Retina Challenges, Rewards, and Career Opportunities

I am often asked what made me want to pursue a career in retina. My goal, when I graduated from the Southern College of Optometry (SCO) in Memphis in 2015, was to complete a residency and then return to SCO to teach. Maybe reading my story will inspire you to pursue a career in retina or another subspecialty from the start (see Me and My Shadow).

FALLING INTO RETINA

When I graduated from SCO, I pursued a residency at Lt. Col. Luke Weathers, Jr VA Medical Center in Memphis because my husband’s job was in the city and we wanted to remain here. The following January, my residency supervisors received a call from Mohammad Rafieetary, OD, FAAO, regarding a 2-year fellowship the Charles Retina Institute (CRI) in Memphis was offering, with the goal of bringing a second optometrist on board. Dr. Rafieetary has been in practice at CRI since 1996.

What intrigued me about CRI’s proposition was that it would give me an opportunity to train in the retina space and determine if it was of interest while allowing them a chance to determine if I would be a good fit for the practice. I agreed to the offer.

After completing my 1-year residency in primary care, I began a fellowship at CRI. The relationship proved successful, and I stayed at CRI after my fellowship. I also worked 1 day a week at SCO’s advanced care ocular disease clinic as a consulting faculty member—a position I retained for about 7 years until the birth of my daughter.

A TYPICAL DAY IN THE CLINIC

The young optometrists I meet often wonder what an optometrist does at a retina clinic. Below is a brief rundown of some of my responsibilities.

Patient Volume

I typically see an average of 50 patients per day. This might sound overwhelming, but it generally is not. All the pretesting and imaging have been completed by the time I see patients, which shortens the duration of each encounter. Similarly, because many of the appointments are follow-up visits, a lot of my patients know what to expect, making the process more efficient. New patient visits can take a little longer.

Workflow

The approach at other retina clinics may differ, but at CRI, any patient may end up on my schedule on a given day. I may see a patient with diabetic retinopathy and determine that continued observation is appropriate. Or, I may see a patient who has been referred for suspected exudative age-related macular degeneration (AMD). In this situation, I conduct a thorough evaluation and confirm a diagnosis of exudative AMD. I then provide counseling on the pros and cons of treatment with anti-VEGF therapy. Most individuals decide to begin treatment, which means receiving an injection from one of our retina specialists. The patient is then scheduled for a follow-up visit with me in 1 month. At that time, I will review their OCT scans with them and determine next steps for management, including whether additional injections are needed.

My clinic days are full of the bread and butter of a retina practice: patients with diabetic retinopathy, AMD, lattice degeneration, retinal tears and detachments, retinal vein occlusion, and retinal artery occlusion. That said, not all my cases are straightforward. Some force me to step back and think. Some conditions are so rare, they are almost once-in-a-career encounters. One recent case of autoimmune retinopathy seen by another provider in our clinic had everyone in the office collaborating on a diagnosis alongside consultations from outside uveitis specialists.

I have found a subspecialty focus highly rewarding.

Another question I often field regards how to get started working with industry.

INDUSTRY COLLABORATION

My top piece of advice is to develop an expertise. Because my niche is retina, it has made sense for me to build relationships around that area of focus as opposed to, say, dry eye disease or practice management.

The next step is to build connections. Identify the speakers in your chosen space and the circles in which they run. For example, the American Academy of Optometry has a retina special interest group. Joining that sort of group allows you to make connections with key opinion leaders in the field who can connect you with their industry partners.

Be forewarned that your early interactions with industry may not come with compensation. This phase is about building expertise and relationships. Industry members are paying attention to who is publishing and lecturing on topics relevant to their companies. As you become an authority on a particular topic, you may be invited to participate on an advisory board or contribute to paid editorial content.

THE MORE YOU KNOW THE MORE YOU GROW

I tell optometry students and recent graduates that they are going to be very different eye care providers in 5 years because they are going to learn so much. I am referring not just to residency and fellowship, should you choose to pursue either or both, but to the education that the first years of clinical practice bring. After a certain point, however, if you do not consciously strive to improve your skills, they will plateau. To become the best eye care provider you can be requires a commitment to continuing education and evolution.