Glaucoma

To acquire experience beyond that of the normal residency in the diagnosis and management of various glaucomas. This will be done primarily with a glaucoma trained specialist at the Eye Institute. There may also be opportunity to acquire medical and surgical experience with other glaucoma attendings at the Eye Institute as well as the Riverside Eye Care Center.

Experience in congenital glaucoma will occur and possibly also with our paediatric ophthalmologists

Specific Educational and Training Objectives
  • To review and develop knowledge, skills and approaches relevant to etiology, pathogenesis, diagnosis, treatment, and prevention of glaucoma.
  • To understand the classification and pathophysiology of primary open angle and angle closure glaucomas as well as various secondary glaucomas
  • To review the management of co-existing cataract and glaucoma.
  • To develop good judgement regarding medical, laser, and surgical treatment of various complicated types of glaucoma. Specifically to understand the indications/contraindications for and to be able to carry out the followings:
    • Medical Therapy – choice of first line and adjunct therapy tailored to each patient;
    • Laser Iridotomy – for occludable angles, treatment of angle closure glaucoma (including fellow eye), combined mechanism glaucoma, and pigment dispersion syndrome (if indicated);
    • Laser Trabeculoplasty – argon and selective lasers;
    • Cyclophotocoagulation - external (diode), transpupillary (argon), endoscopic (diode);
    • Trabeculectomy - with mitomycin C and/or 5-Fluorouracil (5-FU);
    • Combined Cataract and Trabeculectomy - with mitomycin C or 5-FU;
    • Aqueous Drainage Device – e.g. Ahmed valve
    • Newer approaches to surgical management of glaucoma (as appropriate)
    • Goniotomy and Trabeculotomy – for congenital glaucoma
  • To understand the side effects and complications inherent in the above therapies and options and to be able to prevent and/or best manage side effects and complications.
  • To become familiar and experienced with the use of diagnostic equipment for the diagnosis and differential diagnosis of various glaucomas These include but are not limited to: pachymetry, gonioscopy, ultrasonic biomicroscopy, B scan ultrasonography, OCT, HRT, mERG, CT and MRI scan of the orbit and chiasm and various blood tests required to rule out secondary causes of optic atrophy.
  • To instill a deep rooted sense of responsibility for glaucoma patients who often require lifelong follow-up care with appropriate support services. To demonstrate the highest ethical standards when developing rapport with and engaging in treatment of glaucoma patients.
  • To understand the value of basic, clinical, and population research in furthering the understanding of etiology, diagnosis, and the treatment of glaucoma. To participate in at least one glaucoma-related research project and present at resident/fellow research days, as well as at a major international ophthalmic meeting.
  • To participate in teaching of medical students and residents
  • To understand principles behind leadership and management roles related to the practice of glaucoma (in an academic and community practice setting). To appreciate considerations in the optimal utilization of finite resources.
  • To submit for publication at least one paper in a peer-reviewed ophthalmic journal during the course of the fellowship.
Education and Training

There are a number of structured educational components:

1. Clinics

At the Eye Institute, clinical time will be on Monday and Thursday all day as well as Friday morning. Additional experience will be available with other glaucoma specialists. The Fellow will be required to dictate a new consultation or follow-up report if the supervising physician so requests.

2. Direct Operating Room Experience

At the Eye Institute, Surgical experience will be obtained by attending the operating theatre on weekly basis (every Tuesday morning and some Wednesdays once or twice a month). The Fellow will be responsible for dictating cases that he/she assists on or filling in the equivalent of a dictation record (standard OR sheet).

3. Laser Experience

The Fellow will have an opportunity to observe and perform several versions of each type of laser procedure by the end of his/her fellowship.

4. Research Experience

The Fellow will be required to complete a research project each year. This will be carried out with one supervisor chosen from the above group of doctors. The Fellow will also be encouraged to write up results in the form of a paper to be submitted to a peer-reviewed ophthalmic journal as well as a presentation to at least one major ophthalmology meeting in North America.

5. Educational Sessions

Once a week (either Monday 8:00 – 8:45am or Tuesdays 12:00 – 12:45pm) the Fellow will meet with Program Director or a designate, to review a topic pertinent to glaucoma.

Once a month (at Professor’s rounds arranged by the Dept.) the Fellow will present an interesting and relevant case to resident staff at the Eye Institute and facilitate a discussion with them on the topic.

The Fellow will be required to attend Wednesday morning grand rounds and the Dept. Journal club, which is held once a month. The Fellow may attend additional teaching sessions that are organized for residents (e.g. Friday mornings or as part of the basic science course) if relevant to glaucoma.

The Fellow may attend evening sessions on glaucoma (for community ophthalmologists) given by Ottawa Eye Institute faculty or visiting professors on glaucoma.

A Glaucoma Journal Club will be held once every three to four months at an Ottawa Eye Institute staff persons home with all Fellows, staff and residents on the glaucoma rotation present. The fellow will be responsible for organizing the Journal club. Two articles pertaining to glaucoma from recent issues of major journals will be critically reviewed by the Fellow and/or resident and then discussed in detail by the group.

The fellow will participate in discussions and at least one structured educational experience related to leadership and management skill development.

Textbook and other Education Resources

The main textbook that the fellows will be required to master is Shields Textbook of Glaucoma - 5th Edition.

For more information on the Glaucoma fellowship program, please contact Ginette Snook, Departmental Education Program Coordinator. All Foreign Trainee applications to our program must go through the PGME office. Foreign Trainee candidates must apply on-line through the Fellowship application system. The application site for Foreign Trainnees opens in July/August and the deadline for applications is September 30th for the next academic year. All Foreign Trainee candidates are expected to apply to both the SF Match and the PGME Foreign applications.

Back to top