A Virtual Retina Fellows Forum

The COVID-19 pandemic has significantly impacted the landscape for educational and research meetings in the field of ophthalmology, and appropriately so. Almost all ophthalmology meetings at present are being held virtually, if at all. Certainly, virtual meetings lack the jovial social interactions that typically come with any conference, but they make up for it with the ability to host many meetings simultaneously and the chance to “attend” a meeting without having to leave one’s home.

This year’s Annual Retina Fellows Forum was followed a 3-night virtual format. With the benefit of not having to travel to a chilly Chicago in the dead of winter, the online format provided a profoundly educational experience—mingled in with the standard Zoom moments of mic checks and kids running around in the background.

The meeting is typically reserved for second-year vitreoretinal fellows, but the virtual format allowed both first- and second-year surgical retina fellows to experience the Forum this year. This article reports our experiences as the three second-year vitreoretinal fellows at Wills Eye Hospital during this year’s virtual Forum.

PART 1. FROM AMD TO SURGICAL DEVICES

The first evening kicked off with a short introduction from Tarek S. Hassan, MD, before diving into the clinical portion of the meeting. The educational content on the first evening covered a diverse range of pathology from AMD to pediatric retina, and from uveitis to tumors.

Rishi P. Singh, MD, discussed topics in the management of AMD and the many exciting treatment modalities on the horizon that will hopefully soon be integrated into the armamentarium of all practitioners. Caroline R. Baumal, MD, and Thomas A. Albini, MD, gave outstanding lectures on two very different topics, uveitis and pediatric retina, offering pearls for vitreoretinal fellows as they begin their careers. Amy C. Schefler, MD, offered her insight and expertise in the management of intraocular malignancies. The evening concluded with the renowned David R. Chow, MD, FRCSC, describing the many new vitreoretinal surgical devices that fellows will soon incorporate into their surgical management of vitreoretinal diseases.

PART 2. ILM PEELING, AMD MIMICKERS, AND MORE

The second night started off with Dr. Chow, who discussed recent articles in the vitreoretinal literature, and included a panel discussion. Specifically, the articles focused on peeling of the internal limiting membrane (ILM) during rhegmatogenous retinal detachment (RRD) repair. Although studies have shown decreased rates of postoperative epiretinal membrane formation and improved single surgery success rates with ILM peeling, most of the panelists said they do not routinely perform ILM peeling at the time of RRD repair. Several panelists offered valid counterpoints against the practice.

Next, David Sarraf, MD, presented striking images of cases that were sent to him as suspected AMD but that were in fact AMD mimickers. The diagnosis du jour is that of pentosan polysufate maculopathy, which was a common AMD mimickers Dr. Sarraf identified.

Dr. Baumal then switched gears to focus on macular surgery and when to operate, presenting a nice array of cases, prompting great discussion among the panelists. Sticking with the surgical approach, Aleksandra V. Rachitskaya, MD, offered pearls for approaching RRDs in a range of situations from primary buckles to RRDs with concomitant macular holes.

Next, Sunir J. Garg, MD, tackled the topic of secondary IOLs. The biggest pearl perhaps was how to handle and interact with the referring providers when fixing dropped lenses: Communication is key!

The night concluded with a lecture by Dean Eliott, MD—his infamous trauma lecture. He provided many insights into how to manage intraocular trauma at the time of injury and how to approach vitreoretinal surgery after trauma. Many fellows will not soon forget the impressive collection of images of trauma cases Dr. Eliott has amassed over his career.

PART 3. LIFE AS A VITREORETINAL SURGEON

The last evening of the Fellows Forum had a slightly different focus from the previous two sessions. Although still presenting plenty of clinical content, the evening included practical sessions on beginning life as a vitreoretinal attending surgeon.

Dr. Hassan kicked things off with a discussion of the management of diabetic retinopathy (DR). A major point of discussion was the role of anti-VEGF agents in the treatment of nonproliferative DR in the absence of macular edema. Discussing the results of the PANORAMA study of aflibercept (Eylea, Regeneron) in nonproliferative DR, Dr. Garg described the evidence as the “strongest data that I have seen yet to incorporate into clinical practice.” Dr. Garg then continued the discussion with the presentation of surgical cases, offering pearls and insights into the management of macular holes.

Equally insightful was a group of discussions on beginning practice as a new attending. Alan J. Ruby, MD, led a talk on drug reimbursement, pricing, and management within retina practices. His succinct talk was a welcome illumination into an integral part of the economics of a retina practice that is often obscure to trainees.

The final session was a group discussion led by Carl C. Awh, MD, entitled “The Real World.” Discussion topics included the importance of continued learning, communication with the wider retina community, and navigating a new supervisory role over clinic staff. Reassurance was provided through a group poll, in which about 20% to 30% of fellows indicated that they had not finalized a job offer, consistent with previous years, according to Dr. Awh.

Further comfort was provided regarding the daunting mantle of independent practice; an informal poll of the attending faculty suggested that it takes about 3 to 5 years to achieve comfort in practice. Several participants shared valuable early practice advice, such as Dr. Garg’s assertion that it is important to have good relationships with patients, staff, local physicians, and referring providers.

The importance and virtues of work-life balance were also discussed, notably by Dr. Sarraf, who said he still plays tennis 1 or 2 hours a day. The practice sessions were a unique, memorable, and cherished facet of the Forum.