The Retina Fellowships

The medical retina and inherited retinal disease (IRD)  fellowships each focus on training physicians in the major diagnostic and therapeutic techniques of diseases of the retina and vitreous. Emphasis is placed on indirect ophthalmoscopy, fundus biomicroscopy, fluorescein and indocyanine green angiography, ocular coherence tomography and autofluorescent imaging, and ultrasonography.

All retina fellows gain experience treating diverse patient populations through rotations at Grady Memorial Hospital, Children’s Healthcare of Atlanta (CHOA), and the Emory Eye Center. Fellows provide supervisory and teaching support for the Emory Eye Center residency program, in resident outpatient clinics devoted to treating a wide range of retinal and vitreous diseases.

The one-year medical retina and inherited retinal disease fellowship

The medical retina and iherited medical disease (IRD) fellow will work alongside a retina faculty member to evaluate routine and complex cases at the Emory Clinic, Grady Memorial Hospital and Children's Healthcare of Atlanta (CHOA).  

While this fellowship focuses on both medical retina and inherited retinal diseases, incoming fellows will also be given the opportunity to gain exposure to other subspecialities including uveitis, pediatric retina, and oncology. The Retina Section at Emory has numerous faculty with wide a breadth of expertise, including four who specialize in inherited retinal diseases.

Core Areas of Focus  

Multimodal fundus imaging. As a tertiary referral center in a major urban center, the Emory Retina Section manage a broad array of pathologies on a daily basis. Fellows complement their clinical examination skills with training in a comprehensive set of fundus imaging technologies. In particular, fellows are challenged to evaluate and differentiate acquired from hereditary retinal degenerations.

Electrophysiology. The Electrophysiology Laboratory, located next to the retina clinic, is a fully equipped facility offering full field electroretinography, multifocal electrooculography, visual evoked potentials, dark adaptometry and color vision testing.  Fellows will be educated on ERG interpretation and how to integrate this information with other diagnostic tools to solve challenging cases.

Emory Eye Center Retina Clinic. The fellow sees private patients with Retina Section faculty. The fellow is responsible for some supervision and training of the residents, together with the attending staff.

Grady Retina Clinics.  During each week, members of the resident staff collect interesting and difficult patients in the field of retinal disease for presentation at the retina clinics at the Grady Memorial Hospital. The fellow sees these patients and decides on their management in consultation with the Retina Staff physician. 

Procedural Skills. An extensive program of photocoagulation in the treatment of diabetic retinopathy, retinopathy of prematurity, and macular disorders is an ongoing part of the retina work at the Emory Department of Ophthalmology. Multiple types of laser are used including slit-lamp delivery of red, yellow, and green wavelengths, indirect diode laser, photodynamic therapy, and transpupillary thermotherapy. Intravitreal injection of a broad range of therapies plays an important role at all facilities.

Clinical Trials.  The Emory Retina Service has a long history of participation in landmark clinical trials in retinal disease.  The IRD service is involved in a range of observational and interventional studies involving gene-based, cell-based, and small molecule therapies.  Fellows will gain introductory exposure in the conduct of clinical trials.

Conferences

Weekly Retina Service Conference. All fellows, faculty and researchers with an interest in retinal disease meet every Thursday morning at 7AM for a weekly conference. Interesting cases, ongoing research projects and pertinent journal articles are discussed.  Particular focus is given to developing skills for critical appraisal of new literature in our field.

Southeastern Vitreoretinal Conference. Fellows present interesting cases at this annual retina meeting, hosted in Atlanta by the Emory Eye Center faculty.

National Conference Attendance. The medical retina fellow may choose to attend the annual meeting of the Association for Research in Vision and Ophthalmology (ARVO), the annual meeting of the American Academy of Ophthalmology (AAO), the International Society for Genetic Eye Diseases and Retinoblastoma (ISGEDR), or the American Society of Retina Specialists (ASRS). Attendance is predicated on the acceptance of a research presentation of the fellow's choice.

The two-year surgical retina fellowship 

This fellowship provides extensive clinical experience with diverse populations at multiple sites. Our fellows cover Emory Clinic, the Atlanta VA Medical Center, and Grady Memorial Hospital. The initial emphasis of this fellowship is on medical treatment of diseases, with a gradual integration of surgical management. Increasing responsibility for scleral buckling and vitrectomy surgery is provided throughout both years.

Rotations are designed to give Emory surgical retina fellows experience in all vitreoretinal subspecialties. Fellows work with faculty who have interests and expertise in uveitis, inherited retinal disease, pediatric retina, and intraocular tumors. Ample opportunity is provided for fellows to develop their own subspecialty interest and to perform clinical research in these areas.

Clinical Training

Vitrectomy and scleral buckle surgery.  Adult and pediatric patients with retinal detachments are seen on referral on the private service, as well as at the Grady Memorial Hospital and VA Medical Center. Our fellows make and submit  retinal drawing to the staff physician for evaluation. Progressive surgical responsibility is granted as the fellow's skills develop. 

The scleral buckle surgery is an important procedure for retinal detachment repair. Emory Eye Center fellows have ample opportunity to learn this procedure from each retinal faculty. They also gain experience performing the combined buckle and vitrectomy procedure.

Adult and pediatric vitrectomy surgery is a major clinical and research interest of the Retina Section staff. Approximately 20-30 cases are performed for posterior segment disorders weekly. Each week, the second-year fellow, assisted by the retina faculty, is the primary surgeon at Grady Memorial Hospital and the Atlanta VA Medical Center.  The fellow also supervises surgery performed by the senior resident on the retina service at Grady Memorial Hospital and VA Hospital. A staff physician assists with the formulation of the surgical approach in each case.

Photocoagulation.  Retina work at Emory emphasizes extensive photocoagulation in the treatment of diabetic retinopathy, retinopathy of prematurity and macular disorders. Multiple types of laser are used, including slit-lamp delivery of red, yellow, and green wavelengths, indirect diode laser, photodynamic therapy, and transpupillary thermotherapy.  Patients from the VA Medical Center and from Grady's adult ophthalmology clinic and neonatal intensive care unit, provide fellows with extensive experience in  photocoagulation. Intravitreal injection of emerging therapeutic agents plays an important role at all facilities.

Angiography and Ocular Coherence Tomography.  Fluorescein angiograms (FAs) are performed by ophthalmic photographers at the Emory Eye Center, the Atlanta VA, and at the Grady Memorial Hospital.  Pediatric FAs are performed at Children’s Healthcare of Atlanta using the RetCam. Indocyanine green angiography is performed at the Emory Clinic.

The retina fellow is encouraged to learn the techniques of retinal photography, including autofluorescent imaging and OCT. Fellows are assigned primary responsibility for reading FAs done at Grady and are expected to interpret these studies in consultation with the retina staff. Fellows learn to interpret and teach these skills to residents in the Flourescein Angiogram/OCT conference.

Emory Retina Clinic.  Fellows see private patients with retina staff  during their office hours. These patients all have complete diagnostic ophthalmologic examinations with concentration on the retinal diagnostic procedures. Residents work along with members of the Retina Section at all times, and the fellow is responsible for some supervision and training of the residents, together with the attending staff.

Grady & VA Retina Clinics. At these sites, resident ophthalmologists staff patients with the supervising fellows adjacent the faculty for evaluation and management of retinal conditions. A major portion of these retina clinics is devoted to the care of diabetic retinopathy, especially at the Grady Memorial Hospital, which is the largest outpatient clinic caring for diabetics in the United States.

Electrophysiology and Ultrasound.  An active laboratory program is ongoing in both ultrasound and electrophysiology. Two full-time technologists are present. Standard A- and B-scan techniques are utilized in addition to high resolution anterior segment techniques in the Ultrasound Laboratory. The Electrophysiology Laboratory is a computerized facility offering VEP, electroretinography, electrooculography, dark adaptation and color vision testing facilities.

Didactics

Retina Conference.  All fellows, faculty and researchers with an interest in retinal disease meet every Thursday morning at 7 a.m. for a weekly conference. Interesting cases, ongoing research projects and pertinent journal articles are discussed.

Fluorescein/OCT conference.  A monthly fluorescein conference is held weekly at 7 a.m. Interesting fluorescein angiograms and OCT images are presented to the residents by the fellows with input by retina staff.

Annual Conference Attendance.  First-year fellows attend  the annual meeting of the Association for Research in Vision and Ophthalmology. Second-year fellows attend the annual meeting of the American Academy of Ophthalmology or the annual meeting of the American Society of Retina Specialists. Attendance to either ARVO, ASRS or the AAO is predicated on the acceptance of a research presentation of the fellow's choice.