The final year in optometry school is an exciting time for students, as they transition into becoming independent Doctors of Optometry. It is also a time for students to contemplate career paths and consider residency training as a means of achieving their professional goals.
In this article series, we are interviewing residency directors from across the spectrum of optometric practice modalities to give additional insight for students contemplating residency training on whether or not it is right for them.
Today, we are interviewing two residency supervisors and a clinical assistant professor from low vision rehabilitation programs across the country, including Rebecca Marinoff, OD, FAAO; Marlena Chu, OD; and Alexis Malkin, OD, FAAO.
We also spoke with four former low vision residents: Serena Sukhija, OD, FAAO; Jasmine Junge, OD, PhD, FAAO; Leannza Tang, OD; and Jessica Broodryk, OD.
Dr. Marinoff is the Low Vision Rehabilitation Residency Program supervisor at SUNY College of Optometry in New York, NY. She is also an Associate Clinical Professor at SUNY College of Optometry. Dr. Marinoff is a graduate of SUNY Optometry and completed a residency in low vision rehabilitation at Southern College of Optometry.
Dr. Chu is the residency program supervisor for the Ian L. Bailey Low Vision Residency at the University of California, Berkeley, School of Optometry. She is the chief of low vision services at the UC Berkeley School of Optometry, overseeing the low vision clinics in the Meredith Morgan Eye Center, at the California School for the Blind, and the San Francisco LightHouse for the Blind and Visually Impaired. Dr. Chu graduated from UC Berkeley School of Optometry and completed a Low Vision Residency under the mentorship of Drs. Robert B. Greer and Ian Bailey.
Dr. Malkin is a graduate of Emory University and completed her optometry training at New England College of Optometry (NECO). She completed her residency at the Northport VA Hospital with a focus in primary care optometry, low vision rehabilitation, and vision therapy. Dr. Malkin then completed the Lions Vision Rehabilitation Fellowship at Johns Hopkins in 2010. Dr. Malkin joined NECO faculty where she is an attending optometrist at the New England College of Optometry (NECO) Center for Eye Care Commonwealth and Lynn Community Health Center. She is also a clinical assistant professor with a focus on vision rehabilitation.
Characteristics that make a high-quality candidate for residency
Dr. Marinoff: I am looking for students who are motivated and are interested in low vision. Students who are open to feedback, seeking to hone their current clinical skills and clinical thinking, and are open to thinking "outside the box" will be in a good position to get the most out of the program. Students who are proactive, organized, and have good time management skills will be in a better position to do well in any residency program.
I don't require that applicants have completed a low vision externship.
Dr. Chu: Compassion, passion, empathy, flexibility, an open mind, patience, and a joyful heart. Also, the ability to being an excellent team player.
Dr. Malkin: High quality candidates are those candidates who are motivated to learn and see patients in a variety of settings. An ideal resident will be flexible and adaptable, because we see patients ranging from a few months old through centenarians. We look for residents who are good team players and who are committed to the mission of the program.
Advantages and clinical expertise that residents will take away
Dr. Marinoff: One big strength of the program is that the resident will be exposed to a diversity of eye conditions and diversity of patient ages. In some low vision residency programs, the resident only sees elderly patients who have AMD, glaucoma, and diabetic retinopathy, but in the SUNY LVR residency program the resident also sees a range of congenital conditions, and sees kids, teens, young adults and elderly patients.
A second big strength is that the resident rotates through the primary care, ocular disease, contact lens, and the acquired brain injury clinics, which means the resident becomes a well-rounded clinician with a specialty focus.
Low vision is an optometric specialty which can be added to any optometric practice setting. The number of low vision patients are expected to double by 2050 and there is a need for more low vision providers.
Dr. Chu:
- Expert patient communication skills, both verbal and written, which translates to and supports any area of optometry
- Diverse and extensive exposure in ocular, systemic, neurological diseases
- One-on-one mentorship with prestigious leaders in low vision optometry—such as the esteemed Ian Bailey, OD, MS, FBCO, FAAO.
- Solid ophthalmic and low vision optics training with experience in hands free devices (high adds, prism readers, microscopics), handheld magnifiers, stand magnifiers, telescopes, video magnification, wearable technology, etc.
- Understanding of low vision testing, prescribing and theory (including alternative visual acuity testing), magnification, field of view, contrast sensitivity, peripheral field testing (including Goldmann Perimetry and Octopus), central field testing, low luminance testing, etc.
- Fitting of specialty contact lenses, including glare reduction lenses for achromatopsia and cone dystrophy
- Diverse exposure to rehabilitative resources, including auditory and tactile access to information (OCR technology, apps, scanning devices, low vision / blind software and hardware)
- Experience in genetic testing for inherited orphan retinal dystrophies
- Integrated rehabilitative care with teachers of students with visual impairment, orientation and mobility instructors and rehabilitation teachers
- Training in billing/coding
- Unique experience in diabetic retinopathy telemedicine consultation
- Building ability to triage on-call patients under supervision of mentors
Dr. Malkin: NECO Vision Rehabilitation residency is unique in that it combines highly specialized patient care experiences with a strong research training component. Our residents develop the skills necessary to work with individuals with disabilities as well as people with vision impairment of all ages.
In addition, our residents gain valuable experience in vision therapy and traumatic brain injury clinics. Our residency graduates are prepared to see a diverse patient population and to advocate for those who need additional support in their educational, vocational, or independent living journey.
A typical “day in the life” of a low vision rehabilitation resident
Dr. Marinoff: A typical day is spent in the clinic! The resident provides direct patient care in the first half of the year and supervises interns in the clinic during the second half of the year. The resident also serves as a teaching assistant in the low vision laboratory portion of the third year course. The program includes rotating on-call responsibility, which at this time is limited to phone triage.
In addition to the clinical curriculum, there is also a didactic curriculum. The resident takes part in program-specific low vision seminars and discussion of journal articles as well as the "Friday program," which includes lectures and labs for all SUNY in-house and affiliated residencies. Additionally, all SUNY residents get professional development experiences. The residents gain public speaking experience, giving a 20 minute minor presentation to an internal audience and a 50 minute COPE-approved major presentation, which is open to local ODs as a CE program.
There is also the opportunity to present at in-house Grand Rounds. All SUNY residents get experience with scientific writing. The resident writes a publishable quality paper, which is reviewed by a mock editorial board; this puts the resident in a good position to continue to contribute to the optometric literature. All of these combined experiences help the resident to develop expertise in a number of areas.
Dr. Chu:
Weekly schedule
- Mondays: Community Health / Ocular Disease / Visual Functions (Diagnostic clinic : ERGs, EOGs, etc)
- Tuesdays: Low vision @ UC Berkeley
- Wednesdays: Low vision @ California School for the Blind
- Thursdays: AM-UCSF Ophthalmology Grand Rounds / Journal Club / Complex procedure training, PM - Low vision @ UC Berkeley
- Fridays: Low vision @ San Francisco LightHouse for the Blind and Visually Impaired
- Typical hours 8:30am - 5:30pm
Patient care
- Ages: 4yo - 106yo (+)
- Diverse socioeconomic and racial backgrounds
- Diverse low vision conditions, including macular degeneration, glaucoma, inherited orphan retinal dystrophies (Stargardts, retinitis pigmentosa, etc), cone dystrophy, achromatopsia, aniridia, albinism, trauma, cerebral visual impairment, diabetic retinopathy, etc.
- > 1,000 low vision, community health patients / year
Residency requirements and opportunities
- On call ~6-7 weeks a year
- 3x CE quality lectures
- Journal club
- Diabetic eye telemedicine
- Clinical research paper
- Traveling CA School for the Blind low vision clinics (Far northern, central and southern CA)
- Public health lectures @ community venues (nonprofits, senior centers, etc)
- Posters/papers @ conferences (SECO, AAO, AOA)
- Creation and participation in vision screenings
- Endorsement from mentors on their expertise
Dr. Malkin: There is no "typical" day for our vision rehabilitation resident, but our resident gets the chance to work in school-based clinics, hospital-based clinics, and group optometry clinics. Our resident participates in the didactic education of third year students as a lab instructor and our resident regularly attends journal clubs. The vision rehabilitation resident has limited on-call responsibilities and has plenty of time to hone their teaching skills through paid tutoring jobs and pre-clinic monitoring.
Biggest challenges a resident may face
Dr. Marinoff: Providing care to low vision patients is very rewarding but can be challenging. Our patients face life challenges and their vision impairment is layered on top of those. The resident may need to learn to break bad news, like telling a patient they are legally blind or no longer eligible to drive. The resident will also need to learn about the different agencies that provide services to the visually impaired.
Another challenge can be acclimating to a new environment. New York City can feel intimidating to someone who is used to a smaller city or town, but is full of fun things to do and great restaurants to explore. Coming to a new school and clinic means the resident would need to learn their way around.
Dr. Chu:
- Physically on campus 1-2 days/week (returning phone calls/etc)
- Empathetic to self with patient care
- Ultimate highs and lows of optometry
- Acclimating to the four different clinics
Dr. Malkin: The biggest challenge is likely the number of clinics where our resident is assigned to see patients. This requires flexibility and adaptability on the part of the resident, and we ensure that we provide the necessary support to make this process as smooth as possible.
Practice settings and modalities suited for low vision rehabilitation residents
Dr. Marinoff: I am very proud of all my residents! The residents have had interest in a wide range of settings, and no one type of setting is the most common. Past residents have pursued careers in academia, private practice, hospitals, and nonprofit organizations.
Dr. Chu: Private practice (90% former residents), hospital setting optometry, academia clinical / didactic teaching, biotechnology/medical devices industry, PhD in vision science, nonprofit low vision clinics.
Dr. Malkin: Graduates of our residency program are well suited to practice in an OD/MD setting, private practice, or academia/hospital-based care. We work with the resident to ensure that our program will meet their ultimate career goals.
Former residents on how low vision residency impacted their careers
Dr. Sukhija: Without my low vision rehabilitation residency, I would not have the career I have today. My experience in residency in this niche specialty afforded me the tools, skill, and confidence I needed to treat those with all levels of visual impairments of all ages. Completing a low vision rehabilitation residency opened doors to my first job, which happened to be what I considered my dream job at the time —hospital-based optometry. I was able to build a low vision clinic in a prestigious hospital and give back to the community.
Residency sparked my interest in teaching, and it led me to my current job at Western University College of Optometry, paying it forward and educating the optometrists of tomorrow in my field of low vision rehabilitation.
Dr. Junge: Completing a residency in low vision at UC Berkeley was a wonderful way to enhance my optometric training. Serving patients with low vision allowed opportunities for me to be creative with visual solutions and think outside of the box, but it also allowed for moments of compassion, empathy, and patience. It provided an additional year of outstanding mentorship which also fostered relationships that have carried well beyond my residency.
The low vision residency program at Berkeley is diverse, and this allows for evaluation of many different types of patients from small children to centenarians.
After completion of residency, I found it easier to apply for positions because many practices required or preferred residency training in a prospective associate. My residency also inspired me to do further research in children with visual impairment, which has been a rewarding component of my career thus far.
Finally, having an area of expertise has been valuable, even in a primary care private practice setting, because I have been able to dive deeper into my areas of interest when it has been relevant to the patient. This has created an additional value component for my patients, even if they are simply receiving routine care.
I highly recommend low vision as a residency because it is so easy to incorporate into primary care practice in a multitude of settings post-residency!
Dr. Tang: Completing a low vision rehabilitation residency provided me with invaluable experience in this speciality. By primarily focusing on and examining low vision patients, I gained confidence in managing these patients and I had the opportunity to learn from other incredible low vision doctors. Fortunately, because I started my optometric career in low vision in the same area where I completed my residency, I was already familiar with the local organizations and referral processes, which made my transition to practice easier.
Lastly, I am grateful that the low vision residency provided me with networking opportunities and connections with other eyecare professionals!
Dr. Broodryk: I completed the Ian L. Bailey Low Vision / Ocular Disease Residency at UC Berkeley School of Optometry. I learned more than I could have imagined during my time there. This residency is definitely geared towards someone who knows that they want to practice low vision in the future, but I also felt like I had enough experience through the community health clinic to manage ocular disease and primary care patients upon completion of my residency.
I was a member of the class of 2020, so my clinical education was cut short by about 6 weeks. I was so thankful that I had a residency program that helped bring me back up to speed and get comfortable seeing patients again before transitioning into the workforce.
Since completing my residency I have started working at three different locations. I am able to serve patients in a private practice setting where I am starting to fit specialty contact lenses and manage ocular disease. I also get to see low vision patients of all ages. I am currently working in a clinic where I see primarily pediatric low vision patients. This program has been going well, so I have also started to see low vision employees of the organization that I work for, which has been so rewarding. I also fill in part time at another low vision clinic that primarily sees older adults.
I love that I get to work with low vision patients in all stages of life while still also practicing full-scope optometry.
I truly cannot imagine a more fulfilling and interesting career, and I believe that my residency training equipped me to be able to take full advantage of every opportunity that has come my way. The residency mindset inspired me to take control of my own education and dig deeper into topics that help my patients and further my career.
If you are considering a residency, I highly recommend it. You will never regret taking an opportunity to better yourself and further your education. Your future self, and future patients will thank you for the sacrifices you made to become the best doctor you can be.
Conclusion
While residency training may not be necessary for achieving every optometrist’s career goals, it can certainly help facilitate personal and professional growth. Pursuing a residency program in low vision rehabilitation can provide new grad optometrists with invaluable clinical experience that they’ll carry with them throughout their careers. Students interested in practicing in a unique and challenging setting may find that a low vision residency is the perfect starting point to a successful and fulfilling optometric career.
