Bradley Salus, O.D. with with Bryce St. Clair, O.D.

 

Bradley Salus, O.D. is Wilmer Eye Institute, Johns Hopkins Medicine’s inaugural optometry resident. Salus came to Wilmer after completing optometry school at the Southern California College of Optometry at Marshall B. Ketchum University.

During Salus’s one-year residency at Wilmer, which started in July, he is working with fellow optometrists Corinne Casey, O.D.; Amanda Crum, O.D., M.S.; Lee Guo, O.D. and Bryce St. Clair, O.D., to gain experience with commonly encountered ocular diseases and other aspects of optometry. The residency is in primary eye care with an emphasis in specialty contact lenses.

In this first of a three-part series, Salus provides a first-person account of what he has been up to these first three months and what he has learned as an optometry resident at Wilmer.

July 2023: Beginnings

I couldn’t wait to get started. On my first day, Dr. St. Clair allowed me to observe him with some of his patients. Already, I was seeing complicated patient cases and getting the chance to talk with him and go through how we would treat and manage these specific cases.

As my first month at Wilmer went on, I started by observing each doctor while they examined their patients. It then progressed to having the doctors observe me while I examined their patients. Now, it has developed to a point where I’m seeing my own patients, but still checking in with the provider, especially when there are more complicated situations.

It’s been exhilarating and I feel much further along as a provider than where I was even just a few months ago as a student. And, already, I'm seeing more complicated patient cases than I would have otherwise seen, had I not pursued a residency.

Each provider has been exceedingly kind and I've been really impressed by how they treat their patients. They're all extremely thorough and they provide exceptional patient care, which is echoed in how the patients interact with them and talk to them. On top of that, they’re very willing to teach me and train me, as the resident, which I think is very cool. I don't think I ever expected it not to be like this, but it's great that it is. I would say the training I was hoping to and expecting to receive has lived up to my expectations.

My goal, at least at this point in my career, is to be involved in an academic medical center such as Wilmer. I find myself very fortunate to already be in this situation very early on, learning from some of the best, and also getting the opportunity to experience what an academic medical center offers. I love to learn, and I find that being in these settings, I see there are a lot of other passionate providers who are clinically driven. They’re practicing evidence-based medical decision making, always looking for what's the most current up to date standards of practice, and I’m seeing that here. That's what I want to be involved in.

August 2023: Getting Into a Groove

I’ve got a rotation going and am usually seeing patients four days a week. On Mondays, I see comprehensive, specialty contacts and glaucoma patients in the Odenton clinic. On Tuesdays, I’m at Bayview, usually seeing patients with severe dry eye. On Wednesdays, I’ve been observing some of the ophthalmologists for increased exposure to advanced ocular conditions that are specifically referred to Wilmer. I chose to observe our corneal specialists for the first three months as a way to see more pre- and post-operative corneal conditions and the nuances of the anterior segment. This is especially helpful when providing specialty contact lens fitting. On Thursdays, I’m in East Baltimore working in the comprehensive eye care clinic and triaging patients that come in with ocular complaints. On Fridays, it’s back to Odenton, seeing comprehensive, contacts and glaucoma patients.

I enjoy working with providers in multiple sub-specialties, that way I get to see the whole front-to-back of the eye, which is really fantastic. Working with the different providers — each of them very experienced in their specific sub-specialty of optometry — they're all so good at what they do. They're so good at picking up the fine details, which is a skill I hope to learn myself as my residency progresses. They've been really great in the exam rooms and they let me take a second look at a patient and tell me how they are evaluating the situation. It has helped tailor my own exams to look for those certain details.

I'm becoming much more comfortable fitting the specialty contact lenses. In school, we’re taught all about their design and how we should be assessing them, but we didn’t have a lot of hands-on exposure. I've been fortunate to work with Dr. Crum and we fit a lot of these lenses consistently. I've become more comfortable starting to recognize appropriate fits and then how to start making adjustments, and I’ve gotten more comfortable putting the lenses on and assessing them on eyes with complex corneal conditions. If I wasn't in a residency, I might see cases like these few and far between, versus almost every single day like I am at Wilmer, so that's been a nice part of the program.

September 2023: Teaching Times

Dr. St. Clair says it best: Take advantage of as much as you can in this one year you’re in the residency program, because there are a lot of academic opportunities that don’t always present themselves unless you’re in this situation. Just in the last month, there have been a few enjoyable experiences, when it comes to the didactic component of this residency.

I presented for the first time in the Johns Hopkins optometry grand rounds. It was a 40-minute presentation on a patient with a rare retinal condition. Getting a chance to present one of my more unique cases and then talk about how it presents, how we treat and manage it, and then allow some of the optometrists at Wilmer to ask some questions of me, was a really cool experience.

I also got the chance to collaborate with ocular immunology specialist Meghan Berkenstock, M.D. to teach medical students how to do a basic eye exam and how it relates to the cranial nerves. It was very cool to bring in what I've been taught in optometry school and convey that to these medical students. I think it shows the value that optometry has in the eye care field, because it shows just how much we are taught in school, and how much we really can be a part of a patient’s total care management team.

I think I’ve started to express more confidence in the exams I give, as I’m more familiar with my attendings and the process of inputting medical records. I’m also getting more confidence in what I’m seeing. It’s more second nature now, even after just a few months, compared to when I first started. I’ve noticed that expressing more confidence makes the exam go a lot more smoothly, and I think that patients resonate with that.