Sharon Fekrat, MD

Fellowship Director

The mission of the two year Duke Vitreoretinal Surgery Fellowship program is to foster and support your professional development into a highly skilled, cutting-edge vitreoretinal surgeon with an insatiable intellectual curiosity in a collaborative, collegial, and supportive tertiary care environment with high quality and experienced mentoring.  

For more than 35 years the Duke Vitreoretinal Surgery Fellowship has trained over 80 vitreoretinal surgeons who have a strong presence in academic retina. Former Duke fellows have become department chairs, endowed professors,  innovators, and leaders in clinical care and research around the world.  The breadth and depth of clinical and research experience available in the Duke VR Fellowship is unparalleled and provides the experience, tools, and confidence to succeed.

The Vitreoretinal Surgery Fellowship Program is registered with the Association of University Professors of Ophthalmology (AUPO) fellowship compliance program and meets guidelines set forth by the AUPO fellowship compliance committee.

 

 

Fellowship Applications

See SFMatch website for instructions on completing the Central Application Service (CAS) application. Please assure that we receive the following items in addition to your USMLE scores, CAS Application, and 3 letters of reference by August 14, 2017.
 
1. One additional letter of reference from a professional who knows you 
2. A good quality current photograph 
3. A good quality copy of your undergraduate, graduate, and medical school transcripts
 
You may mail these documents to Crystal Solomon, Vitreoretinal Surgery Fellowship Administrative Director, 2351 Erwin Road, DUMC 3802, Durham, NC 27710 or scan and email to crystal.solomon@duke.edu.
 

Clinical Training

Duke is a tertiary referral center for complex surgical pathology and Duke VR fellows will be well-versed in the management of proliferative vitreoretinopathy, recurrent retinal detachments, refractory macular holes, pediatric retinal detachments, myopic traction maculopathies, combined cases with other ophthalmology subspecialty services, as well as many other unusual and challenging situations.
 
Clinical training includes participating in clinics and surgery using advanced imaging techniques and the latest surgical instruments and equipment with Duke VR Surgical Faculty; Sharon Fekrat, MD FACS, Dilraj Grewal, MD Glenn Jaffe, MD, Miguel Materin, MD, Tamer Mahmoud, MD, PhD Eric Postel, MD, Cynthia Toth, MD and Lejla Vajzovic, MD. A highly accomplished and experienced ocular echographer, Cathy DiBernardo RN, is on site as well.
  • Each two-month rotation has about 2 days/week in the OR, 2 days/week of clinic, and one research day. Surgical experience is evenly spread across both the 1st and 2nd years of the fellowship. The clinical and surgical experience is comprehensive with immersion in all subspecialty areas including ocular oncology, pediatric retina, and uveitis. Unique surgical techniques, such as chandelier buckles, mixed-gauge vitrectomy, subretinal displacement of subretinal hemorrhage, various secondary IOL fixation techniques, Retisert implantation, Argus II retinal prosthesis implantation, and autologous retinal transplants, are part of the experience. Surgical technology includes: various gauge surgery (from 20- to 27-gauge), Constellation and StellarisPC vitrectomy machines, contact and non-contact wide field viewing systems including both the BIOM and ReSight, intraoperative optical coherence tomography systems (including a commercial hand-held system and our own investigational real-time microscope-integrated imaging system), chandelier options for bimanual surgery, encircling and radial scleral buckling techniques, commercial and investigational drug delivery implants, radioactive plaque management, endoscopic surgery, and multimodal intraoperative imaging (including ultrasound, Retcam imaging, OCT and FA). Surgical videotaping is streamlined and fellows are encouraged to present surgical videos at our internal surgical conferences as well as national and international meetings.
  • The 2nd year surgical fellows each rotate at the Durham VA Health System, located adjacent to the Duke Eye Center. This includes one full OR day and one half-day VR surgical clinic.  At the VA, fellows develop increasing autonomy as they participate in vitreoretinal surgery and resident education, mentored by Dr. Fekrat. Surgical videotaping is streamlined.
  • Fellows receive both informal and formal periodic feedback from faculty regarding their progress in training.
 

Research Opportunities

The Duke scientific research program is oriented toward the development of future leaders in the vitreoretinal field. Research training plays an important part in our fellowship and each rotation includes dedicated research time, which is a unique feature of our program. Every Fall, fellows present a research plan for feedback from the entire retina service, including clinical and research faculty, fellows, and a dedicated statistician. Ten months later, the research results are presented to the entire Department and typically generate one or more publications. Fellows are also encouraged to present their research at meetings of the ARVO, ASRS, AAO, Retina Society, and Macula Society (and are often nominated for high profile research awards).
 
The opportunities for clinical and basic science research abound and range from simple case reports to retrospective reviews of clinical or reading center data, co-editing textbooks, new instrument or device design, basic science laboratory or animal investigation, industry collaboration, and involvement in prospective trials. Fellows have obtained co-patents with VR faculty through the Duke Office of Licensing and Ventures or through the Duke Law Start-Up Ventures Clinic.  Translational and multidisciplinary avenues are available as well as collaboration with the Duke OCT Reading Center led by Glenn Jaffe MD or with Duke Biomedical Engineering, and many other laboratories throughout this top institution.
 
Participation in preparation for Investigational Review Board approval as well as clinical research ethical training is also facilitated. 
 
The Clinical Research Unit facilitates ethics training prior to engaging in research and can support fellows as they navigate the process of Investigational Review Board review.
 
Duke Eye Center has historically been, and continues to be, a main study site for many investigator-initiated and industry-sponsored multi-center clinical trials. Although these trials are generally under the auspices of a retina faculty primary investigator, fellows often have the opportunity to play an active role in such clinical trials. With several clinical trials ongoing at any given time, the fellow can gain a firsthand understanding of clinical trial operations and procedures.  
 

Career Development

The Duke vitreoretinal faculty guide, mentor, and assist fellows in career development plans throughout the fellowship. Faculty also aid in developing networking opportunities with national and international retina colleagues. Applications for the Heed Fellowship and Ronald G. Michels Fellowship are supported, and fellows are encouraged to apply for many other awards along the way!

Administrative research opportunities are available for those fellows who are interested in future administrative roles since many of our VR faculty hold significant administrative leadership positions. Fellows are also encouraged to participate in leadership and advocacy through the American Academy of Ophthalmology (AAO) as well as state and local societies.

 

Educational Program

Teaching 

See one, do one, teach one! Vitreoretinal surgery fellows have many opportunities during the fellowship to teach and mentor others, including ophthalmology residents and Duke medical students. Fellows are encouraged to mentor residents and medical students in clinical research projects and manuscript writing. At the VA, there is a dedicated vitreoretinal half-day clinic each week that is staffed by the second year VR fellow with faculty consultation available. Surgical fellows have the opportunity to teach senior ophthalmology residents in the operating room and while on-call for vitreoretinal and trauma surgery at both the Duke and the Durham VA.
 
Duke Advanced Vitreous Surgery Course (AVS) and Hands-On Wet Lab
The biannual Duke Advanced Vitreous Surgery (AVS) course was established by Robert Machemer, MD in 1980 as one of the first and most advanced courses in vitreoretinal surgery. The meeting attracts high profile speakers and opinion leaders from across the United States and around the world. Fellows have a chance to be involved in planning, preparation, and presenting at the meeting. They interact with all national and international speakers and get their way by showing their talents through the much anticipated “SKIT”.

Duke Fellows Advanced Vitreous Surgery Course (fAVS) and Hands-On Wet Lab

In 2015, we launched a Fellows AVS (fAVS) meeting that occurs annually. This is a dedicated conference for all first year US fellows and overlaps with main AVS every other year. The fAVS takes place in April when first year fellows have been exposed to enough clinical and surgical cases to appreciate the medical and surgical practice of retina and therefore benefit from the course. The forum includes hands on wet lab, interactive panel discussions, fellows surgical video competition, and one–on-one interaction with invited world class faculty. 

Duke Advanced Pediatric Retina (APR) Course

Duke is recognized as a leading center in pediatric ophthalmology and retinal surgery. The Duke Advanced Pediatric Retina (APR) Course is designed for pediatric ophthalmologists and retinal specialists with interest in diseases such as retinopathy of prematurity (ROP), ROP-like retinovascular diseases, persistent fetal vasculature, retinal dystrophies, pediatric trauma and other retinal diseases. During the 2017 inaugural year, over 50 national and international faculty speakers participated in this informative, cutting-edge meeting. The course showcases utilization of advanced ophthalmic imaging to improve patient outcomes, pharmacologic treatment strategies and the cutting edge retinal surgery. 
 
Lejla Vajzovic, MD and Cynthia Toth, MD are co-directors of this international course. Fellows participate as session moderators and on-site conference reporters for the ASRS.

Duke Vitreoretinal Surgical Rounds Unleashed: What would Machemer do?

The fellows participate as faculty at the Duke Vitreoretinal Rounds yearly at AAO, ASRS, and other vitreoretinal conferences.

The Machemer Manual 

A new initiative in the works (spearheaded by Duke VR Fellows, and supported by the VR surgical faculty) to create a surgically focused manual for beginning vitreoretinal fellows. We are working with a publisher to make the manual available around the world for others to learn from our tips and tricks. Stay tuned for more info!

VR Surgical Laboratories

The DARSI lab, led by Cynthia Toth, MD includes a surgical wet-lab which is available throughout the fellowship for vitreoretinal surgery practice and research collaboration on the microscope-integrated OCT system. We also have a Microsurgery Advanced Technique Lab (MATLAB) that houses an EYESI virtual reality simulator with all of the vitrectomy modules.

VR Surgical Rounds 

As part of a longstanding Duke tradition, VR Surgical Rounds are held weekly during the academic year on Wednesdays at 7 am. In these rounds, which are attended by the surgical retina faculty, retina fellows, retina research fellows, international observers, and the resident rotating on the vitreoretinal service, the surgical fellows present challenging vitreoretinal surgical cases including their own surgical videos. The retina faculty participates in and facilitates these collegial discussions, providing an array of perspectives on management.
 
Preoperative, intraoperative, and postoperative imaging is also discussed at VR Rounds. Duke-National University of Singapore retina fellows often join via video teleconference in addition to guest faculty from around the country.  More networking!
 
Monthly journal clubs are held to discuss the latest literature and management controversies pertaining to our field.

Medical Retinal Imaging Conference

The discussion of retinal imaging is incorporated into the weekly VR Surgical Rounds as outlined above. During the retinal imaging conference, the medical retina fellows present interesting cases that illustrate a particular disease or physical finding. The fellow presents the case and calls upon the residents to describe and diagnose the physical findings.
 
A variety of imaging modalities such as optical coherence tomography (OCT) with enhanced depth imaging and OCT angiography, fluorescein angiography, color fundus photography, indocyanine green angiography, ultrasonography, fundus autofluorescence and electrophysiology are used, as appropriate, to illustrate salient clinical features of the presented cases. The fellow summarizes the disease topic and relevant literature including current and changing standards of management, with additional input by the retina faculty in these discussions. Duke VR fellows benefit from the unique perspectives of Duke Medical Retina faculty at the retinal imaging conference. 

Visiting Professors and Other Departmental Lectures

There are numerous lectures and seminars ongoing at the Duke Eye Center including the Chairman’s Science of Disease Lecture, Grand Rounds, Visiting Professors Seminars, Weekly Departmental Research Conferences, and the Bryan Lectures. In addition, Duke University Medical Center and the basic science departments of the University have many phenomenal guest lectures. Many of the Departmental seminars are mandatory for Faculty, Residents and Fellows, while outside talks are open to all. The Winter Thaw is a departmental social event that brings the faculty and trainees together in mid-winter. Each year, Duke Ophthalmology Residents' and Fellows' Day is an opportunity for formal presentation of the year’s research work, followed by a departmental dinner event and celebration.

National and International Conferences

Duke VR fellows are encouraged to attend and participate in national meetings and even some international conferences pertinent to his/her interests. Such conferences are excellent learning resources and educational experiences for the fellow and an important opportunity to network with retina colleagues for collaboration and job opportunities.  Schedules are designed to allow two of the four vitreoretinal fellows to attend each of the major national meetings including ARVO, ASRS, AAO/Retina Subspecialty Day, and Retina Society. The fellows are also encouraged to attend fellow-specific programming at the MEEI Vitrectomy Course, Vit-Buckle Society, Cole Eye Institute’s Imaging Summit and Retina Summit, Fellows’ Forum, and Retina World Congress. Many of our fellows have been recognized through the research awards at these conferences and have also been recipients of the ASRS Film Festival trophies for surgical video submissions. In addition to industry-sponsored fellow travel grants, the Department provides $3000 of funding per fellow per year to cover meeting travel and approved educational expenses.

North Carolina Retina Club (NCRC)

Duke VR fellows have the opportunity to attend and present at quarterly NCRC meetings around the state. These meetings allow interaction between all retina MDs in the state of NC, allowing Duke VR fellows to network with other local fellows and referring providers. These meetings foster interaction and knowledge transfer between academic retina and private practice retina. Interesting and challenging medical and surgical cases are discussed, in addition to topics related to the practice and business of retina in NC and nationally. 

 

Fellowship for Foreign Nationals

Duke does not provide immigration sponsorship for fellows.  However, we have many visitors who come for a maximum of one year to observe vitreoretinal clinics and surgery and research, but hands-on patient care is not permitted.  If you would like to come for a visit as a “Visiting Observer” or “Visiting Research Scholar” please contact:  Crystal Solomon, Duke Eye Center, Box 3802, Durham, NC 27710 or by telephone 919-684-8434 or by e-mail at crystal.solomon@duke.edu.