Residency Programs

West Los Angeles VA Health Care Center

Description of Rotations

GRECC Rotation

The emphasis of the "GRECC" rotation (GRECC stands for "Geriatric Research, Education, and Clinic Center") is geriatric patient care at the main hospital building on our campus. The resident spends about 2 days at the Geriatric in-patient ward performing bedside exams, attending inpatient team meetings, attending the GRECC outpatient clinic team meeting, and attending the GRECC didactic lecture series. Those GRECC patients who are physically able to be taken to the Eyecare Center in bldg. 304 will be examined by the GRECC resident at the Eyecare Center rather than at bedside.

The Resident attends GRECC inpatient team meetings, where each discipline presents their perspective on the patient and a group decision is made regarding management. The GRECC team generally consists of a Geriatric Fellow (M.D.), an M.D. Intern, Social Worker, Pharmacy Resident, Dentist, Speech Pathologist, Physical Therapist, Audiologist, Nurse, and Dietician. This is an excellent opportunity for the Resident to learn how the other disciplines function (and thus be better able to make referrals to them) and to teach the other disciplines about Optometry, most especially how to recognize ophthalmic problems and refer patients to us.

The GRECC Resident also represents Optometry at the GRECC Outpatient team meeting to help coordinate care of GRECC Outpatients in need of eyecare. GRECC Outpatients are examined by the GRECC Resident at the Eyecare Center in Bldg. 304.

Tuesday afternoons are the GRECC resident’s administrative time.

The GRECC resident spends Wednesday mornings at the Eyecare Center attending the Fluorescein Angiography conference with Ophthalmology trainees and performing primary eyecare examinations in bldg. 304.

Wednesday afternoons are dedicated to Optometry Clinical Seminars and Workshops.

The GRECC resident attends a didactic lecture series conducted by GRECC personnel. The GRECC Resident may be invited to present a lecture on geriatric eyecare at this didactic series. The scheduling of the GRECC didactic series is subject to considerable change from one year to the next; during the 2009-2010 year, two sessions are conducted weekly, on Mondays and Fridays. The GRECC Resident may select which lectures he/she prefers to attend. Topics covered at the GRECC didactic series recently include:

The remainder of the GRECC Resident’s time is spent at the Eyecare Center, divided between direct patient care and precepting of fourth-year optometry interns. The resident is scheduled to precept fourth-year students ½ day per week (may change slightly in 2009-2010). There is a topical discussion on Monday mornings, “e-Rounds” on Friday mornings, and case reviews on Friday mornings at the Eyecare Center with Dr. Ilsen.

Nursing Home (Community Living Center, CLC) Rotation

The resident on the CLC (Nursing Home) rotation spends 2 ½ days (Monday afternoons, Tuesdays, and Thursdays) in our two on-campus nursing homes. The nursing homes have recently been re-named “Community Living Centers” (CLC). We have a full examination lane in one of the nursing homes, and a set of portable equipment for bedside exams.

The Resident attends a weekly Team Meeting at each one of the nursing homes, where each discipline takes a turn reporting their perspective on the patient; then the group works together in arriving at management decisions. Sometimes family members are also involved. The Team Meetings include the Primary Care Physician, Pharmacist, Dentist, Dietician, Physical Therapist, Nurse, etc. These meetings are a great opportunity for the resident to teach other disciplines about what Optometry does, and at the same time learn about other disciplines.

The CLC Resident has administrative time on Monday mornings.

The CLC resident attends a didactic lecture series at the Diabetic Clinic in the main hospital on Wednesday and then performs primary eyecare examinations in bldg. 304. The CLC Resident is usually invited to present a lecture on diabetic retinopathy to the team at the Diabetic Clinic. The Diabetic Clinic Didactic Series currently covers the following topics:

Wednesday afternoons are dedicated to Optometry Clinical Seminars and Workshops.

The remainder of the CLC Resident’s time is spent at the Eyecare Center, divided between direct patient care and precepting of fourth-year optometry interns. The resident is scheduled to precept fourth-year students ½ day per week (may change slightly in 2009-2010). There is a topical discussion on Monday mornings, “e-Rounds” on Friday mornings, and case reviews on Friday mornings at the Eyecare Center with Dr. Ilsen

Low Vision/Vision Rehabilitation Rotation

The Low Vision (LV) Resident has one half-day (Wednesday morning) for Low Vision evaluations on candidates for the Vision Rehabilitation program, determining their legal blindness status and conducting an evaluation for devices. Device dispensing is performed either by the resident on Wednesday mornings or, if desired, dispensing can be done by the Low Vision therapist for the Resident. The Low Vision therapist and/or the Blind Rehabilitation Outpatient Specialist (BROS) from the Vision Rehabilitation program frequently joins the LV Optometry resident for the Vision Rehab exams on Wednesday mornings to observe, in order to most effectively follow up with the patient at his/her home. Eyecare for Traumatic Brain Injury (TBI) patients is currently included within the Low Vision program; however, these patients are currently being given their optometric evaluations in the general Optometry Clinics rather than in the Low Vision clinics.

The LV Resident attends the Fluorescein Angiography Conference at the Eyecare Center with Ophthalmology trainees, followed by Vision Rehab evaluations. Wednesday afternoons are dedicated to Optometry Clinical Seminars and Workshops.

Administrative time is provided on Thursday mornings.

The remainder of the LV Resident’s time is spent at the Eyecare Center, divided between direct patient care and precepting of fourth-year optometry interns. The resident is scheduled to precept fourth-year students on two ½ days per week (may change slightly in 2009-2010). There is a topical discussion on Monday mornings, “e-Rounds” on Friday mornings, and case reviews on Friday mornings at the Eyecare Center with Dr. Ilsen

Contact Lens Rotation

This resident is responsible for our therapeutic contact lens clinic on Monday afternoons and Wednesday mornings in the Eyecare Center. The Monday afternoon clinic is scheduled to coincide with Ophthalmology’s Cornea/Anterior Segment Clinic to facilitate consultations between the two clinics. This also facilitates anterior segment photography for patients in either clinic.

Wednesday afternoons are dedicated to Optometry Clinical Seminars lectures and workshops.

The Contact Lens Resident attends Neurology Grand Rounds on Friday mornings at the main hospital. Some of the topics covered recently at Neurology Grand Rounds include:

The CL Resident has administrative time on Friday afternoons.

The remainder of the VR Resident’s time is spent at the Eyecare Center, divided between direct patient care and precepting of fourth-year optometry interns. The resident is scheduled to precept fourth-year students ½ day per week (may change slightly in 2009-2010). There is a topical discussion on Monday mornings, “e-Rounds” on Friday mornings, and case reviews on Friday mornings at the Eyecare Center with Dr. Ilsen.

Didactics & Discussion Sessions

All four residents attend Optometry Clinical Seminars and Workshops on Wednesday afternoons. Optometry Clinical Seminars are conducted in conjunction with the LA VA Ambulatory Care Clinic, Sepulveda VA Ambulatory Care Clinic, and Santa Monica Center for the Partially Sighted Residency programs.

All WLA VA optometry residents and interns participate in Optometric Discussions held on Monday which include presentation by trainees of interesting cases, discussion of topics or articles assigned to Interns and Residents.

Residents also participate in the Fluorescein Angiography conference with Ophthalmology, conducted by the Retina Specialists on Wednesday mornings.

On Friday mornings, the West LA VA Optometry residents & interns participate in eRounds, where cases are presented to all trainees in PowerPoint format and questions are posed regarding identification of abnormalities, ophthalmic differential diagnoses, systemic differential diagnoses, ophthalmic and systemic management, prognosis, potential complications, etc. Topics covered in eRounds include:

Supervision & Case Reviews

West LA Optometry has three Attendings. Dr David Bright is the chief of optometry; Dr. Pauline Ilsen is the Assistant Chief of Optometry and program coordinator; Dr. Teresa Lim is the Chief of Low Vision Optometry. Drs Bright and Ilsen are at the VA full time. Dr. Lim is currently on staff half-time, on Monday afternoons, Tuesdays, and Wednesdays.

At least one Optometry Attending is available for consultation while patients are being examined. There are specific guidelines for resident consultation with Attendings in regard to medication prescription, laboratory & radiology orders, consultations with other clinics, etc. Consultation with Attendings may consist of discussion of the case and examination of the patient by the Attending or of discussion only, depending on the particular circumstances of the case. Besides the standard supervision guidelines, Residents are encouraged to consult with an Attending at any time. All electronic notes written by Optometry Residents & interns are reviewed by the Optometry Attendings (Drs. Bright, Ilsen, or Lim).

On Friday mornings, the West LA VA Optometry residents and Dr. Ilsen meet for case reviews. Over the course of the week, Dr. Ilsen prints out and sets aside the Progress Notes and other relevant information (e.g., neuro-radiology report) of interesting patients seen by Optometry. This includes patients seen by residents where Dr. Ilsen saw the patient along with the resident, discussed the case with the resident, or reviewed a Progress Note for a patient seen by the resident. Residents are also asked at this meeting if there are any patients whom they would like to discuss with the group.

A case review generally involves a very brief summary of the case with an emphasis on a lesson learned, clinical pearls to be drawn from the case, suggestions for future care of the patient, protocols, etc. Occasionally the patient’s fundus photographs, anterior segment photos, fluorescein angiography, OCT, or visual fields are reviewed by the group.

Eyecare Center Facility

The Optometry and Ophthalmology Services were moved into a new EyeCare Center in January 2006, located in a newly-refurbished wing of a building that is immediately adjacent to the main hospital on the West LA VA campus. While the two services are now working side by side, Optometry maintains its professional autonomy and is administratively independent of Ophthalmology. The new Eyecare Center equipment and arrangement includes the following:

Optometry Residents have an office in the Administrative area of the clinic

The Low Vision Optometrist has her examination room/office within the Optometric examination area of the Eyecare Center. All low vision demonstration devices except CCTVs are stored in the Optometry Low Vision office.

As far as support staff are concerned: We have two health technicians who are primarily responsible for all optical dispensing for both services. Residents perform some minimal dispensing (for patients at nursing homes and GRECC inpatient ward). The Eyecare Center has four to five clerks for scheduling. There are "volunteers" for various minor supportive activities; the number of volunteers varies, as we occasionally get students from UCLA, the American College of Optics, and others who volunteer for limited periods of time. Substantial assistance from Ophthalmology’s health technicians is also provided in the performance of automated perimetry and dispensing responsibilities, as well as maintenance of clinic supplies, equipment, etc.

Vision Rehabilitation Program Staff

The Vision Rehabilitation program was expanded in September 2008. We currently have the following Low Vision staff located at West LA VA:

There is an additional BROS staff person based at the Sepulveda VA who comes to West LA on occasion. He is the Low Vision representative on the Polytrauma/Traumatic Brain Injury patient care team. He refers TBI patients with visual problems to WLAVA Optometry.

Ophthalmology Trainees and Staff

Ophthalmology has four Resident trainees from UCLA’s Jules Stein Eye Institute who rotate approximately every 6 weeks. There is one 1st year resident, two 2nd year residents, and one 3rd year resident. Additionally, Ophthalmology has fellows in Retina, Cornea, and Oculoplastics who spend some time in the Eyecare Center.

Subspecialty Ophthalmology clinics include: Retina, Cornea/Anterior Segment, Uveitis, Oculoplastics, Neuro-Ophthalmology, and Glaucoma, as well as PDT and laser. Part-time subspecialty Ophthalmology Attendings include: one uveitis specialist, three glaucoma specialists, four retina specialists, three cornea/anterior segment specialists, two neuro-ophthalmology specialists, three Oculoplastics specialists, as well as three general ophthalmologists. Ophthalmology is good about providing follow-up information on patients referred to them and are quite generous in accommodating same-day requests for consultation. Optometry patients get returnedto Optometry when their care with Ophthalmology has been completed.

Ophthalmology has 5-6 health technicians who provide pretesting and ancillary testing for the ophthalmology residents. These technicians have been quite willing to assist Optometry when needed with pretesting and other procedures as their availability permits.