2016 Princeternship

Ophthalmologist Dr. Peter Hersh (’78) and his team at the Cornea and Laser Eye Institute-Hersh Vision Group in Teaneck, New Jersey, specialize in corneal surgery and care. On the morning of my Princeternship, I arrived just in time for the first surgery of the day. After brief introductions were given, I was suited up in the proper gear–lab coat, face mask, and hairnet for sanitation purposes–before entering a minimally lit room that contained an Intralase laser. This is a high speed excimer laser which is used for laser in situ keratomileusis (LASIK) eye surgery, a popular operative procedure that corrects natural myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. I was able to observe several of these surgeries in the morning on a large television screen that projected what Dr. Hersh was seeing through his microscope lens. Given the size of a human eye and the even smaller area within the eye that is the focus of surgical activity, an ophthalmologist views the organ through a medical microscope during the entire operation. Something that does not readily come to mind is the impressive hand-eye coordination that the surgeon must possess!

In just one morning, I observed several surgical procedures. In addition to LASIK, I saw Dr. Hersh and his team perform photorefractive keratectomy (PRK) surgery, a procedure which favors separating the eye’s epithelial cells from the cornea rather than pulling back the surface corneal flap. In between the surgeries, Dr. Hersh showed me corneal cross section graphs, the visual results of tests he conducts on patients to analyze their corneal health. In the afternoon, the team switched gears and began performing clinical trial surgeries. Dr. Hersh is currently the only American surgeon studying new treatments for myopia and kertaoconus. As such, he conducted an afternoon’s worth of surgeries that involved the insertion of Intacs (intracorneal ring segments) and corneal collagen crosslinking (CXL). This is often due to keratoconus, which is subsequently treated with Intacs and CXL surgeries. CXL includes implanting Intacs to push back on the bump well as using laser technology to create covalent bonds prevent this issue in the future. Some of the population have thinner than usual corneal layers in their eye(s), which causes slight but significant bump(s) in the eye.

Dr. Hersh’s schedule was very busy with few breaks in between. I was told that this was a normal Thursday in the office. Thursdays are designated as surgery days. At closing time, a few overarching observations stood out to me: in order to run a successful and efficient office, the day’s schedule needs to be followed very closely, and there is very little to no time for chitchat in between the various surgeries. This seems to be an essential rule to follow when taking into consideration the multiple concurrent surgeries with each patient in different stages of his or her procedure. Another observation was the strong mutual trust between the surgeon and his team. Undergoing a successful surgical procedure from start to finish absolutely cannot be achieved without trained and trustworthy professionals by the surgeon’s side, who do everything from relaying measurements to ensuring that the patient is comfortable and at ease.

When we were able to sit and chat for a bit after the workday, I expressed my concern that I may lose volition when pursuing an M.D. degree, given the length of medical school, residency, and fellowships. Dr. Hersh offered a helpful piece of advice: to take everything one step at a time, a philosophy which will continue to be useful past obtaining the degree. There are many steps to take in every surgery, and the key is to focus on what is happening in the moment. The most unique part of this Princeternship was witnessing the interplay between private practice surgeries and clinical trial surgeries for research purposes. Practicing medicine already provides for an extremely busy lifestyle, but the equation changes completely if the doctor decides to pursue research as well. The Princeternship with Dr. Hersh allowed me to take notes on how to handle both. I was highly impressed with the quality of this experience and recommend it to students at any stage of their medical careers.

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