Specialty Profiles

What it’s like in ophthalmology: Shadowing Dr. Aizuss


As a medical student, do you ever wonder what it’s like to specialize in ophthalmology? Meet David H. Aizuss, MD, an ophthalmologist and a featured physician in the AMA’s“Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties. Check out his insights to help determine whether a career in ophthalmology might be a good fit for you.

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David H. Aizuss, MD

“Shadowing” Dr. Aizuss.

Specialty: Ophthalmology.

Practice setting: Private practice multisubspecialty.

Years in practice: 36.

A typical day and week in my practice: I arrive at my office by 7:45 a.m. I review email, snail mail, patient charts or messages as well as any test results that may have arrived. I begin patient phone calls to return leftover messages that arrived either after I left the office or if I was not in the office.

My morning patient schedule then starts at 8:15 a.m. and consists of about 25 to 30 patients for complete eye exams, return office visits, glaucoma checks and other testing. If I am running on schedule, I conclude the morning by 1 p.m. I have lunch at my desk and review patient messages from the morning, return patient phone calls and prepare for afternoon patients. I resume seeing patients at about 2 p.m., which again consists of a schedule of 25 to 30 patients and generally conclude my day at about 6 p.m. I typically see about 200 patients per week.

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Wednesdays are my major surgery day, at an outpatient surgery center next door to my office building. I perform anterior segment surgical procedures there, primarily cataract extraction with intraocular lens implants. I do about 10 procedures between 7 a.m. and 1 p.m.

After the completion of my morning surgery, I return to my office to have lunch at my desk and then laser vision correction procedures such as LASIK or PRK—photorefractive keratectomy. I generally conclude my Wednesday by 3 p.m. and use the afternoon for exercise and recreation or phone calls for organized medicine.

The most challenging and rewarding aspects of ophthalmology: The most challenging aspect of caring for patients in my specialty is the recognition that eyesight is a critical element of the quality of our patients’ lives.

As ophthalmologists we perform highly technical, complex surgery that can easily go awry if there is not extraordinary, constant attention to detail. One error inside of an eye could result in severe visual loss, so the surgery is highly stressful for the patient as well as the physician.

However, this also brings up the most rewarding aspect of ophthalmology, patients tend to be extremely thrilled with their surgical results and very happy after their procedures. In general, patients tend to be very appreciative of their physician’s skills, the attention they receive and the teamwork of the office staff that ensures they receive superb care.

How life in ophthalmology has been affected by the global pandemic: Ophthalmology was one of the specialties most impacted early in the pandemic, and the first physician death related to the pandemic was an ophthalmologist in China. Due to our proximity to patients during examinations, ophthalmologists and their staff were at very high risk.

Most outpatient surgery centers shut down, as well as hospital surgery units for surgeries deemed elective. We were advised to close our offices for over a month at the onset of the pandemic. In order to reopen, we restructured the entire way in which we saw patients.

Special screening began before allowing patients into the office. Chairs were removed from the waiting areas to ensure physical distancing. Patients who used to be moved from room to room for testing and evaluation were kept in a single exam room and professional staff came to them.

Slit lamps—biomicroscopes—were modified with large plexiglass shields to reduce airborne exposure while sitting directly in front of the patient. Additional staff were hired for screening and to ensure cleaning of examination rooms and each waiting room chair as soon as its occupant left.

As a result, our patient schedules needed to be markedly reduced and our overhead costs skyrocketed. Thankfully we were able to obtain the PPP [Paycheck Protection Program] loans to carry our practice through as well as HHS [Department of Health and Human Services] grant monies which kept our staff employed and paid for many of the changes needed in patient flow.

The long-term impact the pandemic will have on ophthalmology: The biggest impact is on our ability to use telehealth to deal with minor problems via FaceTime or the equivalent, thus saving our patients an office visit. Unfortunately, due to the specialized instrumentation necessary to examine an eye, much of what we do is not amenable to telehealth. But there is a great amount of research occurring to create new instrumentation that will improve our ability to provide more effective remote care.

Three adjectives to describe the typical ophthalmologist: Happy, fulfilled, compulsive.

How my lifestyle matches, or differs from, what I had envisioned: I enjoyed most of my rotations in medical school, so I had a terrible time choosing a specialty. Ophthalmology was touted as a specialty with a good lifestyle, a good work-life balance and good for raising a family. All those things are true. However, I take calls every single day and my patients are aware that if they need to reach me, they can easily do so.

Some subspecialties in ophthalmology, such as retina, have more emergencies than others. Ophthalmology practice and care has evolved in that even emergency surgery for retinal detachment can often be scheduled, as opposed to being performed in the middle of the night. True emergencies such as ruptured globes or perforated corneal ulcers still must be handled emergently.

I run an incredibly busy practice and am scheduled weeks ahead with patients. As a result, if I need to be out of the office, I have to cancel patients who may have been waiting quite a while for an appointment, so I take that very seriously.

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Skills every physician in training should have for ophthalmology but won’t be tested for on the board exam: Attention to detail and steady hands free of tremor are critical to be able to perform ophthalmic surgery. Most physicians are attentive to details, but few are aware if they have a microtremor and how their steadiness will be impacted under stressful microsurgery.

Good interpersonal relationships are also important. Patients return to you not because they know of your surgical skills or your keen intelligence, but rather your ability to form a connection with them by listening, projecting empathy, and caring about them and their families.

One question physicians in training should ask themselves before pursuing ophthalmology: Why did I go into medicine and what about this specialty would be fulfilling? I tell everyone that ophthalmology is family practice of the eye. Unlike many surgical specialties, in ophthalmology you provide routine care for years for your patients and their families.

I take care of great-grandparents through their great-grandchildren and have multigenerational relationships with my patients. My specialty allows both medical and surgical therapeutics and is discrete enough that one can achieve subject matter mastery.

Books every medical student interested in ophthalmology should be reading:

  • Basic Ophthalmology: Essentials for Medical Students, published by the American Academy of Ophthalmology, provides an excellent overview of ophthalmology for medical students.
  • Basic Principles of Ophthalmic Surgery, published by the American Academy of Ophthalmology, provides an excellent introduction to key concepts and elements of eye surgery.
  • Basic and Clinical Science Course is a multivolume educational resource published by the American Academy of Ophthalmology. It is a comprehensive resource for residents and ophthalmologists that provides an in-depth review of every aspect of our specialty.

The online resource students interested in ophthalmology should follow: The American Academy of Ophthalmology website is invaluable. They also have EyeWiki, an encyclopedia written by eye physicians and surgeons.

Quick insights I would give students who are considering ophthalmology: I strongly encourage medical students to connect with a member of the ophthalmology faculty, do a research project, write up a case report, and do a clinical rotation to get a better sense of the specialty.

Mantra or song to describe life in ophthalmology:Green Eyes,” by Coldplay.