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What it’s like in ophthalmology: Shadowing Dr. Armstrong

As a medical student, have you ever wondered what it is like to specialize in ophthalmology? Meet Grayson W. Armstrong, MD, MPH, an ophthalmologist and AMA’s Distinguished Physician Specialized “Shadow Me” series, which provides first-hand advice from clinicians about life in their specialties. Check out his vision to help determine if a career in ophthalmology is right for you.

The AMA Specialty Guide simplifies the medical student major selection process, highlights major specialties, detailed training information, and provides access to relevant association information. Produced by FREIDA™, the AMA Residency & Fellowship Database®.

Learn more with the AMA about the medical specialty of ophthalmology.

“Shading” Dr. Armstrong

specialty: ophthalmology.

Practice setting: Academic Hospital.

years in practice: The second – still on the fellowship, but also has been attending when he was the chief resident and as a fellow for the past two years.

A typical day and week in my practice: I am very fortunate to have the opportunity to have incredibly diverse experiences day in and day out. Ophthalmology as a specialty has given me the ability to engage in patient care, surgery, research, education, public health, and entrepreneurship every week. This is perfect for me, because I like to work in multiple areas without having to be tied to just one thing.

I founded a company during my stay, and on Monday and Friday mornings I work through meetings and R&D sessions with my founding partners and employees to invent and create new telemedicine devices.

On Monday, Tuesday, and Friday afternoons, I either help design new virtual curricula for Harvard medical students related to ophthalmology, or I help carry out exciting new research studies in a hospital related to telemedicine and artificial intelligence.

I take care of patients all day Wednesday and Thursday, I usually see 30 patients a day, do eye exams, and provide diagnoses and treatment plans. I have surgery two or three days a month, usually cataract surgery. I am fortunate to be able to teach residents about cataract surgery and sometimes medical students rotate with me as well.

It is always interesting to see what happens every day. Clinical work, entrepreneurship, research, and teaching are all very different skills, and bouncing between each always keeps me on edge. I never get bored.

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The most challenging and rewarding aspect of ophthalmology: One of the hardest things about ophthalmology is that there are a number of eye conditions that can lead to blindness, and we don’t have a cure for all of them. It can be very difficult to advise a patient about vision loss and its impact on his life and the lives of those around him. However, many eye diseases can be treated, either through medication or surgery.

I am fortunate to be able to help patients through the process of restoring vision, preserving vision, or living a successful and fulfilling life despite vision loss. Another part of the challenge in patient care in ophthalmology is also the most exciting. We use tools and techniques such as the slit lamp and direct and indirect ophthalmoscopy to evaluate the eye and retina, and we use a range of interesting new technologies such as laser scanners to evaluate the eye as well.

Running these tests and interpreting the data can sometimes be difficult for early residents and trainees, but I find it fascinating. It also makes the field incredibly amenable to research in artificial intelligence. The massive amount of data we collect is driving research in AI at an amazing speed in our discipline.

How life in ophthalmology has been affected by the global epidemic: Ophthalmology has been one of the disciplines hardest hit during the pandemic. At the start of the epidemic, we saw fewer patients than any other specialty. Eye exams have been found to be very unsafe during an epidemic because you have to be very close to the patient during the examination. If you remember, one of the first whistleblowers in China was an ophthalmologist who died of the virus.

Most of our surgeries are elective surgeries, so many – if not most – have been canceled for several months. This means patients have been losing their sight while waiting for care, and many doctors and practices have been struggling financially for a while. Education was also a challenge. Students and residents were rarely allowed into the hospital to see patients unless absolutely necessary. Since we did not perform surgeries, it was also difficult to train students and residents to perform surgeries.

Fortunately, things have improved a lot. We are starting to see many patients in person and most doctors are back to their normal schedules. We take extra precautions in the hospital to keep things safe wherever possible. While education was challenging, we were able to innovate and bring most educational opportunities online. For example, we had virtual ophthalmology courses for medical students, virtual lectures for residents, virtual surgical training curricula to keep up with surgical skills, and many interesting new teaching techniques.

One of the startling areas of innovation resulting from the pandemic has been the use of telemedicine to see eye patients. Because our specialty is so heavy with tests, it can be difficult to perform many aspects of an eye exam remotely. However, we are beginning to discover new and innovative ways to achieve this, and I am helping to pioneer a lot of this through research at my Boston hospital.

Long-term impact of the epidemic on ophthalmology: Our specialty will continue to embrace the use of telemedicine much more than in the past. The importance of eye care became acutely evident during the pandemic when most patient visits could not be conducted and most surgeries were canceled.

Also, it is likely that a large part of ophthalmology education will remain online for the foreseeable future. This will change the paradigm for medical students and resident education forever.

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Three adjectives to describe a typical ophthalmologist: Good work-life balance, happy and relaxed, innovative and curious.

How does my lifestyle match or differ from what I imagined: When I chose ophthalmology, I expected to have a relatively quiet lifestyle compared to doctors who see patients in hospital all the time, early in the morning, are on call all the time, and deal with emergencies and deaths frequently. I was expecting a mainly mobile outpatient experience. However, I like to fix things and do surgery, so I wanted that too.

I wanted my time with patients to be on a schedule basis, which worked for me because I have so many different interests and having an unpredictable or inflexible schedule makes multitasking difficult. All these expectations were fulfilled in the field of ophthalmology.

Skills that every physician must have in ophthalmology training but will not be tested in a board exam: The ability to perform microsurgery is very important in ophthalmology, but this skill is not tested prior to applying for residency. Even if you don’t want to have surgery for the rest of your life, you need to learn how to perform eye surgery during your residency training. It’s hard to tell if you’re a good precision surgeon while in medical school—these opportunities don’t come up very often. For this reason it has not been tested.

If you love working with your hands, are attentive to detail, focused and precise, and have experience working with microscopes and taking small tasks with precision, you could be a great eye doctor. Most of us don’t know that about ourselves before staying, and that’s okay! You don’t need to know this yet. Just be aware that this is important to you in the future if you are considering this major.

One question clinicians in training should ask themselves before pursuing ophthalmology: First and foremost, do you enjoy looking into the eyes all day every day? Many people are afraid of their eyes. I hear it a lot. My colleagues in other disciplines are affected by eyeballs and do not want to deal with them. Fortunately, I absolutely love the eyes. They are incredibly beautiful, and I never get bored of looking into the eye through slit lamp microscopes.

Online resource students interested in ophthalmology Must follow: Ophthobook.com is a great resource with great videos, exam tips and tricks, and major tips.

Quick insights I would give to students considering ophthalmologyAnd: Getting into this field can be competitive and challenging, but ophthalmology is the best field, and it is well worth the hard work. Ophthalmology is a very rewarding discipline for many reasons, and no matter what any student is interested in, they can find it in our specialty.

For example, people who love children can go to pediatric ophthalmology. People who like neurology can go for neuro-ophthalmology. People who love plastic surgery and dermatology can undergo eye plastic surgery. If you are interested in rheumatic diseases or infectious diseases, you can enter into uveitis. If you don’t like having surgery, no need for that! There are also non-surgical specialties. We literally have something for everyone.

Mantra or song to describe life in ophthalmology: “Blind Light,” by Manfred Mann Earth Band.


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