2022 Gillingham Pan-American Fellowship Experience:
Natasha Ferreira Santos da Cruz MD

5 Sept 2023

With the support of Retina Research Foundation and the Pan-American Ophthalmological Foundation, I spent a year at Bascom Palmer Eye Institute in Miami for a Pediatric Retina Research Fellowship under the supervision of Dr Audina Berrocal. This was by far the most wonderful experience and the best year of my life. I say this because working with her is a daily learning experience that goes far beyond the pediatric retina. I also had the opportunity to work with the dream team which, together with Dr Berrocal, make the Bascom Palmer so unique: residents, fellows, photographers, optometrists, nurses, and every other staff member.

My fellowship was divided mainly between clinic days, operating room (OR) and retinopathy of prematurity rounds (ROP rounds). In addition, I was able to participate weekly in grand rounds and retina and image conferences.

To be able to be in the room/OR with Dr Berrocal made all the difference in my doctor-patient relationship. It meant learning to listen more closely to the patient. It meant paying attention to details such as the patient’s social situation, the family history and its dynamics, the sports choice. It taught me to trust my instinct when it tells me that an eye is worth fighting for. But it also taught me to be more conservative with the treatments. It made me more sensitive while talking to parents and patients about their diseases, what to expect in the long term, possible treatments, and – most importantly – about never giving up because medicine advances every day.

The most impressive cases and their possible outcomes were always discussed in detail along with the images in the end of the clinic. In the OR, examinations under general anesthesia were done to children to perform a good clinical exam. Every piece of equipment available in the market was ready to give the patients a gold-standard care: fundus photos, fluorescein angiography, optical coherence tomography including OCT-A, ultrasound, genetic testing, and every other study required to make the diagnosis and best treatment decision.

The surgical cases were as diverse as possible, ranging from 5-week-old babies to the elderly, and always challenging. I always tried to imagine what I would do if I found myself with that case in hand and then go on to discuss with Dr Berrocal the reasons why she did it in a certain way. One of the best accomplishments for me was seeing the evolution of the diseases, since with 22 years of experience, she has long term follow-up patients.

The ROP rounds were held at the NICU (neonatal intensive care unit) at Jackson Memorial Hospital, and I had the opportunity to witness various treatments in ROP and perceiving the evolution of nano/micropreemies babies. The coolest thing is that the whole team, including the photographer, research coordinator, and nurse, came to the rounds.

In addition to surgical and clinical learning, representatives from large companies were always around explaining new gadgets and putting the most technological devices available on the market to the test. Being able to discuss with them the functionality and tools of each one was also very enriching.

Besides all this, I had the opportunity to carry out a lot of research, including research lines of ROP, fluorescein angiography and OCT-A. As the cases are extremely well documented, it is easier to conduct the studies. I wrote and participated in several papers. Some are already published, while others are either submitted or accepted for publication. And I am also involved in many others that are in more preliminary stages of development. At the same time that Dr Berrocal is incredibly creative and gives us several ideas for papers, she gives us the freedom to write and to reflect upon new hypotheses and theses on the subject.

I also attended to several retina meetings. For instance, I was able to attend Retina World Congress, American Society of Retina Specialists, American Academy of Ophthalmology, Vit-Buckle Society, Bascom Palmer Eye Institute Curso, Envision, and many others. In some of these events I was able to present our research that came to be award winners. Additionally, I had the opportunity to participate in surgical wetlabs provided by Dorc and Alcon, and in ultrasound courses provided by Bascom Palmer.

Dr Berrocal is an incredible mentor and human being. She teaches more than retina. She teaches about life in general. During that year she took care of me as if I were a member of her family. I soon came to realize she does the same for her patients and her staff. Even with her many years of experience and being known worldwide, she continues to work hard and is extremely humble. No wonder she was a pioneer in gene therapy and ROP treatment. She really is an example to be followed.

It wouldn’t be fair to talk about my fellowship without mentioning how much I also learned with the entire team. Residents and fellows, in addition to being qualified and with a high intellectual level, are also extremely fun. All the manager staff, photographers, nurses, technicians, and optometrists were fundamental to guide and help me with technical deficiencies that I had. They are people I will never forget.

This was certainly a wonderful experience that increased not only my knowledge on pediatric retina, but also my skills as a person. I fulfilled my goals completely and I would absolutely recommend this fellowship to other ophthalmologists interested in pediatric retina. I will return to Brazil with a heavy heart. But I’ll carry with me incredible knowledge and skills that I hope will contribute in some way to my country and to my patients.

Natasha Cruz MD