Comprehensive Ophthalmology Fellowship Programme

Comprehensive Ophthalmology long term fellowship programme at VittalaInternational Institute of ophthalmology (VIIO)/ Prabha Eye Clinic (PEC) is of 18 months duration. The fellowship programme aims to provide adequate exposure to all the subspecialties of Ophthalmology. At the end of the fellowship, the trainee should be competent to run a basic ophthalmology unit independently.


Rotations

    In the final 4 months of training , fellows will have
  • 2 months – further rotation in the sub speciality of choice
  • Final 2 months- independent OPD at VIIO with supervised surgical opportunity at VIIO

Ophthalmology competencies to be gained at the end of the fellowship:

    1. Perform advanced refraction techniques (eg, astigmatism, complex refractions, asymmetric accommodative add).
    2. Perform objective and subjective refraction techniques for routine and complex refractive errors, including astigmatism, irregular astigmatism (eg, keratoconus, keratectasia, post-corneal graft), and postoperative refractive error.
    3. Measure the accommodative power.
    4. Demonstrate the measurement of interpupillary distance (IPD).
    5. Demonstrate the prescribing of multifocal lenses.
    6. Demonstrate the prescribing of lenses for children.
    7. Use of IOL calculation algorithms

Diagnostic procedures (Practical):

1. Use of corneal pachymetry.
2. Use of specular microscopy.
3. Use of ultrasound and optical biometry
4. Use of topographic/elevation corneal evaluation (ie, Pentacam/ topography )
5. Use of Verion system for refractive planning for cataract surgery

Cataract:

Initially the fellow assists in a minimum of 10 cases in OT. After this, one case is given under supervision of DrVandanaSayra, who will grade the competency level of the fellow as per the rubric for cataract surgery proficiency which is available with her. After this a graded surgical training plan is devised for SICS + IOL. After the fellow demonstrates adequate compectency and has completed a minimum of 25 cases, graded training in Phacoemulsification can be started. Here again one case if performed ( if fellow is already having some experience in phaco ) by Dr PRM/ Dr VS and a graded phaco training schedule is put in place. Accelerated training of steps can be done using the wetlab for specific surgical skills.

At the end of the fellowship the fellow should have performed
- 100 SICS
- 25Phaco IOL( can be more depending on the surgical competence of the fellow and his/ her interest)
The fellow should have assisted management of complications like posterior capsule rupture/ Vitreous loss/ nuclear drop/ IOL repositioning.

Cornea and refractive:

Adequate exposure to corneal examination techniques using slit lamp , dry eye evaluationand diagnostic modalities corneal topography/ specular microscopy/ confocal microscopy/ donor eye evaluation .

- Perform pterygium surgery with autologous conjunctival graft , amniotic membrane transplantation by suturing and use of tissue glue
- Assist in planning for corneal cross linking surgeries and perform under supervision.
- Assist in corneal tear repair/ keratoplasties
- Assist in planning for refractive corneal surgeries including LASIK and Femto LASIK, and observe the same.
- Assist in phakic IOL surgery

Glaucoma:

Adequate exposure to diagnosis and medical management of all types of primary and secondary glaucomas. Profeciency in performing Applanation tonometry/ Gonioscopy/ Optic disc assessment/ Interpretation of visual field/ Imaging- OCT and and ONH scans.

- Observe YAG PI, and if possible perform under supervision
- Observe and assist Trabeculectomy and combined phacotrab, if possible steps of trabeculectomy under supervision
- Observe and assist Glaucoma valve implantation
- Observe and assist Cyclodestructive procedures.
- Observe Medical and surgical management of hypotony from overfiltration, bleb leak, choroidals, and other causes

Oculoplasty and Orbit:

Adequate exposure to the diagnosis and management of oculoplastic and orbital conditions, including interpretation of CT/MRI scans.

- Observe/ assist in oculoplastic procedures of Eye lid/ adnexa
- Perform under supervision DCT/ if possible DCR
- Observe/ assist Orbital surgeries.
- Observe/ assist use of BOTOX in oculoplasty.

Squint and pediatric ophthalmology:

Out patient management of pediatric ophthalmology clinic , exposure at pediatric ophthalmology clinic at Indira Gandhi Institute of Child Health Adequate exposure to the clinical assessment of squint/ muscle balance/ binocular vision. Examination of children and assessment techniques including examination under anesthesia.

-Observe and assist squint surgeries
- Observe and assist pediatric ophthalmic surgeries.

Retina:

Adequate exposure to both medical and surgical retina.

- Proficiency in indirect ophthalmoscopy with indentation examination techniques
- Performing and interpreting FFA under supervision
- Performing and interpreting OCT scans of the retina
- Performing and interpreting B Scan ultrasound examination
- Observing and preforming under supervision- Pan retinal photocoagulation
- Assisting in scleral buckle, and complex vitreoretinal surgeries
- Intravitreal injections- antibiotics and anti Vegfs
- Assisting in the assessment of retinal disorders in children including ROP

Uvea and Ocular Inflammation:

Adequate exposure to the diagnosis and management of uveitis and ocular inflammatory disorders.

- Proficiency in clinical evaluation, anterior segment and fundus exams
- Differentiating active vs quiescent disease
- Ordering of investigations appropriately
- Principles of management including appropriate use of steroids and immunosuppressants
- AC tap and Vitreous taps- indications and interpretation
- Pre cataract surgery protocols for uveitic eyes

Research Goals:

The fellow is expected to mandatorily get involved in one / two research projects in the duration of fellowship and present at least one paper, and one poster in a national/ state conference. Attempts towards publishing the research project in a peer reviewed paper should also be made.


Teaching responsibility:

The fellow has to mandatorily commit one hour per week for teaching of optometry residents, and 1 hour per week for DNB residents as part of the teaching programme. As and when assigned , he / she should also be involved in teaching other staff of the hospital for training purposes.


Outside postings/ screening camps:

The fellow has to participate in the screening and OPD activities of the hospital held outside the hospital, when assigned as per roster. The fellow also has to take part in the rural outreach activities of VIIO, as posted.


Eye donation/ eye calls: when on duty the fellow is expected to attend to eye donation calls and collect donor eyes, and coordinate with the eye bank in charge after the eye call.