You're in objectively the best field of medicine :) and congrats to getting started on your training. Ophthalmology has a steep learning curve starting out because the field is not something that is emphasized during medical school. At the start it often feels like a foreign language. Thankfully, the clinical training at UCI is excellent and you will catch on quickly and soon be able to handle even the most complex eye pathologies in clinic as a PGY-2. As we get more experience with the joint program which only started ~2022 the interns are coming in much more prepared which has definitely helped ease the transition from medicine. This is not a comprehensive guide on everything you need to know. The purpose is to help you focus on high yield topics so you don't get lost in the sea of information when you're starting out.
You'll spend 3 months total at Long Beach VA during your intern year. The typical schedule is 3 wks of wards then 1 wk ophtho. There's a few elective blocks which you spend 2-4 wks straight on ophtho for. The primary goal for the interns is to develop strong exam skills with the slit lamp and indirect and to start gaining experience with simple office procedures such as intravitreal injections and YAG capsulotomy. The goal is for you to work up to seeing about 8-10 patients a day once you get the hang of things. Intern year is challenging enough with all the inpatient medicine you need to do so we focus on making your ophtho time educational without being overwhelming. It's your time to practice and ask the attending to see that exam finding, help with your DFE, etc.
The VA has different speciality clinic days as follows where specific attendings are present for staffing: general, retina, glaucoma. We have a small cornea clinic on thursdays alongside glaucoma but the volume is not as high as UCI. Since we don't have neuro-ophtho and uveitis and oculoplastics these patients usually get seen in general clinic. The oculoplastics fellow has their own oculoplastics clinic but usually the patients see us in general clinic first before referring to oculoplastics.
You can go to the VA rotation site link for a bunch of the logistical how to info like note templates, orders, etc.
It's best to buy your lenses at some point during intern year. It's good to try out the lenses before you get set on them but IMO at this point in your training you won't appreciate the nuance. Most people buy their lenses from volk site directly******. This is a good lens review: https://eyeguru.org/blog/volk-lens-review/
You basically need two lenses: one for the slit lamp and one for the indirect
-Slit lamp lenses: Most residents have a superfield or 90D lens. The superfield has more glare but wider field of view.
-Indirect lenses: Most residents have either a 20D, 28D, Panretinal. The 20 D has more zoom but more narrow field of view compared to the 28D. The 20 D is larger and the working distance (how far you hold it away from the eye) is further. A lot of people prefer the 28D as it's easier to handle and also better for smaller pupils. The panretinal is a 20 D with a wider field of view closer to the 28D. It is the same size as the 20 D so not as easy to handle as a 28D.
-Gonio lens: Not mandatory because the disposable gonio lens at VA works pretty well but if you want one the most common is the G-4 Mirror Gonio Lens from Volk
Early on you're just trying to pick up on as much info you can each day in clinic. VA clinic is more of the same from intern year it's just building up getting used to bread and butter ophtho. PAV II has more complex patients, less common pathologies, etc. You'll start buddy call with the seniors about 2 weeks in.
Getting ready for call
Teching patients yourself on call
-Vision > pressure > pupils > dilate (get in this rhythm to get the patient tech'd quickly)
Read the call and consults guide (there's a lot of info on there just read up a bit so you're familiar the PGY-3 and PGY-4 will walk you through everything in person)
Call bag
-Get Desmarres eyelid retractors ordered ASAP Amazon Link
-pH paper roll Amazon Link
-Reading glasses (+2.5 add) to check vision
-Near card (I like the one that has the distance chart on the back and near chart on the front)
-Pinhole occluder
-Tonopen covers, dilating drops, proparicaine, fluroscein for staining can be taken from clinic
Wills is your best friend
Procedures to know for on call
-AC Tap (anterior chamber paracentesis)
-Eyelid laceration repair (simple vs marginal lid lac repair)
-Temporary tarsorrhaphy
-Intravitreal tap and inject
Basical clinical science course (BCSC) a large book series all residents get that covers the info we need to know for boards. Usually get this PGY-2 year
https://www.aao.org/education/content/ophthalmology-okap-board-review --> powerpoints covering BCSC pretty quick and divided by topic
https://eyerounds.org --> can look up different exam findings on the atlas and read up on some of the cases. A lot of the cases are just basic optho conditions you will see at some point
https://eyewiki.org --> basically wikipedia for any eye condition you want to read up on
https://eyeguru.org/residency-essentials/ --> very quick reads and all the articles are high yield for interns
Wills Eye Manuel --> I wouldn't use this as a primary resource to learn disease since it doesn't go into enough detail but it's good as quick guide for common eye diseases and goes over the differential and management
Glaucoma: Key topics
Applanation and gonioscopy
Good for learning gonioscopy
Open angle and closed angle glaucomas
https://curriculum.iowaglaucoma.org
Has an excellent video series covering everything about glaucoma. It's a little dense at times but it has a lot of info you'll need to know for boards
Examining the optic nerve head
https://www.youtube.com/watch?v=thO-caAkAkg
Eye drops:
5 types of glaucoma drops beta blockers, carbonic anhydrase inhibitors, prostaglandin analogues, alpha-2 agonists, Rho kinase inhibitors
Retina: Key Topics
Retinal imaging: OCT, fluoroscein angiography, b-scan ultrasound
Diabetic retinopathy
Retinal tears and detachments
Macular Degeneration
Cornea/Refractive: Key Topics
-Dry Eye Syndrome/Meibomian Gland Dysfunction
-Corneal Ulcers
-Corneal transplants
-Keratoconus
-Herpes Simplex Keratitis
Oculoplastics: Key Topics
-Dermatochalasis
-Eyelid lacerations
-Entropion
-Ectropion
-Ptosis
-Epiphora and nasal lacrimal duct obstructions
Common diseases on call
-Orbital fractures
-Optic neuritis
-Corneal Ulcers
-Anterior Uveitis
-Acute glaucoma/uncontrolled IOP (any cause)