Maximizing Refractive Surgery Fellowship

Dr. Zelda Dadachanji, MBBS, MS (Gold Medalist), DNB, FICO (UK), FCRS
  • Dr. Zelda Dadachanji completed her long-term Fellowship in Cornea, Ocular Surface & Refractive Surgery from Narayana Nethralaya, Bengaluru where she also worked as a Clinical and Translational Scientist.
  • She completed her MS Ophthalmology with a Gold Medal from Maharashtra University of Health Sciences & as an alumnus of Nair Hospital (Topiwala National Medical College) in Mumbai. She holds an MBBS degree from the Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai.
  • Her fields of interest include Corneal Transplantation, Cataract and Refractive Surgery, Research on  Keratoconus, Dry eye and its biomarkers.

Interview

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

A1. Ever since I entered ophthalmology, the subject of Refractive Surgery always piqued my interest. As an ophthalmologist-in-training, using the knowledge of optics to give someone spectacle independence was extremely fascinating. I wanted to learn more, but sadly, most postgraduate programs in India do not give much exposure in this field and I knew there had to be more to the nuances of getting your patient that perfect 20/20 (or even 20/16) & that’s when I decided I had to learn it the right way. The fact that I was always drawn towards cornea as a super speciality was an added advantage & I decided to do my fellowship in an institute that gave me an equal balance of both.

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

A2. While choosing a fellowship (both place and branch) you need to evaluate your areas of interest first and do your research as to which place will give you equal amounts of exposure in all your areas of interest. Coming to why I chose Narayana Nethralaya;

As a PG, I attended various CMEs and Conferences where I was exposed to a lot of doyens in the field of Cornea. However when it came to refractive surgery only one name kept recurring – Narayana Nethralaya. After doing my preliminary research I figured it was the best (and probably only) institute where I would not only be exposed to every latest laser platform and surgery; LASIK, SMILE, TransPRK (along with plenty hands-on) but more importantly every diagnostic facility on this planet – all under one roof! Having done my post-graduation from a government college, I yearned to be part of an institute that would also give me some exposure to the world of research. Also, Narayana Nethralaya is known to give its fellows a national and international platform to showcase your work and research – I don’t think any other fellowship in the country lets you attend so many conferences for that matter.

The wet lab training and hands-on surgical experience in cornea at Narayana Nethralaya were already pretty well known and hence the combined Cornea and Refractive Fellowship Programme ticked all the boxes I had on my checklist.

Q3. What were your areas of interest?

A3. My areas of interest were;

  • Corneal Transplantation Surgery – Penetrating and Lamellar Transplants
  • Infectious diseases of the Cornea
  • Keratoconus
  • Ocular Surface Diseases and Rehabilitation
  • Refractive Surgery

So naturally, a fellowship in Cornea and Refractive Surgery became an obvious choice.

Q4. Is it mandatory to have had some surgical experience before joining Cornea / Refractive Fellowship?

A4. You cannot always control the amount of surgical experience you get during your PG training so most fellowships take that into account and structure their training programs accordingly. Be honest with your mentors about your past surgical experience when you start your fellowship.

It is absolutely ok to not have any prior exposure to refractive surgery.

Q5. How to build a good rapport with your mentor?

A5. To find an effective mentor, you need to first identify your goals – this will help you decide who will be a good mentor for you. The best mentoring is a two-way street; don’t take your mentor for granted; don’t be passive. It’s important to work hard, take the time to prepare and to ask questions, and to really put their advice to work. Hard work is always appreciated. Also, if you are lucky, you can have more than one mentor!

Q6. How important is the support of your colleagues?

A6. At any stage of your career, your colleagues will be the people you will have a natural tendency to lean on the most, as they will understand your situation; good or bad. Your effort to make things better for others will improve your own morale. Do not see you colleagues as competition, instead try to learn something from whoever you work with.

Q7. How to cope up with the stress and not let it reflect in your work?

A7. Having a clear goal and the ambition to achieve it, can help you stay focused, energetic, and able to meet new challenges in the workplace. However, don’t let it reach a point when it leads to stress that exceeds your ability to cope. Having a good support system is crucial and this can be your colleagues, friends, and family. Do not forget to pursue your hobbies, watch your favorite shows or read that book you were reading.

Q8. Quick checklist for young aspiring Refractive Surgery fellows to follow during their fellowship.

A8. The key to being a good refractive surgeon is to understand that not everyone is an eligible candidate and to use the best of whatever diagnostic facilities you have to arrive at a decision that is beneficial and safe for your patient.

Keep this in mind while navigating through your fellowship. A few pointers:

  1. Be thorough with your knowledge of optics and refraction – A good refractive surgeon must know how to “Refract”.
  2. See as many topographies you can, and discuss with your mentor/seniors and colleagues.
  3. Learn to take scans on every machine you can get your hands on – learn nuances and finer technicalities from the technicians in your institute – will go a long way to help you take perfect scans when you have your own practice.
  4. The most important aspect according to me in Refractive Surgery is patient counseling – before, during, and after surgery. These patients also happen to be the most demanding set of patients that any ophthalmologist will encounter in their practice so make sure you learn how to deal with them during your fellowship.
  5. Dealing with Complicated cases like Irregular Corneas post-Refractive surgery, post LASIK ectasias, Cataract in patients post-refractive surgery, or in patients with keratoconus are some of the situations best learned during your fellowship and will set you apart from your peers.
  6. Get involved in as many research projects as you can. Good cutting edge research in India is sadly a rarity and if you are fortunate enough to be in an institute that does indulge in it, do not miss your chance.
  7. Don’t worry about the number of surgeries you get. It’s not a competition. The number of surgeries doesn’t make you a good surgeon. It’s how you approach each surgery that matters.
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