Maximizing Glaucoma Fellowship

Dr. Amit Pandey, MBBS, DO, DNB, FICO (UK), FMRF
  • Dr. Amit Pandey completed his Glaucoma fellowship from Sankara Nethralaya, Chennai.
  • He completed his Ophthalmology Residency from MGM medical college, Mumbai. He holds an MBBS degree from SMIMER, Surat.
  • He has been practicing Glaucoma and Phacorefractive surgery at Eye-Q superspeciality Eye hospital since 3 years.

  • He has vast experience in performing Glaucoma, cataract, refractive surgeries. He has performed over 6000 cataract and more than 2000 glaucoma surgeries.

Interview

Q1. Why did you choose Glaucoma as your Superspeciality of interest?

A1. During my post graduation I realized that there is an acute shortage of trained glaucoma specialists in our country and specially in the region where I wanted to practice. Glaucoma is being misdiagnosed and mistreated widely and drastically needs specialized doctors for improving the current scenario. Moreover, the demand of experts in this field will be high for many years, as glaucoma is one of the most common causes of visual loss in our country. Hence, it made perfect sense to choose Glaucoma as my superspeciality of interest.

Q2. Why did you choose Sankara Nethralaya for your fellowship?

A2. I chose Sankara Nethralaya, Chennai, as my Institute for fellowship training. Or should I say, I was lucky to be chosen by the institute. They have one of the best, if not the best fellowship programs in the country. The teachers are world renowned glaucoma specialists and pioneers in this field. Spending ample time in their OPDs, observing them interacting with their patients, assisting them in surgeries and imbibing their practice patterns made all the difference in the world. Also, the infrastructure gave me hands-on with the latest ground breaking equipment in management of glaucoma. Lastly, Sankara Nethralaya is the leading institute in the country in terms of academics and research in the field of Ophthalmology.

Q3. What were your areas of interest?

A3. Management of Neovascular Glaucoma, one of the most devastating types of glaucoma, interested me as many of these patients are left without hope of regaining vision and usually end up with a painful blind eye. However, with timely and aggressive management many of these eyes can be saved. Secondary Uveitic glaucoma was also of special interest to me during the fellowship program. And these interests have percolated now into my practice as well.

Q4. Is it mandatory to have had some surgical experience before joining Glaucoma Fellowship?

A4. It is advisable to have a good exposure to Manual Cataract surgery including Extracapsular and small incision cataract surgery before joining the fellowship. Also atleast some experience with phacoemulsification will be very helpful. This enables one to concentrate more on the glaucoma training and makes it much more simpler to understand and learn glaucoma filtration surgeries. As trabeculectomy and Glaucoma Valve implantation requires expertise in micro suturing techniques, prior experience definitely gives an added advantage.

Q5. How important is wet lab/simulator training according to you?

A5. Wet lab training can definitely be helpful in the initial part of the surgical training or in training of a new surgical technique before performing it on patients. I remember training on Goat’s eyes when Endocyclophotocoagulation was first introduced during my fellowship. The  wet lab training helped me a lot in getting a feel on the instrument and anatomy. That said, simulators and wet lab cannot replace actual training on patients under expert supervision.

Q6. Clinics, Research, Conferences and Surgery – please elaborate on each, your challenges and how you tackled them and experiences.

A6. The Glaucoma fellowship program at SN was very well structured. The initial 6 months of the program was Research fellowship followed by 18 months of clinical work. I utilized the first 6 months to learn data collection, biostatistical analysis and clinical research and could generate 2 international publications as first author, 1 international publication as co-author and 4 posters in national conferences during my fellowship. Each fellow was also sponsored one AIOC and one Glaucoma society of India Conference by the institute if they are presenting any paper/poster/eposter.

We used to have weekly academic sessions where the whole department would discuss journal articles, interesting cases and clinical scenarios. This gave us a balanced mix of clinical and theoretical knowledge about the subject and kept us up to date.

The surgical training was also well designed in a layered manner, starting from ECCE to SICS and Phacoemulsification and Trabeculectomy training going side by side. As majority of glaucoma surgeries are combined with cataract surgery, this kind of coaching was very supportive.

The last 6 months was called Senior Residency where we were given independent OPD and surgical work. As seniors, we also handled surgical complications of junior post graduate students. This trained us to be ready for the next phase of our career and gave us confidence to face the real world.

Q7. How to build a good rapport with your mentor?

A7. A good rapport can be developed in many ways. As many of the senior consultants are busy in their clinical work and do not get enough time to do research work, assisting them in things like data collection and statistical analysis is a good way to start. Demonstrating that you share the same passion in the subject as them will make them take notice of you. Speaking up in academic session shows that you are well read and up to date with the current topics.

Discussing difficult cases with them in their free time also shows your interest in the subject and that you want to fully utilize your fellowship in learning. Showing utmost respect to your seniors will also make them reciprocate. 

Q8. How important is the support of your colleagues?

A8. Fellowship is not always an easy period. Balancing duty timings, family responsibilities and limited resources all can take a toll on you. Having a helpful colleague can be very important. Sharing clerical work, learning the local language, exchanging duties, learning from each other’s mistakes and supporting each other during stressful times are a few of many things a supportive colleague might help you with.

Q9. How to cope up with the stress and not let it reflect in your work?

A9. Stress is part and parcel of a doctor’s life. Accept failure, learn from your mistake and make sure you do not repeat them. Celebrate success and share it with your colleagues. Pursue your passions like singing, dancing, going to the movies in your free time. Exercise and meditation great stress busters. Do not bring your work stress home and vice versa.

Q10. Quick checklist for young aspiring Glaucoma fellows to follow during their fellowship.

A10.

  1. Do not shy away from research. It will help you in many ways.
  2. Build a solid Resume.
  3. Perform atleast 25 trabeculectomies, 5 Glaucoma drainage device implantations.
  4. Assist alteast 10 pediatric glaucoma surgeries.
  5. Glaucoma surgeries do not have a steep learning curve. Pre op evaluation and post op management are the tricky parts.
  6. Surgery is important but not everything during your fellowship. You learn a lot from clinics.
  7. Do your own Visual field analysis and OCT.
  8. Try to publish at least 2 original articles in peer reviewed journals.
  9. Present atleast 1 paper/poster at a national level conference.
  10. Complete your FICO/FRCS during the fellowship. It will be difficult to do it afterwards.
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