When you think of retina fellowship programs, you think of academic programs throughout the United States. Private practice fellowships do exist and AIO, Associates in Ophthalmology, in West Mifflin, PA, suburban Pittsburgh, started their fellows program in 2007. On July 1st, they will embark on their 11th fellow during the last 11 years and had one research fellow, too.
Miguel A. Busquets, MD, FACS, said, “Private practice has an advantage to academic fellowships because we merge cutting edge technology and clinical trials. We have an environment conducive to medical, surgical and clinical training under one roof within our practice and integrated ambulatory surgery center. This allows us to train our fellows in a way that is above and beyond what is customary, while allowing them to develop proper business acumen in a real-world retina practice setting. They are exposed to healthcare policy, EMR, billing, proper coding, and insurance matters, in addition to the usual clinical considerations. We fuse diagnostics by allowing fellows autonomous, yet supervised, decision-making with their Attendings.” One example of the business acumen their fellows develop relates to AIO having access to all injectable medications for DME, RVO and AMD. Inventory management is staggering when you have LUCENTIS® (ranibizumab), EYLEA® (aflibercept) and Avastin (bevacizumab), all readily available. This not only teaches the fellows the clinical particulars, but also billing, inventory and financial assistance offered to our patients.
Regarding surgical technology and platforms, AIO uses ALCON’s NGENUITY®, 3D Digitally Assisted Visualization system, which is revolutionary in retinal surgery and offers better surgical outcomes for patients. All MIVS platforms are available, including 23, 25 and 27 gauge technologies, as well as the new 10,000 cpm vitrectomy probe. AIO’s mindset is to integrate the best technologies available along with optimal business practices, in order to maximize patient outcomes. Intraoperative OCT for use during macular surgery is currently being evaluated and AIO may acquire this technology in the future. Another exciting area of growth involves the development of dry AMD clinics. The latest diagnostic technology including preferential hyperperimetry (PHP) and autofluorescence will be used for better tracking and management of the condition, in conjunction with accessibility to the latest clinical trials for those patients that qualify. Specific clinics dedicated to retinal dystrophies are also being designed, in order to provide tailored diagnostic testing (such as the AdaptDX dark adaptation test) to these patients in an environment catering to their unique needs.
“Our fellowship really brings it all together, clinically, surgically, best business practices, diagnostics and technology,” adds Dr. Busquets.
RetinaLink is honored to feature AIO’s Fellows and asked them several questions to gain their perspective and impressions.
RetinaLink (RL): Please outline your academic background.
Tailun Zhao, MD (TZ): I received my undergraduate degree from University of North Carolina, Chapel Hill in 2005. Prior to medical school I spent a year at Drexel University in a Medical Science Post-baccalaureate program, and two years of research divided between Duke University and University of Pennsylvania. I eventually obtained my Medical Degree from UNC School of Medicine in 2012. I then completed internship in Internal Medicine at Harbor UCLA Medical Center in Los Angeles. And finally completed my residency program in Ophthalmology at the Flaum Eye Institute, University of Rochester in June 2016.
Bilal Yousufzai, MD (BY): I completed my undergraduate degree at the University of Georgia, then, medical school at Medical College of Georgia and residency at Georgetown University Hospital in Washington DC.
RL: Why did you decide on retina and why AIO?
TZ: I decided to specialize in retina because of the diverse amount of pathology associated with the retina. The photography we obtain are amazing and moves me in the same way art does. I still remember being blown away by this amazing CRVO montage in residency. But most of all it is the retinal surgeries that drew me retina.
I chose to do my fellowship at AIO because I wanted to be in private practice as my career advanced, and I wanted to be in a private practice fellowship so that I did not miss out on many of the more practical aspects of being a Vitreo-Retinal surgeon. The Retina fellow during my residency had told me about this high volume practice in Pittsburgh, and once I checked it out, I was sold.
BY: I love the diverse pathology we see in retina, both in the clinic and the operating room. AIO provided me an opportunity to be independent early as a fellow with my own clinics where I could see my own patients. Being in a private practice, the clinics run pretty efficiently and I can still maintain a busy patient schedule while maintaining a good quality of life outside of work. In a private practice fellowship, I also can see the business decisions involved in running a private practice.
RL: What’s your preferred small gauge platform?
TZ: I prefer 25G, but also find 23G to be easier in RD Repair and Diabetics.
BY: I’ve become comfortable with the ALCON CONSTELLATION® system.
RL: Regarding NGENUITY®, what has been your “ah-ha” moment in the OR with Dr. Busquets and how many cases did you perform before you were comfortable with 3D technology?
TZ: I was blown away as soon as the retina came into focus on the very first case. The system is surprisingly intuitive. I would say by the third case felt comfortable enough to do a membrane peel with it.
BY: It didn’t take me long to become comfortable with the 3D technology. I did my first membrane peel on the NGENUITY and was impressed by the clarity on the screen. I didn’t have to hunch over the microscope, so my neck felt better as well!
RL: What is your opinion of Intraoperative OCT? Does it change your surgical plan?
TZ: I feel the intraoperative OCT definitely has its benefits. To be able to confirm adequate peeling of the ILM intraoperatively is helpful. In a case of Stage 1 Mac hole with VMT, it would be nice to know the status of the hole upon release of the vitreous traction.
BY: I think intraoperative OCT is particularly useful in macular surgery, particularly with macular hole and EMM surgery. It may help better delineate residual membranes after a peel.
RL: What is your best advice to the incoming fellows that start in July?
TZ: My best piece of advice for the incoming fellows is to keep a surgical diary, it will help your surgical skills grow so much faster. Write down everything notable that happens in every case as well as reflections on what could have been done differently or better.
BY: Every patient provides an opportunity to learn! Reading up on interesting cases you see in clinic is a good way to correlate what we read in textbooks to clinical care.
RL: What is your favorite thing to do when you have some free time?
TZ: My favorite thing to do is hopping on a bicycle and riding along the Three Rivers Heritage Trails right across from my apartment. Riding along the river with a fantastic view of the city is one of my most relaxing activities.
BY: When I’m not at work, my wife and I enjoy finding new and fun places to eat in Pittsburgh.