Basic Level Goals: Year 1
A. Cognitive Skills
1. List
advantages and disadvantages of contact lens (CL) wear.**
2. List
indications and contraindications for CL wear.**
3. List
medical indications for CL wear.**
4. Describe
a systematic and comprehensive ophthalmic examination oriented for CL
fitting, including complex and challenging cases.**
5.
Describe the various CL indications and options for each contact
lens type (eg, soft CL [SCL], rigid gas permeable [RGP] CL, toric CL,
multifocal CL, scleral CL).**
6.
Describe how to decide which CL categories (eg, SCL, RGP CL, hybrid
CL, and subgroups within each category (eg, sphere, toric, bifocal,
frequent planned replacement) are best suited for a particular
patient.**
7.
Describe how to convey the basic CL parameters for SCL and RGP CL:**
a. Base
curve**
b. Diameter
refractive power**
c. Lens
materials**
i. Center
thickness**
ii. Peripheral
curvature**
8. Explain
the concept and clinical relevance of oxygen permeability (Dk) and
oxygen transmissibility (Dk/center thickness).**
9.
Describe various materials used in the manufacture of CL.
10. Explain
the optics of SCL and RGP CL:**
a. Base
curve changes**
b. Lacrimal
lens**
c. Vertex
distance**
d. Optic
zone.**
11.
Recognize the importance of obtaining central keratometry in CL
fitting of patients without complex needs, and explain the conversion
between radians and diopters.**
12.
Identify different methods of obtaining central keratometry readings
(eg, manual keratometry, computerized corneal topography).
13. Explain
the importance of using diagnostic staining agents (eg, fluorescein,
lissamine green, rose bengal) to assess corneal and conjunctival
staining patterns.**
14.
Describe basic tests to assess the tear film properties (eg, Schirmer
test, tear break-up time, phenol red thread tear test, meibomian
gland assessment).**
15.
Describe conversion of a spectacle prescription (Rx) to a CL Rx,
including method of converting from plus to minus cylinder and vertex
distance calculations.**
16.
Describe basic steps for SCL fitting.**
17.
Identify the main characteristics to be present in a CL prescription
(eye designation, brand identification, base curve, diameter, and
refractive power).**
18.
Describe CL care guidelines to be given to the patient related to
insertion, removal, and disinfection of CL.**
19.
Describe risk factors for CL-related complications (eg, overnight
wear, nonpreserved saline solution usage).**
20.
Describe treatment of CL-related complications (eg, tight lens
syndrome, overwear syndrome, giant papillary conjunctivitis,
infectious keratitis).**
B. Technical/Surgical Skills
1. Perform
a basic CL history.**
2. Perform
all the steps of a basic clinical examination oriented for CL fitting
(ie, refraction, keratometry, visual acuity assessment).**
3. Perform
a routine comprehensive slit-lamp examination of the anterior segment
as applied to CL fitting.**
4. Perform
tear film assessment required for CL patients.**
5. Perform
the techniques of retinoscopy, refraction, and over-refraction in the
routine CL patient.**
6. Perform
central keratometry.**
7. Discuss
with the patient the most appropriate choice for their particular
clinical case.**
8. Perform
initial SCL fitting, evaluation of fit (loose CL versus tight CL),
and over-refraction.**
9. Insert
and remove a trial SCL.**
10. Instruct
patients regarding safe CL insertion and removal, CL wearing
schedule, lens care regimens, CL disinfection care, indications,
contraindications, and possible complications.**
11. Work
effectively within a medical care team.**
Standard Level Goals: Year 2
A. Cognitive Skills
1. Explain
applied anatomy and physiology (eg, corneal metabolism and
temperature, oxygen consumption, stromal acidosis, tear osmolarity,
tissue fragility, cell apoptosis, corneal sensitivity, closed
eyelid-related ocular surface repercussions).**
2.
Recognize signs and symptoms of CL intolerance and overwear.**
3. Explain
the importance of assessing tear film and ocular surface condition
with more complex auxiliary tests in certain CL fitting situations
(eg, tear film osmolarity and biochemical composition, impression
cytology).
4.
Identify CL fitting situations requiring corneal topography (eg,
computerized/Placido rings).**
5. Explain
the rationale underlying different topography profiles and how these
relate to the manifest refraction.**
6.
Summarize and analyze topography maps.
7. Explain
physical properties of CL materials:
a. International
Organization for Standardization (ISO) classification
8. Explain
advantages and disadvantages of SCL materials.**
9. Explain
advantages and disadvantages of RGP CL materials.**
10. Explain
RGP/SCL geometry relation with corneal geometry (ie, lacrimal
meniscus, refraction, and ocular surface implications).**
11. Explain
main principles to fit RGP CL (eg, first trial CL choice, fluorescein
patterns, alignment, movement, wearing and replacement schedule,
fitting motivation, and follow up).**
12. Explain
main principles to fit toric SCL:**
a. Stabilization**
i. LARS
rule (ie, Left Add, Right Subtract)
ii. Movement
iii. Rotation
iv. Possible
refitting needs
13.
Appraise clinical situations best suited for RGP CL fitting versus
toric SCL fitting.**
14. Explain
when CL refitting is indicated and perform refitting when needed.**
15.
Recognize signs and symptoms of a tight, optimal, and loose CL
fitting.**
16. Explain
advantages and disadvantages of different wearing schedules (eg,
conventional, frequent planned replacement, flexible, daily).**
17.
Describe ocular impact and physiological needs regarding different CL
wearing schedules.
18.
Identify and describe CL requirements for materials needed for
extended/flexible CL wearing.**
19. Explain
patient and CL selection and fitting techniques as applied to fit
presbyopia.**
20. Explain
how to keep a CL fitting trial set (ie, CL, equipment, and
disinfection care).**
21.
Describe and evaluate different CL care systems.
22. Explain
the clinical importance of CL environment (ie, CL patient
surrounding, ocular surface, and storage case).**
B. Technical Skills
1. Perform
a CL history in patients requiring more complex CL fitting (eg,
subclinical ectatic corneal disorders such as keratoconus and
pellucid marginal degeneration, regular moderate astigmatism,
presbyopia, ocular surface disease, and post-refractive surgery).**
2. Perform
a clinical examination, including retinoscopy and refraction
techniques to verify and inspect CL in patients requiring more
complex CL fitting (eg, subclinical ectatic corneal disorders such as
keratoconus and pellucid marginal degeneration, regular moderate
astigmatism, presbyopia, ocular surface disease, and post-refractive
surgery).**
3.
Indicate more complex additional auxiliary tests (eg, computer-based
corneal topography, tear film osmolarity, impression cytology) in
patients requiring more complex CL fitting (eg, subclinical ectatic
corneal disorders such as keratoconus, pellucid marginal
degeneration, regular moderate astigmatism, presbyopia, ocular
surface disease, and post-refractive surgery).
4. Perform
RGP CL fitting (spherical).**
5. Perform
SCL toric fitting.**
6. Perform
presbyopia CL fitting.**
7. Perform
appropriate CL selection and material or parameters modification in
CL refit.**
8. Perform
CL verification for visual acuity, fitting, and comfort in patients
requiring more complex CL fitting.**
9. Educate
patients regarding CL-related complications.**
10.
Diagnose, manage, and treat CL-related complications.**
11. Perform
the skills needed for long-term management and follow up of CL
patients.**
Advanced Level Goals: Year 3
A. Cognitive Skills
1.
Describe the various options for SCL, RPG CL, and hybrid CL fitting
in advanced ectatic corneal disorders such as keratoconus and
pellucid marginal degeneration, including post-intracorneal ring
segment implantation cases.**
2.
Describe the various options for SCL and RPG CL fitting in
postkeratoplasty cases.**
3.
Describe the various options for SCL and RPG CL fitting in complex
post-refractive surgery, including corneal ectasia.**
4.
Describe CL fitting in special clinical situations such as severe
dry eye, glaucoma, diabetes, allergy, pregnancy, strabismus, sports
practice, adverse environmental and occupational conditions.**
5.
Describe indications, fitting techniques, and long-term management
of CL wear for children and adolescents.**
6.
Describe CL options and most complex fitting techniques for medical
CL indications such as aphakia, albinism, recurrent corneal erosions,
neurotrophic keratitis, corneal scarring, aniridia, and prosthetic
cosmesis.**
7.
Identify indications for scleral CL fitting.**
8. Explain
reverse geometry RGP CL for post-graft or post-refractive surgery
cases.**
9.
Synthesize the concept underlying orthokeratology.
10. List
the indications for therapeutic CL.**
11.
Describe material selection, physiological implications, mechanisms
of action, and adjuvant topical treatment associated with therapeutic
CL.**
12. Describe
the various possibilities of fitting with soft and hard therapeutic
CL.
13. Explain
the importance of appreciating visual acuity, fit, and comfort in
therapeutic CL.**
14
Describe the differences among CL material choices especially suited
for more complex cases and its clinical correlation.**
15. Explain
the influence of both systemic and topical medication on CL fitting
and tolerance.**
16.
Describe the methods of modifying a CL to improve comfort, vision, or
physiological response.**
17.
Evaluate CL-induced complications, and describe treatment strategies
for their management, in particular acanthamoeba and fungi
infections.**
18. Appraise
clinical situations requiring additional complementary examinations
in CL fitting and follow up (eg, endothelial, confocal biomicroscopy,
aberrometry).
19.
Describe indications and methods for fitting front surface toric,
back surface toric, and bitoric RGP CL.
B. Technical Skills
1. Perform
an advanced CL history and examination.**
2. Obtain
a full ocular history and conduct necessary tests to perform a
complex CL fitting examination (eg, postkeratoplasty, multiple
surgeries, post-refractive surgery, corneal ectasia, advanced corneal
ectatic disorders such as keratoconus and pellucid marginal
degeneration, and active corneal and ocular surface disease).**
3. Perform
CL fitting and management in babies, children, and adolescents.**
4. Perform
scleral CL fitting.
5. Perform
refraction, retinoscopy, and over-refraction in complex cases.**
6. Use
advanced CL designs including reverse geometry.**
7.
Indicate the auxiliary CL instruments in patients with complex needs
(eg, computerized topography, fluorescein patterns, diagnostic
lenses).**
8.
Interpret and interpret topography in complex CL fittings.**
9. Perform
and analyze aberrometry and endothelial/confocal biomicroscopy.
10.
Indicate CL modification and refitting in complex cases, when
needed.**
11. Select
the appropriate CL in complex clinical cases (eg, postkeratoplasty,
multiple surgeries, post-refractive surgery, corneal ectasia,
advanced ectatic corneal disorders such as keratoconus, pellucid
marginal degeneration, and active corneal and ocular surface
disease).**
12. Perform
therapeutic CL fitting and follow up.**
13.
Diagnose and treat CL-induced complications, both infectious and
noninfectious
(eg,
sterile infiltrates, corneal neovascularization, corneal permanent
staining, giant papillary conjunctivitis).**
14. Develop
an educational skill set to effectively educate rotating students and
residents about CL topics.**
*
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Note:
Inclusion of therapies and investigations in the ICO Residency
Curriculum does not imply that listings are all inclusive or that
methods are endorsed by the ICO. Appropriate levels of expertise and
knowledge should be achieved based on the care provided.
Practitioners should know of therapies and investigations not
available at their hospital or clinic, so that they can advise
patients who may be able to seek care elsewhere.
