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Dr. Meenakshi S
Director - Academics
drms@snmail.org
For more details, please contact
Sri N Sivakumar (Academic Officer)
academic@snmail.org
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Glaucoma Fellowship Training Programme
Last Updated: January 2016
Smt. Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya
Smt. Jadhavbai Nathmal Singhvee Glaucoma Services, is a specialty department of Sankara Nethralaya and is equipped with all necessary instrumentation for diagnosis and management of glaucoma.
Available Instruments in the Department:
Apart from routine instruments for evaluation (Applanation tonometer, 3 and 4 mirror gonioscopes, 90 D), other specialized equipments available include;
Tonopen
Perkins tonometer
Dynamic Contour Tonometer (DCT)
Ocular Response Analyzer
Proview tonometer
Ultrasound pachymeter
Koeppe direct gonioscopes (for pediatric angle assessment)
Humphrey visual field analyzer (i series)
Frequency Doubling Perimeter (FDP)
Heidelberg Retinal tomography (HRT III)
Optical coherence tomography (OCT)-Retinal Nerve Fibre Layer (RNFL), Ganglion Cell Complex (GCC)
Anterior segment Swept Source OCT
Anterior Segment OCT (ASOCT)
Ultrasound Biomicroscopy (UBM)
Zeiss fundus photography unit (for stereoscopic disc photography)
Outpatient activities:

Routine comprehensive evaluation for glaucoma patients and glaucoma suspects include: Applanation tonometry, indentation gonioscopy, optic disc and fundus evaluations. This is followed by further testing as deemed necessary which may include-Visual field analysis (Humphrey), Disc photography or Imaging (HRT, OCT, Swept source OCT, anterior segment OCT, Ultrasound biomicroscopy)

Management of pediatric glaucomas

Cross consultations for glaucoma from other departments in the institute and referrals from outside which may include complicated glaucomas and post surgical glaucomas (such as post penetrating keratoplasty, post vitreo-retinal surgeries, post uveitic, post traumatic).

Minor OPD procedures:
Nd: YAG peripheral Iridotomy
Argon Laser Trabeculoplasty (ALT)
Selective laser Trabeculoplasty (SLT)
Argon Laser Iridoplasty
Argon Laser Suturelysis
Postoperative 5-Flurouracil injections
Inpatient procedures:
Major
External trabeculotomy and/or trabeculectomy for congenital glaucomas
Combined cataract (Phacoemulsification) and glaucoma filtering surgery (Trabeculectomy)
Trabeculectomy with/without use of antimetabolites
Combined Filtering surgeries with vitreoretinal surgeries
Combined Filtering surgeries with corneal/ocular surface surgeries
Aqueous drainage implants (valved or non-valved)
AC reformation + choroidal drainage
Needling of blebs
Revision of blebs
Endoscopic cyclophotocoagulation
Management of overfiltering and leaking blebs (Autologous blood injections or conjunctival patch grafts)
Cataract surgery (ECCE or Phacoemulsification) in post filter situations
Minor
Evaluation under anaesthesia for pediatric glaucomas
Diode cyclophotocoagulation
Research activities:

Drug trials

Basic and clinical research-availabilty of large retrospective data and avenues for conducting prospective studies are widely available.

Fellowship program:

The glaucoma fellowship program is meant to train the ophthalmologist in the subspecialty of glaucoma including both medical and surgical management of common and complicated glaucomas

Training period: 18 months

Research fellowship includes 6 months of research based activities including data collection, statistical analysis and if possible publication of articles.

Eligibility: D.O. or M.S. or DNB from a recognized institute with adequate surgical exposure to routine cataract surgery with IOL implantation. Preferable to have personal interest to pursue a career in the sub specialty of glaucoma, at least as part of his/her clinical practice.

Break up of training period:

First 3 months: The fellow is oriented to the routine practices of the institute in the first month. Subsequently he/she is posted in the Neuro-Ophthalmology department and Glaucoma Diagnostics for 15 days each. In the third month, the fellow has an option to choose any 2 postings of their choice (of 15 days duration each) either in the Vitreo-Retina, Cornea, Uvea or Emergency departments. This period serves to prepare the fellow for the forthcoming glaucoma training.

During this tenure, the fellow, after consultation with the director of the department has to formulate a prospective research proposal for his/her period of stay (minimum of one year) which needs to be approved by the research / ethics committees of the hospital.

Next 8 months: The fellow will have rotation postings with glaucoma consultants. The fellow will be trained in basic OPD evaluation, visual field evaluation, postoperative care and follow up of patients along with observation of minor OPD and OT procedures and major OT procedures. The fellow will actively assist in OT procedures. The fellow will also be responsible for inpatients of the consultant under whom he/she is posted. The fellow will be allowed to perform OPD and OT procedures as mentioned above under the consultants' supervision.

Besides a once weekly posting throughout the fellowship, an exclusive one month period in the community ophthalmology department to further train for cataract and glaucoma surgeries.

The fellow should start on the research schedule he/she has prepared under the guidance of one of the senior glaucoma consultants. The fellow is encouraged to do combined cataract and glaucoma procedures and trabeculectomies under supervision on selected patients. The fellow has ample opportunity and is encouraged to use with all instruments and diagnostics under supervision during this period.

Last 7 months: In the 12th Month of the fellowship program, the fellow will see day to day glaucoma cross consultations under the supervision of glaucoma consultant to prepare for an independent role. In the last 6 months, the fellow sees independent consultations in the outpatient department. They will continue to perform surgeries and are also encouraged to supervise their junior colleagues. During this time he/she will have a weekly diagnostic posting to continue training in use of imaging modalities and perimetry.

The fellow has additional posting of one month in this period exclusively in the community ophthalmology department for cataract and glaucoma surgeries.

The fellows are encouraged to present their research work in a scientific meetings, [National, State and City meetings] and publish it in peer reviewed journals during this period.

Summary of clinical training:

Level 1
Basic evaluation of glaucoma patient (Tonometry, Gonioscopy, Disc evaluation)
Hands on with Humphrey visual field analyzer,Frequency Doubling Perimetry
Imaging in glaucoma (HRT, OCT, Disc photographs)
Ultrasound Biomicroscopy, Anterior Segment OCT

Level 2
Nd-YAG peripheral iridotomy
Cyclodestructive procedures
Postoperative wound modulation in glaucoma surgeries
Evaluation under general anesthesia for pediatric glaucomas
Trabeculectomy with / without antimetabolites
Combined cataract and glaucoma procedures

Level 3
Basic research methodology and publication

Apart from clinical and surgical training, active participation in journal clubs and clinical presentations in weekly department meetings, case presentations, journal clubs, quiz and academic sessions within and outside the institute is encouraged. They are encouraged to present their research at National meetings.

Evaluation of performance of fellows will be done by regular internal assessment tests. Fellows have to maintain a log-book for the period of their fellowship duration which is assessed every month end by their mentors.

Please click here to download Application Form