomicroscopy and contact lens examination of the macula with slit-lamp and fundus contact lens. This experience is acquired by supervised examination of patients who have peripheral retinal degenerations, retinal detachments, retinal tears, and all types of macular disease. There are over 20,000 outpatient visits per year on the Vitreoretinal Service. Indirect ophthalmoscopy and slit lamp biomicroscopy can be recorded on dedicated video instruments kept in the Retina Clinic.

2. Imaging

The technique and interpretation of high-resolution optical coherence tomography, OCT-angiography, autofluorescence, and stereoscopic and wide-field fluorescein angiography for the diagnosis of diseases of the posterior pole of the eye is acquired in coordination with the Photography Service of the Department of Ophthalmology. 1st-year vitreoretinal and medical retina fellows direct an imaging conference once a week during the academic year. This conference is attended by staff members of the Service as well as by fellows and residents in the Department of Ophthalmology.

Imaging is performed with state of the art devices for OCT, FA/ICG, autofluorescence, ultrawide field photography and OCTA, including:

  • Heidelberg Spectralis SD-OCT machines 
  • TopCon photography and SD-OCT machines
  • Zeiss SD-OCT units with OCT-angiography 
  • Zeiss Plex Elite 9000 for ultra-wide swept source OCT and OCT angiography
  • ultrawide field photography, FA, and autofluorescence with Optos, Clarus 500 and Clarus 700 units
  • Portable OCT using the Bioptigen handheld SD-OCT unit

3. Inherited Retinal Diseases

The surgical and medical retina fellows learn the diagnostic work-up and phenotypes of patients with inherited retinal diseases in clinics of Drs. Ian Han, Elliott Sohn, and Edwin Stone. As the genetic diagnosis and treatment of these rare diseases are primary missions of the University of Iowa Institute for Vision Research, fellows gain extensive knowledge and experience in the latest treatments for these disorders, e.g. assisting in first-in-human surgeries using gene and stem cell therapy. Fellow research projects in inherited retinal diseases are encouraged. Electrophysiologic tests (dark adaptation, multi-focal and full field electroretinography) are performed by the Electrophysiology Service of the Department of Ophthalmology.

4. Surgery of Retinal Detachments and Peripheral Retinal Degenerations

Patients with varying and progressively more complex retinal detachments and retinal degenerations leading to detachment are studied and examined by the fellows as the patients are referred to the Service. Surgery is performed by a fellow under the direct supervision of the staff in the operating room. Primary scleral buckling procedures and pneumatic retinopexies are also performed. Post-operative care is directed by the staff surgeon but also seen and followed by the fellow who was involved in the surgery. See the Vitreoretinal Surgery section for further details.

5. Treatment of Diabetic Retinopathy

The diagnosis and selection of patients with diabetic retinopathy for treatment is performed as patients are referred to the Service. The necessary clinical judgment in selecting patients who can be expected to benefit from laser photocoagulation, anti-VEGF and steroidal therapies, and/or surgical intervention is acquired by examination of patients and consultation with the faculty. Clinical, translational and animal research projects in diabetic retinopathy are readily available.

6. Macular Disease

The Vitreoretinal Service evaluates over 2000 new patients a year with macular disease, the majority being patients with age-related macular degeneration (AMD) but a wide variety of other macular diseases are also seen. Fellows play an integral part in the evaluation and treatment of all patients. Fellows gain an understanding of the role of genetic research in AMD and macular dystrophies with application to clinic patients through the Carver Lab. In addition, there are numerous studies being carried out including phase I, II, and III trials in AMD with which fellows have the opportunity to be involved with.

7. Laser Photocoagulation

Fellows develop skills in treating a wide range of retinal and choroidal vascular diseases in addition to managing peripheral retinal tears using multiple wavelengths of visible and intrared laser for photocoagulation. Green and infrared indirect laser ophthalmoscopes are available for use.

Two Pascal lasers are used regularly in the retina clinic along with micropulse yellow and diode lasers.

8. YAG Laser

A Nd:YAG lasers are readily available.

9. Cryopexy Treatment of Retinal Disease

Patients are treated under supervision of the staff on an outpatient basis (treatment room or minor operating room), in the ambulatory surgery center, or in the main operating rooms.

10. Ultrasound

The Echography Service is run by Dr. Boldt. There are two technicians with over 30 years of combined experience in standardized echographic techniques. Fellows are expected to learn echographic techniques in the surgical management of vitreoretinal disease, and have both didactic and hands-on training in ocular echography.

11. Tumors

Experience in evaluation of uveal melanomas, metastatic tumors, and vascular tumors will be gained under direct supervision of Drs. Boldt and Binkley. We were a clinical center for the COMS. We were also the COMS Photographic Reading Center, and we still act as a part of the COMS Archival Repository. Fellows participate in the evaluation and management for approximately 100 new uveal melanomas a year. They also participate in the screening and treatment of approximately 6 new patients with retinoblastoma a year.

12. Pediatric Eye Disease

Retinopathy of prematurity screening is performed by the pediatric service and laser for ROP is performed by several members of the retina service. Opportunities to interact with the NICU service are available. Fellows specifically interested in pediatric dis­ease can get experience in these areas.

13. Posterior Uveitis

Dr. Folk and other retina faculty have a special interest in inflammatory diseases of the choroid and retina. Patients are evaluated and treated by the fellows in conjunction with the faculty. Experience in diagnostic vitrectomy and administration of chemotherapeutic agents will be gained. Clinical trials for new therapies targeting posterior uveitic diseases are readily available for participation by fellows.