Two rotations down, 2 more to go!

3 female students smiling at eye clinic

Two rotations down, 2 more to go!

It’s hard to believe that I’m almost done with my third clinical rotation of fourth year!

A lot has happened since my last blog post in April last year. I completed my first two 4th year rotations, took Part 3 of the NBEO Board Exams, traveled to Florida and Texas to visit Johnson and Johnson and Alcon headquarters, moved to California and Alaska, and finished my residency applications!

The fact that this is my final year of optometry school has officially sunk in, and with the end in sight, I’ve found myself becoming increasingly sentimental. Reading my old blog posts (I started blogging for NECO as a first-year student!) always reminds me of how far I have come, both in clinical knowledge and personal growth.

When choosing my rotation sites, I wanted to explore optometry through different modes of practice, patient populations, and geographic locations. And luckily for me, that’s exactly what I got. I tell people that my fourth-year rotation sites are giving me a tour of the country. My first 2 rotations were at South End Community Health Center in Boston, and VA Long Beach in Southern California. I am currently in Bethel, Alaska working at an IHS hospital, and my last one site is VA Hudson Valley in New York.

First stop: South End Community Center, Boston

I had an incredibly positive experience at my first rotation site, South End Community Health Center. I really fell in love with the health center setting because I felt like a member of each patient’s health care team. There was rarely a day that I didn’t look at a patient’s labs or notes from another health care provider to help complete the patient’s clinical picture.

I also loved the diversity of the patient population. I saw children as young as 3 years old and adults as old as in their 90’s. I was also able to improve my ability to take case history and complete most components of the eye exam in Spanish. Even though my Spanish is far from perfect, my patients seemed to really appreciate the effort I put in to break down the communication barrier. Each day at South End was different: from pediatric eye exams and co-managing glaucoma with an ophthalmologist, to contact lens fittings and diabetic eye exams. The rotation really set me up for clinical success and set high expectations for my following rotations. Leaving was difficult and tear- filled, especially having to say goodbye to the preceptors, fellow interns, and administrative staff I got so close to over 3 months.

Second stop: Low vision experience at the VA Long Beach, CA

One of my top choices for my fourth-year rotations was VA Long Beach. Not only did it offer opportunities to work in both primary care and low vision optometry, but the story behind the Major Charles Robert Soltes O.D. Blind Rehabilitation Center (BRC) was something that had inspired me since the start of my optometry journey. Dr. Charles Soltes, a NECO alumnus, was the first military optometrist to be killed in action while on active duty in the United States Army. I had the great fortune of working with the doctors and the blind rehabilitation specialists who care for our veterans in a way that continues to uphold the legacy of Dr. Soltes’ life and his dedication to service.

The Low Vision Clinic at VA Long Beach sees both outpatients and inpatients for eye exams and evaluation of low vision devices. While many of the outpatients are followed routinely by their ophthalmologists to ensure that their eye conditions are stable, they are also scheduled for annual low vision exams so that the patient’s functional goals and devices can be assessed and updated regularly.

A thorough low vision exam includes an accurate measure of acuity, trial frame refraction, evaluation of near vision with both single letter and continuous text acuity measures, tint evaluation, trialing of different magnifiers and devices, and more. Although we learn how to calculate magnification powers in school, I’ve learned that while formulas are useful to establish a starting point, it is ultimately based on what the patient’s subjective responses are. Every component of the low vision exam revolves around the patient’s visual goals and aims to maximize the patient’s current vision.

I also had a few opportunities to shadow my low vision patients at the BRC. The inpatient program provides veterans with individualized plans tailored towards their specific goals. Veterans are able to focus on areas such as living skills (kitchen safety, meal preparation, labeling), visual skills (additional training on low vision aids), orientation and mobility, manual skills (wood working, leather crafting), and computer training.

Through one-on-one instruction, veterans reach a level of independence that they previously thought was not possible. It was also a great opportunity for me to witness optometrists and vision rehabilitation specialists working together cohesively to provide the best care for patients with visual impairments.

Needless to say, my rotations so far have been fantastic! The diversity of my clinical experiences this year have prepared me for any mode of practice that I decide to pursue, and I’ve also become really flexible in my exams for patients of all ages and eye conditions. With only 4 months left until graduation, I am going to continue making the most out of the opportunities we’re given as students to make clinical decisions and have meaningful conversations about them with our knowledgeable attendings!

Current stop: Indian Health Services hospital in Alaska.

More on this later!