Student Training

Narayana Nethralaya has been accredited as a post graduate training institute in Ophthalmology by the National board of examinations. Since the last few decades we have initiated and trained several ophthalmologists who are leaving their own footprints in the arena. The intake of candidates for the DNB training, which started with one per year, has increased to eight candidates per year presently.

The academic session starts from June each year. DNB candidates are admitted as per the allotment letter given by the DNB Board, based on the ranklist of the NEET Post-MBBS examination .

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 along with contact lens and low vision aids. They are posted with a particular consultant in each department and undergo vigorous training in their tenure in that specific department. The primary candidates are first posted in the optometry department and get trained in visual assessment methods, refraction and spectacle prescriptions. At the same time they are trained to handle and master the slit lamp biomicroscope, the direct and the indirect ophthalmoscopes, which are the basic but indispensable assists to any ophthalmology OPD. They are trained in various procedures like keratometry, A- scan, lacrimal syringing, visual fields, fluorescein angiography, ICG, fundus photography, anterior segment photography.

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In the department of Cornea, the candidates get to evaluate, diagnose and manage a limitless variety of corneal disorders like corneal ulcers, dystrophies, keratoconus, pterygium, chemical injuries and corneal tears. Along with routine cases they are also exposed to the cutting edge technologies and the most advanced management methods like INTACS, Collagen cross linking and so on for these varieties of corneal disorders. They are skillfully trained in the interpretation of Orbscan, confocal microscope, specular microscope, corneal topography and in the work up of cases for Lasik and other refractive surgeries. They also learn to assist in several corneal surgeries including keratoplasties, corneal tear repair and cross linkings. The candidates are trained in the removal of the donor corneal button and also enucleation procedures.

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In the Retina depatment, the candidates learn to diagnose and manage a variety of retinal disorders and learn to perform and interpret the allied investigations required in the diagnosis like 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 including both LIO and the slit lamp delivery system. They are exposed to PDT and other special procedures for the management of specific retinal disorders like ARMD. They are trained in the formulation and delivery of various intra vitreal injections like intravitreal antibiotics, steroids, Anti – VEGF (avastin and Lucentis) and are taught to give the intravitreal injections. They assist the consultants in surgeries like scleral buckling, vitrectomy and allied procedures.

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In the department of glaucoma, the candidates learn to use the slit lamp biomicroscope with the expert handling of 78D and 90D lenses for examination of the optic disc for all the outpatient cases. They master gonioscopy including 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.

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In the department of paediatric ophthalmology, the candidates are exposed to a huge volume of paediatric eye disorders like congenital cataract, strabismus concomitant and paralytic and disorders of the lid and the lacrimal system. The candidates learn to take vision in childern using special charts like the Teller visual acuity chart, Allen picture cards. They are trained in the evaluation and 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.

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In the Oculoplasty department, the candidates learn to evaluate various disorders of the lacrimal system and learn their management including probing, silicone tube intubation, external DCR, laser DCR, endoscopic DCR and DCT. They learn the management of lid disorders like ptosis, entropion, ectropion, lid tears and reconstruction of the lids. They are exposed to the section of aesthetics including a variety of cosmetic procedures on the lids and adjoining face including Botox injections. They are also exposed to the use of prostheses and management of ocular tumors.

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In the cataract and refractive lens surgery department, the candidates learn about the latest techniques of cataract extraction including phacoemulsification, micro-incision phaco, Femtolaser assisted Phacoemulsification and learn the usage of advanced IOLs including multifocal, abberation free IOLs and ICLs.

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In the Uvea department, the candidates are trained to diagnose infective and non infective inflammatory disorders of the uveal tract and ocular manifestations of systemic diseases. Candidates get to attend and follow up on cross referrals to and from other subspecialties such as rheumatology and Immunology. They also get systematically trained in detailed history taking with special emphasis on systemic disorders. PGs also get trained in the indication, presentation and monitoring of immuno modulatory therapy.

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Our Institution also contributes to community ophthalmology in a significant 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.

Candidates also get hands on training in Phacoemulsification in their final year. Wet lab facilities are also available to students where they get to practice cataract and other surgeries and perfect their techniques prior to operating on patients. Regarding the teaching schedule, six days a week classes are conducted 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 receive expert guidance in completion of their thesis by consultants from the specific department. 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 also have a series of accolation and awards for the same. They are also encouraged to participate in various 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 and they are encouraged immensely to contribute and provide their inputs in the field.

 

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