I looked for a glaucoma program that valued the fellow's interest in learning. I wanted hands-on experience in all aspects of care—surgical and clinical. Because I think a major part of managing glaucoma occurs in the clinic, both pre- and postoperatively, I desired a program that emphasized both the OR and the office. I also wanted a program that would expose me to the newest glaucoma procedures (Trabectome [NeoMedix] and iStent Trabecular Micro-Bypass Stent [Glaukos]) as well as to tube shunts and trabeculectomy.

In the beginning, I focused on surgery, but I soon began to recognize the fine balance between managing patients with glaucoma medically and surgically. For example, particularly postoperatively, medical management can be crucial to the success of surgery. After my initial emphasis on surgical volume, I started to focus on finesse and finetuning my skills in the OR and in the office later in the year.

I sought a strong, fundamental grip on the basics of ophthalmology and ophthalmic surgery. Of course, a glaucoma fellowship tremendously improved my understanding and management of the disease's complexity, but I also found that a well-rounded residency had instilled in me a level of confidence in taking care of patients that helped me tremendously. Many patients with complex glaucoma have ocular issues related to other causes. My ability to comfortably manage or triage those issues was important. In my residency program, I had executed a fair amount of glaucoma surgery, mostly involving the Baerveldt glaucoma implant (Abbott Medical Optics) and trabeculectomy. Fellowship was when I could learn the subtle nuances of glaucoma surgery.

One of the things I enjoy the most about the field of glaucoma is the long-standing relationship physicians develop with their patients. During fellowship, I learned the importance of building patients' confidence in my expertise and my commitment to their care and of setting realistic expectations. I found establishing a good rapport with patients and educating them about their disease and prognosis to be critical.

There is barely enough time in a short year of fellowship to hone the skills a glaucoma specialist needs. My research exposure definitely enhanced my experience, as I got involved in clinical trials and research projects. Perhaps most interesting to me in this area was a study that examined an association between pigmentary glaucoma and nonsenile nuclear cataracts that was presented at this year's annual meeting of the American Society of Cataract and Refractive Surgery and is currently in the process of submission for publication.1

Upon completing my fellowship, I will join a multispecialty group just outside Los Angeles as the main glaucoma doctor in that practice.

Section Editor Albert S. Khouri, MD, is an assistant professor and program director of the ophthalmology residency, and he is an associate director of the Glaucoma Division at Rutgers New Jersey Medical School in Newark, New Jersey. Dr. Khouri may be reached at (973) 972-2045; albert.khouri@rutgers.edu

Deborah Kim, MD, is a glaucoma fellow at the Gavin Herbert Eye Institute, University of California, Irvine. She acknowledged no financial interest in the products or companies mentioned herein. Dr. Kim may be reached at debork4@uci.edu.

  1. Kim D. Association of pigmentary glaucoma and nuclear cataract. Paper presented at: ASCRS/ASOA Symposium and Congress; April 25-29, 2014; Boston, MA.