- 17 Sep, 2024
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Surgical Retina Fellowship
Surgical Retina Fellowship
A surgical retina fellowship is a specialized training program that offers trainees
the opportunity to gain expertise in the field of surgical retina.
The purpose of such a fellowship is to provide comprehensive, structured,
and hands-on training and experience in the medical and surgical management
of vitreoretinal diseases and uveitis.
Extensive surgical experience and clinical and basic science research opportunities
help to maximize the fellows’ transition to a successful career in an academic or private practice setting.
A well-designed and executed surgical retina fellowship is an important step toward
developing the next generation of leaders in vitreoretinal disease and surgery.
Benefits of Pursuing a Surgical Retina Fellowship
A surgical retina fellowship comes with many benefits:
– It allows for recent graduates of ophthalmology residency programs to bolster their knowledge
in vitreoretinal diseases and complex surgical cases.
– This can help jumpstart a successful career in the treatment of vitreoretinal diseases.
– In addition to the advanced medical and surgical knowledge gained during the fellowship,
the ability to build personal confidence in treating complex cases is a major benefit.
Retina specialists are often consulted for patients with vague symptoms or vitreoretinal
findings that are difficult to diagnose or manage.
– The exposure and guidance received from leaders in the retina specialty is a major advantage
of committing to a surgical retina fellowship.
– Surgeons’ major surgical experience includes complex retinal detachment repairs of all types,
including proliferative vitreoretinopathy, giant retinal tears, macular holes, and epiretinal membranes.
– Surgeons in the program have experience with numerous complex cases,
including retinal detachment repair of all types, ocular trauma, diabetic vitrectomy,
advanced macular surgeries, and surgeries for complex proliferative diabetic retinopathy.
– The fellowship provides experience with preoperative and post-operative management.
Surgical Retina Fellowship Curriculum
The curriculum of a surgical retina fellowship is designed to provide advanced fellows
with the necessary skills and knowledge to be a successful surgeon
and consultants in the field of surgical retina.
The training includes a broad exposure to the diagnosis and management of vitreoretinal diseases,
followed by increasing experience in surgical techniques and procedures.
The first phase covers mostly vitreoretinal surgical training.
The second and third phases start to include more complex vitreoretinal surgeries
including macular and retinal detachment cases, and fellows will gradually
spend more time in the operating room.
Surgical retina fellowships are divided into two parts. The first section is usually theoretical.
The second is predominantly clinical
The first section starts with the basics of examination such as indirect and direct ophthalmoscopy.
There is a progression to more complex surgery in theatres.
The second section builds upon this, and there is more work in theaters
and an increasing volume of surgery to be performed.
The experience is consultant-delivered care with the fellow gaining increasing independence.
Wet lab experience is vital, and this is offered as a built-in part of the curriculum
The surgical retina fellowship aims to train individuals to a level beyond that of core training
to a standard at which they may be appointed as a substantive consultant in a similar post.
This involves not only providing excellent instruction and experience in all aspects
of the surgical retina but also the development of leadership and research skills.
Candidates are selected based on their experience and referred and a true desire
to undertake a career in the surgical retina.
This fellowship looks to provide excellence in patient care and to develop future leaders in the field.
Each candidate may have varying degrees of vitreoretinal surgical skills depending
on their background and previous experience.
The curriculum and rotation that they follow must seek to build on these skills further
enhance them and support the overall aim of the fellowship.
Overview of Surgical Retina Fellowship
The fellowship program covers a broad range of topics with a focus on surgical retina.
Clinical experience makes up the bulk of the curriculum, with extensive exposure to retinal surgeries and clinics.
The program is designed to provide comprehensive and hands-on training in all aspects
of the surgical retina, including preoperative evaluation, operative techniques,
and post-operative management.
This also includes the use of modern microsurgical equipment and various laser systems.
In addition, the program emphasizes a smooth transition and cultivation of independence
in the fellow’s transition to becoming a successful vitreoretinal faculty member.
Management of Retinal Diseases
Management of retinal diseases includes a broad spectrum of medical,
laser, and surgical options. The management strategy depends on the type and
cause of the retinal condition, the extent of the disease, and the condition of the fellow eye.
Through a Surgical Retina Fellowship, many retinal diseases are studied, as follows:
– Macular diseases are the most common cause of blindness in the developed world.
Intravitreal therapy has revolutionized the management of wet age-related macular degeneration,
macular edema, and macular vein occlusion.
Fellows will have the opportunity to learn about the most recent advances in the field of intravitreal
therapy and will participate in the delivery of the service.
– Retinal vein occlusion is a common sight-threatening vascular disease,
and it can affect both central and branch veins. In the presence of significant macular edema,
laser therapy can help to reduce the chance of further visual loss.
Surgical treatment is available for various retinal conditions, including retinal detachment,
epiretinal membrane, macular hole, subhyaloid hemorrhage, and extensive vitreous hemorrhage.
Hands-on Surgical Training
The hands-on surgical training starts from the first of the surgical retina fellowship
and continues throughout the fellowship.
In the beginning, the fellow focuses on mastering the scleral depressed and the straight needle.
After acquiring a certain level of comfort in the surgical room,
the next step is to perform vitrectomies in the wet lab.
By gaining experience in the use of the vitrectomy system, the fellow can transform
theoretical knowledge gained from didactic training into hands-on experiences.
The fellow also learns how to use a surgical microscope, a diagnostic fundus camera,
and a research electronic ophthalmic surgical image capture software.
As the surgery experiences grow, the fellow starts to take on more responsibilities in the operating room.
By the end of the fellowship, the goal is to enable the fellow to perform vitreoretinal surgeries,
and some of these surgeries are independently performed by the fellow.
The fellow will also become competent at scleral depressed indirect ophthalmoscopy,
which is useful intra-operatively and in a comprehensive ophthalmology practice.
By performing surgeries across the entire spectrum of vitreoretinal diseases,
the fellow will be fully prepared for a career in either academic medicine or private practice.
Surgical Techniques and Procedures
The Surgical Retina Fellowship covers not only medical and surgical treatment of vitreoretinal
diseases but also provides a systematic approach to the management and consultation of complex cases.
The management of vitreoretinal diseases, including macular degeneration, diabetic retinopathy,
and retinal detachment, has greatly involved the applications and advancements of various imaging technologies.
Fellows must have a complete grasp and in-depth understanding of these technologies,
including the latest 3-D OCT and OCTA, fundus autofluorescence, fluorescein angiography,
B-scan ultrasonography, electrophysiology studies, microperimetry,
and genetic testing, to deliver the best surgical outcome and patient care.
In this section of the curricular training program, the vast majority of the surgical procedures
and treatments would be instructed and performed by our faculty.
By repeated exposure to surgeries with emphasis on delicate tissue handling, wound construction,
instrument selections, and proper use of energy devices, fellows would master all surgical
skills required to become successful vitreoretinal surgeons.
Exposure to Various Retinal Diseases and Conditions
During the A surgical retina fellowship, clinical experience is acquired through exposure
to various retinal diseases and conditions including diabetes, age-related macular degeneration,
retinal tears and detachments, hereditary retinal disorders, uveitis, and intraocular infections.
The fellow is trained in taking a tailored and comprehensive history,
as well as acquiring a targeted and detailed clinical examination.
The fellow is also trained in all relevant investigative and diagnostic techniques
that are routinely used in the field of medical retina.
These techniques include visual acuity assessment, slit-lamp and fundus examination,
intraocular pressure measurement, optical coherence tomography,
fluorescein and indocyanine green angiography, and electrophysiological investigations
such as electroretinogram and electrooculogram.
Emergencies
During a vitrectomy, in which the retina is typically manipulated, drainage of subretinal fluid
can create a retinal break.
It is important to respond quickly to any findings of a retinal break to repair it as soon as possible
and improve the chances of better visual recovery.
Retinal breaks that are repaired within a few days of being diagnosed generally carry an excellent prognosis.
However, failure to repair the break promptly can lead to retinal detachment and permanently
decreased vision or even blindness.
Fellows are taught, at surgical retina fellowship, how to reduce patients with periocular
or retrobulbar anesthesia as necessitated for performing urgent procedures.
Assessment Methods
The assessment is done essentially through direct observation of the competence of the fellows by faculty members.
This is done through the use of an evaluation form known as the Direct Ophthalmoscope Evaluation
or the Indirect Ophthalmoscope Evaluation.
These forms are used to evaluate the ability of the fellows to perform a detailed
fundus examination with the direct and the indirect ophthalmoscopes.
The regular assessment of the surgical logs and the evaluation of the quality of the surgical
procedures submitted in these logs is another method used to assess the fellow’s progress.
Each fellow’s surgical experience is reviewed frequently to ensure that the volume as well as the complexity
of the surgeries performed is appropriate and meets the fellowship requirements.
Fellowship Completion Criteria
– Before completing the fellowship, there is a requirement to pass the written examination
administered by the American Board of Ophthalmology.
– The fellow should actively participate in the clinical and surgical activities of the fellowship program,
and it is necessary to show satisfactory performance in these activities.
Such satisfactory participation and performance are determined by the Program Director.
– The fellow should be eligible for certification by the American Board of Ophthalmology.
This is a mandatory condition.
The successful completion of the Surgical Retina Fellowship program does not necessarily
mean that the fellow will be awarded the certificate of successful completion if he/she falls
short of satisfying the conditions required for this certification.