PURPOSE OF PROGRAM
The Glaucoma Fellowship Program in the Department of Ophthalmology & Visual Sciences at the University of Nebraska Medical Center provides individuals with a comprehensive understanding of various kinds of glaucomas. Fellows diagnose and manage patients with complex glaucoma problems, and learn the methods of clinical research applicable to glaucoma. Participation in clinical trials evaluating the effect of promising new agents for glaucoma therapy is expected. An opportunity for basic scientific laboratory research also is available. The fellowship is designed to provide the clinical fellows with a broad experience, including clinical care, surgery, teaching, and research. The surgical training includes participation in advanced techniques of laser, ciliodestructive procedures, valved shunts, filtration procedures with anti-scarring agents, new surgical techniques, and congenital glaucoma procedures. The purpose of the fellowship is to train physicians to become knowledgeable and skillful experts in glaucoma, with encouragement to become academic leaders, by providing the necessary philosophical, scientific and technical grounding. This is a one year fellowship.
EXPERIENCE OF THE CLINICAL FELLOW ON THE GLAUCOMA SERVICE
The fellow's teaching experience has a variety of sources:
- Work up, diagnosis, and management of patients with a variety of glaucoma
- Surgical responsibility: working closely under the supervision of Dr. Rai and Dr. Gulati and occasionally assisting the residents
- Participation in teaching conferences and other less formal conferences designed to cover the entire area of the diagnosis and management of glaucoma
- Participation in formal conferences by presenting papers at national/international meetings, which describe research advances in a variety of areas, including the medical and surgical management of glaucoma
- Weekly research meetings/journal clubs
- Daily meetings after clinic with Dr. Rai, the director of glaucoma fellowship to discuss patients
By the end of the Fellowship Program, he/she should be competent in preparing and delivering informal teaching lectures as well as presentations of a more formal nature at conferences.
Emphasis is placed on both clinical care and research. Fellows are expected to fully manage their patients, including diagnostic, medical, and surgical aspects, and to participate in research.
The clinical fellow is actively involved in the preoperative preparation, surgical performance, and postoperative care of patients with glaucoma and complex cataracts. This includes one, possibly two, half days each week in the operating room, with time spent in preoperative preparation and postoperative care. The surgical experience varies depending upon the fellow's skills and interest, and is designed to enable him or her to perform all surgical procedures related to glaucoma and complex cataract surgery, including trabeculectomy with released sutures, peripheral iridectomy, cyclodialysis, glaucoma drainage devices (including Ahmed, Krupin, and Baerveldt devices), trabeculotomy, cataract extraction (including clear corneal, small incision phacoemulsification under topical anesthesia), combined cataract/glaucoma procedures, the placement of intraocular lenses, and ciliodestructive procedures using a diode laser. In addition, there is extensive surgical experience with the argon and the Nd:YAG lasers including trabeculoplasties, iridotomies, peripheral iridoplasties, and laser suture lysis. Bleb revision procedures include needle lysis, autologous blood injection, and surgical repair.
The fellow is encouraged to participate in clinical research projects, supervised by various members of the staff. The fellow is also encouraged to present research projects in oral form and to prepare papers suitable for publications. They are assisted by members of the staff in the design and performance of these projects, and in the analysis of data and the preparation of papers and presentations.
EVALUATION OF THE FELLOW
Responsibility for evaluation of the fellow lies with Drs. Rai, Gulati and Toris. It will include the following areas:
1) Clinical competence (ophthalmoscopy, gonioscopy, performance and interpretation of visual fields, overall diagnostic evaluation of the patient, formulation of a plan of management, general and specific knowledge regarding therapeutic options and techniques, understanding of the special problems attendant to the long-term management of a chronic disease)
2) Surgical competence (indications for surgery, selection of the proper procedure, preoperative preparation, intraoperative management, postoperative care)
3) Design of clinical studies (preparation of the protocol, patient selection, management, evaluation and analysis of the results)
4) Ability to make oral presentations
5) Ability to prepare papers for publication
6) Leadership abilities
7) Communication skills
8) Overall assessment
Applications for the glaucoma fellowship should reach us before the beginning of September, because we plan to interview selected applicants during October and November in order to meet the deadline for submitting the match list in December. Information and forms relating to the fellowship matching program can be obtained from: Ophthalmology Fellowship Match, P.O. Box 7584, San Francisco, California 94120-7584, tel: (415) 447-0350.
985540 Nebraska Medical Center
Omaha, NE 68198-5540
fax: (402) 559-5514