SITE OF ELECTIVE: OCULAR ONCOLOGY DEPARTMENT, WILLS EYE INSTITUTE, PHILADELPHIA, PENNSYLVANNIA, USA

Size: px

Start display at page:

Download "SITE OF ELECTIVE: OCULAR ONCOLOGY DEPARTMENT, WILLS EYE INSTITUTE, PHILADELPHIA, PENNSYLVANNIA, USA"

Justina Goodwin
6 years ago
Views:

1 TEJAL MAGAN FINAL YEAR MEDICAL ELECTIVE REPORT 2015 SITE OF ELECTIVE: OCULAR ONCOLOGY DEPARTMENT, WILLS EYE INSTITUTE, PHILADELPHIA, PENNSYLVANNIA, USA FUNDING: ROYAL COLLEGE OF OPHTHALMOLOGISTS PATRICK TREVOR ROPER UNDERGRADUATE AWARD Introduction Wills Eye Institute in Philadelphia, Pennsylvania is the United States of Americas first specialist eye hospital, which was established in This makes it the oldest continually operating eye facility in the country. Located in the heart of Philadelphia, it is the busiest eye hospital in the region offering emergency eye services 24 hours a day and 7 days a week. There are various subspecialty departments at Wills Eye, including; cornea, glaucoma, vitreo-retinal, medical retina, oculoplastics, oncology and neuroophthalmology. Over the years, Wills Eye Institute has built a prestigious reputation consistently being ranked in the top three eye hospitals in the country. Thus, it is no surprise that patients from all over the world visit the hospital to receive care. Annual rankings of the best ophthalmologists by Philadelphia magazine have shown that the majority of these doctors are based at Wills Eye. These doctors continue to diagnose and treat the most challenging cases encountered in ophthalmology. Of these cases more than half are directed to the ocular oncology department to Dr Jerry Shields and Dr Carol Shields, with whom I completed my elective. My reasons behind choosing this particular elective stems from my immense interest in the specialty of ophthalmology. Furthermore, as already described, Wills Eye Institute is a highly reputable place to work. More recently all Thomas Jefferson University affiliate hospitals such as Wills Eye, now allow students from St George s University of London (SGUL), to undertake a 1

2 medical elective as a part of a new exchange programme. I was privileged to be one of only two students to have been involved in this programme. By the end of the elective period I was confident I had acquired a much better understanding of the diagnosis and treatment of the most common conditions seen in the ocular oncology department. I was able to do this in both a clinic setting and in the operating room. In the clinic, I followed patients throughout their visit, which allowed me to observe their care with multiple healthcare professionals. For instance, each patient would get their visual acuity measured by an optician, then if relevant have imaging of the eye by a ophthalmic imaging technician before subsequently seeing the doctor for examination. Following these patients increased my understanding significantly about the processes involved in being able to formulate a diagnosis. I was given the opportunity to also examine patients to see their pathology, for instance conditions that I commonly encountered included; ocular melanoma, retinoblastoma, conjunctival squamous cell carcinoma and iris cysts. With this opportunity, I was able to become more proficient in operating the slit-lamp to examine both the front and the back of the eye. I would then observe Dr Shields explain the diagnosis and management plan to each patient, learning from her vast experience. Due to the nature of the subspecialty I was able to appreciate the importance of empathy, patience and effective communication skills between the doctor and patient. One memorable patient was a young infant who was diagnosed with an advanced stage intraocular tumour, known as retinoblastoma. My understanding was that in this age group removal of the eye (enucleation) is usually the treatment. However, I was able to learn that eye-salvaging treatment with intra-arterial chemotherapy was performed in this baby. The tumour responded and successfully regressed. I was then assigned to write up a case report on this unique patient. With this assignment I was able to further increase my knowledge about retinoblastoma and its management. Spending time in the operating room, I was able to observe for the first time the treatment of intraocular melanomas. This was by use of plaque radiotherapy and was a privilege to observe, as this technique was pioneered 2

3 at Wills Eye. I was able to examine this patient using direct ophthalmoscopy before the procedure. This allowed me to appreciate its clinical characteristics such that in future I am able to distinguish malignant melanoma from a benign nevus in the eye. During my time at Wills Eye, I was also fortunate to be invited to the 6 th annual intraocular tumour conference, which was held within the institute. Here I was able to observe unique case presentations and learn about recent advances in the treatment of conditions seen by ocular oncologists. I was also able to gain insight into newer techniques and imaging modalities to diagnose particular tumours. In all, during the elective rotation due to the department I was working in and reputation of the doctors here, I was fortunate to observe referrals of the most challenging and unique cases in the world. Overall, melanomas and retinoblastomas were the two most common conditions I encountered and I now feel more knowledgeable in both of these areas. When beginning my elective rotation, I was given the opportunity to be involved in multiple research projects. I was already aware that Wills Eye Institute is a leading centre in education and research, and thus relished this chance. I was involved in three research projects during the entire period of the elective. Firstly, as already mentioned I helped write up a case report regarding an infant who was treated with intra-arterial chemotherapy for retinoblastoma at Wills Eye. In addition I was assigned another complementary case report to write up, this was the use of intra-arterial chemotherapy for retinoblastoma in an adult also seen at Wills Eye. To successfully complete these case reports, I did a thorough literature review using a PubMed search of retinoblastoma, its current treatment overview and looked in more detail at intra-arterial chemotherapy. This greatly increased my understanding of the disease as it pushed me to understand its deep pathophysiology. In addition, I was able to become confident in the skills required to write up a case report. Both reports have been submitted for potential publication. I was also involved in some data collection and entry for another colleagues study. This research was based on Coats disease, where Wills Eye Hospital 3

4 currently has the largest number of patients diagnosed with this particular condition in the world. My role involved typing the characteristic features seen on optic coherence tomography and ultrasonography findings onto a flow sheet. It is unclear yet what the focus of this study will be, however it allowed me to appreciate the importance of having organised patient notes and collecting data systematically. Discussion Reflecting on the elective as a whole, my experience at Wills Eye Institute was impeccable. I felt honoured to have been working with both Drs Carol and Jerry Shields who are the leading experts in the field of ocular oncology. The knowledge that I have acquired at Wills Eye regarding advances in management of ocular oncological conditions has been invaluable for my own learning. Alongside this, being able to attend a conference and being given the opportunity to be involved in multiple research projects were extremely valuable, as collectively they will make me more a competitive candidate when applying for the ophthalmology-training programme. The elective defiantly gave me better insight into the importance of research for the future of medicine. Having the opportunity to be involved in research will benefit patients vision, a vital component of life, which without can be extremely debilitating physically and mentally for the patient. For instance, in my case report, I highlight how intra-arterial chemotherapy can be considered in younger infants in expert hands resulting in eye-salvage therapy. Conclusion Ophthalmology like most other fields in medicine is an ever-evolving entity particularly the subspecialty of ocular oncology, which is one of the forefront areas. I learnt that I really enjoyed ocular oncology, a subspecialty that I had never before considered, but now feel that I could potentially specialise in this area. Thus, partaking in this research holds me in good stead for the future to come. In all, my experiences on this medical elective have only fuelled my desire to enter the field of ophthalmology. 4

5 Acknowledgements Royal College of Ophthalmologists for awarding me The Patrick Trevor Roper Undergraduate Award to fund this elective Ocular oncology department at Wills Eye Institute for accommodating me on this elective and providing multiple learning opportunities St George s, University of London and Thomas Jefferson University for allowing me undertake this elective as part of an exchange programme Photograph 1: Dr Jerry Shields, myself and Dr Carol Shields at Wills Eye Institute Photograph 2: Entrance of Wills Eye Institute 5

6 6

7 7

A Career in Ophthalmology in the West Midlands

A Career in Ophthalmology in the West Midlands Contents Ophthalmology Overview Advantages / Disadvantages Career Pathway Competition ratios Commitment to Specialty Further Information (Please click on