Basic Level Goals: Year 1
Year
1 equivalent: trainee ophthalmologist, any grade, not expecting to
specialize in ocular oncology.
A. Cognitive Skills
1.
Describe the basic categorization of common conjunctival and
intraocular tumors.**
2.
Describe the clinical features of the major types of ocular tumor.**
3.
Describe the symptoms and clinical manifestations indicating the
presence of an ocular tumor (eg, leukocoria, sentinel vessels).**
4.
Describe the differential diagnosis of the major tumors.**
5.
Describe the examinations and tests by which ocular tumors are
diagnosed.**
6.
Describe the systemic features of ocular tumors and how these
features are detected.**
7.
Describe the basic management principles of ocular tumors.**
8.
Describe the epidemiology of the more common tumors (eg,
melanoma).**
9.
Describe the methods, risks, and benefits of tumor biopsy.**
B. Technical/Surgical Skills
1. Perform
slit-lamp and ophthalmoscopic examination of patients with an ocular
tumor.**
2.
Recognize an ocular tumor and refer to an ocular oncology
subspecialist.**
3.
Contribute to the care of patients after treatment.**
Year
2 equivalent: senior general ophthalmologist who may need to diagnose
and refer patients with an ocular tumor and collaborate with an
ocular oncologist in long-term aftercare.
A. Cognitive Skills
1.
Describe the classification of ocular tumors (ie, conjunctival and
intraocular).**
2.
Describe the clinical features of ocular tumors and their secondary
effects.**
3. List
the differential diagnosis for each of the ocular tumors.**
4.
Describe diagnostic techniques for ocular tumors (eg, examination
under anesthesia for pediatric tumors, imaging, biopsy, laboratory
tests, oncology referral).**
5.
Describe indications (eg, biopsy for lymphoma) and contraindications
(eg, biopsy for retinoblastoma) for the various diagnostic
techniques.**
6.
Describe the management options for ocular tumors with indications
and contraindications for each form of management.**
7.
Describe the complications of ocular therapy and their management.**
8.
Describe basic histopathology of tumors, including
immunohistochemistry.**
9.
Describe the prognosis of the different types of ocular tumor.**
10.
Describe the epidemiology of the more common tumors (eg, melanoma).**
11.
Describe the methods, risks, and benefits of tumor biopsy.**
B. Technical/Surgical Skills
1. Perform
naked-eye examination (eg, to recognize oculodermal melanosis).**
2. Perform
palpation of cervical lymph nodes.**
3. Perform
slit-lamp examination, gonioscopy, and indirect ophthalmoscopy to
diagnose and localize ocular tumors.**
4. Perform
transillumination for intraocular tumors.**
5. Perform
B-scan ultrasonography to detect and measure intraocular tumors.**
6. Perform
sequential examination to assess the tumor over time (eg, atypical
nevus).**
7. Guide
evaluation for systemic disease (eg, metastases, primary tumor,
syndromes).**
8. Perform
excision of conjunctival tumors, avoiding seeding, or refer to an
ocular oncology subspecialist for such surgery if possible.**
9. Perform
enucleation, obtaining long optic nerve if appropriate, or refer to a
subspecialist for this surgery if necessary.**
10.
Collaborate with subspecialist in the preoperative care and referral
of selected patients with an ocular tumor, avoiding potential
pitfalls.**
11. Provide
short-term and long-term postoperative care to patients with an
ocular tumor, collaborating with a subspecialist and other health
care workers as appropriate.**
12.
Investigate and manage ocular complications as appropriate (eg,
radiation retinopathy, macular edema, cataract, glaucoma).**
13.
Interpret the results of laboratory investigations and adjust
management accordingly.**
14. Discuss
prognosis and various management options with patients and their
families in a detailed, ethical, and compassionate manner.**
A. Cognitive Skills
1. Describe
the applied surgical anatomy, histology, and physiology of the eye
and ocular adnexa with relevance to ocular oncology.
2. List the
most common conjunctival and intraocular tumors.**
3. Describe
relevant pathological conditions, such as:**
a. Nonneoplastic
tumors (eg, hamartomas)**
b. Neoplastic
tumors**
i. Benign
(eg, nevus, hemangioma)
ii. Malignant
(eg, melanoma, carcinoma, metastasis)
c. Traumatic
lesions (eg, implantation cysts, hemorrhages)**
d. Degenerative
lesions (eg, disciforms, sclerochoroidal calcification)**
e. Idiopathic
disease (eg, juvenile xanthogranuloma, vasoproliferative tumor)**
f. Paraneoplastic
disease (eg, Bilateral diffuse uveal melanocytic
proliferation)**
g. Iatrogenic
disease (eg, radiation-induced disease)**
4. Describe
relevant pathological techniques (eg, fixation, histology,
immunohistochemistry).
5. Describe
relevant genetic abnormalities and techniques:**
a. Germinal
and somatic mutations relevant to oncology (eg, retinoblastoma)**
b. Important
genetic techniques (eg, fluorescence in situ hybridization)**
6. Describe
the relevance of staging tumors (eg, TNM [Tumor, lymph Nodes,
Metastasis] Classification of Malignant Tumors).
7. Describe
the etiology of ocular tumors, such as:
a. Environmental
factors (eg, conjunctival squamous cell carcinoma)
b. Genetic
factors (eg, retinoblastoma)
c. Syndromes
(eg, von Hippel-Lindau disease)
d. Malformations
(eg, choroidal osteoma)
8. Describe
the pathogenesis of ocular tumors (ie, how tumors cause harm):**
a. Ocular
effects (eg, neovascular glaucoma)**
b. Systemic
effects (eg, metastatic disease)**
9. Describe
the epidemiology of the more common ocular tumors (eg, melanoma).**
10. Describe
the principles of examination techniques:
a. Inspection
b. Transillumination
c. Color
photography
d. Optical
coherence tomography
e. Autofluorescence
f. Angiography
(indocyanine green and fluorescein)
g. Ultrasonography
h. Magnetic
resonance imaging
i. Computerized
tomography
j. Positron
emission tomography
k. Biopsy
i. Aspiration
ii. Incisional
iii. Excisional
iv. Impression
cytology
l. Systemic
investigation according to ocular tumor diagnosis
i. History
ii. Clinical
examination
iii. Hematology
and biochemistry
iv. Radiography
v. Ultrasonography
vi. Computerized
tomography
vii. Magnetic
resonance imaging
viii. Genetic
testing
11.
Describe the clinical features of each tumor type:**
a. Inspection/color
photography**
b. Investigational
(ie, angiography, echography)**
12. List
the differential diagnosis of each tumor, and describe the
investigational approach for each condition.**
13.
Describe how the following therapeutic modalities and their effects
are relevant to ocular tumors:**
a. Radiotherapy
(eg, brachytherapy, external beam radiotherapy, proton beam)**
b. Chemotherapy
(eg, topical, intraocular, systemic)**
c. Phototherapy
(eg, photocoagulation, photodynamic therapy)**
d. Cryotherapy
(eg, liquid nitrogen, carbon dioxide)**
e. Surgical
resection (eg, local resection, enucleation)**
14.
Describe how statistics can be applied to ocular oncology (eg,
survival analysis).
15.
Describe the methods, risks, and benefits of tumor biopsy and how
these can be avoided (eg, biopsy of retinoblastoma, incisional biopsy
of conjunctival tumor).**
B. Technical/Surgical Skills
1. Perform
or request appropriate examinations and investigations according to
differential diagnosis.**
2. Perform
or refer for treatment for conjunctival or intraocular tumors,
demonstrating awareness of the indications, contraindications, and
complications of each treatment and having skill to administer
short-term and long-term postoperative care:**
a. Radiotherapy
(eg, brachytherapy, external beam radiotherapy)**
b. Phototherapy
(eg, photodynamic therapy, transpupillary thermotherapy)**
c. Surgical
excision (eg, local resection, enucleation, exenteration)**
d. Ocular
pharmacological therapy by various routes (ie, topical, intravitreal,
ophthalmic artery infusion, subtenon, systemic)**
i. Chemotherapy
and biological therapy
ii. Antiangiogenic
agents
iii. Steroids
3. Interpret
results of relevant laboratory tests and communicate results to
patients, relatives, and health care workers; and adjust patient
management accordingly.
4. Communicate
prognosis with patients, relatives, and health care workers; and
adjust patient management accordingly in collaboration, if necessary,
with a subspecialist.**
5. Use
information technology and other aids to cope with lack of expert
knowledge.**
6. Assist
patients with selecting the most appropriate management in
collaboration, if necessary, with a subspecialist in ocular oncology.
7. Provide
or organize appropriate psychological support, demonstrating empathy
and an adequate awareness of the principles of this aspect of care
(eg, giving bad news).**
8. Collaborate
with subspecialists and other health care professionals to provide
patient-focused care.**
9. Develop
protocols and infrastructure for practice-based learning and
improvement (eg, access to information, outcomes data).
Subspecialist
equivalent: senior ophthalmologist responsible for ocular oncology,
either part-time or full-time, who receives ocular oncology patient
referrals.
A. Cognitive Skills
1. Describe
the applied surgical anatomy, histology, and embryology of the eye
and ocular adnexa with relevance to ocular oncology.
2. Describe
the applied physiology of the eye and adnexa with relevance to ocular
oncology.
3. Describe
the applied pathology of the following:**
a. Ocular
tumors and pseudotumors**
i. Congenital/developmental
1.1. Conjunctiva
a. Dermoid
b. Dermolipoma
c. Choristoma
(simple and complex)
2.1. Uvea
a. Lisch
nodules
b. Stromal
iris cyst
c. Lacrimal
gland choristoma
3.1. Retina
a. Multiple
congenital hypertrophy of the retinal pigment epithelium (CHRPE)
b. Astrocytic
hamartoma
c. Hemangioblastoma
d. Cavernous
angioma
e. Dominant
exudative vitreoretinopathy
f. Norrie
disease
g. Incontinentia
pigmenti
h. Solitary
CHRPE
i. Grouped
pigmentation
j. Arteriovenous
malformation (racemose angioma)
k. Posterior
primary hyperplastic vitreous (PPHV)
l. Glioneuroma
ii. Inflammatory
(infectious, noninfectious)
1.1. Conjunctiva
a. Granuloma
(eg, syphilis, sarcoid)
2.1. Uvea
a. Granuloma
(eg, tuberculosis)
b. Uveal
effusion
c. Posterior
scleritis
3.1. Retina
a. Granuloma
(eg, toxocara)
iii. Neoplastic
1.1. Benign
a. Conjunctiva
i. Nevus
ii. Papilloma
iii. Oncocytoma
iv. Primary
acquired melanosis
v. Reactive
lymphoid hyperplasia
vi. Other
b. Uvea
i. Nevus/melanocytoma
ii. Hemangioma
iii. Osteoma
iv. Neurilemmoma
v. Neurofibroma
vi. Leiomyoma
vii. Mesectodermal
leiomyoma
viii. Reactive
lymphoid hyperplasia
ix. Bilateral
diffuse uveal melanocytic proliferation
x. Other
rare conditions
c. Retina
i. Retinoma/retinocytoma
ii. Adenoma
iii. Fuchs
adenoma
iv. Benign
medulloepithelioma
v. Other
2.1. Malignant
a. Conjunctiva
i. Melanoma
ii. Squamous
cell carcinoma
iii. Sebaceous
carcinoma
iv. Kaposi
sarcoma
v. Lymphoma
vi. Extraocular
tumor spread
vii. Metastasis
viii. Other
b. Uvea
i. Melanoma
ii. Lymphoma
iii. Intraocular
tumor spread from conjunctiva
iv. Systemic
lymphoma
v. Systemic
leukemia
vi. Metastasis
vii. Other
c. Retina
i. Retinoblastoma
ii. Adenocarcinoma
iii. Malignant
medulloepithelioma
iv. Lymphoma
v. Leukemia
vi. Metastasis
vii. Other
iv. Traumatic
1.1. Conjunctiva
a. Implantation
cyst
b. Foreign
body granuloma
c. Pyogenic
granuloma
2.1. Uvea
a. Implantation
cyst
b. Choroidal
hemorrhage
c. Miotic
cyst
3.1. Retina
a. Retinopathy
of prematurity
b. Retinal
detachment
c. Massive
reactive gliosis
v. Degenerative
1.1. Conjunctiva
a. Lacrimal
retention cyst
2.1. Uvea
a. Disciform
lesion
b. Sclerochoroidal
calcification
c. Vortex
vein ampulla
3.1. Retina
a. Vasoproliferative
tumor
vi. Idiopathic
1.1. Conjunctiva
a. Lymphangiectatic
cyst
2.1. Uvea
a. Juvenile
xanthogranuloma
3.1. Retina
a. Coats
disease
b. Combined
hamartoma of retina and retinal pigment epithelium
c. Iris
cyst
d. Ciliary
epithelial cyst
vii. Paraneoplastic
disease
1.1. Bilateral
diffuse uveal melanocytic proliferation
2.1. Carcinoma-associated
retinopathy
3.1. Melanoma-associated
retinopathy
4.1. Other
4. Describe
the following pathological conditions:**
a. Non-neoplastic
tumors**
i. Hamartoma
ii. Choristoma
iii. Granuloma
iv. Cyst
v. Hyperplasia
vi. Metaplasia
b. Neoplastic
tumors**
i. Benign
ii. Malignant
1.1. Proliferation
2.1. Invasion
3.1. Seeding
4.1. Metastasis
iii. Iatrogenic
disease
1.1. Radiation
2.1. Pharmacology
3.1. Surgery
4.1. Phototherapy
5. Describe
relevant pathological techniques, such as:
a. Fixatives**
b. Frozen
sections
c. Histology
d. Immunohistochemistry
e. Flow
cytometry
f. Other
6. Describe
the following genetic abnormalities and techniques:
a. Germinal
mutations relevant to oncology**
b. Somatic
mutations in tumors**
c. Genetic techniques
i. Karyotyping
ii. Polymerase
chain reaction
iii. Fluorescence
in situ hybridization
iv. Multiplex
ligation-dependent probe amplification
v. Gene
expression profiling
vi. Comparative
genomic hybridization
vii. Other
7. Describe
the relevant staging and grading systems for ocular tumors (with
ability to use appropriate methods as necessary, using appropriate
references sources):
a. TNM
Classification of Malignant Tumors cancer staging system
i. Uveal
melanoma
ii. Retinoblastoma
iii. Conjunctival
melanoma
iv. Conjunctival
carcinoma
v. Ocular
adnexal lymphoma
b. International
retinoblastoma staging system
c. Reese-Ellsworth
staging system for retinoblastoma
d. Other
staging systems (eg, Collaborative
Ocular Melanoma Study)
8. Describe
the etiology of ocular tumors:
a. Environmental
factors
b. Genetic
factors
c. Syndromes
d. Malformations
e. Other
9. Describe
the pathogenesis of ocular tumors:**
a. Secondary
effects of uveal melanoma**
b. Secondary
effects of retinoblastoma**
c. Secondary
effects of other tumors (eg, conjunctival tumors)**
10. Describe
the epidemiology of ocular tumors:
a. Principles
of epidemiology
11. Describe
the principles of examination techniques:**
a. Inspection**
i. Slit-lamp
examination
ii. Gonioscopy
and 3-mirror examination
iii. Ophthalmoscopy
b. Transillumination**
i. Transpupillary
ii. Transscleral
c. Color
photography**
i. Standard
ocular photography
ii. Specialized
cameras (eg, RetCam, Optos)
iii. Autofluorescence photography
d. Angiography**
i. Fluorescein
angiography
ii. Indocyanine
green angiography
e. Ultrasonography**
i. A-scan
ultrasonography
ii. B-scan
ultrasonography (including high frequency)
iii. Doppler
ultrasonography
f. Magnetic
resonance imaging**
g. Computerized
tomography**
h. Positron
emission tomography**
i. Biopsy**
i. Aspiration
ii. Incisional
iii. Excisional
iv. Impression
cytology
j. Systemic
investigation according to ocular tumor diagnosis**
i. History
ii. Clinical
examination
iii. Hematology
and biochemistry
iv. Radiography
v. Ultrasonography
vi. Computerized
tomography
vii. Magnetic
resonance imaging
viii. Genetic
testing
12. Describe
the clinical features of each tumor type:**
a. Inspection/color
photography**
b. Investigational
(ie, angiography, echography)**
13. List
the differential diagnosis of each tumor and describe the
investigational approach for each condition.**
14. Describe
how the following therapeutic modalities and their effects are
relevant to ocular tumors:**
a. Radiotherapy**
i. Radiation
1.1. Radioactive
sources (eg, iodine, ruthenium)
2.1. Types
of radiation (eg, gamma, beta, proton)
ii. Biological
effects
b. Chemotherapy**
c. Phototherapy**
d. Cryotherapy**
e. Surgical
resection**
15. Describe
how the following statistics can be applied to ocular oncology:
a. Statistical
correlations
i. Univariate
ii. Multivariate
b. Survival
statistics
i. Kaplan-Meier
analysis
ii. Cox
analysis
iii. Neural
networks
iv. Accelerated
failure time
c. Bias
d. Power
calculations
e. Other
relevant statistical methods
B. Technical/Surgical Skills
1. Perform
or request the following examinations, interpreting and documenting
any findings, demonstrating awareness of the indications,
contraindications, and limitations of each investigation:**
a. Slit-lamp
examination of conjunctiva and assessment of conjunctival fornices**
b. Slit-lamp
examination of anterior chamber and gonioscopy**
c. Binocular
indirect ophthalmoscopy with indentation**
d. Transpupillary
transillumination**
e. A-scan
and B-scan ultrasonography of anterior and posterior eye**
f. Color
and autofluorescence photography**
g. Fluorescein
angiography**
h. Indocyanine
green angiography**
i. Magnetic
resonance imaging**
j. Incisional
and excisional conjunctival tumor biopsy**
k. Aspiration,
incisional, or excisional biopsy of intraocular tumor**
l. Other
relevant examinations and investigations**
2. Perform
or refer for the following treatments for conjunctival tumors,
demonstrating awareness of the indications, contraindications, and
complications of each treatment:**
a. Surgical
excision**
b. Cryotherapy**
c. Brachytherapy**
d. External
beam radiotherapy, including proton beam radiotherapy**
e. Topical
therapy (eg, mitomycin C, 5-fluorouracil, interferon)**
3. Perform
or refer for the following treatments for intraocular tumors,
demonstrating awareness of the indications, contraindications, and
complications of each treatment:**
a. Radiotherapy**
i. Brachytherapy
(eg, iodine, ruthenium, strontium, palladium, iridium)
ii. External
beam radiotherapy
iii. Stereotactic
radiotherapy
iv. Charged
particle radiotherapy (eg, proton beam)
b. Phototherapy**
i. Photocoagulation
ii. Transpupillary
thermotherapy
iii. Photodynamic
therapy
c. Surgical
excision**
i. Iridectomy
ii. Iridocyclectomy
iii. Transscleral
choroidectomy
iv. Transretinal
choroidectomy
v. Enucleation
vi. Exenteration
d. Ocular
pharmacological therapy by various routes (ie, topical, intravitreal,
ophthalmic artery infusion, subtenon, systemic)**
i. Chemotherapy
and biological therapy
ii. Antiangiogenic
agents
iii. Steroids
4. Request
the following investigations, interpreting and communicating the
results to patients, relatives, and health care workers, adjusting
patient management accordingly:**
a. Histopathological
assessment of tumor samples**
b. Genetic
assessment of tumor samples**
c. Laboratory
investigation of vitreous samples**
d. Other**
5. Estimate
the prognosis and communicate the following implications with
patients, relatives, and health care workers, adjusting patient
management accordingly:**
a. Visual
acuity**
b. Local
tumor control**
c. Possible
side effects and complications of therapy**
d. Ocular
conservation**
e. Systemic
manifestations of disease, including metastasis**
f. Systemic
complications and side effects of therapy**
g. Survival
probability and chances of disease-related mortality**
h. Heritability**
i. Use
information technology and other aids to enhance prognostication**
6. Communicate
the following to patients, relatives, and health care workers:**
a. Diagnosis,
extent and severity of disease, including diagnostic uncertainty**
b. Natural
history without treatment**
c. Therapeutic
options with advantages and limitations of each therapy, including
methods available elsewhere**
d. Logistical
implications of selected treatment**
e. Use
information technology and other aids to support this process**
i. Websites
ii. Printed
leaflets
iii. Audio
recordings
f. Other
relevant materials**
7. Assist
patients with selecting the most appropriate management, taking into
account:**
a. Patient
age, gender, culture, wishes, needs, and fears**
b. Costs
and logistics**
c. Availability
of health care resources, locally and elsewhere**
8. Provide
or organize appropriate psychological support, demonstrating empathy
and an adequate awareness of the principles of this aspect of care,
such as:**
a. Giving
bad news**
b. Communicating
with relatives**
c. Enabling
long-term communication and support**
9. Develop
and maintain a multidisciplinary team of health care professionals to
provide patient-focused care by activities, such as:
a. Recruiting
staff and coworkers
b. Developing
service operating procedures.
c. Maintaining
efficient and varied methods of communication and education
i. Between
multidisciplinary team members (MDT)
ii. Between
MDT and other practitioners (eg, pathologists)
iii. Between
MDT and patient
10. Develop
protocols and infrastructure for practice-based learning and
improvement, including:
a. Proformas
and databases for storing data
b. Protocols
for extracting and analyzing data
c. Application
of study designs and statistical methods
d. Adherence
to clinical governance
i. Informed
consent
ii. Confidentiality
iii. Ethical
committee approval
*
* *
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.
