Residency training in India

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Indian Journal of Ophthalmology

Residency training in India

References 1.

Thomas R, Dogra M. An evaluation of medical college departments of ophthalmology in India and change following provision of modern instrumentation and training. Indian J Ophthalmol 2008;56:9-16.

2.

Grover AK. Postgraduate ophthalmic education in India: Are we on the right track? Indian J Ophthalmol 2008;56:3-4.

Dear Editor, We read with interest the article by Thomas et al. 1 They highlighted an important issue in their article on standards of ophthalmic education in the country.1 What is shocking is the absence of any signiÞcant improvements over an eight-year period. This would suggest that improvements in infrastructure alone are inadequate to address this problem. In the accompanying editorial Grover recommends setting up an advisory board.2 A smaller body comprising persons who have run programs that have actually achieved the benchmarks recommended for education would be a better option, instead of a monolithic body comprising “ex-officio” members who do not necessarily have a track record in education. There is no question that state-of-the-art ophthalmic care is available in both the private and public sector in the country. In such a setting are we justiÞed in claiming to have provided appropriate ophthalmic training for residents who have been allowed to perform less than 10 cases of cataract surgery in their three-year courses? Perhaps the most telling commentary on training in the country are the various courses that offer to teach slit-lamp examination, gonioscopy or indirect ophthalmoscopy to those who have completed postgraduate training !! A certain proportion of ophthalmology graduates make the effort to upgrade their skills. Those who are unable to do so because of Þnancial or other constraints are unlikely to provide appropriate standards of care to their patients both to start with, and for the three to four-decade duration of their professional career. The postgraduate practical examination system is pointless in the current form. Having gone through examinations conducted by various agencies within the past decades I can attest to the fact that it is purely theory-based. The term “practical” examination seems to have lost its meaning. What matters are how many causes or differential diagnosis you can recall and not how the patient was examined. This is far removed from the medical and surgical practical examination at the undergraduate level where more often than not, one is asked to demonstrate an examination technique or test at the bedside. In addition, the quality of equipment provided at some recognized examination centers is unacceptable for patient evaluation, let alone an examination. Many residents trained at the better residency programs in the country are actually penalized because “you know only the high-tech stuff and cannot spout the examiners favorite lines from the older edition of an undergraduate textbook.” Perhaps part of the reasons for this is lack of familiarity. Do we need to initiate certiÞcation for examiners to ensure that basic levels of competence are met, instead of continuing to rely on “senior” examiners (whose basic training may never have reached the prescribed standards)?

Ronnie George, MS Medical Research Foundation, Sankara Nethralaya, Chennai, India Correspondence to Dr. Ronnie George, Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai600 006, India. E-mail: georgejronnie@rediffmail.com

Vol. 56 No. 6

Sustained closure of surgically repaired macular hole after proliferative vitreoretinopathy Dear Editor, There are some reports in which a persistent closure of a surgically repaired macular hole in patients with subsequent retinal detachment (RD) with submacular ßuid is described.1-4 Here, we report a patient with postoperative macular hole closure who subsequently developed proliferative vitreoretinopathy (PVR) with submacular ßuid. Despite the submacular ßuid and tangential traction due to PVR, the macular hole remained closed. A 66-year-old man presented with a two-month history of decreased visual acuity and metamorphopsia in the left eye. On initial examination, his best-corrected visual acuity was 20/200 in the left eye. Fundus examination and optical coherence tomography (OCT) disclosed an idiopathic Stage 3 macular hole [Figures 1A, 2A]. The patient underwent pars plana vitrectomy combined with phacoemulsification, intraocular lens implantation, internal limiting membrane peeling, and sulfur hexaßuoride gas tamponade. Intraoperatively, a large iatrogenic oral dialysis was found in the superonasal quadrant, and scleral bucking was added. The patient was kept face down positioning for 10 days. The patient was asked to maintain facedown position for two weeks. Two weeks later, his visual acuity was 20/100 in the left eye. The anatomic closure of the macular hole was achieved and confirmed by OCT [Figures 1B, 2B]. There was no rhegmatogenous RD. Twelve weeks after the initial vitrectomy, visual acuity decreased to 20/300. Proliferative vitreoretinopathy (Grade CP-12, Type 1) with submacular ßuid had developed [Figure 1C]. No defect was observed in the fovea and the previous iatrogenic oral dialysis became unsealed partially. The OCT images demonstrated submacular RD without the reopening of the macular hole [Figure 2C]. Vitrectomy with membrane peeling and silicone tire encircling was performed and retinal reattachment was achieved. The patient kept face down positioning for two weeks. The patient was asked to maintain facedown position for 10 days. After the second surgery, the macular hole remained closed and Þnal visual acuity was 20/200. A histopathologic study of repaired macular holes after vitrectomy has shown the plugging of a retinal defect by glial tissue.5 Hainsworth et al.,1 reported four patients who underwent a successful surgical closure of macular holes and subsequently