Ocular Disease/Low Vision Rehabilitation - VA Los Angeles Ambulatory Care Center '02-'03

• Briefly describe the patient population and types of disorders that routinely present at your clinic. Also, provide the typical number of patient encounters you have in a day.
  • The patients whom I see myself are the low vision geriatric veterans. The most common disorders that I have encountered are advanced-stage glaucoma, age-related macular degeneration, and proliferative diabetic retinopathy. Other conditions that I have dealt with on a less common basis are various acquired optic atrophy, ischemic optic neuropathy, stargardt’s dystrophy, retinitis pigmentosa, retinal detachment, Fuch’s dystrophy, and other various forms of glaucoma. I am responsible for the emergency walk-ins that we get in our service. They are primary red eye cases with conjunctivitis, subconjunctival hemorrhages, or other various pathologies causing acute reduction in visual acuity. Other times I assist Dr. Kim in staffing the 4th year interns with their patients. These are normally patients in a primary care setting, those who need a comprehensive eye exam or ones we are treating glaucoma and other anterior/posterior segment conditions. A typical number of patient encounters for low vision clinic usually ranges from 5 to 7 per day. These are low vision encounters that do not include the emergency walk-ins. An average number of patients that I would staff per day is usually 4 to 6.

• Describe other activities that you are available to participate in besides direct patient care. (i.e. Grand rounds, internal lectures, interaction with other health professionals, staffing of student interns).
  • Once a week on Wednesday, I would attend Grand rounds with the other VA residents from Sepulveda or West LA. Grand rounds are normally held there. I would also travel to OCLA on Low Vision days which are held on the 1st, 3rd, and 5th Friday of every month. There I would help staff low vision and primary care patients. This also enables me to shadow a low vision specialist in Dr. Gordon. About once a quarter, I have the task of giving a lecture on the gist and optics of low vision to the 4th year interns at OCLA. There is also a case report or research project that is due at the end of residency, much like a residency thesis. Each of us are also responsible in giving a 15-20 minutes lecture on an interesting case or research that we plan on writing about.

• Briefly describe the setting of the clinic and the surrounding area.
  • The clinic is a VA setting. The patients are all veterans with age ranging from the Gulf War era to all the way to World War I era. Our department is located right next to ophthalmology services, ENT (ear, nose, throat), and neurology. We have a pretty good working relationship with ophthalmology where cross-referrals are often made.

• What are some strengths of the program and what areas do you feel need improvement.
  • The main strength in this program lies in the fact that I have a very good chief of optometry service to work with. Dr. Kim is a great person to have as a mentor. He is trusting of your skills and capabilities. He is always available when you have any questions or uncertainty about a diagnosis or treatment plan. Having been in low vision pretty much means that you’ll see most of the more common pathologies and a lot of those that you won’t see at a regular normal practice setting. Having seen the worst of the worst cases on a daily basis pretty has brought my confidence high up there when it comes to diagnosis. I feel that having more practice in low vision also enables me to give my patients one more opportunity or alternative in enabling them to regain a somewhat normal lifestyle. The only weakness that I find in this program is the shortage of staffs for the interns. This pretty much means that I am the alternate or second staff there. I enjoy staffing the interns; but at certain times when I have my own patients, it can get a little overwhelming when I take it upon myself to staff. Although it’s not a requirement, I see it as an obligation to the department to get the service rolling when we are backed up with students waiting on only Dr. Kim.

• Briefly describe the geographic location/area of your residency program (what should one expect).
  • We are located in the heart of downtown Los Angeles. Expected a good amount of traffic when commuting to work every morning. The VA clinic is adjacent to the Federal meeting and is near Japanese town and city hall. Occasionally there will be protestors which makes mornings pretty interesting.

• Has your residency thus far been what you expected?
  • It has met my expectations in the type of patients I will encounter. I have rotated through the site as an intern before doing the residency, so I knew what to expect in not just a VA environment but its location in downtown LA.

• What were your reasons for applying for a residency and have they been addressed?
  • My main reason for doing this residency is purely in my enjoyment in working with veterans while interning at this outreach site. I understand that doing a residency will open doors to an opportunity in working at the VA. I plan on returning to a VA setting somewhere in the near future. I enjoyed working with Dr. Kim as an intern before and expected the same or better being here for an entire year versus three months. My reasons for doing this residency have been pretty much met within a month or so of doing it. I feel that the chief of staff and myself complement one another in our working relationship and that we make a pretty good team at VA-LAACC. Every quarter, we always have a blast working with the new interns. I know that I’ll miss this place once the residency is over.