Basic Level Goals: Year 1
A. Cognitive Skills
1. Describe the basic anatomy, embryology, physiology, pathology, microbiology, immunology, genetics, epidemiology, and pharmacology of the cornea, conjunctiva, sclera, eyelids, lacrimal apparatus, and ocular adnexa.**
2. Understand the fundamentals of corneal optics and refraction (eg, astigmatism, keratoconus).**
3. Describe congenital abnormalities of the cornea, sclera, and globe (eg, Peter anomaly, microphthalmos, birth trauma, buphthalmos).**
4. Describe characteristic corneal and conjunctival degenerations (eg, pterygium, pinguecula, Salzmann nodular degeneration, senile plaques of the sclera).**
5. Recognize the most common corneal dystrophies (eg, map-dot-fingerprint dystrophy, lattice dystrophy, granular dystrophy, macular dystrophy, Fuchs dystrophy).**
6. Describe the fundamentals of ocular microbiology and recognize corneal and conjunctival inflammations and infections (eg, staphylococcal hypersensitivity, simple microbial keratitis, fungal corneal ulcers, trachoma, ophthalmia neonatorum, herpes zoster ophthalmicus, herpes simplex keratitis, and conjunctivitis).**
7. Describe the basic principles of ocular pharmacology of anti-infective, anti-inflammatory, and immune modulating agents (eg, indications and contraindications for topical corticosteroids, nonsteroidal anti-inflammatory agents, and antibiotics).**
8. Recognize and treat lid margin disease (eg, staphylococcal blepharitis, meibomian gland dysfunction).**
9. Describe the basic differential diagnosis of acute and chronic conjunctivitis or red eye (eg, scleritis, episcleritis, conjunctivitis, orbital cellulitis, gonococcal and chlamydial conjunctivitis).**
10. Recognize and treat pyogenic granuloma.**
11. Recognize the basic presentations of ocular allergy (eg, phlyctenules, seasonal hay fever, vernal conjunctivitis, allergic and atopic conjunctivitis, giant papillary conjunctivitis).**
12. Understand the mechanisms of ocular immunology and recognize the external manifestations of anterior segment inflammation (eg, red eye associated with acute and chronic iritis).**
13. Describe the symptoms, signs, testing and evaluation for keratopathy and dry eye (eg, Schirmer test, tarsorrhaphy), and treatment.**
14. Describe the etiologies and treatment of superficial punctate keratitis (eg, dry eye, Thygeson superficial punctate keratopathy, neurotrophic keratitis, blepharitis, toxicity, ultraviolet photo keratopathy, contact lens-related keratitis).**
15. Recognize and describe the etiologies of hyphema and microhyphema.**
16. Describe the basic mechanisms of traumatic and toxic injury to the anterior segment and treatment (eg, chemical and thermal burns, lid laceration, orbital fracture).**
17. Recognize corneal lacerations (perforating and nonperforating), anterior segment trauma, corneal and conjunctival foreign bodies.**
18. Perform Seidel test.**
19. Describe the epidemiology, differential diagnosis, evaluation and management of common benign and malignant lid lesions, including pigmented lesions of the conjunctiva and lid (eg, nevi, melanoma, primary acquired melanosis, ocular surface squamous neoplasia).**
B. Technical Skills
1. Perform external examination (illuminated and magnified) and slit lamp biomicroscopy, including drawing of anterior segment findings.**
2. Administer topical anesthesia, as well as special topical stains of the cornea (eg, fluorescein dye and rose bengal).**
3. Perform tests for dry eye (eg, Schirmer test, tear film break-up and dye disappearance).**
4. Perform punctal occlusion (temporary or permanent) or insert plugs.**
5. Perform simple corneal sensation testing (eg, cotton-tipped swab).**
6. Perform tonometry (eg, applanation, Tono-Pen, Schiøtz, pneumotonometry).**
7. Perform techniques of sampling for viral, bacterial, fungal, and protozoal ocular infections (eg, corneal scraping and appropriate culture techniques).**
8. Interpret simple stains of the cornea and conjunctiva (eg, Gram stain, Giemsa stain).**
9. Manage corneal epithelial defects (eg, pressure patching and bandage contact lenses).**
10. Perform removal of a conjunctival or corneal foreign body (eg, rust ring).**
11. Perform simple (nonrecurrent) pterygium excision (eg, with autologous conjunctival transplantation).**
12. Perform an isolated lid laceration repair.**
13. Perform an isolated corneal laceration repair (eg, linear laceration not extending to limbus, not involving uveal or intraocular structures).**
14. Perform epilation.**
15. Perform a lateral tarsorrhaphy.**
16. Perform incision, drainage, and/or remove a primary chalazion/stye.**
17. Perform a simple incisional or excisional biopsy of a lid lesion.**
18. Perform irrigation of chemical burn to the eye.**
Standard Level Goals: Year 2
A. Cognitive Skills
1. Describe the more complex anatomy, embryology, physiology, pathology, microbiology, immunology, genetics, epidemiology, and pharmacology of the cornea, conjunctiva, sclera, eyelids, lacrimal apparatus, and ocular adnexa.
2. Describe the more complex congenital abnormalities of the cornea, sclera, anterior segment and globe and their associated systemic manifestations (eg, Axenfeld, Rieger, and Peter anomalies, aniridia, hamartomas and choristomas).
3. Understand more complex corneal optics and refraction (eg, irregular astigmatism, keratoconus, anisometropia).
4. Correlate the concordance of the visual acuity with the density of media opacity (eg, cataract, corneal scars, and edema) and evaluate the etiology of discordance between acuity and findings from examination of the media.
5. Recognize and treat less common corneal or conjunctival presentations of degenerations and common conjunctival neoplasms (eg, inflamed, atypical, or recurrent pterygium, band keratopathy, benign and malignant tumors).
6. Describe the epidemiology, clinical features, pathology, evaluation, and treatment of peripheral corneal thinning disorders or ulceration (eg, Terrien marginal degeneration, Mooren ulcer, rheumatoid arthritis-related corneal melt, dellen).
7. Describe the epidemiology, differential diagnosis, evaluation, and management of vitamin A deficiency (eg, Bitot spot, dry eye, slowed dark adaptation) and neurotrophic corneal diseases.
8. Recognize and treat recurrent corneal erosions.
9. Recognize, evaluate, and treat chronic conjunctivitis (eg, chlamydia, trachoma, molluscum contagiosum, Parinaud oculoglandular syndrome, ocular rosacea).
10. Describe more complex ocular microbiology and describe the differential diagnosis of more complicated corneal and conjunctival infections (eg, complex, mixed, or atypical bacterial, fungal, Acanthamoeba, viral, or parasitic keratitis).
11. Describe the more complex principles of ocular pharmacology of anti-infective, anti-inflammatory, and immune modulating agents (eg, use of topical nonsteroidal and steroidal agents, cyclosporine, and anti-tumor necrosis factor agents).
12. Describe the differential diagnosis, evaluation, and management of Thygeson superficial punctate keratopathy.
13. Describe more complex differential diagnosis of red eye (eg, autoimmune and inflammatory disorders causing scleritis, episcleritis, conjunctivitis, orbital cellulitis).
14. Describe key features of trachoma, including epidemiology, clinical features, staging, and its complications (eg, cicatrization), prevention (eg, facial hygiene), and topical and systemic antibiotic treatment (especially in hyperendemic regions), and surgery (eg, tarsal rotation).
15. Describe differential diagnosis, evaluation, and treatment of interstitial keratitis (eg, syphilis, viral diseases, noninfectious, immunologic, inflammation).
16. Describe the differential diagnosis and the external manifestations of more complex anterior segment inflammation (eg, acute and chronic iritis with and without systemic disease).
17. Recognize, evaluate, and treat the ocular complications of severe diseases, such as chronic exposure keratopathy, contact dermatitis, and rosacea.
18. Describe the clinical features, pathology, evaluation, and treatment of ocular cicatricial pemphigoid and Stevens-Johnson syndrome.
19. Describe the classification, pathology, indications for surgery, and prognosis of common eyelid abnormalities (eg, blepharoptosis, trichiasis, distichiasis, essential blepharospasm, entropion, ectropion) and understand their relationship to secondary diseases of the cornea and conjunctiva (eg, exposure keratopathy).
20. Recognize and treat foreign body, animal, and plant substance injuries and understand the risk of injury with organic material.
21. Describe more complex mechanisms of traumatic and toxic injury to the anterior segment (eg, long-term sequelae of acid and alkali burn, complex lid laceration involving the lacrimal system, full-thickness laceration).
22. Recognize and treat corneal lacerations (perforating and nonperforating).
23. Recognize and treat more complex hyphemas (eg, surgical indications, evacuation).
24. Recognize the anterior segment manifestations of systemic diseases (eg, Wilson disease) and pharmacologic side effects (eg, amiodarone vortex keratopathy).
25. Recognize and treat common and uncommon benign and malignant lid lesions.
B. Technical Skills
1. Perform more advanced techniques, including keratometry, keratoscopy, endothelial cell count and/or evaluation, specular microscopy, and pachymetry.**2. Perform stromal micropuncture.**
3. Perform application of corneal glue.**
4. Perform simple keratectomy and lamellar keratectomy.**
5. Assist in more complex corneal surgery (eg, penetrating keratoplasty and lamellar keratoplasty).**
6. Perform more complex and recurrent pterygium excision, including conjunctival grafting.**
7. Perform more complex lid laceration repair.**
8. Perform more complex corneal laceration repair (eg, stellate perforating laceration).**
9. Perform and interpret more complex stains of the cornea and conjunctiva (eg, calcofluor white, acid fast).
10. Repair simple lacerations of the lacrimal drainage apparatus (eg, perform intubations and primary closure).
11. Treat hyphema and microhyphema with associated increased intraocular pressure and/or blood staining (eg, surgical evacuation).
Advanced Level Goals: Year 3
A. Cognitive Skills
1.
Describe the basic anatomy, embryology, physiology, pathology,
microbiology, immunology, genetics, epidemiology, and pharmacology of
the cornea, conjunctiva, sclera, eyelids, lacrimal apparatus, and
ocular adnexa.**
2. Understand the fundamentals of corneal optics and refraction (eg, astigmatism, keratoconus).**
3. Describe congenital abnormalities of the cornea, sclera, and globe (eg, Peter anomaly, microphthalmos, birth trauma, buphthalmos).**
4. Describe characteristic corneal and conjunctival degenerations (eg, pterygium, pinguecula, Salzmann nodular degeneration, senile plaques of the sclera).**
5. Recognize the classic corneal dystrophies (eg, map-dot-fingerprint dystrophy, lattice dystrophy, granular dystrophy, macular dystrophy, Fuchs dystrophy).**
6. Describe the fundamentals of ocular microbiology and recognize corneal and conjunctival inflammations and infections (eg, staphylococcal hypersensitivity, simple microbial keratitis, fungal corneal ulcers, trachoma, ophthalmia neonatorum, herpes zoster ophthalmicus, herpes simplex keratitis, adenovirus keratoconjunctivitis and conjunctivitis).**
7. Describe the basic principles of ocular pharmacology of anti-infective, anti-inflammatory, and immune modulating agents (eg, indications and contraindications for topical corticosteroids, nonsteroidal anti-inflammatory agents, and antibiotics).**
8. Recognize and treat lid margin disease (eg, staphylococcal blepharitis, meibomian gland dysfunction).**
9. Describe the basic differential diagnosis of acute and chronic conjunctivitis or red eye (eg, scleritis, episcleritis, conjunctivitis, orbital cellulitis, gonococcal and chlamydial conjunctivitis).**
10. Recognize and treat pyogenic granuloma.**
11. Recognize the basic presentations of ocular allergy (eg, phlyctenules, seasonal hay fever, vernal conjunctivitis, allergic and atopic conjunctivitis, giant papillary conjunctivitis).**
12. Understand the mechanisms of ocular immunology and recognize the external manifestations of anterior segment inflammation (eg, red eye associated with acute and chronic iritis).**
13. Describe the symptoms, signs, testing, and evaluation for dry eye (eg, Schirmer test, tarsorrhaphy); and treatment for dry eye.**
14. Describe the etiologies and treatment of superficial punctate keratopathy (eg, dry eye, Thygeson superficial punctate keratopathy, neurotrophic keratitis, blepharitis, toxicity, ultraviolet photo keratopathy, contact lens-related keratitis).**
15. Recognize and describe the etiologies of hyphema and microhyphema.**
16. Describe the basic mechanisms of traumatic and toxic injury to the anterior segment and treatment (eg, chemical and thermal burns, lid laceration, orbital fracture).**
17. Recognize corneal lacerations (perforating and nonperforating), anterior segment trauma, corneal and conjunctival foreign bodies.**
18. Describe the epidemiology, differential diagnosis, evaluation, and management of common benign and malignant lid lesions, including pigmented lesions of the conjunctiva and lid (eg, nevi, melanoma, primary acquired melanosis, ocular surface squamous neoplasia).**
2. Understand the fundamentals of corneal optics and refraction (eg, astigmatism, keratoconus).**
3. Describe congenital abnormalities of the cornea, sclera, and globe (eg, Peter anomaly, microphthalmos, birth trauma, buphthalmos).**
4. Describe characteristic corneal and conjunctival degenerations (eg, pterygium, pinguecula, Salzmann nodular degeneration, senile plaques of the sclera).**
5. Recognize the classic corneal dystrophies (eg, map-dot-fingerprint dystrophy, lattice dystrophy, granular dystrophy, macular dystrophy, Fuchs dystrophy).**
6. Describe the fundamentals of ocular microbiology and recognize corneal and conjunctival inflammations and infections (eg, staphylococcal hypersensitivity, simple microbial keratitis, fungal corneal ulcers, trachoma, ophthalmia neonatorum, herpes zoster ophthalmicus, herpes simplex keratitis, adenovirus keratoconjunctivitis and conjunctivitis).**
7. Describe the basic principles of ocular pharmacology of anti-infective, anti-inflammatory, and immune modulating agents (eg, indications and contraindications for topical corticosteroids, nonsteroidal anti-inflammatory agents, and antibiotics).**
8. Recognize and treat lid margin disease (eg, staphylococcal blepharitis, meibomian gland dysfunction).**
9. Describe the basic differential diagnosis of acute and chronic conjunctivitis or red eye (eg, scleritis, episcleritis, conjunctivitis, orbital cellulitis, gonococcal and chlamydial conjunctivitis).**
10. Recognize and treat pyogenic granuloma.**
11. Recognize the basic presentations of ocular allergy (eg, phlyctenules, seasonal hay fever, vernal conjunctivitis, allergic and atopic conjunctivitis, giant papillary conjunctivitis).**
12. Understand the mechanisms of ocular immunology and recognize the external manifestations of anterior segment inflammation (eg, red eye associated with acute and chronic iritis).**
13. Describe the symptoms, signs, testing, and evaluation for dry eye (eg, Schirmer test, tarsorrhaphy); and treatment for dry eye.**
14. Describe the etiologies and treatment of superficial punctate keratopathy (eg, dry eye, Thygeson superficial punctate keratopathy, neurotrophic keratitis, blepharitis, toxicity, ultraviolet photo keratopathy, contact lens-related keratitis).**
15. Recognize and describe the etiologies of hyphema and microhyphema.**
16. Describe the basic mechanisms of traumatic and toxic injury to the anterior segment and treatment (eg, chemical and thermal burns, lid laceration, orbital fracture).**
17. Recognize corneal lacerations (perforating and nonperforating), anterior segment trauma, corneal and conjunctival foreign bodies.**
18. Describe the epidemiology, differential diagnosis, evaluation, and management of common benign and malignant lid lesions, including pigmented lesions of the conjunctiva and lid (eg, nevi, melanoma, primary acquired melanosis, ocular surface squamous neoplasia).**
B. Technical/Surgical Skills
1.
Perform external examination (illuminated and magnified) and
slit-lamp biomicroscopy, including drawing of anterior segment
findings.**
2. Administer topical anesthesia, as well as special topical stains of the cornea (eg, fluorescein dye and rose bengal).**
3. Perform tests for dry eye (eg, Schirmer test, tear film breakup, and dye disappearance).**
4. Perform punctal occlusion (temporary or permanent) or insert plugs.**
5. Perform simple corneal sensation testing (eg, cotton-tipped swab).**
6. Perform tonometry (eg, applanation, Tono-Pen, Schiøtz, pneumotonometry).**
7. Perform techniques of sampling for viral, bacterial, fungal, and protozoal ocular infections (eg, corneal scraping and appropriate culture techniques).**
8. Interpret simple stains of the cornea and conjunctiva (eg, Gram stain, Giemsa stain).**
9. Manage corneal epithelial defects (eg, pressure patching and bandage contact lenses).**
10. Perform removal of a conjunctival or corneal foreign body (eg, rust ring).**
11. Perform simple (nonrecurrent) pterygium excision (eg, with autologous conjunctival transplantation).**
12. Perform an isolated lid laceration repair.**
13. Perform an isolated corneal laceration repair (eg, linear laceration not extending to limbus, not involving uveal or intraocular structures).**
14. Perform epilation.**
15. Perform a lateral tarsorrhaphy.**
16. Perform incision, drainage, and/or remove a primary chalazion/stye.**
17. Perform a simple incisional or excisional biopsy of a lid lesion.**
18. Perform irrigation of chemical burn to the eye.**
19. Perform Seidel test.**
2. Administer topical anesthesia, as well as special topical stains of the cornea (eg, fluorescein dye and rose bengal).**
3. Perform tests for dry eye (eg, Schirmer test, tear film breakup, and dye disappearance).**
4. Perform punctal occlusion (temporary or permanent) or insert plugs.**
5. Perform simple corneal sensation testing (eg, cotton-tipped swab).**
6. Perform tonometry (eg, applanation, Tono-Pen, Schiøtz, pneumotonometry).**
7. Perform techniques of sampling for viral, bacterial, fungal, and protozoal ocular infections (eg, corneal scraping and appropriate culture techniques).**
8. Interpret simple stains of the cornea and conjunctiva (eg, Gram stain, Giemsa stain).**
9. Manage corneal epithelial defects (eg, pressure patching and bandage contact lenses).**
10. Perform removal of a conjunctival or corneal foreign body (eg, rust ring).**
11. Perform simple (nonrecurrent) pterygium excision (eg, with autologous conjunctival transplantation).**
12. Perform an isolated lid laceration repair.**
13. Perform an isolated corneal laceration repair (eg, linear laceration not extending to limbus, not involving uveal or intraocular structures).**
14. Perform epilation.**
15. Perform a lateral tarsorrhaphy.**
16. Perform incision, drainage, and/or remove a primary chalazion/stye.**
17. Perform a simple incisional or excisional biopsy of a lid lesion.**
18. Perform irrigation of chemical burn to the eye.**
19. Perform Seidel test.**
Standard Level Goals: Year 2
A. Cognitive Skills
1.
Describe the more complex anatomy, embryology, physiology,
pathology, microbiology, immunology, genetics, epidemiology, and
pharmacology of the cornea, conjunctiva, sclera, eyelids, lacrimal
apparatus, and ocular adnexa.
2.
Describe the more complex congenital abnormalities of the cornea,
sclera, anterior segment and globe and their associated systemic
manifestations (eg, Axenfeld, Rieger, and Peter anomalies, aniridia,
hamartomas and choristomas).
3.
Understand more complex corneal optics and refraction (eg, irregular
astigmatism, keratoconus, anisometropia).
4.
Correlate the concordance of the visual acuity with the density of
media opacity (eg, cataract, corneal scars, edema), and evaluate the
etiology of discordance between acuity and findings from examination
of the media.
5.
Recognize and treat less common corneal or conjunctival
presentations of degenerations and common conjunctival neoplasms (eg,
inflamed, atypical, or recurrent pterygium, band keratopathy, benign
and malignant tumors).
6.
Describe the epidemiology, clinical features, pathology, evaluation,
and treatment of peripheral corneal thinning disorders or ulceration
(eg, Terrien marginal degeneration, Mooren ulcer, rheumatoid
arthritis-related corneal melt, dellen).
7.
Describe the epidemiology, differential diagnosis, evaluation, and
management of vitamin A deficiency (eg, Bitot spot, dry eye, slowed
dark adaptation) and neurotrophic corneal diseases.
8.
Recognize and treat recurrent corneal erosions.
9.
Recognize, evaluate, and treat chronic conjunctivitis (eg,
chlamydia, trachoma, molluscum contagiosum, Parinaud oculoglandular
syndrome, ocular rosacea).
10.
Describe more complex ocular microbiology and describe the
differential diagnosis of more complicated corneal and conjunctival
infections (eg, complex, mixed, or atypical bacterial, fungal,
Acanthamoeba, viral, or parasitic keratitis).
11.
Describe the more complex principles of ocular pharmacology of
anti-infective, anti-inflammatory, and immune modulating agents (eg,
use of topical nonsteroidal and steroidal agents, cyclosporine, and
anti-tumor necrosis factor agents).
12.
Describe the differential diagnosis, evaluation, and management of
Thygeson superficial punctate keratopathy.
13.
Describe more complex differential diagnosis of red eye (eg,
autoimmune and inflammatory disorders causing scleritis,
episcleritis, conjunctivitis, orbital cellulitis).
14.
Describe key features of trachoma, including epidemiology, clinical
features, staging, and its complications (eg, cicatrization),
prevention (eg, facial hygiene), and topical and systemic antibiotic
treatment (especially in hyperendemic regions), and surgery (eg,
tarsal rotation).
15.
Describe differential diagnosis, evaluation, and treatment of
interstitial keratitis (eg, syphilis, viral diseases, noninfectious,
immunologic, inflammation).
16.
Describe the differential diagnosis and the external manifestations
of more complex anterior segment inflammation (eg, acute and chronic
iritis with and without systemic disease).
17.
Recognize, evaluate, and treat the ocular complications of severe
diseases, such as chronic exposure keratopathy, contact dermatitis,
and rosacea.
18.
Describe the clinical features, pathology, evaluation, and treatment
of ocular cicatricial pemphigoid and Stevens-Johnson syndrome.
19.
Describe the classification, pathology, indications for surgery, and
prognosis of common eyelid abnormalities (eg, blepharoptosis,
trichiasis, distichiasis, essential blepharospasm, entropion,
ectropion) and understand their relationship to secondary diseases of
the cornea and conjunctiva (eg, exposure keratopathy).
20.
Recognize and treat foreign body, animal, and plant substance
injuries and understand the risk of injury with organic material.
21.
Describe more complex mechanisms of traumatic and toxic injury to the
anterior segment (eg, long-term sequelae of acid and alkali burn,
complex lid laceration involving the lacrimal system, full-thickness
laceration).
22.
Recognize and treat corneal lacerations (perforating and
nonperforating).
23.
Recognize and treat more complex hyphemas (eg, surgical indications,
evacuation).
24.
Recognize the anterior segment manifestations of systemic diseases
(eg, Wilson disease) and pharmacologic side effects (eg, amiodarone
vortex keratopathy).
25.
Recognize and treat common and uncommon benign and malignant lid
lesions.
B. Technical/Surgical Skills
1.
Perform more advanced techniques, including keratometry,
keratoscopy, endothelial cell count and/or evaluation, specular
microscopy, and pachymetry.**
2.
Perform stromal micropuncture.**
3.
Perform application of corneal glue.**
4.
Perform simple keratectomy and lamellar keratectomy.**
5.
Assist in more complex corneal surgery (eg, penetrating keratoplasty
and lamellar keratoplasty).**
6.
Perform more complex and recurrent pterygium excision, including
conjunctival grafting.**
7.
Perform more complex lid laceration repair.**
8.
Perform more complex corneal laceration repair (eg, stellate
perforating laceration).**
9.
Perform and interpret more complex stains of the cornea and
conjunctiva (eg, calcofluor white, acid fast).
10.
Repair simple lacerations of the lacrimal drainage apparatus (eg,
perform intubations and primary closure).
11.
Treat hyphema and microhyphema with associated increased intraocular
pressure and/or blood staining (eg, surgical evacuation).
Advanced Level Goals: Year 3
A. Cognitive Skills
1. Describe
the most complex anatomy, embryology, physiology, histopathology,
microbiology, immunology, genetics, epidemiology, and pharmacology of
the cornea, conjunctiva, sclera, eyelids, lacrimal apparatus, and
ocular adnexa.
2. Understand
the most complex corneal optics and refraction (eg, postkeratoplasty)
and their methods of treatment (eg, contact lenses, refractive
surgery).
3. Describe
the most complex and less common congenital abnormalities of the
cornea, sclera, and globe (eg, cornea plana, keratoglobus).
4. Recognize
the less common corneal dystrophies and degenerations (eg, Meesman
dystrophy, Reis-Buckler dystrophy, François syndrome, Schnyder
crystalline dystrophy, congenital hereditary stromal dystrophy,
congenital hereditary endothelial dystrophy, posterior polymorphous
dystrophy) in addition to the
more common dystrophies (eg, anterior membrane dystrophy, granular,
lattice, and macular).
5.
Recognize common and uncommon corneal and conjunctival neoplasms and
degenerations (eg, spheroidal degeneration, carcinoma in situ).
6.
Describe less common and rare ocular infections, and describe the
differential diagnosis of the most complicated corneal and
conjunctival infections (eg, amoebas, leishmaniasis, nematodes).
7.
In nonendemic areas, describe the basic features of onchocerciasis.
8.
In endemic areas, define the etiology, vector (eg, black fly), and
incidence, diagnostic features (eg, microfilariae, keratitis,
iritis), diagnosis (eg, skin snip test), course and prognosis,
treatment (eg, ivermectin, nodulectomy), and prevention (eg, vector
control, environmental and behavioral changes) of onchocerciasis.
9.
Describe the most complex principles of ocular pharmacology of
anti-infective, anti-inflammatory, and immune modulating agents (eg,
combination therapies of antiviral and anti-inflammatory agents).
10.
Describe the most complex differential diagnosis of red eye (eg,
pemphigoid, pemphigus, Stevens-Johnson syndrome).
11.
Describe the differential diagnosis and the external manifestations
of the most complex or uncommon anterior segment inflammations (eg,
syphilitic keratouveitis).
12.
Diagnose and treat the most complex traumatic and toxic injuries to
the anterior segment (eg, total lid avulsion, severe alkali burn).
13.
Recognize and treat complex corneal lacerations (eg, lacerations
extending beyond the limbus, uveal involvement).
14.
Diagnose and treat the most severe corneal exposure cases (eg,
conjunctival flap).
15.
Describe the indications for ocular surface transplantation,
including conjunctival autograft/flap, amniotic membrane
transplantation, and limbal stem cell transplantation.
16.
Describe the surgical indications (eg, Fuchs dystrophy,
aphakic/pseudophakic bullous keratopathy, keratoconus), surgical
techniques, and recognition and management of postoperative
complications (especially immunologically-mediated rejection) of
corneal transplantation (eg, penetrating, lamellar).
B. Technical/Surgical Skills
1.
Perform and interpret the most advanced corneal techniques (eg,
endothelial microscopy, computerized corneal topography and
tomography, anterior segment ocular coherence tomography).**
2.
Perform a thin conjunctival flap (eg, Gunderson flap).
3.
Perform specialized and complicated fitting of contact lenses (eg,
postkeratoplasty, advanced keratoconus).
4.
Perform more complex corneal surgery (eg, penetrating or lamellar
keratoplasty, keratorefractive procedures, and phototherapeutic
keratectomy), and understand the
postoperative management including postkeratoplasty astigmatism
management and graft rejection.
5.
Perform other complex conjunctival surgery (eg, autograft, stem cell
transplant).
6.
Manage and treat more complex neoplasms of the conjunctiva (eg,
carcinoma, melanoma).
Very Advanced Level Goals: Subspecialist
Fellowship
training requires more in‐depth
education about the pathophysiology and management than can usually
be obtained in residency training in ophthalmology. Fellowships
include a continuous period of intense and focused training in
developing and maintaining knowledge, skills, scholarship, and
professionalism. A fellow should be knowledgeable and proficient in
all the activities listed for residency training. Subspecialty
fellowship training should include a more in-depth exposure and
understanding of the diagnosis and medical management of diseases of
the eyelids, conjunctiva, cornea/sclera, and anterior ocular segment,
as well as recognition and treatment of posterior segment disease
that may affect the anterior segment. Subspecialty fellowship
training should include hands-on training covering surgery of the
conjunctiva, cornea/sclera, anterior segment, lens, and anterior
vitreous, with special emphasis on corneal transplantation and
related procedures. The fellow should be exposed to opportunities to
develop research skills. A specific block of time may be set aside
for clinical or laboratory research.
A. Cognitive Skills
1.
Recognize acute and chronic blepharitis, including both infectious
and noninfectious etiologies, with emphasis on microbial blepharitis,
meibomian gland dysfunction, and rosacea.**
2.
Recognize acute and chronic conjunctivitis, neonatal conjunctivitis,
chlamydial disease, adenoviral conjunctivitis, allergic
conjunctivitis, and bacterial conjunctivitis.**
3.
Recognize acute and chronic infectious keratitis including
bacterial, viral, fungal, and parasitic, with emphasis on herpes
simplex, herpes zoster, adenovirus, acanthamoeba, and contact
lens‐associated
problems.**
4.
Recognize noninfectious keratitis including marginal keratitis,
central ulcerative keratitis, epitheliopathy, endothelialitis,
and interstitial keratitis.**
5.
Recognize anterior segment anomalies, including various anomalies
associated with specific genetic abnormalities, corneal dystrophies,
and corneal degenerations.**
6.
Recognize autoimmune and immunologic diseases of the anterior
segment including allergy, corneal graft rejection, and cicatrizing
conjunctivitis.**
7. Recognize
and be familiar with oral and topical immunosuppression and
anti‐allergy
medications.**
8.
Describe fundamentals of anterior segment anatomy, chemistry,
physiology, and wound healing including tear formation and function,
corneal topography/tomography,
endothelial cell
function, and maintenance of corneal clarity.**
9.
Understand principles of anterior segment pharmacology including
antimicrobial, anti‐inflammatory,
ocular hypotensive and immunosuppressive agents, with emphasis on
bioavailability, mechanism of actions, relative efficacy, safety, and
potential complications.**
10.
Demonstrate fundamental knowledge of contact lens physiology, design
and materials, and complications for both cosmetic and therapeutic
use.**
11.
Develop proficiency in performing diagnostic techniques including
biomicroscopy, specular microscopy, corneal topography/tomography,
vital stains of the ocular surface, corneal biopsy techniques and
interpretation, and corneal pachymetry.**
12.
Develop proficiency in medical and surgical management of corneal
thinning and perforation, including techniques of pharmacological
manipulation; and office procedures, such as application of tissue
glue and therapeutic contact lenses.**
13.
Demonstrate a detailed understanding of cornea and conjunctival
pathology results and interpretation of ocular cultures.**
14. Complete
an eye-banking curriculum, including a review of specific eye banking
functions (recovery, processing, storage, evaluation, and
distribution of tissue), donor eligibility, and donor selection.**
15.
Demonstrate skill in use of reference material, including electronic
searching and retrieval of relevant articles, monographs, and
abstracts.**
B. Technical/Surgical Skills
1.
Demonstrate skill in anterior segment surgery including eyelid,
conjunctival, scleral, and corneal procedures, with emphasis on
corneal protective procedures (eg, tarsorrhaphy), reconstruction of
the ocular surface, surgical management of corneal erosions, and
phototherapeutic keratectomy.**
2.
Demonstrate skill in penetrating and lamellar keratoplasty, with
emphasis on patient selection, surgical technique, and postoperative
care including recognition and management of graft rejection and
endophthalmitis and advanced techniques for lamellar and penetrating
keratoplasty, including full thickness
and lamellar
transplants and endothelial keratoplasty.**
3.
The fellow should receive instruction and develop surgical
proficiency in both full-thickness penetrating keratoplasty and
selective endothelial keratoplasty and lamellar keratoplasty. The
faculty must participate as primary surgeon or assistant surgeon to
the fellow in a sufficient number of surgical procedures to confirm
the fellow’s surgical judgment and skill.
4.
The fellow should actively participate in the postoperative
management in the majority of grafts where they are part of the
surgical team.**
5.
The fellow should have sufficient experience and demonstrate
proficiency with other surgeries, including pterygium excision with
graft, corneal and conjunctival biopsies, astigmatic keratotomies,
and phototherapeutic keratectomy.**
6.
The fellow should participate in the surgery of more complex
conditions, including extensive conjunctival reconstruction, amniotic
membrane transplantation, ocular surface neoplasia, and limbal stem
cell transplantation.**
7. The
fellow should have knowledge of different techniques of
keratoprosthesis surgery.**
8. The
fellow should be familiar with the use of mitomycin (and/or other
chemotherapeutic agents) in corneal and conjunctival surgeries and
recognize the appropriate application and potential side effects.**
*
* *
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.
