Ophthalmology Residency Overview

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Ophthalmology, the branch of Medicine dealing with the diagnosis and treatment of conditions relating to the eye and visual system, as well as its broader structure and function, is a highly competitive residency. Patients will be provided with complete eye care working across medical and surgical techniques and services. Ophthalmologists have the opportunity to form longer-term relationships with their patients, and will typically work more in patient-focused roles than in consultative roles. The median clinical salary is high, at $370,000 per year.

Residency Core Requirements

Ophthalmology training must consist of at least three years of core residency, preceded by a year spent in a transitional role. This transitional year is a ‘general postgraduate clinical year of training’ and must be in a program accredited by the ACGME or Royal College of Physicians and Surgeons of Canada. The PGY-1 must involve direct patient care experience in fields like family medicine, internal medicine, emergency medicine, neurology, obstetrics and gynecology, peds, general surgery or a transitional internship. Subspecialty training is available after completing the residency, and includes the following areas / specialties: cornea/external disease, glaucoma, neuro-ophthalmology, ophthalmic pathology, oculoplastics, pediatric ophthalmology, vitreoretinal disease, and uveitis/immunology.

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Application Statistics & Competition

Ophthalmology is considered one of the most competitive fields. An average applicant makes between 70 and 80 applications to different programs, although a ‘highly qualified’ applicant appears to receive no statistics benefit from applying to any more than 45 programs. For those who successfully matched, the average number of interviews was 10, whilst for those who failed to match the average number of interviews was 4. It’s therefore vital to recognise that despite applying to numerous programs, you are unlikely to receive a significant number of interviews, and that this applies to the most competitive students as well as the less competitive. You must therefore be prepared to apply to a high number of programs if you wish to increase your chance of interviewing and matching.

The numbers aren’t too daunting, however – for US MD Seniors at least. More than 75% of this cohort matched successfully. In contrast, other cohorts have a much more difficult time with this competitive specialty. In particular, looking at IMGs the picture is rather bleak, with a match rate of only 3% of positions filled by IMGs.

Sample Interview questions

What subspecialty are you particularly interested in? How long will training take?

I’m most interested in paediatric ophthalmology, as I believe it will allow the chance to further my training in ophthalmology whilst still maintaining a relatively broad view of the specialty. I’ve always believed that working with young patients is especially rewarding, so being able to specialise, maintain some degree of generalisation with the specialty, and work with young patients is the perfect combination for me. Training would take four years for Residency, plus one year for the fellowship, so five years in total.

How would you manage amblyopia?

Management should involve eliminating the obstacle to vision, correcting refractive error, and if needed forcing use of the poorer eye.

Optical correction is the first step, and is then followed by either spectacle correction or patching if needed. Patching of the good eye forces use of the weak eye. Duration of patching depends on the severity of the amblyopia and how it responds to treatment – for example, moderate amblyopia would require two hours per day, increased to six hours per day as improvement stops. Atropine penalisation is the purposeful degradation of the better eye with cycloplegic drops, forcing the use of the weaker eye. It is used if spectacles alone have no impact and patching compliance is poor. Atropine 1% can be used.

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Important considerations

Firstly, you need to be aware of the fact that ophthalmology is an ‘early match’ specialty, with an early February match. Therefore you must make a decision earlier than you would need to with other specialties. Additionally, it’s vital to be aware of just how competitive this field is. Even as a strong US MD applicant, you will certainly not be guaranteed a place, and if you’re applying as either a US DO applicant or an IMG your chances of matching become very slim indeed.

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