The first year of ophthalmology residency has a steep initial learning curve. Medical school curriculums rarely cover eye anatomy or the physical exam in detail, so the adjustment to ophthalmology residency can be challenging. Ophthalmology not only uses a relatively unique language that residents must learn quickly, but industry lingo and proprietary names also add to the confusion. Thankfully, many resources are available to assist. The AAO now has a question bank based directly on its Basic and Clinical Science Course that even features a research-backed spaced repetition feature.
However, the greatest source of support during the transition from medical school to residency is often senior residents, co-residents, and faculty. I (A.M.) am lucky to be part of a program that is full of helpful mentors who are always willing to teach. My senior resident, Matt Hirabayashi MD, developed a website (EyeFlyMD.com) that is full of resources that have been particularly helpful, specifically The Eye Guide series, which is available on Amazon as a paperback book or on his website as a free PDF. Another particularly helpful resource developed by Dr. Hirabayashi and my junior resident, Gurpal Virdi, MD, is an iOS application known as eyeSpace.
EYESPACE
Learning that an IOL can come in dozens of models, with new versions released every year, can be a lot to process. IOLs have different uses and power ranges, and, to our knowledge, there is no comprehensive source of FDA-approved IOLs to learn from. eyeSpace contains the IOL Reference utility (also available on IOLReference.com for Android users), which has a comprehensive catalog of almost 10,000 individually FDA-approved IOLs. Users can easily search and browse the lenses available in the United States and can quickly view all relevant information in a standardized way.
The sleek interface has an advanced search function that allows surgeons to input their desired lens parameters, including power, one-piece or three-piece design, material, toricity, color, compatible cartridges, and others. It is often difficult to track down current IOL information (eg, A-constants or asphericity), but IOL Reference makes this an easy task. Using the search function, ophthalmologists can quickly find lenses to fit their unique cases, such as extreme powers or rare lens configurations (eg, a preloaded three-piece IOL). This application streamlines surgical decision-making and planning and has the potential to individualize cataract surgery while allowing residents and attendings alike to stay current on the full spectrum of US lens technologies.
eyeSpace also recently introduced a new feature for tracking cataract surgery refractive outcomes, which all residents should make a point to do. Users simply input preoperative biometry, other case details at their preference (eg, case time, cumulative dissipated energy, etc.), and postoperative refraction and keratometry to access their personalized refractive outcome analysis, including refractive miss rate and surgically induced astigmatism (SIA). Many calculators and biometers require SIA, and the eyeSpace app allows even new surgeons to input their personalized data.
The eyeSpace team has immediate plans to further expand functionality. Dr. Hirabayashi is most excited about the implementation of double-angle plots for SIA, personalized A-constants, refractive outcome graphs, a patient-facing outcome tracker where patients can contribute to data collection, and a forum that connects mentors and mentees. According to Dr. Virdi, machine learning will be able to interpolate the data and construct real-world performance and defocus curves of each IOL based on aggregation of data; the possibilities to improve both individual and industry-wide outcomes are endless. The eyeSpace team is exploring other subspecialty spaces, including retina and glaucoma.
CONCLUSION
I (A.M.) am grateful to be part of a program that is full of teachers, mentors, and entrepreneurs and that provides an opportunity to operate early in residency. eyeSpace has given me the tools to get ahead in the OR, and I am excited to keep adding cases to my digital log and seeing where the app goes. Giving direct feedback to the creators has its perks, too.
