Fellowship Training

Ocular Immunology Fellowship Program Overview

Our major goal is to provide a resource for individuals who are determined to become the best that they’re capable of becoming: from a personal, character point of view, as well as from a physician/clinician/caretaker point of view, and from a restless, question-asking, scientist point of view.

The level to which we succeed in our goal is mirrored by the behaviors of the individuals completing the Fellowship training program: behaviors both from a character/social perspective and from a clinician/scientist perspective. We have reason, so far, to believe that the program accomplishes its goal. Some Fellows take more with them from this environment than do others. All, however, have selflessly recognized the quid pro quo for the benefits they derive from the program: 100% dedicated effort to the Fellowship training program while in it, total commitment to the patients for whom they are responsible, and absolute honesty and scientific integrity.

C. Stephen Foster, MD, FACS, FACR, Founder of MERSI and OIUF

Educational Goals
The primary goals of the OIUF Fellowship at MERSI are to develop diagnostic and therapeutic skills in caring for patients with destructive ocular diseases mediated by abnormal autoimmune or infectious processes, as well as an enhanced understanding of general ophthalmic disease, and to develop an information base in basic ocular immunology, with associated research skills, to facilitate appropriate total care of patients with ocular inflammation and any associated secondary comorbidities. Fellows are expected to utilize their growing understanding to formulate and lead their own research projects to be submitted for publication throughout the year.

Basic Objectives
Differential diagnosis, evaluation for formulation of diagnostic strategy, and management of the following diseases and associated co-morbidities:

1. Cicatricial pemphigoid and other forms of chronic cicatrizing conjunctivitis
2. Peripheral ulcerative keratitis
3. Scleritis
4. Uveitis
5. Retinal vasculitis
6. Orbital Inflammation
7. Cystoid macular edema

Familiarity with the following clinical skills will be gained/assessed:

1. Pertinent yet detailed formation of history/review of systems, assessment, and plan
2. Measurement of visual acuity
3. Measurement of intraocular pressure via tonometry
4. Slit lamp examination (including SUN and IUSG criteria for inflammation)
5. Dilated fundus examination, including slit lamp biomicroscopy and indirect ophthalmoscopy with retina drawing
6. External photography and interpretation of diagnostic testing, including but not limited to
   optical coherence tomography (OCT), fluorescein angiography (FA), and visual field (VF)
7. Interpretation of monitoring blood work and serologies
8. Laboratory evaluation of conjunctival/scleral specimens
9. Formulation of monitoring and treatment plans for patients with ocular inflammatory diseases

Additionally, fellows will gain ample experience in conditions of general ophthalmology, including medical and surgical interventions, and how these can be managed in patients with ocular inflammatory disease. This consists of conditions such as dry eye, glaucoma, cataracts, retinopathy, medical and surgical retina, in patients with OID or otherwise, etc. Additionally, it is to be emphasized that the proper, safe use of cytotoxic and biologic drugs requires significant medical training and experience, and significant, frequent, longitudinal experience in the use of such agents, recognition of complications induced by these agents, and management of such complications.

Our teaching emphasizes the case method approach in which each patient is to be examined initially by the Fellow and then formally presented to the attending staff member for discussion of diagnosis and treatment. Clinical work will be the primary source of education for this fellowship. Additional readings and pertinent references from suggested readings will often supplement clinical experiences. Used properly, this will provide the opportunity for recognition and diagnosis of disease and will be the stimulus for in-depth reading about each disease entity.

Clinical Activities

Fellowship training will take place at MERSI in Waltham, MA. This comprehensive outpatient clinic provides tertiary care not only for uveitis and OID but also for many subspecialties of Ophthalmology, including dry eye, cataracts, glaucoma, and medical and surgical retina. MERSI houses a blood lab, a pathology lab, an infusion suite, and minor procedure and laser rooms, and is conveniently located above an outpatient surgery center where our surgeons practice. The clinic is in operation Monday through Friday as well as on one Saturday per month.

Clinical training will be supplemented by lectures from preceptors and guest speakers, presentations from fellows, and regular laboratory meetings to discuss the progress of individual research projects. Research, presentation, and/or publication of interesting cases or series by fellows is strongly encouraged, especially for Research and Pre-Residency Fellows. We believe that a doctor is a better physician as a result of carefully analyzing a case, reviewing the literature, and reporting the case than by not doing so. We also have the opportunity to present new and/or rare cases to the scientific community and the outcomes associated with our care.