Ethical Global Outreach in Residency Training

Acknowledging how self-interest, altruism, and global health experiences intersect.

Grace Sun, MD, and Alina Husain, BS

Glaucoma Today

During my (G.S.) 10 years of serving as the program director of the ophthalmology residency at Weill Cornell Medicine, I interviewed hundreds of applicants who were interested in global ophthalmology. When asked to describe their interest in global health training, applicants often replied with some variant of the same response: to help those in need and to provide care to underserved populations. When I, in turn, described our international opportunities, I always sensed their surprise, and occasionally their disappointment, at my response: “Your experience may be largely nonsurgical.” In the residency interview setting, I was not able to delve into the complexities surrounding global health experiences. I wanted to share my experience as a Peace Corps volunteer in Nicaragua, where I, too, set out with idealistic (and rather naïve) intentions to “save the world.” I wished I could explain that, although we engage in global health experiences with altruistic intentions, we often stand to gain more from these experiences than do the communities that host us. Given the growing interest in global ophthalmology during residency training,1 it is important to reflect on how best to engage in global health experiences and serve host communities. GLOBAL OPHTHALMOLOGY ROTATIONS In July 2013, the Accreditation Council for Graduate Medical Education began to allow up to 1 month of international rotations to be applied to residency training.2 Since then, a growing number of US ophthalmology residency programs have been adopting global health curricula. At least half of ophthalmology residency programs offer or support resident international experiences,3-5 but the global health curricula offered differs substantially by program. Not all programs have mandatory requirements that residents must meet before practicing abroad, even though many faculty believe additional training outside of the standard ophthalmology curriculum is necessary to practice in an international setting. The lengths of international experiences vary from weeks to months, with the most commonly reported duration being 1 week or less.3 Given residents’ limited preparation for—and the short duration of—global health experiences, it is important to understand the motivations for these experiences from the perspective of residency programs and learners. By offering global health opportunities, US ophthalmology residency programs aim to provide residents with international experiences, deliver humanitarian aid, and engage in medical diplomacy.3,6 Through these rotations, residents gain increased exposure to ophthalmology and other health care systems; broadened clinical, surgical, and research experience; and exposure to other cultures.

Behold, the Power to Reverse Mydriasis Is Here!

The wait is finally over.

Modern Optometry

HOT TOPIC Mydriasis Reversal Drop Now Available in US Viatris has announced the US commercial launch of phentolamine ophthalmic solution 0.75% (Ryzumvi) to treat pharmacologically induced mydriasis produced by adrenergic agonists (eg, phenylephrine) or parasympatholytic (eg, tropicamide) agents. Initially FDA-approved in September, Ryzumvi was evaluated across two random, vehicle-controlled, double-masked MIRA-2 and MIRA-3 clinical trials. The drug’s onset of action was found to occur in roughly 30 minutes. Ninety minutes after administration, 49% and 58% of patients who were administered two drops of Ryzumvi returned to < 0.2 mm of baseline pupil diameter compared with 7% and 6% who were administered a placebo, respectively. My Two Cents It will be wonderful to tell patients that we do in fact have “that drop that reverses dilation.” After being routinely asked for this drop for the past 11 years of clinical practice, I’ll finally have an answer that patients will appreciate. I do, however, have a few questions about the product. First off—and it’s probably a dumb question, as I usually seem to have, but—I noticed the indication for the drop is “for the treatment of pharmacologically induced mydriasis produced by adrenergic agonists or parasympatholytic agents.” What about hydroxyamphetamine hydrobromide and tropicamide (Paremyd, Akorn) drops or compounded combination drops (such as the ones we get from Imprimis) that have phenylephrine and tropicamide? Would this drop be considered “off label” to reverse patients dilated with combination drops? Also, what’s the price point? Do practices bear this cost, or do we charge patients for the dilation reversal?

A Global Community

Callan Navitsky, Editor-in-Chief

Glaucoma Today

Working in proximity to many trainees through YoungMD Connect, BMC’s platform for young and aspiring ophthalmologists, I regularly hear that one of the most appealing aspects of ophthalmology is its community feel. People in the field are perceived as welcoming, connected, and collegial. Although community may seem synonymous with closeness, the concept itself may be broader than that. For some, community is not defined solely by shared geography, nationality, or other social or cultural ties. In this issue of GT, ophthalmologists recount experiences in which they traveled abroad to serve and support others from different backgrounds, in different settings, and with different resources—but with a common goal to combat blindness. The anecdotes and photographs they share are snapshots of comprehensive initiatives and continuous collaborations. For example, after observing unmet needs in trabeculectomy care in Bali, Oluwatosin Smith, MD, is now working to establish a program within her home practice to address this obstacle. Annette L. Giangiacomo, MD, communicates regularly with providers she has met on past trips to remain an active part of their support team. Shawn Gulati, MD, MPH, is participating in a dedicated global ophthalmology fellowship.