Glaucoma Mr. Salil Datta

 Mr. Datta has a subspeciality interest in glaucoma, and will run a clinic dedicated to this group of diseases.  This will facilitate training not only of junior doctors but specialist nurses.  We have already run a pilot scheme for this and intend to roll this out to encmpass all stable glaucomas.

The management of such cases may well include measurement of intra-ocular pressures in the community by local optometrists, and discussions are ongoing in that respect.  We have for several years run a scheme whereby local optometrists monitor patients with ocular hypertension (including using aplanation tonometry).

 Centralisation of glaucoma services will ensure more expertise in glaucoma surgery and facilitate SpR surgical training.

 Visual field service is provided by the Orthoptic department using a Humphrey field analyser, including the latest software and statistics packs.  We have a Keeler Pulsair machine as well as Goldman aplanation.  Stereo photography of optic discs is routinely done in clinic and  forms part of our plans for the nurse led clinics.  We recently obtained a Zeiss OCT machine and this will be available for use on all glaucoma patients.

 Mandatory objectives

 ·       Learn to assess all forms of glaucoma attending the clinic, both new referrals and return patients, discussing care with the consultant as appropriate.

·       Learn to examine the anterior chamber angle using gonioscopy

·       Learn to use the Keeler Pulsair to measure intra-ocular pressure

·       Learn to assess the corneal pachymetry measurements and interpet the intra-ocular pressure measurements in light of the corneal thickness

·       Learn to produce and interpret stereo photographs of the optic disc

·       Learn to produce and interpret OCT images of the opic disc and retinal nerve fibre layer

·       Learn to produce and interpret visual field analysis using the Humphrey field analyser

·       Observe glaucoma surgery, Trabeculectomy or non-penetrating surgery.

 Desirable Objectives

 ·       Perform supervised glaucoma drainage surgery.

 The training given in this subspeciality will enable the trainee to achieve level four competence as set out in the Curriculum of Higher Surgical Training.