Ophthalmology is one of the most dynamic and exciting fields in medicine. Recent strides in laser vision, correction, and intraocular lens implantation have given many people the opportunity to regain their vision, as well as improve their quality of life. Ophthalmologists prevent, diagnose, and treat the diseases and abnormalities of the eye and periocular structures. A combination of both outpatient medicine and surgical treatment makes ophthalmology one of the most attractive (and competitive) surgical subspecialties. Reasons for entering the field vary from person to person but usually include: an excellent lifestyle, the ability to treat patients both medically and surgically, financial rewards, and the opportunity to help people regain their vision. Most of the practitioners in this field are very happy, and would choose the same specialty if they had the chance to do it all over again.

Ophthalmology is a three-year residency following an internship of your choosing. Internships in preliminary medicine or surgery, as well as a transitional year are acceptable. Most applicants currently choose either preliminary medicine or a transitional year for obvious reasons. Ophthalmology programs usually will not ask (or care) what type of internship you complete. The bad part of this is that you must apply to your internship separately from the ophthalmology match. The ophthalmology match is currently run through the San Francisco Matching Program (http://www.sfmatch.org) and the internship match is through the NRMP (National Residency Matching Program). You will interview for these matches separately, which can create an extra financial burden during the interview process, but preliminary years are not very competitive, so you WILL be able to match into something. The ophthalmology part is a different story.

Currently, the overall match rate for Ophthalmology is around 48%. This means that one half of the people that apply do not get accepted into a position. The good news is that for U.S. Seniors from U.S. medical schools, the match rate in the January 2000 match was 82%. For whatever reasons, residency programs like their residents to be fresh out of U.S. medical schools. Because of this, your best chance of getting accepted is as a senior, so apply wisely and apply to a wide range of academic programs. In the 2000 match, there were 434 residency positions available, and 1 was left over after the match was completed. The average applicant sent out 35 applications and went on approximately 8 interviews. Be sure and check out the SFMatch website at http://www.sfmatch.org. This site is key in keeping you up to date on the application process, as well as current match statistics.

The first thing you must do is to confirm your interest in ophthalmology. If you have time, you can shadow physicians at the Gunderson Eye Center at the DOB or at the HAC eye clinic. Dr. Behrooz Koleini at the Boston VA is one of the nicest faculty members at BU and is an excellent person to shadow as well as to ask for an exceptional letter of reference. You can also get involved with research projects at BU. The Lions Eye Research Center is located on the 9th floor of the L building, and they typically have research projects available if you are interested and willing to dedicate the time. Helpful people in the Dept. of Ophthalmology to talk to include Dr. Ippolit Matjucha, who is the residency program director; Dr. Edward Feinberg, who is a retina specialist; and Dr. Arthur Boruchoff, an old-school ophthalmologist who is well-known throughout the country in academic ophthalmology. These people will be willing to meet with you and help you through the process, but the Department at BU is not known for its advocacy of students entering the field. Ultimately, the application and interview process will very much depend on your own self-assertiveness and desire to enter the field.

You do not have to be AOA to get into ophthalmology. Of course, it doesn’t hurt, and you will most likely get into an excellent program if you are, but it is not a requirement in any way. USMLE Step I scores are very important, but again, non-stellar scores do not make you a non-competitive candidate. Some say that 210 is the magic cut off, but this varies from year to year. The more you have, the better. Letters of recommendation are also key, since academic ophthalmology is such a small and tight community. You will find that everybody knows everybody, and there are some politics involved. A glowing letter from a well-known chairman can get you key interviews. Grades in the preclinical years are not as important as the third year clerkships and your audition electives in ophthalmology. Research experience is also looked upon very favorably, especially research which has culminated in an abstract, publication, or presentation at a national conference.

Presently, there is a wide range of academic and community based programs available. However, the number of programs and thus positions available continues to decline yearly, as the Academy tries to decrease the number of residents in training. Candidates typically apply to a wide range of programs to maximize their chances of matching. In addition, you can often find "safety in numbers." Apply to many programs- it is better to turn down interviews than to wish that you had applied to more programs. The process is expensive but just remember that you only have to go through this once (hopefully!). It also helps if you are not geographically limited, especially to highly competitive areas of the country like Boston. Again, there are only approximately 430 residency positions available, so applicants have little room to be picky. The ophthalmology match is an early match, and takes place in late January. You therefore need to finish third year and jump right into your ophthalmology rotations. These electives should be done BEFORE September so that you will have adequate time to get those stellar letters of recommendation from those you want writing your letters. Remember that letters typically take 2-4 weeks to be completed and mailed to you. Doing your Sub I early on, as well as taking Step II if you feel you can improve upon your Step I scores can also be helpful. Applicants typically do a 4-week ophthalmology elective at BU, and then one rotation away. These away rotations can be a double-edged sword. If the program likes you, they may select you as a resident. However, if just one attending did not like the way you adjusted the phoropter, you may be out. Typically, people do these rotations at reach programs, so they have not lost anything if they are not accepted. This is totally up to you though, and if you are dressed to impress, do a rotation at a program that you think may be your top choice. You need 3 letters of recommendation, with at least one being from a core rotation (a third year clerkship or your Sub I). Applications are through the San Francisco Matching Program and you should register for the match in April of your third year. Applications are suggested to be turned in by late August, and you should work HARD to get it in by this time. The earlier you get your application in, the more interviews you will get. You will also have greater selection in choosing dates for these interviews.

You should go on as many interviews as you get; for most applicants this is typically around 10, but for some as many as 15. Interviews can also be difficult to schedule since programs usually have only 1-3 dates available, and many programs interview on the same days. The interviews themselves are very laid back and informal; the program just wants to see what kind of person you are, and if you will be compatible with program philosophies and the attendings for 3 years. They also want to assess your interest in ophthalmology as well as your other academic and non-academic pursuits. Dress conservatively, look sharp and smart, be confident, and you will be fine. Interview season is typically from October to December, and you may be flying all over the country, so be ready to spend some money. In addition, you will be interviewing for your PGY-1 position as well. Remember to just have fun and enjoy this time. You will meet some of the most friendly and enthusiastic medical students at these interviews.

Rank lists are due in mid-January. You should write to the programs at the top of your list and tell them that you intend to rank them very highly, and what it was in particular that you liked about them. Don’t tell a program that they are number one on your list unless they really are. In addition, Dr. Culbert will make one phone call on your behalf to your top choice. Use this call wisely- it definitely cannot hurt your chances of getting into your most desired training program.

In late January, you will receive your match result and you will be psyched! Congratulations on matching into one of the most exciting and fun fields that medicine has to offer.

Current matching trends in ophthalmology do not reveal any surprises--that is, declining matching percentages for US graduating seniors. Although this trend may seem concerning for applicants, do not be discouraged because the field of ophthalmology offers a wide breadth of residency programs, each having a different blend of clinical, surgical, and research opportunities.

The variables that many residency directors expect from successful candidates are a combination of grades, USMLE board scores, and letters of recommendations. As expected, most strong programs tend to attract academically proven candidates who have performed at least above the average within their respective class and attained good boards scores (USMLE Step 1). I suspect most directors prefer above average scores as it is often listed on a candidate’s profile during the interview day. This is all that really needs to be said about objective standards. Letters of recommendation are extremely helpful in establishing an immediate rapport with interviewers. For reasons unclear, at BUSM, it is virtually impossible to obtain a letter from the Chair. This is unfortunate because Dr. Leibowitz is arguably the most recognized ophthalmologist at this institution. Therefore, it is incumbent to find an advisor who has national or regional acclaim. One way to develop a relationship with a potential advisor is by participating in basic or clinical research. If possible, try to arrange research electives at institutions (e.g. Joslin Diabetes Center or Mass Eye and Ear Infirmary) that conduct high-quality ophthalmologic research. Not only will this opportunity allow one to learn and engage in the current focus of vision research, but, equally as important, it will help define the character of the residency program (i.e. basic-research, clinical-research or community-based) that one would feel most comfortable with for the following three years.

The question of engaging in away rotations is a difficult one to answer. There are several ophthalmology programs that offer stellar clinical training for medical students who seek a general appreciation of ophthalmology. One of these programs is the Bascom Palmer Eye Instute at University of Miami. This program is well structured and offers ample clinical experience for a two-week period. I chose to visit this institution for many reasons, some of which had no relation to ophthalmology, and I am glad to have had the experience. So, if anything, an away rotation can broaden your perspective on the styles of ophthalmology programs and will further define the type of residency program that you seek. Others in my class spent time at Emory, Cornell, and University of Chicago.

There are different types of ophthalmology residency programs, some of which may be tailored to your interests. If you seek a research-oriented program, there are several programs that successfully secure a majority of NIH/NSF funding and have expertise in many vision disciplines. The "top twenty or so in NIH FY 1999" looked something like this, and in no particular order: Mass Eye and Ear (Hahhvahd), Wilmer (JHU), Wills (excellent clinical research, TJU), Jules Stein (UCLA), Washington U, Duke, UCSF, Emory, Illinois, Michigan, Penn, Iowa (excellent basic and clinical research), Oregon, Baylor, Mount Sinai, and Wisconsin. If you seek an exceptional clinical program, there are a handful: Wills (author institute for the Wills Eye Manual, a staple for every resident), Bascom Palmer, Jules Stein (UCLA), Wilmer (JHU), New York Eye and Ear Infirmary, Doheny (USC), Michigan, Iowa, Tufts, and UCSF. While the aforementioned programs are academic in nature, there are many programs that offer excellent clinical training in a community-based setting.

I hope that this has been helpful. Below, I jotted down some of my candid impressions of programs that I visited and hope that it will serve of some use for those in the future classes. Good luck.

Pros: good clinical and surgical volume, VA system, 4 residents per year, rotations at Children’s, strong chair, nice staff and faculty, majority of graduating residents obtain fellowships.

Cons: few research opportunities, Q4 (in-house)

Interview day: consists of three interviews (e.g. one on one or two on one). Not intense and pleasant style of questioning. Tour of the facilities with several residents. One of the residents said, "Don’t bother with this place or any place if you don’t like it...if I had to do it again, who knows." However, a majority of residents loved the surgical volume and diverse patient population. This program seems like it is growing and becoming less in the shadow of Tufts and Haahhvahd. About 25 applicants per day. (Half-day)

 

Pros: strong research in glaucoma, in upper Manhattan, great ancillary services, certifies LASIK, VA system, good surgical volume, attending ophthalmologist present in resident clinics, 4 residents per year, half of the residents seek fellowships.

Cons: rotate at Elmhurst, smaller clinical facilities than other programs

Interview Day: consists of three interviews (e.g. one on one or two on one). Pleasant. The faculty members are extremely nice and concerned with resident education. There is a good glaucoma service. Tour of facilities (nice hospital). Residents liked the program and said that there is plenty of surgical volume. This program is not the top-dog in the city, but the residency director believes that it is on its way up. About 25 applicants per day. (Full-day)

 

Pros: great resident and faculty work relationship, residents love the program and will tell you so, mucho nice hospital, rotate through New York Eye and Ear Infirmary for LASIK, housing

Cons: unsure of clinical and surgical volume, 3 residents per year

Interview Day: consists of two interviews (e.g. three on one and six on one). Breakfast and lunch with residents. Fun hanging out with the residents. Seemed like a low-stress environment. Although, the program is not regarded as a strong program, the residents and faculty foster an excellent working environment (I really liked this program). About 20 applicants per day. (half-day)

 

Pros: housed in own building, only ocular trauma center in state, strong research programs, VA system, 6 residents per year, Q 6 (not in-house), research projects required for residents, large faculty, all residents obtained fellowships

Cons: not in downtown Chicago, "so-so" associated university hospital, pink scrubs!

Interview Day: consists of four interviews (e.g., one on one). Pleasant and relaxed. The residents enjoyed the mix of research and clinic opportunities. There are strong occuloplastics and retina services. The top-dog in the city. About 15 applicants per day.

 

Pros: large research facilities, excellent hospital, 6 residents per year, large faculty, strong clinical and surgical volume, excellent research faculty, VA system, 6 residents per year

Cons: St Louis

Interview Day: consists of five interviews (e.g. one on one). Intense questioning. Tour of facilities with residents. Most residents loved the program because of the clinical and basic research resources. Has a strong ocular immunology department. The top-dog in the city. About 20 applicants per day.

 

Pros: large hospital, good faculty, good research opportunities, VA system, extensive surgical volume, 8 residents per year

Cons: Dallas and its weather, Cowboys

Interview Day: consists of six interviews (you will know if you will be ranked after talking with Dr. Cavanaugh). Pleasant except for one interviewer who is well-known for his interviewing style. Residents say that they work very, very, very hard. They start surgery during the first year at the Dallas-VA.