Fellowship

Glaucoma Fellowship Training Programme

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.

The Glaucoma Fellowship Program at our tertiary eye care institute offers an opportunity for aspiring ophthalmologists to cultivate advanced expertise in the field of glaucoma. The program is designed to teach both clinical acumen and surgical skills in the field of glaucoma. In addition, this program also provides training in the management of complex cases, cutting-edge research, and invaluable interactions with national and international leaders in the field.

Program Highlights

Training

The program provides robust exposure to a diverse patient population, encompassing all forms of primary and secondary glaucomas. Fellows will develop comprehensive skills in using and mastering the interpretation of various instruments required for the diagnosis and management of complex glaucomas.

Outpatient department activities

Comprehensive evaluation for glaucoma patients and glaucoma suspects include: Detailed history taking, slit lamp evaluation, applanation tonometry, indentation gonioscopy, optic disc and fundus evaluations. This is followed by further testing as deemed necessary which may include-

arrow_right Functional tests like visual field analysis (Humphrey visual fields and Virtual perimetry)

arrow_right Structural tests – optic disc and retinal nerve fibre layer photography or imaging (HRT, OCT, Swept source OCT

arrow_right Anterior segment imaging - Anterior segment OCT, Ultrasound biomicroscopy

Management of complex primary and secondary glaucoma as well as pediatric glaucomas.

Cross consultations for glaucoma from other departments in the institute and referrals from outside which may include complex glaucomas and post surgical glaucomas (such as post penetrating keratoplasty, post vitreo-retinal surgeries, post uveitic, post traumatic). This will help the fellow understand the interplay between glaucoma, systemic diseases and other ocular co morbidities and the nuances of management.

They will also learn how to differentiate glaucoma from other optic neuropathies.

In depth knowledge and application of medical and laser therapy in glaucoma

arrow_right Nd: YAG peripheral Iridotomy

arrow_right Selective laser Trabeculoplasty (SLT)

arrow_right Argon Laser Iridoplasty

arrow_right Argon Laser Suturelysis

Post operative bleb modulation

arrow_right Postoperative 5-Flurouracil injections, releasable sutures, bleb needling

Training

Fellows will gain surgical experience, progressing from observing simple and complex surgeries, wet lab training, assisting to performing a wide range of glaucoma procedures under expert supervision. The surgeries being performed in the department include:

arrow_right Trabeculectomy with anti-metabolites

arrow_right Glaucoma Drainage Device Implantation (AGV, ACP)

arrow_right Minimally Invasive Glaucoma Surgeries (MIGS)- Istent, Kahook’s Dual Blade, Tanito Hook goniotomy etc

arrow_right Combined Cataract and Glaucoma Procedures

arrow_right Combined Filtering surgeries with vitreoretinal surgeries

arrow_right Cyclodestructive Procedures: Diode Cyclophotocoagulation, Micropulse Diode CPC, Endo cyclophotocoagulation

arrow_right Cyclodialysis cleft repair

arrow_right Pupilloplasty and iridodialysis repair

arrow_right Evaluation under anaesthesia for pediatric glaucomas

arrow_right External trabeculotomy, goniotomy , external trabeculotomy with trabeculectomy, glaucoma drainage devices,

arrow_right Management and Complication Resolution:Acquiring expertise in managing post-operative complications such as hypotony, overfiltering blebs, bleb leaks, and choroidal detachments, like bleb needling, revisions, patch grafts, choroidal drainage etc.

Academics and Research activities:

arrow_right Didactic Lectures and Seminars: A structured curriculum of weekly journal clubs lectures, grand rounds, and case presentations covering the breadth of glaucoma knowledge, from basic science to advanced clinical concepts.

arrow_right Wet lab training

arrow_right Clinical Research -The fellows will be trained in research methodology (workshops, projects) and critical appraisal of the latest literature in the field of glaucoma

Training period:

Long term Clinical Fellowship: 18 months

Long term Research Fellowship: includes an initial 6 months of research based activities including data collection, statistical analysis, writing of manuscripts and participation in publication of articles followed by 18 months of clinical fellowship.

Fellowship for International candidates- Case to case basis, with preference to candidates from SAARC nations

Stipend

Current stipend is 55,000 INR per month (subject to change) Annually, 14 days of paid vacation

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.

Age Limit:Upto 40 years

Break up of training period (in detail):

First 3 months:

Glaucoma Basics and Diagnostics The fellow is oriented to the routine practices of the institute in the first month along with postings in the Glaucoma department, Neuro-Ophthalmology department and Glaucoma Diagnostics for 15 days each.

Ancillary postingsIn 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.

Research Project:During this tenure, the fellow, after consultation with the director of the department also formulates 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 9 months:

Clinical Postings and Surgical training

Postings in the glaucoma department

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

Last 6 months-Senior Resident Fellow:

The fellow sees independent consultations in the outpatient department as a senior resident. Additional posting of one month in this period exclusively in the community ophthalmology department for cataract and glaucoma surgeries.

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.

Apart from clinical and surgical training, the fellows actively participation in journal clubs and clinical presentations in weekly department meetings, case presentations, journal clubs, quiz and academic sessions within and outside the institute.

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.They will get opportunities for direct mentorship, interaction with national and international leaders in the field of glaucoma as well as other subspecialities which will provide invaluable insight into the subject.

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.