Introduction

In this article, I hope to highlight the experience of a medical student shadowing the MAEC as well as documenting the impact of the clinic on patient care. The MAEC, previously at the Royal Victoria Hospital and the Montreal General Hospital, moved to a newly renovated building accessible by Metro station. The MAEC offers many services, including neuro-ophthalmology, oculoplastic, ocular oncology, and comprehensive ophthalmology. With an array of services, the MAEC serves as the academic hub of all MUHC adult ophthalmology care. As a second-year medical student, I had the privilege of shadowing in a rather busy clinic (8:00-18:00) and experienced first-hand the subtleties that make ophthalmology such a unique specialty. 

The day began with meeting the team. On a rather busy day, there were two clerkship students, a handful of residents as well as two fellows and an attending. After speaking with a few people, it was very clear how passionate everyone was to be in this specialty, which only motivated me further. Experience is always enhanced when the people around you are passionate.

The attending in question completed his fellowship training in Orbital Oncology, Ophthalmic Plastic and Reconstructive Surgery. Therefore, I had the unique opportunity to see a blepharoplasty as my first procedure of the day. A blepharoplasty is a rejuvenating procedure performed on the upper and/or lower eyelids to excise excess skin or fat and possibly repair a muscle.With no formal instruction on ophthalmology in didactic lecturing, I was unaware that an ophthalmologist, rather than a plastic surgeon, would handle these types of procedures. The specialized area of oculoplastic surgery is fascinating and comprises ptosis repair, eyebrow lift, tear duct surgery, eyelid growths and skin cancers, and of course blepharoplasty being the most common [1].  

I was first interested in shadowing in the MAEC as I had read a paper titled, Development and validation of the first Canadian Aboriginal syllabics visual acuity chart published by Bhambra, N et al., (2023), which documents the design and validation of a Snellen chart used to assess visual acuity to help Inuit people who speak and read Inuktitut [2]. Dr. Christian El-Hadad is the Principal Investigator (PI) and I had the honour of shadowing him at the MAEC [3]. A striking majority of the patients that I saw that day at the clinic were indigenous. Although I did not see the Snellen chart in action, as most appointments were follow-ups, I did witness the language barriers that many Indigenous patients faced, especially those that were elderly. Many of the older patients were accompanied by a member of their community that spoke English or French. While all patients used the chart written in the English alphabet, the offering and acknowledgement of an Aboriginal Chart for an Indigenous patient can make them feel more comfortable and supportive in a foreign environment. Similar to the effect of implementing Bannock at the hospital for indigenous patients at the MUHC [4].  

I haven’t started Transition to Clinical Practice (TCP) or clerkship yet, therefore many of the specialized tools used in ophthalmology were unknown to me. There are many tools used in an assessment that elevate the traditional physical exam and implement ground-breaking diagnostics. I will go through them in point-form for ease of referral. 

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Slit Lamp

• Aim: It is used to get a detailed picture of front of the eye including the sclera, conjunctiva, iris, lens, and cornea.
• Experience: It is best described as a microscope with a bright light. I found it interesting the ways you can manipulate the lamp to get a three-dimensional view of the eye and examine many areas at the same time to enhance your view.
• Pathology: The lamp can assess for cataracts, corneal ulcers, or eye infections.

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Tonometry

• Aim: It measures intraocular pressure involving a gentle puff of air or a pressure-sensitive tip touching the eye.
• Experience: It was used to assess on a young patient presenting with headaches, pain-like pressure and blurred, narrow vision.
• Pathology: Used as part of screening and monitoring in glaucoma.

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Snellen Chart

• Aim: Assess for visual acuity and measure how well a patient can see at various distances.
• Experience: It was used to assess pre-operatively two elderly patients scheduled to have cataract surgery. It was surprising that despite the extensiveness of the eye disease, they performed well on the exam.
• Pathology: Determine need for corrective lenses and assess eye disease progression.

Conclusion

Spending the day at MAEC was a great experience where witnesses the blend of passion, precision, and patient care that make it such a wonderful place. The intersection of cultural sensitivity and innovation, as showcased at the MAEC, will inform my pursuit in medicine while staying grounded in the individual needs of patients.

The opportunity to engage in clinical settings as a medical student is truly a privilege. As I move into TCP, I will surely carry with me the lessons learned here, with a renewed commitment to serve my future patients with the same dedication and excellenceI experienced at the MAEC.

Acknowledgments

I’d like to thank Dr. Christian El-Hadad and Dr. Jacqueline Coblentz for the opportunity to shadow them and their generosity in teaching me insightful skills that I will carry forward as I navigate the next chapters in my education.

Author: Lauren Khoury, McGill 2nd year medical student

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References

1.     https://www.starlingphysicians.com/types-oculoplastic-surgery/

2.     https://www.canadianjournalofophthalmology.ca/article/S0008-4182(23)00010-8/fulltext

3.     https://montreal.ctvnews.ca/first-ever-inuktitut-eye-chart-reaches-indigenous-communities-in-their-language-1.6347015

4.     https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwi85Oqsk-yCAxVzEFkFHUlYDJAQFnoECA4QAQ&url=https%3A%2F%2Fmuhc.ca%2Fnews-and-patient-stories%2Fnews%2Fbannock-bread-now-available-indigenous-inpatients&usg=AOvVaw0aKbWhwe9YGMcb2H86MuuI&opi=89978449

5.      https://muhc.ca/newsroom/article/adult-ophthalmology-muhc-new-home-new-name