Cincinnati Eye Institute Vitreoretinal Surgery Fellowship
History of the Cincinnati Eye Institute
The Cincinnati Eye Institute (CEI) was started in 1945 by Morris “Maury” Osher, and grew to seven ophthalmologists by 1978. Leadership of the group was passed to Maury’s son, Robert “Bobby” Osher, who instituted a paradigm shift for the group. The goal became to recruit the very best fellowship-trained subspecialists so patients could be treated expertly at CEI for any ophthalmic disease. Bobby grew CEI to 37 doctors. The leadership of CEI changed to an elected board of directors in 2001, and CEI remains one of the largest ophthalmic practices in the country with 64 doctors. The main CEI facility is 120,000 square feet with an adjacent CEI ambulatory surgical center with seven dedicated operating rooms, numerous laser suites, and a LASIK suite. In 2015, CEI and the University of Cincinnati (UC) re-signed a robust and enhanced academic services agreement that formalizes a relationship that goes back decades, becoming a true hybrid model of practice. The clinical research at CEI complements bench/clinical/translational research at UC, and currently more than half of CEI ophthalmology doctors hold some type of appointment at UC. Residents and fellows frequently rotate at both institutions, providing the opportunity to benefit from the unique learning opportunities of both academic and private practice.
History of the CEI Surgical Retina Fellowship
The CEI Surgical Retina Fellowship began in 2003 and includes training by 11 full-time fellowship-trained retina faculty. In 2016, the clinical and surgical volume allowed for expansion to two fellows each year for a total of four fellows at any given time. The fellows spend time at the main CEI location in Blue Ash, at multiple satellite clinics throughout the Greater Cincinnati area, at the University of Cincinnati Medical Center, the Cincinnati Children’s Hospital, and the Cincinnati Veterans Affairs Hospital. Additional details about each training location and clinical responsibilities are provided below. All are within a 30-minute drive of the main CEI facility in Blue Ash.
Rotation Schedule and Clinical Responsibilities
Cincinnati Eye Institute
At any one time, there are at least two to three retina specialists seeing private patients in the main Blue Ash office. These clinics are filled with a mixture of "bread and butter" retinal disease and quaternary care referrals for complex disease from out-of-state as well as from international colleagues. A wide variety of pathology, with great depth and breadth, punctuates the experience in these clinics. All facets of medical and surgical retina are well represented. These are very busy clinics with attending physicians seeing from 50 to upwards of 100 patients in a day. A finely tuned referral network of general and non-retina subspecialty ophthalmologists as well as a large optometric network have pre-screened these patients prior to the referral to the retina service so the pathology density is extremely high. Fellows interpret ancillary testing, examine patients, and develop assessments and plans before the patient is examined by faculty. The attending clinics provide the opportunity to develop clinical skills under the direct tutelage of experienced faculty. Attending physicians have sufficient ancillary staff in their clinics to efficiently run independently without a fellow, but greatly enjoy the opportunity to teach fellows in clinic. The fellow’s sole job is to learn with little to no “scut work.” Unlike many other fellowships, there is no fellow-run injection clinic. Faculty perform intravitreal injections, lasers, and in-office procedures on their own patients, allowing fellows to maximize the “teachable moments” in clinic. Mentored education is the primary priority for the fellows!
Retina Officer of the Day
A highlight of the fellowship is the Retina Officer of the Day clinic, termed “ROOTD.” This clinic is staffed by one fellow at a time and is fully facilitated with technicians, photographers, and a scribe. This is an urgent, same-day retina clinic for patients with acute retina problems or concerns from within CEI, as well as from a wide network of outside referring doctors who draw from an immediate catchment area of 2.3 million people. In addition, established retina patients who call in with an acute problem and whose attending surgeon is unavailable are seen by the ROOTD. In a typical half day, the fellow may see 10-25 patients, many of which are new patients with urgent referrals or new symptoms. The fellow sees and manages patients independently, but always has a designated faculty member assigned who is on site running their own clinic, and is immediately accessible for questions or to staff a complex patient. The ROOTD clinic serves the main purpose of eliminating the barrier to entry for patients to be seen by the CEI retina service. It is a bright red “open for business” sign and the face of the CEI retina service. Fellowship alumni consider the graduated autonomy of the ROOTD clinic to be a vitally important aspect of the fellowship.
University of Cincinnati Ocular Oncology
Fellows rotate with Dr. Zelia Correa and Dr. James Augsburger at the University of Cincinnati Ocular Oncology clinic. This clinic provides exposure to management of ocular tumors, with a primary focus on tumors of the posterior segment. Fellows learn to diagnose, treat, and follow choroidal melanomas as well as the whole gamut of other ocular oncological conditions. Techniques including ultrasound echography, ultrasound biomicroscopy, I-125 plaque radiotherapy, proton bean radiation, fine-needle aspiration biopsy are taught in the setting of a university-based multidisciplinary approach to these patients. Drs. Correa and Augsburger and a retina fellow also manage retinoblastoma patients at the Cincinnati Children's Hospital, widely considered among the top pediatric hospitals nationwide. Fellows graduate with a fellowship certificate in Vitreoretinal Surgery and Ocular Oncology, and are trained to be ready to incorporate ocular oncology into their future clinical practices. Depending on individual fellow preference, the Oncology experience can be adjusted up and down somewhat.
University of Cincinnati Hoxworth Retina Clinic
The University of Cincinnati Hoxworth Center is the main eye clinic for the UC ophthalmology residency program. Fellows have great responsibility in this setting. Resident retina clinics are staffed with second year fellows autonomously (functioning as medical retina faculty) or with a first year fellows and a retina faculty member. Lasers are performed in the mornings before clinic, and all intravitreal injections are performed in a separate, resident-run injection clinic, freeing up valuable time for fellows to see patients in this busy, weekly retina clinic. The UC retina clinic provides ample opportunity for fellows to interact one-on-one with the residents, and play a very substantive role in resident education. The Hoxworth clinic provides a healthy balance of autonomy and graduated supervision. Fellows have block time at University Hospital each week with a retina faculty member to operate on patients from the Hoxworth clinic. In addition, second-year fellows will soon be credentialed to perform routine retina surgeries autonomously at UC after clearing these with a retina faculty member.
Cincinnati Children’s Hospital Medical Center
Fellows get in-depth exposure to pediatric retina at Cincinnati Children’s Hospital. Like CEI, CCHMC also has a worldwide referral network and is consistently among the top-ranked Children’s Hospitals in the nation. CCHMC also has a worldwide referral network. On select rotations, the fellow will spend a half day bi-weekly in the pediatric retina clinic with Dr. Robert Sisk and be intimately involved in the management of inherited retinal diseases, developmental malformations, trauma, retinal detachments, and retinopathy of prematurity, among other diseases. While on this rotation, fellows spend one day every other week in the operating room at Cincinnati Children’s Hospital performing examinations under anesthesia, electroretinography, laser, intravitreal pharmacologic treatments, and various surgical procedures on infants and children. There is the option of additional training in ROP screening and treatment for those interested.
Cincinnati Veterans Affairs Medical Center
Fellows have a weekly resident-run retina clinic at the Cincinnati VA. These clinics are in a magnificent recently constructed freestanding eye clinic facility and are staffed either by a retina faculty member (for the first year fellows) or by the second year fellows who have medical retina privileges. Vitreoretinal surgical cases are diagnosed in the VA retina clinic and operated by the fellow with direct one on one supervision by faculty at CEI, UC, or a surrounding community hospital depending on the medical fact pattern at hand.
The CEI retina fellowship is fully committed to training highly qualified vitreoretinal surgeons. Fellows begin this surgical training on July 1 and the learning curve is steep. Fellows average between 2 and 2.5 full days in the OR each week during the two years. Fellowship faculty are accustomed to running their own clinics without a fellow, and having the fellow in the OR is always prioritized over helping in clinic. Being such a large practice CEI draws patients from a large area, often with very complex pathology. In addition to learning basics of vitreoretinal surgery, including vitrectomy, primary scleral buckling, and macular surgery, fellows learn to treat extremely complex cases of PVR and diabetic tractional detachment. Fellows perform subretinal TPA injections and become skilled at secondary IOL placement. Two of the surgeons do all their cases using digitally assisted heads-up 3D surgery. Endoscopic retina cases are performed regularly. CEI has a robust clinical trials program, which lends the opportunity to work with cutting edge novel technologies presently including suprachoroidal approaches to access the subretinal space (Prelude Trial), transscleral sustained release antiVEGF resevoirs (Ladder Trail), and other novel surgical techniques. Fellows are intimately involved in the management of all trauma cases that involve the posterior segment coming into the level one trauma center at UC and participate in the bi-weekly pediatric retina cases at Cincinnati Children’s Hospital. Fellows graduate the CEI/UC vitreoretinal fellowship with the ability to confidently manage any patient that needs any kind of vitreoretinal intervention.
All four fellows split call evenly throughout the two years of fellowship training, with each fellow taking one week of call approximately every four weeks. Call responsibilities are substantial and multiple but are combined into weekly call rotations so that call obligations average one week every four weeks:
- Fellows take CEI retina-only first call but always have a designated CEI faculty member on backup call. This is by far the busiest aspect of call. Established CEI retina patients are usually managed directly by the retina fellow on call. Established CEI non-retina patients and patients new to CEI with possible retina-related conditions are first triaged by an after-hours answering service, and are often seen by the ophthalmologist on-call, and then discussed with and or referred to the retina fellow on call as appropriate. With the daily urgent retina officer of the day clinic (ROOTD), patients with urgent (but not emergent) retina-related concerns are easily added to the next day’s ROOTD clinic rather than routinely seen after-hours without technician support. After hours emergencies are managed by the CEI on call fellow (with scheduled staff back-up). Dedicated OR time is made available for add-on cases during business hours, and less commonly, on weekends. On Saturday mornings, the on-call retina fellow sees all post-op patients from the prior day’s surgery by any retina faculty - typically between 5-20 patients. This clinic is fully staffed by technicians and scribes to facilitate efficient clinic flow.
- Fellows take first call for retina emergencies identified by ophthalmology residents, other ophthalmology fellows, and other services at UC, Children’s Hospital, and the VA. Backup faculty is always scheduled and available. These responsibilities are always combined with the scheduled CEI retina call.
- Retina fellows also cover about 60% of the general ophthalmology trauma-call at UC. In this case the retina fellow functions as a general ophthalmology faculty for primary ruptured globe cases and mentors the residents who primarily manage the patients. If the surgical case turns into a retinal surgical emergency such as an IOFB, retinal faculty are called in to staff the case. These responsibilities are always combined with the scheduled CEI retina call. Ruptured globes happen unpredictably and sporadically but average out to about once per week.
- Retina fellows also take some primary call for inpatient ophthalmology consults at several surrounding community hospitals. Calls for emergent inpatient ophthalmology consults are triaged by the fellow. Most consults can be appropriately deferred until the patient can be seen in clinic. True emergency inpatient consults occur about 2 – 3 times per year. This call is also always combined with the scheduled CEI retina call.
Fellows do not carry pagers, but are reachable by the phone triage personnel via Doc-Halo, a HIPAA-compliant smartphone application.
Second Year Fellows:
Matthew Manry, M.D.
- Residency: University of Michigan
- Medical School: University of South Florida
- Undergrad: University of Florida
Yogin Patel, M.D.
- Residency: Henry Ford Hospital
- Medical School: Medical College of Georgia
- Undergrad: University of Georgia
First Year Fellows:
Steven Christiansen, M.D.
- Residency: University of Iowa
- Medical School: University of Utah
- Undergrad: Brigham Young University
Prashant Parekh, M.D., M.B.A.
- Residency: University of Iowa
- Medical School: University of Miami
- Business School: University of Miami
- Undergrad: Florida International University
- James J Augsburger, MD
- UC Ocular Oncology, Chairman emeritus, UC Department of Ophthalmology
- Zelia M Correa, MD PhD
- UC Ocular Oncology
- Robert E. Foster, M.D.
- Chairman, CEI Board of Directors
- Robert K. Hutchins, M.D.
- CEI, UC
- Luke B. Lindsell, O.D., M.D.
- CEI, UC
- Daniel M. Miller, M.D., Ph.D.
- Chief Medical Officer, CEI
- James M. Osher, M.D.
- CEI, UC, Cincinnati Children's Hospital
- Michael R. Petersen, M.D., Ph.D.
- Chairman emeritus, CEI Board of Directors
- Radhika Ramenaden, MD
- Christopher D. Riemann, M.D.
- Fellowship Director, CEI Board of Directors, UC
- Robert A. Sisk, M.D.
- CEI, UC, Cincinnati Children's Hospital
- Vrinda Hershberger, MD, PhD., - 7/2003 to 7/2004 - Florida Eye Care Associates, Orlando, FL
- Sam Dahr, MD - 7/2005 - 7/2006 - Retina Center of Oklahoma, Oklahoma City, OK.
- Nikolaos Trichopoulos, MD - 7/2006 - 7/2008 - Bay Pines VA Healthcare System Bay Pines, FL. (Tampa / St Pete)
- Matt Appenzeller, MD - 7/2008 - 7/2010 - Midwest Eye Center, Omaha, NE
- Ahmed El-Sanhouri, MD - 7/2009 - 7/2011 - Lansing Ophthalmology, Lansing, MI.
- Mario DelCid, MD - 7/2010 - 7/2012 - Retina Group of Florida, Ft. Lauderdale, FL.
- Martin Wilkes, MD - 7/2011 - 7/2013 - Atlanta Eye Consultants, Atlanta, GA.
- Adeel Shaikh, MD - 7/2012 - 7/2014 - Houston Eye Associates, Houston, TX
- Brian Toussaint, MD - 7/2013 - 7/2015 – Charles Wang MD PA, Wilmington, DE.
- Matt Guess, MD - 7/2014 - 7/2016 - Alaska Retinal Consultants, Anchorage, AK.
- Cindy Mi, MD - 7/2015 - 7/2017 - Vitreoretinal Associates of Washington, Seattle, WA.
Salary and Benefits
- Salary is pegged to University of Cincinnati PGY 5&6 rates
- Additional payroll deductions
- Health Insurance (PPO and HMO options) and dental insurance for fellow and his/her dependents
- Health-savings account with up to $25 CEI contribution per 2-week pay period
- Flex-spending account
- Ten days paid vacation per year
- Life insurance ($50,000 policy for all CEI employees – no cost)
- Ten days paid meeting-allowance per year with $1200 annual meeting-related expense stipend
- $300 meeting-related incentive for research presentations at research conferences or national ophthalmic meetings
- Free parking at CEI, UC, UC Childrens Hospital, and at all CEI-staffed community hospitals
- Additional note: matched fellows are asked to sign a one-year non-compete covenant restricting post-fellowship employment within 10 miles of CEI clinics.
- Additional payroll deductions
Application and Interviews
If you are interested in applying for vitreoretinal surgery fellowship at CEI, complete application materials at www.SFMatch.org. No supplemental materials are required. Interviews will be held on two Saturdays in late October and early November. Contact fellowship coordinator, Angie Johnsen, with questions: email@example.com.