Updated on: November 2024
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.
Clinical Glaucoma Fellowship program: 12 months
Course Content:
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
Break up of training period
First 2 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.
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 7 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 all instruments and diagnostics under
supervision during this period.
Next 3 months:
In the 9th 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 3 months, the fellow sees independent consultations in the outpatient
department as a senior resident. 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 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.
Throughout the fellowship period, fellows will be on call on designated dates for emergency
night on-call where he/she will be seeing emergency glaucoma/non-glaucoma/trauma patients
and manage them in OPD as well as OT under the supervision of the consultant
on-call.
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.
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
Rebound 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
MIGS procedures such as Kahookâs Dual Blade Goniotomy, iStent and others
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 patch
grafts)
Cataract surgery (ECCE or Phacoemulsification) in post filter situations
Minor
Evaluation under anaesthesia for pediatric glaucomas
Diode cyclophotocoagulation
Micropulse laser cyclophotocoagulation
Research activities:
Basic and clinical research-availability of large retrospective data and avenues for
conducting prospective studies are widely available.
Please click the below link to know more details about:
Faculty details
Infrastructure facilities