Glaucoma Fellowship

David Crandall, M.D., Program Director
Hannah Lanthier, Fellowship Program Coordinator
Email: hlanthi1@hfhs.org

Overview

The Glaucoma Fellowship is designed to provide an in-depth 12 month exposure to all facets of glaucoma management with an emphasis upon evaluating patients with complex ocular problems and developing excellent surgical skills. The fellow is an integral member of the Glaucoma Service and is credentialed as junior faculty. The fellow will rotate primarily with Dr. David Crandall, but will have a close working relationship with the other members of the glaucoma service.

Goals & objectives

Upon completing training, the fellow will have developed the knowledge and skills necessary to independently manage a busy glaucoma service. The following skills will be gained.

1. Diagnosis of all forms of glaucoma
2. Appropriate pharmacological management of glaucoma
3. Surgical competency in performing trabeculectomy, Ex-Press shunt surgery, glaucoma drainage device placement, combined glaucoma and cataract surgery and management of complex cataracts
4. Performance of glaucoma lasers including LPI, trabeculoplasty and cycloablation
5. Gonioscopy
6. Understand the principles of managing juvenile and pediatric glaucoma
7. Interaction with other ophthalmic specialties for diagnosis and treatment of complex ocular pathology requiring an interdisciplinary approach
8. Mentoring residents in the clinic and operating room settings
9. Obtain an introduction to clinical research culminating in a presentation at our annual alumni day meeting
10. Develop a life-long commitment to ongoing learning

Clinical training

The fellow will work in conjunction with the glaucoma staff, residents and technicians in examining patients in clinic including complete ophthalmic histories and examinations on new patients and appropriate interval histories and examinations on return patients. The fellow will become competent to:

• Identify angle structures with gonioscopy and determine the likelihood that the angle is occludable
• Assess the optic disc with biomicroscopy using 90D lens or fundus contact lens
• Evaluate disc photos
• Interpret visual fields
• Interpret OCT

Laser procedures:

• Document appropriate indications for all laser procedures
• Performance of glaucoma lasers including LPI, trabeculoplasty and cycloablation
• Document performance of all laser procedures

Surgical training

The fellow will operate with Dr. David Crandall and Dr. Nauman Imami. The fellow will also have the opportunity to operative with all members of the glaucoma service. The fellow will also staff residents performing anterior segment surgery when Dr. Crandall determines his or her surgical skills have progressed appropriately. In addition to learning multiple forms of glaucoma surgery, the fellow will also be exposed to complex anterior segment surgery including IOL exchanges, scleral fixation of IOLs, goniosynechialysis, anterior segment reconstruction and combined cataract surgery and vitrectomy. The selection of fellow cases will be based upon the individual fellow's surgical skills and graded increase in surgical experience will occur throughout the fellowship. The fellow will also have exposure to pediatric glaucoma with Dr. Segar.

The fellow should utilize the state of the art ophthalmic surgical simulator suite to prepare for surgical procedures.

Assessment

1. The fellow will have ongoing verbal evaluations during the year along with formal written evaluations twice a year.
2. A global, competency-based written evaluation will be completed by the fellowship director at the end of the fellowship.

Requirements

1. Successful completion of an ACGME accredited Ophthalmology residency program
2. Full Michigan medical licensure (not a training license) prior to commencement of training

We participate in the San Francisco Matching Program. Applications must be submitted through the Ophthalmology Fellowship Matching Program.