Cornea and External Disease Fellowship

Wills Eye, one of the premiere eye hospitals in the country, is affiliated with, and is on the medical campus of Thomas Jefferson University Hospital Medical Center. Both the Wills Eye residency program and numerous subspecialty fellowships are highly sought after.

The Corneal and External Disease fellowship is usually one-year duration beginning the first week of July and ending the first week of July the following year. Recently there have been two American full-time fellows who perform surgery and one or more research fellows, typically from other countries. The fellowship is primarily patient care oriented with significant clinical research opportunities. The fellowship is based in the Corneal Associates cornea and external disease practice at Wills Eye of Drs. Rapuano, Hammersmith and Nagra, who see approximately 300 patients a week. The fellows examine the Corneal Associates' patients, after which the staff physician will see each patient and review the fellows' evaluation. There are eight other active cornea specialists on the Cornea Service with whom the fellows work. In addition, the fellows are involved in staffing the resident Cornea Clinic. The clinic visits number about 75 per week.

The practices of Drs. Rapuano, Hammersmith and Nagra specialize in corneal transplantation, external disease and contact lens problems. Dr. Rapuano and Dr. Nagra are actively involved in refractive surgery, primarily with the excimer laser. There is also an Ocular Cicatricial Pemphigoid Clinic one afternoon a month staffed by Dr. Irving Raber and Dr. Kristin Hammersmith from Cornea, Dr. Robert Penne from Oculoplastics, as well as a Dermatologist.

Corneal Associates and the rest of the members of the Cornea Service perform over 350 corneal transplants, including PKs, DSEKs and DALKSs, at Wills Eye each year. Wills has an IntraLase femtosecond laser in the OR for IEKs and Intacs. In addition, many other cornea and anterior segment procedures are performed, including secondary intraocular lens implants (including sutured posterior chamber intraocular lenses), intraocular lens exchanges, anterior segment reconstructions, temporary and permanent keratoprostheses, pterygium/conjunctival excisions and others. Refractive surgery such as relaxing incisions, compression sutures, astigmatic keratotomies, wedge resections, and radial and astigmatic keratotomies are also performed. The fellows assist on all cases performed by the Corneal Associates doctors at Wills. By the end of the fellowship each fellow has typically completed 20 to 40 corneal transplants from start to finish and has performed parts of 50 to 60 other corneal transplants and various other surgical procedures.

The Lions Eye Bank of Delaware Valley  provides corneal tissue to the Cornea Service at Wills Eye. The fellows get first hand experience in evaluating corneal tissue. The Eye Bank also provides the fellows with practice eyes on which to advance their surgical skills and try new techniques.

Clinical research is an important part of the cornea fellowship. Some time during the week may be provided for research. A database of all corneal transplants performed by Corneal Associates since 1983 is available and has been used extensively for projects. Prospective studies involving new medications and therapies are always ongoing. The Cornea Service has a Humphrey corneal topography analyzer, a Galilei tomographer and an ORA unit, and several projects utilize these machines.

The Cornea Service works closely with Dr. Ralph Eagle and the Pathology Department on various projects. Also the Cornea Service meets with Dr. Eagle to review interesting pathologic specimens every three months. A Cornea Journal Club, run by Dr. Hammersmith and the fellows, meets four times a year.

Call from home for Corneal Associates is divided by the two primary fellows on a weekly basis. At the same time, the Corneal fellow is also on call for the Wills Eye Emergency Department. There, the ophthalmology resident on call will evaluate the patient and call the Cornea fellow for advise over the phone or to come in and see the patient. The fellows also assist the residents in the repair of anterior segment trauma. The Cornea fellow in turn has a Cornea Service staff member on call if needed. There are typically 1 to 3 in-patients at any given time, usually with corneal trauma, infection, or post-operative patients. The fellows follow these patients every morning on rounds with the Cornea staff.

The fellows are expected to present a project at the Wills Eye Annual Conference in the spring, and are encouraged to present their research at ASCRS, ARVO, and the American Academy of Ophthalmology, the Cornea Society, EBAA, or CLAO meetings. While the strength of the fellowship lies in the clinical evaluation and management of the large number and variety of cornea and external disease patients (and consequently a sizable and diverse surgical population), there is also an opportunity for a wide variety of research projects. There is an active immunology and molecular genetics laboratory at Wills Eye. There is a Thomas Jefferson University Research Center where the animal research facility is housed along with numerous basic science laboratories.

Cornea fellows also may give talks to the residents or medical students during the year, and teach Jefferson medical students who rotate through the Wills Eye Cornea Service.

We feel our Cornea and External Disease Fellowship is one of the finest in the country. We are especially happy to be able to offer it in such a friendly, receptive environment.

For information, please contact Bernadette Bishop at (215) 928-3172.