Ocular Oncology

[ophtho12345]

Hi. I'm an incoming ophthalmology resident and I have recently been getting interested in possibly pursuing a fellowship in Ocular oncology. During one of my ophthalmology aways I had seen a very interesting case of a rhabdomyoscarcoma of the orbit. I have been trying to find more information about that field but there seems to be very little information out there. I see that there are not many fellowships offered but I was hoping either a resident applying for fellowship, a current fellow, or even an attending could offer some advice or information about that field. How competitive is it? What kind of job opportunities are there after fellowship? I know there are no ocular oncologist in my state and in a few surrounding states.

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[MstaKing10]

There are only a maybe few dozen ocular oncologists in the country at most. Ocular tumors are rare and thus the job market is somewhat limited. However, given the lack of availability, having a retina or other fellowship in addition to ocular oncolgy training would really make you an attractive candidate for a job down the road. Not sure there are that many exclusive ocular oncologist out there. I think most do some retina or the like in addition to ocular oncology. Academic centers are more likely to allow you an oncology only practice. Also, you may be able to join a large group and be the oncology person for the group in private practice as well.

Patients take a lot of chair time thus limiting volume and reimbursement is low. Only a few private practice docs out there have made it work in solo practice (ie. Tim Murray in Miami).

In terms of fellowship, there are only a few in the country (Wills, Tennessee, San Francisco,Bascom etc). They are not very competitive as there is not a lot of demand for them, though, in a given year this may vary.

Also, keep in mind rhabdomyosarcoma is a tumor of the orbit, that is, the area behind the eye. Ocular oncologist typically focus on Intra-ocular tumors, that is tumors in the eye. Tumors of the orbit are typically in the realm of oculoplastic surgeons. Oculoplastics docs take care of a lot of interesting orbital tumors including hemangiomas and the like. There is a large difference between ocular oncologist and oculoplastic surgeons which I'm sure others may expand on.

 

[TheLesPaul]

How are intra/extraocular tumors in children handled? Does peds ophtho do this? Thanks.

 

[JMK2005]

How are intra/extraocular tumors in children handled? Does peds ophtho do this? Thanks.

It is usually a team effort. combination of oculoplastics, neuro-ophth, retina, peds ophth, neurology, oncology, and/or rad onc

 

[DrZeke]

I know a cornea attending that does research in ocular surface tumors. She has now switched her practice entirely to tumors. She stopped taking new patients that did NOT have an ocular surface/anterior chamber lesion. I think some of these people end up there via some non-traditional routes.

 

[DrZeke]

There are only a maybe few dozen ocular oncologists in the country at most. Ocular tumors are rare and thus the job market is somewhat limited. However, given the lack of availability, having a retina or other fellowship in addition to ocular oncolgy training would really make you an attractive candidate for a job down the road. Not sure there are that many exclusive ocular oncologist out there. I think most do some retina or the like in addition to ocular oncology. Academic centers are more likely to allow you an oncology only practice. Also, you may be able to join a large group and be the oncology person for the group in private practice as well.

Patients take a lot of chair time thus limiting volume and reimbursement is low. Only a few private practice docs out there have made it work in solo practice (ie. Tim Murray in Miami).

In terms of fellowship, there are only a few in the country (Wills, Tennessee, San Francisco,Bascom etc). They are not very competitive as there is not a lot of demand for them, though, in a given year this may vary.

Also, keep in mind rhabdomyosarcoma is a tumor of the orbit, that is, the area behind the eye. Ocular oncologist typically focus on Intra-ocular tumors, that is tumors in the eye. Tumors of the orbit are typically in the realm of oculoplastic surgeons. Oculoplastics docs take care of a lot of interesting orbital tumors including hemangiomas and the like. There is a large difference between ocular oncologist and oculoplastic surgeons which I'm sure others may expand on.

Reviving a old thread, because I would like the full list of ocular oncology fellowships:

1) Cole eye institute
2) Bascom Palmer?
3) Tim Murray?
4) Emory
5) Wills Eye
6) Memorial Sloan Kettering
7) University of Tennessee

Anyone know of any other programs ?

Thanks!

 

[100D]

UCSF http://ucsfeye.net/fellowshipprograms.shtml#oncology

 

[DrZeke]

For people w ocular onc experience, would the recommendation be to do a different fellowship first i.e retina/plastics/cornea and then do an onc fellowship? The argument is that surgical skills will be better developed. However, doing the onc fellowship would help decide the area of the eye/orbit one likes the most...


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Doing the onc fellowship first can help with retina and plastics match especially if you go to a middle tier regional program...


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[sab3156]

Are there any integrated programs (like vitreoretinal + oncology) being offered or being developed? Oncology is a cool field and it sucks that ophthalmologists have to decide against it if financial burdens are a priority.

 

[Equality]

Duke now has an oncology fellowship.
Not sure if MSK is taking fellows anymore. I heard they got physician assistants so they don't need fellows.
Also consider Moorfields Eye Hospital in London for oncology fellowship.
If you're Indian (in India), Santosh Honavar has a super intense fellowship in Hyderabad covering intraocular, ocular surface, and orbital tumors. Lots and lots of retinoblastoma.
Wills onc fellowship covers both intraocular, ocular surface, and orbital tumors. It's the most comprehensive oncology fellowship in the US. Still, this does not include VR.

There is no officially integrated fellowship for VR and onc. The most intense onc people I know have done both VR fellowship AND onc fellowship. Yes, that is 3 years total of fellowship.

I wonder if UW, Oregon, Cincinnati, or MassEye will make oncology fellowships. They all have excellent, academic-minded oncologists.

ASOPRS fellowship at MD Anderson in Houston Texas may be the most integrated fellowship for oculoplastic and oncology, but you don't manage intraocular tumors.

 

[AQ888]

I plan on doing both, an Ocular Oncology and a VR fellowship, in no specific order. If I apply to both the ocular oncology and VR fellowships at a specific program during a given match cycle, will it effect my application negatively?

 

[Equality]

I don't think it'll affect your application negatively to apply to both, but it will save you money/time to apply to one subspecialty fellowship at a time because you can only match into one program at a time anyway. But I guess there could be an upside to applying for onc and VR at the same institution for some deals to be made. For example, at a place like Duke where the oncologist is basically a part of the retina team, maybe call up the preceptor and ask if you can do onc and retina both there in whatever sequence they would need a fellow.

I've known people who've done VRthenOnc and also OncthenVR, so the order doesn't seem to matter. Wills may require you to do two years of onc fellowship if you're straight out of residency as opposed to one year of onc fellowship if you've already done VR.

For Onc, you can basically pick a program that you like and tell them you're coming because there is almost always more program than number of applicants. For VR, the competition is more normal. Maybe you'll have an advantage having onc on your CV when you apply for VR.

 

[0phtho]

I plan on doing both, an Ocular Oncology and a VR fellowship, in no specific order. If I apply to both the ocular oncology and VR fellowships at a specific program during a given match cycle, will it effect my application negatively?

I think it's better to figure out the pros/cons of doing one before the other and then just applying to one fellowship specialty during an application cycle. There are very good reasons to do it in either order.

You'll come off more organized, and it'll be easier to explain what you are looking for in a program.

I'm doing Onc then VR. As DrZeke mentioned, it may help to standout during your VR fellowship interviews, but at the end of the day, I think it matters how you hit it off with the interviewers and who vouches for you.

There is an excellent variety of oncology fellowships in the country right now with great mentors at every program. Every place has a different feel and slightly different focus. I was able to spend time at a few programs before applying, and it allowed me to appreciate the differences among the programs and make an educated decision on where I would fit in the best.

For anyone interested in doing VR and Oncology, the Duke Ocular Oncology Fellowship with Dr. Miguel Materin is particularly appealing because Dr. Materin is in the retina department and works very closely with the surgical retina attendings. He's also a super nice guy and great to work with on a daily basis. We routinely do combo cases, and the oncology fellow has time to participate in the VR rounds and journal clubs. Also, all the VR attendings are more than happy to have you join them in their clinic and the OR.

PM if you have any questions about the Duke Onc Fellowship or any general questions about doing Onc and VR.

 

[Slide]

I didn't do an onc fellowship but I had a lot of training in ocular onc as a retina fellow. From a skills standpoint, to me it makes more sense to do onc first and VR later. The surgical skills from onc carry over better to VR than vice versa. After you finish your VR fellowship, you don't want to take a year off doing vitrectomies and buckling; your first year as an attending is crucial for figuring out operating on your own and developing your style. If you don't operate much for a year then return to it, it is much, much tougher to keep up the skills you developed as a fellow.