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As an intern in Baylor's ophthalmology residency program integrated with the Department of Internal Medicine, I look forward to a unique year that combines early immersion in ophthalmology with a strong foundation in general medicine. We spend four months on ophthalmology services, primarily at the Michael E. DeBakey VA Medical Center Eye Clinic, and the remaining eight months rotating through inpatient medicine, ICU, EM and specialty services. Our ophthalmology time is split into two separate blocks and spread throughout the year, giving us the opportunity to return to the eye clinic with new perspectives and clinical skills gained from our medicine rotations. This structure provides an early and meaningful exposure to ophthalmology while helping us develop into well-rounded physicians.

On our first ophthalmology block, we begin with two weeks of dedicated orientation focused on learning the ophthalmic exam, understanding clinic workflow, becoming familiar with imaging modalities, and getting to know our faculty and senior residents. Although ophthalmology can initially feel like an entirely new language, the faculty and residents are incredibly supportive and invested in our growth. Early on, we begin working up patients in our own dedicated office, which is an exciting opportunity as interns, and receive close guidance from faculty and senior residents as we refine our examination skills, clinical reasoning, and management approach. The eye clinic is fast-paced and highly educational, exposing us to a wide spectrum of pathology and providing countless opportunities to build confidence in patient care. We also participate in lectures, Grand Rounds, and our new surgical wet lab, where the faculty's commitment to teaching is especially evident. Whether it's suturing, microscope techniques, or other surgical skills, faculty consistently emphasize their willingness to spend additional time with us in the wet lab after hours to provide one-on-one mentorship. We even participate in buddy call with our PGY-2 residents, gaining early mentored exposure to call responsibilities.

A major strength of PGY-1 is the breadth of our medicine training across Ben Taub (county hospital), the VA, and Baylor St. Luke's (private). Rotating through these diverse settings exposes us to a wide variety of patient populations and disease processes, from bread-and-butter cases to more complex and uncommon presentations, while teaching us how to navigate different healthcare systems and practice environments. The medicine faculty are incredibly kind, patient, and dedicated teachers, and these experiences not only strengthen our clinical foundation but also provide valuable insight and relationships that will continue to benefit us throughout our ophthalmology training.

Beyond the clinical experience, Baylor truly feels like a community. Whether we're learning together in the resident lounge, participating in educational activities, or spending time together outside the hospital, there is a strong sense of camaraderie among residents across specialties. As I continue my PGY-1 year, I am grateful to be part of a program that places such an emphasis on education, mentorship and community.

Entering PGY-2 year, you get the opportunity to fully immerse yourself in the world of the orbit. The four months you get during PGY-1 serve as an excellent launching point into the second year, as you enter your first full year of ophthalmology with likely the most amount of clinical/procedural exposure an intern can get! Second year offers the chance to delve both deeper and broader into the vast pathology of the eye, with even more hands-on experience with intravitreal injections, laser procedures, and early surgical exposure. You learn SO much!

Our VA eye clinic is in the Michael E. DeBakey VA, which is the second largest federal building in the country. We spend two full months at the Houston VA eye clinic, but with graduated responsibility from our time there as interns. On Mondays, we start the day in the OR, gradually performing the individual steps of cataract surgeries and graduating to our own full cases by the end of the year! After the OR, we join our co-residents in clinic for the rest of the day. The general clinic at our DeBakey VA in Houston is a massive referral center for our small towns and our neighboring states alike, and you can never know what pathology will walk through the door. Many times you are the first person seeing the patient for simple complaints like “vision loss”, with a differential that includes a simple cataract all the way to choroidal melanoma that may need urgent intervention. On other days of clinic, we perform YAG capsulotomies, laser retinopexies, intravitreal injections, and many other procedures. This is the biggest VA eye clinic in the nation, and as such, it can get very busy. But this volume means our clinical skills and efficiency quickly improve. Attendings from multiple different sub-specialties are available to staff/see the patient daily, so a patient can get comprehensive care for all their diagnoses in a single visit. You get the chance to truly make an impact in patient’s lives, often at the forefront of their overall health (working with their other providers to manage their HTN, diabetes, and even autoimmune conditions).

As PGY-2s, we have two separate rotations (four months total) at the Ben Taub, Houston's county hospital. Around here we say, “there is never a normal day at Ben Taub” because the pathology at this hospital can vary as widely as the diversity of the patients we serve. Ben Taub is an incredible place to learn, filled with amazing multi-specialty faculty who are passionate about teaching. Patients at Ben Taub are all scheduled into a sub-specialty clinic staffed by a specific attending per half-day. The volume and pathology of the Ben Taub Retina clinic helps our dilated exams improve quickly, and after only a few weeks, we become very familiar with treatment/diagnosis of very advanced pathologies. We also treat severe pathology in oculoplastic, glaucoma, cornea, and neuro-ophthalmology clinics. In regard to procedures, once a week there is a dedicated PGY-2 intravitreal injection clinic and a regularly scheduled half-day laser clinic where, with faculty mentorship, we get to perform PRP and YAG capsulotomies. During our first block, we have the opportunity to go to the OR for primary oculoplastic cases and perform/assist in the minor procedure room, as well as review steps (and potentially even assist). During the second block, the Ben Taub PGY-2 has the opportunity to perform additional cataract surgery steps and progress to primary cataract cases depending on case openings and preparation.

At both Ben Taub and the VA, clinic ends when all the patients are seen across each clinic. We pride ourselves on following the Baylor way- ensuring we all work hard while also working together. At the end of every day, senior residents set aside dedicated time to review interesting pathologies and clinical challenges encountered throughout the day. Our rotations at both these institutions are incredibly rewarding, allowing us to see a high volume of patients and diverse pathologies, get hands-on experience, and grow tremendously as an ophthalmologist. An invaluable experience during these rotations is the opportunity to follow the treatment course of patients seen during call.

In addition to our VA and Ben Taub experiences, we also rotate at the main and satellite locations for Texas Children’s Hospital, as well as the private clinics at the Alkek Eye Center. We have early experiences in Oculoplastics and Neuro-ophthalmology with dedicated rotations during the PGY-2 year. We build a foundation for procedures and surgeries, generally finishing our year with 10-12 primary strabismus cases, 4-8 primary cataracts, and various primary oculoplastics procedures. We have academic half-days every Friday morning, during which we participate in Grand Rounds, receive lectures by leaders in the field, and partake in the outstanding surgical curriculum. The surgical curriculum begins early in the year, when faculty from every sub-specialty host multiple wet-labs on phacoemulsification, corneal laceration suturing, lid laceration repair, and strabismus surgery, as well as other advanced surgical skills. We are often pushed by our faculty (who often are also field experts) with both formal and informal learning opportunities across each pavilion, and leave the day feeling clinically and academically challenged. During this year, we take primary call for Ben Taub County Hospital, the Houston VA, and Alkek Eye Center. Call is busy and challenging, but it is an exciting opportunity to become more confident in our exam skills and identify knowledge gaps. With guidance from an incredible faculty and support from our Baylor resident family, call is, overall, a fruitful and high-volume experience.

PGY-3 at Baylor is a consult, subspecialty, and surgical year. Your PGY-2 introduction to surgery is put to the test as your numbers ramp up and you tackle cataract surgery of increasing complexity, perform dozens of strabismus surgeries, and perform your first subspecialty cornea, glaucoma, and retina primaries. You reap the rewards of your busy year of PGY-2 call and use your newfound clinical proficiency to autonomously run the consult services at Ben Taub, the VA, and Texas Children’s Hospital, longitudinally managing acute ophthalmic pathology across these sites.

The year comprises six rotations, each two months in duration: Texas Children’s Hospital, Ben Taub, VA, cornea, glaucoma, and retina. Texas Children’s Hospital, Ben Taub, and the VA have your time mostly split between consults and the operating room. At Texas Children’s Hospital, you spend around half the week in the operating room, with case volume including strabismus surgeries, pediatric cataracts, ROP laser, ocular oncology, retina, and oculoplastics. When not operating, you will work on consults or pediatric subspecialty clinics, seeing tertiary referrals of the rarest ophthalmic diseases typically just relegated to board examinations.

At the VA, the PGY-3 resident serves as the primary consult resident, gaining extensive exposure to longitudinal management of acute pathology typically seen in a comprehensive ophthalmology clinic. With open walk-ins for veterans, the eye clinic is structured as an ophthalmic urgent care, with an outstanding team of technicians that work up patients, obtain studies, and route less acute patients to our supporting optometrists, freeing the PGY-3 resident to see higher acuity pathology requiring medical or surgical intervention. One day a week is spent in the operating room, gaining increasing experience in cataract surgery.

Ben Taub is structured similarly to the VA, with time split between consults and the OR. Harris Health is among the largest county hospital systems, serving a massive, diverse and underserved population in a county of nearly 5 million. Harris Health’s eye care buck stops at the Ben Taub PGY-3, who, with full support of the Ben Taub technicians, nurses, residents, and attendings, runs the consult service, accepting community referrals, ER, and inpatient consults of the most severe, complex, and end-stage acute pathology in the country. Your bread and butter will be diseases like complex atypical corneal ulcers or neovascular glaucoma, in an awesome educational and humanistic experience, as you treat some of America’s most underserved and sickest patients.

Finally, your rotations through cornea, glaucoma and retina see you rotating in faculty Baylor subspecialty clinics and operating rooms with Baylor’s many expert-in-their-field faculty. These rotations are of a lighter pace, with continuous one-on-one time with these dedicated faculty, who are excited to sit down and teach residents their high-level clinical and surgical knowledge. You will have the opportunity to rotate with affiliate faculty in private practice as well, joining them in their clinics and ORs. As you work extensively with Baylor’s faculty, you may join them on research and get to know them well both personally and professionally.

PGY-3 call remains on an every-6th-day schedule, as your class transitions to covering Texas Children’s Hospital, Baylor ophthalmology subspecialty clinics, and Baylor St. Luke’s Emergency Room overnight/weekend calls. This year is of a much lighter volume and intensity than PGY-2, freeing more time to pursue activities of professional development, research, and other interests as you start to better realize your career ambitions over the year. Overall, PGY-3 is an incredible experience in clinical and surgical education, with an excellent balance of autonomy and supervision, as your knowledge and skills continue to grow, and you are primed for your final year of training. 

For many residents, the fourth year is the most anticipated and fun part of residency! Surgical training takes center stage, with residents spending 1–3 days each week in the operating room as the primary surgeon under attending guidance. Residents take ownership of their surgical patients from preoperative evaluation through postoperative care, allowing them to critically evaluate their own surgical techniques, recognize patterns in their outcomes, and continually refine their approach. This continuity also fosters meaningful relationships with patients and provides the opportunity to experience firsthand the profound impact that restoring and preserving vision can have on quality of life. Combined with high surgical volume, graduated autonomy, and dedicated faculty mentorship, the PGY-4 year is where residents refine the skills, judgment, and confidence to become independent ophthalmic surgeons.

The PGY-4 rotations include four months at the Michael E. DeBakey Veterans Affairs Hospital (split into one- or two-month segments), four months at Ben Taub County Hospital (split into one- or two-month segments), two months in retina clinic (split into one-month segments), and two months in anterior segment clinic (split into one-month segments).

The Michael E. Debakey VA Medical Center provides an outstanding comprehensive surgical experience, as it is the country's largest and busiest VA ophthalmology service. Residents perform high-volume cataract surgery while also participating in a dedicated weekly operating room day that consistently includes one to two oculoplastics cases. At Ben Taub, a level-1 trauma center and public hospital serving uninsured and underinsured patients from around the world, residents encounter a wide range of advanced pathology. We perform routine and complex cataract surgery, MIGS, tube shunts, trabeculectomies, vitreoretinal procedures, and pterygium excisions, among others. Complex cataract cases often include advanced techniques such as synechiolysis, capsular tension ring placement, and capsular tension segment fixation.

Dedicated retina and anterior segment rotations further expand residents' procedural experience. On retina, residents perform laser retinopexy, panretinal photocoagulation (PRP), and primary pars plana vitrectomies while caring for a diverse spectrum of medical and surgical retinal disease. During the anterior segment rotation, residents gain experience with corneal and refractive procedures including limbal relaxing incisions (LRI), superficial keratectomy with EDTA chelation, photorefractive keratectomy (PRK), and assist with complex anterior segment cases.

One of the greatest strengths of the final year is its flexibility. Faculty work closely with each resident to tailor operative experience to individual career goals. Residents pursuing comprehensive ophthalmology graduate with strong experience in complex cataract surgery, MIGS, and basic anterior segment surgery, while those pursuing fellowship can further focus their training within their chosen subspecialty – whether through additional strabismus surgery, greater exposure to glaucoma procedures such as tube shunts and CPC, or increased participation in corneal transplantation and advanced anterior segment surgery. Faculty are deeply invested in resident success, providing mentorship, research opportunities, career guidance, and strong advocacy throughout the fellowship or job application process.

PGY-4 residents take backup call during their four months on the Ben Taub rotation and do not take primary call. In this role, senior residents provide guidance to junior residents while continuing to develop their own independence. Faculty and fellows are always available for support, and PGY-4 residents frequently serve as the primary or assistant surgeon for emergent cases including open globe injuries, eyelid lacerations, pneumatic retinopexy, and therapeutic keratoplasties. Your years of accumulated experience as a PGY-4 don't only help on call, as senior residents are the crux of managing complex clinic patients and teaching junior residents cataract surgery steps in the operating room.

The final year of residency is both humbling and immensely rewarding. After three years of building a strong foundation, residents graduate with the breadth of clinical and surgical experience, confidence, and judgment needed to succeed in any ophthalmology career path.