Sharon Fekrat, MD
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.
- 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.
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.
Duke Fellows Advanced Vitreous Surgery Course (fAVS) and Hands-On Wet Lab
Duke Advanced Pediatric Retina (APR) Course
Duke Vitreoretinal Surgical Rounds Unleashed: What would Machemer do?
The Machemer Manual
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.