Advanced Medical Retina Fellowship at GEI
This comprehensive 12-month fellowship curriculum is structured to transition a general ophthalmologist into a confident, independent medical retina specialist within a high-volume tertiary care setting. Additional skills- Conversant with retinal examination methods – Slit-lamp biomicroscopy with 78 or 90 D lens and Indirect ophthalmoscopy with 20 or 28D lens and scleral depression.
Overview & Objectives
- Clinical Competency: Master the clinical skills for the diagnosis and non-surgical management of adult and paediatric retinal diseases.
- Diagnostic Expertise: Achieve absolute independence in acquiring, interpreting, and correlation of multimodal imaging.
- Treatment Skills: Perform high-volume intravitreal injections and various laser photocoagulation procedures.
- Academic & Research Contribution: Actively participate in teaching programs and conduct clinically relevant research.
Core Content Knowledge
The fellow must master the pathophysiology and clinical presentation of the common retinal conditions like:
- Retinal Vascular Diseases: Diabetic Retinopathy, Retinal Vein/Artery Occlusions.
- Macular Disorders: Age-Related Macular Degeneration (AMD), Myopic Maculopathy, Pachychoroid disease spectrum including Central Serous Chorioretinopathy (CSR) and Polypoidal choroidal vasculopathy (PCV), macular holes/puckers (for surgical referral).
- Hereditary Diseases: Retinitis Pigmentosa, Stargardts disease and other dystrophies.
- Inflammatory and Oncological: Posterior uveitis (Infectious -TB, Viral retinitis or Noninfectious), Ocular tumours (Retinoblastoma, Melanoma).
- Peripheral retinal pathologies: Lattice degeneration, retinal tears
- Paediatric Retina: Standardized screening and treatment for Retinopathy of Prematurity (ROP).
Rotational & Clinical Workflow
The fellowship is divided into four modules, progressively increasing in clinical responsibility and surgical/procedural independence.
Months 1-2 (Module 1): Foundation & Diagnostics
- Focus on comprehensive dilated fundus evaluation using 90D/78D lenses and indirect ophthalmoscopy with scleral depression.
- Observation and supervised performance of diagnostic testing.
- Posting with consultant in the OPD for observation
- Introduction to basic intravitreal injections.
Months 3–8 (Module 2): Guided Independence
- Rotated between various consultants in their OPD to learn clinical evaluation of cases, decision making and appropriate management.
- Independent performance and interpretation of multimodal imaging.
- Initiation of peripheral retinal lasers and regular injection lists.
- Posting in the emergency room to handle acute posterior segment trauma and emergencies
- Months 9-10 (Module 3): Advanced Therapeutics & Research
- Management of complex cases (uveitis, inherited retinal dystrophies, ocular oncology basics).
- Performance of advanced macular lasers (focal/grid/micropulse).
- Weekly visits to NICU for ROP screening with a specialist- also limited hands on training in treatment of ROP (Laser and injections)
- Mid-term research project review and manuscript drafting.
Months 11-12 (Module 4): Transition to Specialist
- Independent decision-making in fast-paced clinics.
- Completion and submission of the research project.
- Final exit assessments and mentoring junior residents.
Procedural & Treatment Log Targets - By the end of the 12-month tenure, the fellow is expected to log a substantial number of procedures to achieve mastery.
Procedural & Treatment Log Targets
By the end of the 12-month tenure, the fellow is expected to log a substantial number of procedures to achieve mastery.
Diagnostic procedures
- OCT and OCT-Angiography: Minimum 2000 OCT and 100 OCTA.
- Angiography- Minimum 300 Fluorescein Angiography and 150 ICG angiography.
- Non-invasive imaging modalities- Minimum 200 each of Fundus Autofluorescence imaging, Multicolor imaging and Optos UWF imaging.
- Ultrasonography Minimum 200 B-scans.
- Electrophysiology - Interpretation of ERG, EOG, and VEP- minimum 40.
Intravitreal Injections (Target: 500+ procedures) Therapeutics: Intravitreal Injections
- Anti-VEGF agents (Ranibizumab, Aflibercept, Brolucizumab, Faricimab, Bevacizumab)
- Sustained-release corticosteroid implants (Ozurdex)
- Antibiotics in Endophthalmitis
- Immunosuppressives (Methotrexate)/ Biologicals (Rituximab) in Vitreoretinal Lymphoma.
Retinal Laser Photocoagulation (Target: 200+ procedures)
- Panretinal Photocoagulation (PRP): Multi-spot and single-spot lasers for proliferative diabetic retinopathy (PDR) and ischemic CRVO/BRVO
- Macular Laser: Focal and grid laser techniques; sub-threshold/micropulse laser applications for chronic central serous chorioretinopathy (CSCR).
- Peripheral Laser: Barrage laser for retinal tears, lattice degenerations.
- Laser by indirect ophthalmoscopy: In ROP, peripheral retinal lesions
Academic Activities & Continuing Medical Education (CME)
A structured weekly academic calendar ensures the fellow stays at the forefront of evidence-based retina care
Weekly Retina Classes: Presentation of
- Seminar presentation – To enhance knowledge on the pathophysiology, clinical presentation and management of the common retinal conditions - Case Presentation- Ambiguous, rare, or challenging cases seen in the clinic during the week, focusing on diagnostic or treatment dilemmas.
- Interesting images of FFA/ ICGA/ OCT/ OCTA/ B scan/ ERG, EOG- focussing on interpretation.
- Bi-Weekly Journal Club: Critical appraisal of landmark retina trials (e.g., DRCR.net protocols, CATT, HAWK/HARRIER, TENAYA/LUCERNE) and emerging literature.
- Retina grand rounds: Presentation of challenging or unusual cases with discussions involving external faculty.
- CME Presentations: The fellow is required to present at least two topics at the institutional or regional CME level to hone public speaking and evidence synthesis skills.
Research Activities
The tertiary care setting offers an immense database for clinical study.
Timeline:
- Month 2: Protocol submission and Institutional Review Board (IRB) approval.
- Months 3–8: Data collection and prospective patient follow-ups.
- Months 9–10: Statistical analysis and abstract submission to regional/national/international conferences (e.g., KSOS, AIOC, VRSI, AAO).
- Months 11–12: Final manuscript write-up ready for peer-reviewed journal submission.
- Requirement: Completion of at least one original research project and one or two peer-reviewed case reports/photo essay during the 12 months.
Periodic Assessments & Feedback
To ensure benchmarks are hit, a strict 360-degree evaluation dashboard is maintained:
- Logbook Review (Monthly): Clinical mentors review injection numbers, laser logs, and diagnostic study interpretations to ensure balanced exposure.
- Workplace-Based Assessments (Quarterly): Direct Observation of Procedural Skills (DOPS) for lasers and intravitreal injections.
- Objective Structured Clinical Examination (OSCE): Conducted at the 6-month and 12- month marks, focusing on rapid multimodal image analysis and management pathways.
- Exit Criteria: A passing grade on the final comprehensive written exam plus clinical viva and submission of the approved research manuscript/ a presentation in a state level meeting are prerequisites for the award of the Fellowship Certificate
