Narayana Nethralaya was given the privilege of imparting post graduate training in Ophthalmology by the National board of examinations after assessing the patient load and the infrastructure of the hospital. The intake of candidates for the DNB training has increased from one seat to three seats now.
The academic session starts from January each year. DNB candidates are admitted as per the alotment letter given by the DNB Board.
Once selected, the candidates undergo an orientation programme with respect to the functioning of the institute, the various departments, the teaching programmes and their duties during their tenure in the Institute. The candidates are posted in both the hospitals owned by the Institute on rotation.
The candidates are rotated through various departments including Cornea, Retina, Paediatric ophthalmology, Oculoplasty, Uvea, Glaucoma, Cataract and refractive lens surgery, Community ophthalmology and contact lens and low vision aids with the particular consultant.. The primary candidates are first posted in the outpatient and get trained in visual assessment methods, refraction and spectacle prescriptions. At the same time they get to handle the slit lamp biomicroscope, the direct and the indirect ophthalmoscopes. They are trained to do various procedures like keratometry, A- scan, lacrimal syringing, visual fields, fluorescein angiography, ICG, fundus photography, anterior segment photography.
In the department of Cornea, the candidates get to examine (and learn management of) variety of corneal disorders like corneal ulcers, dystrophies, keratoconus, pterygium, chemical injuries and corneal tears. They are exposed to the management of these conditions, and also to the recent methods of handling some of the conditions mentioned above, like INTACS, Collagen cross linking for moderate to severe keratoconus. They are trained in the interpretation of Orbscan, corneal topography and work up of cases for Lasik. They assisst various types of keratoplasties in the Operation theatre, like Penetrating keratoplasty, deep anterior lamellar keratoplasty and therapeutic kertoplasty. The candidates are trained in the removal of the donor corneal button and also enucleation procedures. They are also exposed to confocal microscope and specular microscope.
The candidates learn to diagnose a variety of retinal disorders and allied investigations required like the B-scan, Fundus fluorescein angiography, Indocyanine green angiography, OCT, ERG, Multifocal ERG , VEP and EOG. All candidates during their posting in the Retina department are given hands on training in laser photocoagulation, both LIO and the slit lamp delivery system. They are exposed to PDT and other special procedures for the management of ARMD. They are trained in the formulation of various intra vitreal injections like intravitreal antibiotics, triamcinolone, Anti – VEGF (avastin and Lucentis) and are taught to give the intravitreal injections. They assisst the consultants in scleral buckling, vitrectomy and allied procedures.
In the department of glaucoma, the candidates learn to use the slit lamp biomicroscope with the 78D and the 90D lenses for examination of the optic disc for all the outpatient cases. They get to do gonioscopy, the 3-mirror and 4-mirror gonioscopy. They get hands on training in Yag laser iridotomies and selective laser trabeculoplasty (SLT). The candidates are exposed to various investigational procedures like visual fields, both Humphery and Octopus, RNFL analyzer-GDX and OCT, optic disc analyzer- the HRT II, the UBM and their interpretations. They assist the consultant in various glaucoma surgeries like trabeculectomy, combined surgeries, phaco trab and trabeculotomy and also get hands on training in the above procedures.
In the department of paediatric ophthalmology, the candidates are exposed to all types of paediatric eye disorders like congenital cataract, strabismus concomitant and paralytic and disorders of the lid and the lacrimal system. The candidates get to use the various types of visual chart for different age groups like the Teller visual acuity chart, Allen picture cards. They are trained in the management of amblyopia, measurement of deviation using prisms, tests for stereopsis and the synoptophore. They assist the consultant in various strabismus surgeries and paediatric cataract surgeries.
In the Oculoplasty department, the candidates learn about the various disorders of the lacrimal system and their management like probing, silicone tube intubation, external DCR, laser DCR, endoscopic DCR and DCT. They learn the various methods of managing lid disorders like ptosis, entropion, ectropion, lid tears and reconstruction of the lids. They are also exposed to the use of prostheses.
In the cataract and refractive lens surgery department, the candidates learn about the latest techniques in the management of cataract-phacoemulsification, microphaco, various IOLs – multifocal, abberation free IOLs and ICLs.
In the Uvea department, the candidates get to diagnose various infective and non infective inflammatory disorders of the uveal tract including HIV and its ocular manifestations. Candidates exposure to cross referrals to other subspecialties such as rheumatologist, Immunologist. Candidates also get systematically trained in detailed history taking with special emphasis on systemic disorders. PGs also get exposed to indication, presenting and monitoring of immuno modulatory therapy.
Our Institution is into community ophthalmology in a big way. Screening camps are conducted in various far flung areas and selected subjects are operated for cataract at the base hospital. The DNB candidates are involved both in the screening and surgical procedures of these patients under the guidance of the camp organizer and the concerned consultant. The DNB candidates get to operate cataracts, first under the supervision of a consultant and later independently in the camp set up. The candidates are taught small incision cataract surgeries and various other techniques like the Bluementhal technique.
Phacoemulsification is taught to the candidates in the final year. Wet lab facilities are available to students.
Regarding the teaching schedule, three days in a week are reserved for DNB training. They include case presentations, seminars and journal clubs based on the DNB curriculum. Our institute subscribes to both foreign and Indian journals. The library is equipped with latest editions of books in most of the sub specialities. The candidates are helped by the consultants in their thesis from time to time. Our institute has internet facilities and teleconferencing equipment for the benefit of the candidates. Our candidates are encouraged to present cases and papers at various CMEs, State and National conferences. They have even received awards for the same. They are encouraged to participate in the clinical trials conducted at the institute and also contribute to articles in various journals. Due recognition is given to the research work done by the PGs. For example post graduates have co-authored original work in peer-reviewed journals.