Department of Ophthalmology

Glaucoma and Anterior Segment Fellowship

Supervisors
•    Dr. Christoph Kranemann, Fellowship Director
•    Dr. Catherine Birt

Contact Information

Dr. Christoph Kranemann
1260 Lawrence Avenue East,
North York, ON M3A 1C4
Tel: 416-289-4000 
Fax: 416-289-2318
Email: christophkranemann@rogers.com

Dr. Catherine Birt
Sunnybrook Health Sciences Centre
M1 302a, Department of Ophthalmology
2075 Bayview Avenue
Toronto, Ontario, M4N 3M5
Tel: 416.480.5882
Fax: 416.480.4481
Email: Catherine.Birt@sunnybrook.ca

Locations
•    Sunnybrook Health Sciences Centre
•    Kensington Eye Institute
•    St. Michael's Hospital
•    Credit Valley Hospital

Sunnybrook Health Sciences Centre
M1 302a, Department of Ophthalmology
2075 Bayview Avenue
Toronto, Ontario, M4N 3M5
3000 Lawrence Avenue East
Building C, Room 12
Toronto, Ontario, M5P 2V1

The Fellow is expected to be on premises at a minimum of Monday to Friday, 8:00 a.m. to 5:00 p.m. regardless of clinical activities. The Fellow is expected to be available for weekend clinical evaluations of post-operative cases or any complicated glaucoma patients. All time not occupied by patient responsibilities must be used to further academic pursuits such as research and teaching. All absences during the week must be cleared well in advance.

Fellowship Objectives
1.    Exposure to and competence in diagnosis and management of the full spectrum of glaucoma disorders
2.    Primary focus is in juvenile and adult glaucoma with some exposure to congenital/pediatric glaucoma
3.    Exposure to and competence in advanced anterior segment surgery
4.    Design, conduct, analyze, present and publish relevant clinical and/or basic research in glaucoma/anterior segment diseases
5.    Prepare for practice in a tertiary-level/academic setting
6.    Participate in medical education activities to colleagues, residents, and medical students, including journal clubs, small group teaching, and weekly departmental rounds.

General Description
The candidate will be exposed to and trained in the most advanced diagnostic and surgical techniques in the management of anterior segment and glaucoma problems. A special focus will be placed on the role and development of diagnostic glaucoma technologies including, but not limited to, methods of optic nerve imaging and IOP determination as well as the biomechanical properties of the cornea. Special emphasis will be placed on the latest innovations in glaucoma surgery, in particular new lasers in glaucoma, developments in non-penetrating glaucoma surgery, the application of endoscopy to glaucoma surgery and tube shunt surgery. There is also a particular interest in the management of iris abnormalities, and dislocated cataracts and intraocular lenses.

Clinical Duties
The Fellow will spend 6 month rotations with each of the glaucoma consultants. Approximately 80% of the time will be spent in clinical responsibilities. This includes all aspects of adult and paediatric glaucoma care including glaucoma diagnostic workup and medical management, as well as laser and surgical procedures. These will be done under the supervision of the consultant.

The supervisors have busy tertiary care glaucoma practices. In addition to the outpatient clinics, there are significant laser and surgical volumes. Laser procedures performed include laser iridotomies, selective and argon laser trabeculoplasties, laser gonioplasty, laser suture lysis, and laser cycloablation procedures.

One of the hallmarks of this fellowship is heavy advanced surgical exposure and hands on training. The Fellow can expect to be in the OR from one to two days a week. When skilled, the Fellow will be well qualified to handle the most complex of advanced glaucoma, cataract or anterior segment surgical problems with the most innovative techniques available.

Glaucoma surgical procedures are done at four hospital sites, and include
•    trabeculectomies with and without antimetabolites
•    nonpenetrating procedures, including viscocanalostomy and deep sclerectomy with collagen wick implantation
•    combined phaco-trabeculectomy, and phaco-deep sclerectomy
•    tube-shunt procedures using the Ahmed, Krupin and Baerveldt drainage devices
•    Minimally invasive glaucoma surgery procedures, including Xen implants and ECP laser among others
•    goniotomy and trabeculotomy

Although the emphasis of this fellowship is on glaucoma, there will be exposure and opportunity for involvement in the assessment and management of complex anterior segment problems.

Anterior segment procedures include:
•    phacoemulsification/IOL implantation
•    surgical management of dislocated cataracts,  IOL complications and aphakia 

The Fellow is expected to perform Diurnal Tension Curves from 6:00 pm to 10:00 pm as necessary, usually once per month while at the Sunnybrook site and the St. Michael's site.

The Fellow is expected to carry a pager at all times. When on holidays the staff person, senior resident and clinic co-coordinator must be informed in advance that the Fellow will not be available. The Fellow may be responsible for first call during some days and evenings and on Friday during resident lectures. On call is not onerous for the fellow.

Research
At least 20% of the time will be spent in clinical and/or basic science research. Research projects will be suggested by the supervisors, however, if the candidate has a specific interest this will be considered. It is mandatory that the research be presented at the Department of Ophthalmology Annual Research Day usually in May and at if possible, also at ARVO. In addition it is expected that a manuscript will be submitted for publication in a major Ophthalmology journal.

Teaching
The Fellow will be responsible for occasional resident and/or medical student formal and informal teaching. Presentation of interesting cases at grand rounds when the guest speaker is from the subspecialty of glaucoma is also expected (on average twice in an academic year). The Fellow is expected to attend weekly Visiting Professors' Rounds held on Friday mornings from 7:30 to 8:30.  Remote attendance from the Sunnybrook site is acceptable.

Vacation
2 weeks’ vacation per year.

Conference
Up to 2 weeks of conference time may be taken on approval of the Supervisors.

Evaluation
An evaluation after one month of the fellowship will be held to determine performance and to validate the educational license. A mid-term evaluation will be held with the Fellow to evaluate his or her performance and to give feedback regarding his/her activities. Fellows are encouraged to provide feedback and express their comments on how their fellowship is progressing.

Duration
1 or 2 years, as negotiated.

Salary
$53,000 CAD/year. The Fellow will be encouraged to apply for available scholarships.

Application Process
Interested applicants should forward a letter of intent, current Curriculum Vitae, and at least 3 closed references to Dr. Kranemann as listed above. Fellowships run for a minimum of a full year usually from July 1st to June 30th, but flexible start dates are considered. Generally, decisions are made approximately 6-9 months prior to the start date. A personal interview is usually required. Applications are due on August 31st of the year prior to beginning the fellowship in July, but are preferred earlier. For flexible start dates, applicants should enquire as to availability.