A Deeper Look Into Pediatric Ophthalmology

Session 202

Dr. Roni Levin is an academic pediatric ophthalmologist. She joins me to bust myths, talk about the training pathway, and how to become a competitive applicant. If this is something you might be interested in, check out the American Association for Pediatric Ophthalmology and Strabismus and American Academy of Ophthalmology.

For more podcast resources to help you with your medical school journey and beyond, check out Meded Media.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:15] Interest in Pediatric Ophthalmology

Roni went through medical school with an open mind although she had a preference for doing pediatrics because it was all she knew of being a doctor. And so, she eventually did pediatrics rotation and she loved it.

She found it to be emotionally draining and she couldn’t just detach, always thinking about the kids. She didn’t initially find interest in ophthalmology except for knowing there was free pizza at the department. But once she showed up and saw videos of cataract surgery, she decided to do a rotation and had so much fun doing it that she knew it was the right specialty for her.

'I had found everything that I was looking for in a specialty, working with my hands doing these meaningful life-changing procedures where you can impact people's lives and change their vision.”Click To Tweet

[03:39] The Biggest Myths or Misconceptions Around Pediatric Ophthalmology

Roni’s colleague describes a pediatric ophthalmologist as part-physician, part-magician, and part-clown. And Roni couldn’t agree more. Roni stresses the importance of having a rapport with children because it’s a scary thing for them.

'One of the skills that you have to develop is getting important information from patients in a calming way without intimidating them.'Click To Tweet

[05:38] Types of Patients

Roni’s fellowship is in pediatric ophthalmology and adult strabismus, which is the misalignment of the eyes. She also treats adults that have double vision, neurologic disorders, like cranial nerve palsies. But the majority of the patients she sees are children.

Of her surgical patients, adults tend to need strabismus surgery more, so she performs surgeries in about 50% adults and 50% children. As a pediatric ophthalmologist, she sees patients from newborn infants to older adults, and as young as a two-year-old newborn and as old as a 90-year-old adult.

[08:01] Typical Day

Roni says her day varies and one of the important things she does is she sees infants that are at risk for a condition called retinopathy of prematurity (ROP).

Infants born at a very early gestational age or a low birth weight and end up in the NICU are at risk for this debilitating disease that can cause blindness. So once a week, she would go to the NICU to screen infants for this disease.

She also travels to other NICUs since there are very few people that do this type of work. And being in academic medicine, she covers the consult service on the days that she’s in the hospital.

Roni is also in charge of the medical student education for their department. And so, once a week, she does research or she mentors and gives lectures to medical students.

[11:03] Can Surgical Skill Be Learned Along the Way?

Roni says this is something that can be learned. In fact, she works with beginning surgeons. These are residents from day one of their first year of ophthalmology who are with her in the operating room assisting with strabismus surgery. And so, she works with the very earliest trainees.

Ronie says she rarely finds someone that was a natural born surgeon so this is something that can really be learned.

One of her areas of interest is teaching Surgical Education. Some of her projects include working with a group of medical students to help find ways to teach surgical skills. And they’ve come up with different projects.

They spend a lot of time as educators, teaching medical students and residents how to do surgery. One project was teaching how to do laser eye surgery using a simple ping pong ball as an eye model. Another project was working on a 3D-printed model eye that residents and medical students can practice suturing on.

Roni assures that this may be something a lot of residents are nervous or anxious about but they’re going to train you along the way. And if this is something you’re interested in, she recommends buying a suture kit on Amazon and then taking time to practice suturing, even using a tomato peel or a banana. Just get the experience with the hand-eye coordination but don’t stress about it.

'The types of surgeries that we do in ophthalmology are microsurgical. So we use an operating microscope, some of the suture that we're using is as thin as a strand of hair.'Click To Tweet

One of the treatments Roni does for infants that are born premature with ROP disease is a laser treatment. And so, for students that are really interested in high tech, Roni says they have a lot of really cool, new equipment and new surgical techniques. So lots of new innovation and things are constantly changing.

[13:58] Taking Calls

Since Roni is at an academic medical center, they all participate in trauma calls. Their residents will be on call for a week at a time. They’re seeing patients in the emergency room, in the trauma setting, in the inpatient unit, and pediatrics. As a faculty member, the residents call her to discuss things. And the times she’s going in would be a ruptured globe surgery.

“For the most part, the majority of ophthalmologists are in a private practice setting. Those traumas are going to the major academic medical centers.”Click To Tweet

And so, about 80% of ophthalmologists who are in private practice are not dealing with those types of serious eye emergencies. Hence, the lifestyle is typically much more flexible in terms of hours.

[15:27] Subspecialties Within the Field of Ophthalmology

Roni’s fellowship training is pediatric ophthalmology and adult strabismus. So the types of problems she sees are misalignment of the eyes – crossed eyes and drifted eyes – that happen in children and adults.

About 75% to 80% of the patients she sees in the clinic are children. But she also sees adults that have strabismus.

Roni adds that about one or two days a month, she sees comprehensive adults that come in with any type of eye problem (ex. glaucoma, cataracts, diabetic retinopathy). So she still continues to see some of the comprehensive ophthalmology.

'While the eyes sound so specialized in such a small part of the body, there's actually many different fields or sub-specialties within the field of ophthalmology.'Click To Tweet

Roni explains there are several subspecialties within ophthalmology including glaucoma specialists, and uveitis specialists. There are those taking care of tumors around the eyelids and cosmetic procedures. They have neuro-ophthalmologists, a combination of neurology and ophthalmology. You can check out American Academy of Ophthalmology to find a list of the different subspecialties within the field.

Specifically, one of the things Roni loves about pediatric ophthalmology is that you’re really a big comprehensive ophthalmologist for kids. This means they do all of those specialties she just mentioned.

[18:11] Life Outside of the Hospital

Roni feels ophthalmology is traditionally one of the fields where you can have more of a work life balance. Although she does trauma calls in academic medicine, it happens very infrequently.

She enjoys spending time with family and she gets to travel and go to the beach. That being said, she also enjoys going to work. And it’s great she has time to hang out with friends and do her hobbies.

[21:26] The Training Path

Traditionally, residents did a one-year internship either in internal medicine, general surgery or a transitional year, followed by three years of ophthalmology. This past year, they made it a requirement to integrate the programs, which means ophthalmology is now a four-year program.

During the intern year, the students do internal medicine and transitional year, but there’s also some ophthalmology component into it. And if you want to specialize, and do pediatric ophthalmology fellowship, that would be an additional year.

[22:30] How to Competitive for Matching

Roni serves on her department’s residency admission committee, and the director of medical student education. And she says that while it isn’t a competitive subspecialty, there are different things they look at.

Preclinical year grades are important, obviously, Step score, and they also look for involvement. They want to see that students are really dedicated and passionate about the field. Whether that’s in the form of research projects, volunteering, those types of things are really important.

When screening applications, she looks for someone who’s going to be compassionate, well-rounded and to be an advocate for their patients. And so, she pays a lot of attention to things like letters of recommendation, the clinical years comments and grades.

And during interviews, she looks for those who can really communicate and can carry a conversation with her.

'Get involved as early as possible.'Click To Tweet

Roni recommends some ways to get involved. If you can during your first and second year, shadow them in the clinic or volunteer in their research projects.

[25:24] Overcoming the DO Bias

Roni says they view the DO and MD applicants equally. When looking at the candidates, she looks with a holistic approach in terms of their application, their grades, their personal statement, their background.

They also look at what medical school they come from because there are several medical schools that don’t have a home ophthalmology program. They don’t have a department of ophthalmology residency program within their medical school.

And as the clerkship director, she seeks to accommodate these students and welcome them to rotate with them. She writes letters of recommendation for several students that have come to their department that don’t have a home department.

That being said, Roni encourages students to seek out those opportunities. Find a mentor or do away rotations.

'Every student no matter what school they come from should really seek out those opportunities…. mentorship and support can go a long way.”Click To Tweet

[27:30] What She Wished She Knew Before Getting Into Pediatric Ophthalmology

Roni recalls wanting to do everything the first time she came out of training. And she found there were certain procedures or certain fields that were very stressful, and that there were super subspecialists who can do those.

And so, over time, she had learned to let go of some of the things she found stressful or uncomfortable or difficult to manage.

[30:56] The Most and Least Liked Things

Roni finds that being able to treat different types of patients is very rewarding. But her most rewarding patient experiences are with teenagers, specifically, teenage girls,with eye misalignment. These girls come in with very low self-confidence. And after the eye muscle surgery, they’re like a whole new person with this newly found confidence.

Just seeing the joy and the satisfaction with helping those teenagers become confident and seeing them make that eye contact is her favorite and the most rewarding part of her job.

What she likes the least, on the flip side, is crying children. You just can’t reason with them because they don’t understand what’s going on. And they’re screaming and crying. And so, sometimes it can be very challenging, to hold down a kid and put drops in. And so, making kids cry is not the fun part. But they will get used to it. It just takes some time for them to trust you.

[35:01] Final Words of Wisdom

For students who are interested in pediatric ophthalmology, Roni says you are always welcome to spend time with a pediatric ophthalmologist, shadow in the clinic and the operating room and see if it’s what you really like to do.

To do a pediatric ophthalmology fellowship, you first do ophthalmology. You’re going to be working with adults doing cataract surgery, all of those procedures.

“Spend time doing ophthalmology, get that early exposure, participate in service projects, and then just explore.”Click To Tweet

Roni also advises students to always go with an open mind. For students not going into ophthalmology, that rotation is even more important, because that’s the only chance they’re going to get to learn about ophthalmology.

Ultimately, whatever field you do in medicine, you’re going to run into patients with eye complaints. And so, take the time to learn about it because it’s an area that a lot of doctors don’t have a high comfort level so familiarize yourself with the eye.