Ophthalmology Residency Application: Overview and Preparation

Overview of Ophthalmology Residency

Ophthalmology residency takes four years- one year of internship in internal medicine, surgery or a transitional year followed by three years of training in ophthalmology.  The three years are usually divided as follows:

  • 1st year- general ophthalmology, emphasis on examination skills and diagnosis, limited to some exposure in subspecialty ophthalmology, limited exposure to surgery.
  • 2nd year- general and subspecialty ophthalmology, emphasis on diagnosis and management, limited to some exposure to surgery.
  • 3rd year- emphasis on surgery.

After three years of residency, you will have the opportunity to subspecialize or start practicing as a general/comprehensive ophthalmologist.  Fellowship takes an additional 1-2 years and the available subsepcialties are glaucoma, surgical retina, medical retina, oculoplastics, uveitis, cornea and refractive surgery, cornea and external ocular diseases, pediatric ophthalmology and strabismus, and ophthalmic pathology. 

Exploring and Preparaing to Apply to the Specialty

I have the following recommendations for you to prepare for your application to ophthalmology:

Perform a small research project during the summer after your 1st year.  Alternatively, perform a small research project during the regular academic year.  Select an ophthalmologist who you think will actually spend some time with you and write a strong letter of reference on your behalf.  It also helps if this ophthalmologist is well known across the country.  Academic ophthalmology is a relatively small community and many academic ophthalmologists know each other very well.  Members of  the residency selection committees often trust the recommendation of their colleagues and a strong letter of reference will carry you a long way.

Do well on your USMLE Step 1.  Ophthalmology is a competitive specialty and it will definitely help you get your foot in the door, especially the top programs, if you have a good score!

Rotate in ophthalmology as soon as possible to gain an exposure to the field to see it is the right field for you.  I would start with an one month rotation at a county or VA hospital where you can learn your examination skills with the residents.  Residents are often willing to teach you because you will help them see patients in busy clinics.  I would suggest you read the following books:

  • Basic Ophthalmology for Medical Students and Primary Care Residents by Cynthia A. Bradford- a good introduction, read prior to your rotation.
  • The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology by Peter Kaiser et al.  This book has a decent text with good illustrations suitable for beginners in the field.  Use it to look up diseases you have encountered in clinic and as a guide to further reading.
  • Practical Ophthalmology: A Manual for Beginning Residents by Fred M. Wilson.  Ask one of the senior residents to borrow this book and use it during your rotation to learn your examination skills.

After you initial public hospital rotation, rotate with one or two ophthalmologists in their university-based or private clinics.  By this time you should have sufficiency skills to demonstrate you can examine patients and pick up some interesting findings to impress the attendings.  You will likely ask for a letter of reference from these rotations.

If your medical school does not have an ophthalmology department or has a small ophthalmology department, you should apply for an away rotation at a large academic institution.  Again, a letter of reference from a well-known ophthalmologist will carry you a long way!

Plan early because you need to have all of your application material ready by the end of August/beginning of September of your 4th year.  If you did not plan ahead and cannot get an ophthalmology elective until August, you will likely not have enough time to get the letters of recommendation.


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