Our residency program at Mayo Clinic is structured by monthly rotations. As a first year ophtho resident, we spend our first 4 months in refraction clinic and the resident-run acute care clinic. We then separate into monthly subspecialty rotations. These rotations are: oculoplastics, retina, cornea (2 months), pathology, and neuro-ophthalmology. We also spend another 2 separate months in the resident-run clinic.
All second year rotations are 2 months long. My first 2 months were in oculoplastics, since I needed to decide if that was really what I wanted to do with my life (yep!). My next 2 months were retina (torture). Now, I am on my pediatric ophthalmology rotation.
Pediatric Ophthalmology Rotation at Mayo Clinic
Pediatric ophthalmology is unlike any other ophtho specialty and there is SO much to learn. As all pediatricians say, children are not just “little adults” and this is so true in ophthalmology. One of the key pathologies in children is strabismus, or misalignment of the eyes. The causes of strabismus in kids is different from adult causes and is often congenital, but can have other issues driving eye misalignment as well.
Six different muscles control the movement of the eyes, and they all work together in a complicated fashion. The eyes work together to fixate on one object and the brain fuses the two images from each eye. Certain eye muscles are “yolked” together. Other eye muscles oppose each other, so changing one eye position affects the other eye… it’s very complicated! Here are some measurements recorded in our eye chart. This looked like hieroglyphics to me at first 🙂
This little chart from OphthoBook (great resource) demonstrates what types of things you can see when certain muscles aren’t working properly.
In a superior oblique palsy, children will tilt their head to compensate for the vertical and torsional misalignment. Look at this little guy who has had a SO palsy since he was a baby. The head tilt has been there all along!
We spend a lot of time in the operating room moving eye muscles around. Our goal is to optimize the eye alignment to provide improved cosmesis, good vision in both eyes, and a better chance of 3D vision and depth perception. Unfortunately, this isn’t always possible and many kids with strabismus have weaker depth perception and amblyopia.
The days in the OR are busy and I have found myself scarfing down snacks in between cases a lot this month!
But the kids are ridiculously cute, and make it all so enjoyable. Just look at these tiny, adorable glasses!
Working with kids is way more fun than I anticipated. They are all so funny and respond to everything differently, which makes each day fun and exciting. I really love working with kids and it’s making me wonder if I could somehow do pediatric oculoplastics?
Since there is so much new material, I have been reading more than usual and trying to grasp everything related to pediatric ophthalmology.
But… I’ve also been enjoying myself in clinic. The orthoptists are pretty good at convincing our attendings to take us to get frozen yogurt when we have down time 🙂
So that’s peds! I am 1/2 way through now that it’s December, so I know I will learn even more.
Do you like kids? Do you think you could work with kids?