3rd May 2015
Small Incision Cataract Surgery
I have started this personal and professional adventure with a month long Small Incision Cataract Surgery (SICS) course in Hyderabad at the L.V Prasad Eye Institute (LVPEI). These courses are run for national and international faculty to expand their surgical skills. I have completed 4 and a half years (out of 5) of ophthalmology residency in Australia and have trained solely in the phacoemulsification technique of cataract surgery so I am looking forward to learning a new technique and exposure to the excellent surgeons and trainers at LVPEI. SICS was developed to provide a rapid, safe and cost-effective cataract service and is largely used in the developing world and resource poor environments. Its equipment requirements are far less than phacoemulsification, requiring just a microscope, or simply surgical loupes in some instances. It is the technique that I will be performing for the subsequent 6 months in Timor Leste (East Timor) as the fellow with the East Timor Eye Program
Hyderabad is located in Andhra Pradesh state in central India and is an easy one stop flight from Australia to Singapore and then directly to Hyderabad. It is by no means on the tourist trail compared to other cities in India but I was looking forward to getting to know the locals as well as the Hyderabadi food. I’d happily eat famous Hyderabad Biryani, a mixed rice rice dish, every day!
I have travelled to India previously but still found arriving an assault on the senses. The traffic, pollution, poverty and density of population can at times be overwhelming but I have also found beauty in the Indian people, their joie de vivre and the vibrancy and colour with which life is lived.
My home for the next 4 weeks is the international hostel located at LVPEI at the Banjara Hills campus. Thankfully a cool and quiet refuge and very comfortable lodgings consisting of a private room and bathroom and communal living area, located above the clinical and surgical sections of the hospital The walls of LVPEI are adorned with beautiful examples of Indian art and the hostel was no exception. The canteen at the hospital provided 3 meals a day for very low cost and there was additional external restaurants across the (very busy) road.
LVPEI is a prestigious and international renewed eye hospital established in 1987 with rigorous residency and fellowship programs. Most residents and fellows do a 12 hour + day for six days a week. The morning starts at 7 with clinical teaching in the main auditorium and this often split into subspecialty departments. There are very fast internet linkups with the other LVPEI campuses and occasionally international speakers.
There are 2-3 doctors doing the one month long SICS training course at any one time. The trainees are a mix of paying individuals such as myself as well as local residents and international fellows. The training courses start at the beginning of each month and continue for 30 days. We are required to assess our preoperative patients the night before surgery as well as our postoperative patients the following day after teaching. The surgical training itself was not in the Banjara Hills campus but rather at a day surgery in the city which reached by ‘auto’ for between 50 -100 Indian Rupees. During surgery we were assisted by a different fellow each day which was extremely valuable in terms of picking up different approaches and ‘tricks of the trade’ of SICS. I was so impressed by their surgical standards as most fellows were trained in extracapsular cataract surgery (ECCE), SICS and phacoemulsifcation and had done roughly 1500-2000 cataract operations after 3 years of residency and 12-18 months of fellowship. It certainly reinforces the fact that nothing beats numbers in terms of experience in cataract surgery. By comparison a registrar (resident) in Australia can expect to have completed 300-500 after 4-5 years of training.
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