Columbia University Medical Center
The Harkness Eye Institute is part of the New York Presbyterian Hospital/Columbia University Medical Center (CUMC). The 20-acre CUMC campus in upper Manhattan is home to Columbia University’s College of Physicians and Surgeons, the schools of dentistry, nursing, and public health, as well as to several specialized establishments, including the Morgan Stanley Children’s Hospital of New York, the Cohen Pediatric Emergency Department, the New York Heart Hospital, the Neurological Institute, the New York Orthopedic Hospital and the New York State Psychiatric Institute. Collectively, the medical center comprises nearly half of Columbia University’s $3 billion annual budget.
The Presbyterian Hospital (now known as the New York-Presbyterian Hospital) was founded in 1868. The Milstein Hospital Building, a state-of-the-art inpatient facility, is one of the most comprehensive university hospitals in the world, with leading specialists in every field of medicine. The New York-Presbyterian Hospital system also includes a satellite community hospital, community health centers, long-term care facilities, and numerous private physician practices. It belongs to a larger network of 32 tertiary and community hospitals. The Department of Ophthalmology sees a rich variety of consult patients from the core institutions on campus and in the nearby catchment area.
Innovation at the Edward S. Harkness Eye Institute
The Edward S. Harkness Eye Institute has a rich history of scientific discoveries and clinical innovation among its clinicians and scientists. In 1933, Dr. Ramon Castroviejo performed the first corneal transplant. In the 1970s, Dr. Endre Balazs developed Healon, a viscoelastic material now used in practically all cataract surgeries. In the 1990s, Drs. Carl Camras and Laszlo Bito developed latanoprost, a prostaglandin analog drop, to treat glaucoma. In particular, our clinicians and scientists were very influential in the application of lasers in Ophthalmology. In 1962 Dr. Charles Campbell was the first to use the ruby laser to treat retinal breaks. In 1968, Dr. Francis L'Esperance, Jr. was one of the first ophthalmologists in the world to use the argon laser photocoagulator, which is still considered the gold standard laser for the treatment of retinal breaks and diabetic retinopathy. In the 1980’s, Drs. Stephen Trokel and Francis A. L'Esperance, Jr. pioneered excimer laser surgery and its potential clinical applications. Genes for color blindness were first mapped at Columbia, and the genes encoding several other inherited retinal dystrophies, including Stargardt’s disease, were identified by scientists at Harkness. These discoveries created tremendous research opportunities for residents at the Harkness Eye Institute.
Recent Developments at the Harkness Eye Institute
Under the guidance of the Chairman Emeritus, Dr. Stanley Chang, and the current Chairman, Dr. George Cioffi, the Harkness Eye Institute’s operating rooms have undergone a multi-million dollar renovation, adding state-of-the-art Leica surgical microscopes, high-definition digital video recording capabilities, advanced retinal viewing systems, and the latest phacoemulsification and vitrectomy systems. With the majority of resident and faculty surgical cases performed “in house” at the Eye Institute, the operating rooms and dedicated OR support staff are an invaluable asset to the program.
Mirroring the clinical side of the Harkness Eye Institute, the research division has also had a fruitful decade. Our research scientists are actively investigating a wide range of areas, including the genomics of retinal dystrophies, stem cell research, corneal cross linking, and quantitative autofluorescence. The NIH funding to the Department of Ophthalmology at Columbia University increased substantially in the past few years. The Department is now ranked seventh in the country among all ophthalmology departments/eye institutes, with NIH funding totaling $7.5 million.
The Eye Institute’s clinical faculty consists of more than 50 ophthalmologists, many of whom trained and practice at the Eye Institute, and take a keen interest in training the next generation. Dr. Bryan Winn, the Residency Program Director, and Dr. Royce Chen, the Associate Residency Director, are actively involved in the clinical, surgical, and administrative aspects of the residency. Drs. Winn and Chen meet regularly with the Chairman, Dr. Cioffi, to actively review and improve the residency program. Drs. Winn and Chen meet with the residents formally on a monthly basis to discuss any program concerns that would benefit from further review. Dr. Jason Horowitz, Medical Director of the Eye Clinic, coordinates resident education and supervision within the clinic. Faculty participate in all aspects of resident training, such as assisting resident surgical cases, staffing resident clinics, leading wet labs, presenting lectures and conferences, collaborating in research, and participating in a formal mentoring program for the residents.
Although the nine-story Eye Institute is more than 75 years old, it has been modernized to accommodate the changing modalities of ophthalmic health care delivery. Currently, the Eye Institute is undergoing a major renovation that will result in a brand new, state-of-the-art resident clinic on the first floor, a new ocular imaging center, as well as more minor structural updates. The resident clinic will be fully equipped with examination lanes, procedure rooms, and diagnostic equipment, including spectral-domain OCT, slit lamp photography, ultrasonography, and retinal/anterior segment lasers. Residents use an electronic medical record system fully integrated into the New York-Presbyterian healthcare system, and clinical care is supported by full-time attending faculty, nursing staff, and ophthalmic technicians.
Additional specialized resources found in the Harkness Eye Institute outside the resident clinics are made available to residents and their patients. These include the most cutting-edge diagnostic and therapeutic modalities in ophthalmology, such as OCT- angiography, swept-source OCT, ultra-wide field fluorescein angiography, anterior segment ultrasound biomicroscopy, corneal collagen cross linking, adaptive optics imaging, infrared and autofluorescence scanning laser ophthalmoscopy, microperimetry and full-field electroretinography.
The residency and fellowship programs at the Harkness Eye Institute directly benefit from our research and attending-driven clinical divisions. Scientists and clinician-scientists are dedicated to teaching residents and fellows throughout the year, and more intensively in a month-long January course. Additionally, attending physicians supervise residents and fellows as the primary caregivers and surgeons in a fully-equipped eye clinic serving a large community of patients from the New York City area. More than 20,000 patient visits are recorded annually, allowing for diversity of pathology and continuity of care. Many of the patients are members of an active Hispanic community thriving in the Washington Heights neighborhood. This experience is augmented by dedicated private practice rotations in oculoplastics, retina, refractive surgery, and neuro-ophthalmology.
Approximately 70% of adult resident surgeries, including emergencies, are performed at the Eye Institute. Pediatric cases are performed at the Children’s Hospital in an operating room that is fully equipped with ophthalmic equipment, including an operating microscope. Collectively, the faculty and residents perform greater than 4,000 surgeries and 3,500 in-office procedures annually at the Eye Institute.
A surgical wet lab is equipped with two surgical microscopes and an observer scope, phacoemulsification and vitrectomy machines, as well as a full array of surgical instruments. It is available for independent study at all times, and is incorporated into structured training sessions. Porcine eyes are available for training as needed. As an adjunct to the wet lab experience, the state-of-the-art EYESI surgical simulator is available for residents at all times, and has been shown to effectively supplement patient-based training in cataract and vitreoretinal surgery.
Finally, a comprehensive collection of journals, textbooks, and audiovisual media on ophthalmology is conveniently available in the John Wheeler Library on the eighth floor of the Eye Institute. This supplements the Augustus C. Long Health Science Library on the medical campus, which contains over 500,000 volumes and 4,400 current periodical subscriptions, as well as open access to Columbia University’s vast library network.
Ophthalmology Residency Program Overview
First-year residents spend the majority of their time in comprehensive ophthalmology clinic mastering the ophthalmic exam, seeing walk-in emergencies as well as scheduled patients. ER and triage patient encounters introduce residents to the identification and effective management of diverse pathology and trauma. These supervised responsibilities allow for efficient development of examination skills and complement the clinical curriculum.
First-year residents also regularly staff the pediatric, neuro-ophthalmology, uveitis, and oculoplastic and orbital surgery clinics. During the first year, each resident has one half-day assigned to the operating room, where they assist on a wide variety of ophthalmic cases and perform pterygium surgery as primary surgeons. In addition, they perform minor ophthalmic procedures (e.g. chalazion excision) in the clinic under attending physician supervision.
In January, first-year residents attend the four-week Columbia Basic Science Course, taught by an internationally renowned panel of more than 80 clinicians and scientists from the Harkness Eye Institute as well as other institutions worldwide. Residents from New York, as well as international attendees from Europe, Asia, and the Americas make up the diverse student body. Topics include the anatomy, histology, embryology and development of the orbit and globe, pathophysiology and treatment of ophthalmic disease across various subspecialties, molecular physiology, and avenues of basic science inquiry in ophthalmology. The course also includes a two-day guided orbital and facial workshop, phacoemulsification wet lab, refraction and retinoscopy workshops, and full-day clinical optics and pathology sessions.
During the second year of the residency curriculum, residents refine their clinical acumen with three major rotations: adult consult, pediatric consult, and subspecialty clinic. Adult and pediatric consult residents follow inpatients and emergency room patients with active ophthalmic disease at the CUMC campus. The adult consult residents rotate through the Lighthouse Guild -- augmenting low vision service training-- as well as through the contact lens clinic. A weekly rotation in Dr. Michael Kazim’s private orbital surgery practice complements the ample orbital pathology seen on the inpatient service. Oculoplastic surgical skills are further honed during the resident oculoplastic and orbital surgery clinic, and while assisting on cases in the surgical suite and operating room. Finally, any extracapsular cataracts presenting in clinic are performed by the adult consult resident.
During the pediatric consult rotation, the residents assist and perform primary strabismus surgery, as well as pediatric cataract extractions. Consistent exposure to pediatric glaucoma, cornea and retina surgery adds to the pediatric consult experience. The pediatric consult resident is the senior resident in neuro-ophthalmology clinic, which complements the first-year private and resident-clinic neuro-ophthalmic curriculum.
Finally, subspecialty clinic rotation exposes the second-year residents to a wealth of ophthalmic pathology, with the opportunity to perform scores of anterior and posterior segment laser procedures and intravitreal injections. The retina education is supplemented by a weekly rotation in the private office of Dr. Stanley Chang.
At the end of the second year, residents participate in the Massachusetts Eye and Ear Infirmary’s Cataract Surgery Course in order to ease the transition into the heavily surgical curriculum of third year.
In the third year of residency, residents hone their skills in the operating room, performing primary cornea, glaucoma, plastics, retina, and trauma surgeries with two full days per week in the operating room. They perform cataract extraction with clear cornea incision and phacoemulsification, and, as the senior in each specialty clinic, they operate on specialty cases. Senior residents also enhance their medical decision-making process through supervision of junior residents in clinic and on back-up call. A rotation at the Memorial Sloane Kettering Cancer Center with Dr. David H. Abramson, Chief of Ophthalmic Oncology, exposes the residents to cutting-edge management of patients with ocular melanoma and retinoblastoma, as well as other intraocular tumors.
In addition to rotations at the Harkness Eye Institute, Columbia residents spend 3 months in each PGY-year at Harlem Hospital Center, a public, municipally-owned teaching hospital affiliated with Columbia University. As a Level 1 Trauma Center that serves an economically disadvantaged community, Harlem Hospital Center provides a tremendous breadth of pathology that fully complements the experience at the Eye Institute. Patients are seen daily in the ambulatory clinic, and surgical procedures including cataracts, glaucoma, and strabismus cases are performed on site in state-of-the-art operating rooms. In this rotation, residents are immersed in a diverse patient care environment and have the opportunity to offer superlative medical care to a population in need.
Primary call responsibilities are divided between first year and second year residents, with most primary call taken by the first year residents. Third year residents provide back-up call and assist in the management of complicated medical and emergency surgical cases. All call is taken from home, although there is an on-call room available to the residents in case they need to stay onsite for an extended period of time. The residency program is in full compliance with ACGME work-hour regulations.
The adult and pediatric emergency rooms are equipped with slit lamps, and the on-call resident has a full palette of hand-held instruments and lenses to bring to consults, including wireless indirect ophthalmoscopy, portable slit lamp and portable ultrasound. Adult emergency surgeries are performed at the Eye Institute, and pediatric emergency surgeries take place in the Children’s Hospital.
Residents are encouraged to collaborate with the Eye Institute’s clinical and research faculty on projects. Every resident is required to present a clinical or scientific paper at the annual Resident-Fellow Research meeting held every June. Funding is available to help support independent resident research. In addition, residents are encouraged to present their research at regional and national meetings and are funded to present first-author papers and/or posters. Senior residents are allowed to attend one scientific conference of their choice. The depth and diversity of research at Harkness enables residents to have tremendous opportunities that are truly unique.
The Ophthalmology Residency at Columbia/Edward S. Harkness Eye is an ACGME-accredited training program in Ophthalmology. Based on the most recent site visit by the ACGME in 2012, the program has received a five-year accreditation cycle, the longest accreditation cycle available.
Salary for residents is based on the PGY pay scale at New York Presbyterian Hospital, which is competitive with other New York residencies. Malpractice, health, dental and disability insurance are also provided by the hospital. Residents are given four weeks of vacation each year, as well as leave of absence as approved by the Program Director and Graduate Medical Education Committee.
A variety of housing options are available in the area immediately surrounding the medical center. Many residents choose to live in Manhattan’s Upper West Side, which is an easy and short commute via subway or bus. There is also discounted housing available at New York Presbyterian’s East (Cornell) and West (Columbia) campuses.