This post marks the inauguration of a series of blog posts exploring various medical specialties in the United States. We’re going to kick off this series with a discussion with Dr. Oscar Otero, an international medical graduate (IMG) who matched into ophthalmology at New York Eye and Ear Infirmary in New York City, USA. Oscar has a unique story because he completed medical school and ophthalmology residency training in Colombia prior to moving to the United States for research. He applied for the residency application cycle in 2021-2022 after completing 1.5 years of research with various attending vitreoretinal surgeons at New York Eye and Ear.
1. Tell us more about your background. What did you study when you were in Colombia and why did you choose to relocate to the United States?
I matriculated into medical school when I was 18 years old and graduated when I was 23. I went to a prestigious, private institution in Colombia (University of Javeriana) and my parents paid for my education there. My class was only 60 people and so I was very fortunate to be able to get to know all of my friends. In Colombia, you can practice as a physician after graduating from medical school, so I worked for two years as a general practitioner. During the first year, I did something very close to what interns do during their first year of residency (i.e., interfacing with social work) and the following year, I was hired as a general practitioner by a private hospital. Thereafter, I completed my three-year ophthalmology residency back in Colombia at Barraquer Clinic. I chose to relocate to the United States because I wanted to gain more experience and train with some of the most accomplished ophthalmologists in the world. Health care institutions in the United States have resources and novel imaging devices that are unparalleled compared to the developing world.
2. What was your motivation for beginning a residency in ophthalmology?
Vision is such an indispensable tool to experience the world around us. I consider it a privilege to be able to restore vision for people whose lives are upended by sudden manifestations of disease such as diabetic retinopathy or central serous retinopathy. When I was younger, I had a close friend who developed vision loss secondary to an inherited condition called retinitis pigmentosa. It was truly heartbreaking to watch his steady decline and his gradual dependence on his parents as his primary caregivers. I resolved to become an ophthalmologist after witnessing the toll taken on my friend as he grappled with this condition.
Retinitis pigmentosa (Courtesy of Wikipedia)
3. Tell us a little bit about your research. How many abstracts, publications, etc. would you recommend future ophthalmology applicants should have prior to applying for residency?
I have been conducting research in Dr. Richard Rosen’s laboratory for the past 1.5 years. I would recommend having at least one ophthalmology-related publication prior to applying for residency. The average number of publications per residency applicant is 2.5 I believe. For my clinical research fellowship, I currently investigate vascular and cellular imaging biomarkers for sickle cell retinopathy, diabetic retinopathy, and glaucoma. I also use novel imaging devices like OCT-Angiography (OCTA), Adaptive Optics (AO), and Retinal Metabolic Analysis (RMA) to visualize the retinal microvasculature and hyalocytes, which are macrophages located in the vitreous cavity. I am currently working on a number of different projects, one of which involves characterizing the peri-arteriolar and perivenular capillary density of sickle cell patients with various genotypes and visualization of hyalocytes in patients with thyroid eye disease.
A cross-section of the macula (courtesy of Wikipedia)
Fluorescein angiogram of a patient with central retinal artery occlusion (CRAO) (Courtesy of Wikipedia)
3. What was your most memorable experience in residency back in Colombia and how do you expect this to differ from your residency training in the United States?
My residency training in Colombia enabled me to have contact with a lot of underserved populations. I was able to treat elderly patients with very advanced cataracts and I was able to witness how surgical intervention can drastically alter the trajectory and quality of life for some patients. A lot of the patients I saw in Colombia didn’t have access to ophthalmologists. I often saw patients from nursing homes who didn’t have access to health insurance. I expect to have the same experience here during my residency training in New York City. The difference will be that I’m going to have access to cutting edge technology and the latest medications. I’m going to be able to treat patients with tools that I didn’t have back in Colombia, such as OCT. In Colombia, I needed to assess patients’ visual acuity without access to diagnostic or imaging tools. Here, things will be very different.
4. What was the residency application process like for you?
The application process was very tough as an international medical graduate. I didn’t get a lot of interviews and I was very stressed about it. I was told that my residency completion in Colombia would serve as a deterrent to securing a residency position here in the US. However, despite being told this, I had a lot of research under my belt and I was confident that I had a good chance because I was working as a research fellow for over one year. I had good research output and was able to talk about my research during my residency interview.
5. How were you able to gather letters of recommendation for your residency application?
I mainly asked two attendings with whom I conducted research and who funded my clinical research fellowship. It’s important to be able to obtain letters of recommendation from attendings you have personally worked with because they will be able to attest to your work ethic, determination, dedication, and passion for the field.
6. What is one topic in ophthalmology that interests you the most?
Retinal imaging fascinates me. Luckily, I’ve been able to work with Dr. Rosen and I have access to all of these new devices that enable non-invasive, rapid assessments of the retina. I also am very passionate about artificial intelligence. I currently grade color fundus photos to diagnose the three most common pathologies in ophthalmology (diabetic retinopathy, glaucoma, and wet AMD) to help formulate an algorithm so that a computer can do it without input from an ophthalmologist. I think artificial intelligence is the future of opthalmology.
9. What advice would you give to current medical students who are potentially interested in pursuing ophthalmology as a specialty?
I would highly recommend conducting research in ophthalmology. Aside from board scores, program directors look at research and they will heavily rely on the interview to decide whether they want you in their program. This is not an easy process, so don’t give up. You should persevere and work for your dreams. Another piece of advice I have is to try to get involved with residents, attendings, and ophthalmology free clinics at your home institution.
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