Basic Level Goals: Year 1
A. Cognitive Skills
Physical Optics
1. Describe the wave and particle nature of light.
2. Explain the phenomenon of diffraction.
3. Explain the concepts of interference and coherence.
4. Define optical resolution.
5. Explain polarization.
6. Explain light scattering.
7. Define and compare transmission and absorption.
8. Explain photometry.
9. Define illumination.
10. Describe image quality.
11. Differentiate brightness and radiance.
12. Define refractive index.
Geometric Optics
Reflection (Mirrors)
1. List the laws of reflection.
2. Explain images and objects as light sources.
3. Define refractive index.
Refraction
1. Explain the law of refraction (Snell law), including:
a. Passage of light from one medium to another
b. Absolute index of refraction
c. Total internal reflection
2. Explain critical angle and total internal reflection.
Prisms
1. Define a prism.**
2. Explain the notation of prisms (eg, prism diopters).**
3. Describe the use of prisms in ophthalmology (ie, diagnostic and therapeutic).**
4. Explain Prentice rule.
5. Describe Fresnel and similar prisms.
6. Explain the concept of thin prisms.
7. Explain the prismatic effect of lenses.**
8. Define spherical decentration and prism power.
Spherical Lenses
1. Define a spherical lens.**
2. Describe the cardinal points.
3. Recite the thin lens and thick lens formulas.
4. Define vergence of light, including diopter, convergence, divergence, and vergence formula.
5. Define the terms concave and convex.**
6. Define the term magnification, including linear, angular, relative size, and electronic.
Astigmatic Lenses
1. Describe cylindrical lenses, including:**
a. Spherocylinder lenses and surfaces**
b. Cross cylinders (eg, Jackson cross cylinder)**
2. Describe toric lenses.
Clinical Optics
1. Define emmetropia.**
2. Define ametropia.**
3. Define myopia.**
4. Define hypermetropia (hyperopia).**
5. Define astigmatism.**
6. Define anisometropia.**
7. Define aniseikonia (including Knapp rule).**
8. Define aphakia. **
9. Explain optical parameters affecting retinal image size.
10. Describe the pupillary response and its effect on the resolution of the optical system (Stiles-Crawford effect).
11. Define visual acuity, including:**
a. Distance and near acuity measurement
b. Minimal acuity (ie, visible, perceptible, separable, legible)
c. Visual acuity charts
12. Describe higher-order aberrations of the eye.
13. Explain how accommodation is affected by age.**
14. Explain how the pinhole effect impacts visual acuity.**
15. Explain accommodative problems.**
16. Describe convergence or accommodative insufficiency or excess.
17. Define accommodative-convergence over accommodation (AC/A) ratio.
18. Describe the epidemiology of refractive errors, including:**
a. Prevalence
b. Inheritance
c. Changes with age
d. Surgical considerations
19. Describe the potential problems with aphakic spectacles.**
20. Describe the effect of spectacles and contact lens correction on accommodation and convergence (ie, amplitude, near point, far point).**
21. Explain the principles of contrast sensitivity measurements.
22. Describe the correction of ametropia, including:**
a. General principles**
b. Spectacle lenses**
c. Contact lenses**
d. Intraocular lenses
e. Principles of refractive surgery**
Clinical Refraction
Objective Refraction: Retinoscopy
1. List the principles and indications for retinoscopy.**
Subjective Refraction Techniques**
1. Describe the major types of refractive errors.
2. Describe the indications for and use of trial lenses for simple refractive error.
Cycloplegic Refraction**
1. Describe medication concentrations according to age (eg, cyclopentolate, atropine).
B. Technical/Surgical Skills
Geometric Optics
Reflection (Mirrors)
1. Illustrate reflection at a plane surface (ie, image and field of a plane mirror).**
2. Illustrate reflection at curved surfaces (ie, focal point and focal length of a spherical mirror).**
3. Demonstrate a multiple lens system.
Refraction
1. Illustrate refraction at a plane surface.** 2. Illustrate refraction at curved surfaces.** 3. Demonstrate image jump and displacement.
Prisms
1. Demonstrate the types of prisms (eg, plane, parallel, plate).
2. Illustrate refraction of light through a prism.
Spherical Lenses
1. Draw out the formation of the image.**
2. Demonstrate binocular balancing.
Astigmatic Lenses
1. Demonstrate how the Maddox rod works.**
2. Locate the conoid of Sturm.
Notation of Lenses
1. Design myopic, hyperopic, and astigmatic lenses.**
2. Perform simple transposition.**
3. Perform toric transposition.
4. Calculate a lens prescription.**
Aberration of Lenses
1. Correct aberrations relevant to the eye, including spherical, coma, astigmatism, and distortion.
2. Describe color aberrations and perform the duochrome test.
Clinical Optics
1. Illustrate optics of the eye, including the dioptric power of different structures.
2. Draw a schematic eye and reduced eye.
3. Demonstrate contrast sensitivity measurements.
4. Demonstrate the calculation of intraocular lens power.
Clinical Refraction
Objective Refraction: Retinoscopy
1. Perform the technique of retinoscopy.**
2. Perform an integrated refraction based upon retinoscopic results.**
3. Identify media opacities with retinoscopy.
4. Perform cycloplegia.**
5. Prescribe refractive correction based on the obtained objective and subjective measurements.**
Subjective Refraction Techniques**
1. Perform elementary refraction techniques for myopia, hyperopia, and near-vision add.
2. Perform techniques for the correction for presbyopia (ie, measuring for near adds).
Instruments and Tests
1. Demonstrate the use of the direct ophthalmoscope.**
2. Demonstrate the use of the indirect ophthalmoscope.**
3. Demonstrate the use of the retinoscope.**
4. Demonstrate glare and contrast sensitivity testing.**
5. Demonstrate the use of the automated refractor.
6. Demonstrate measurement of higher-order aberrations.
7. Demonstrate the use of stereoacuity testing.
8. Demonstrate the use of corneal topography (eg, placido disc, keratometer, automated corneal topography).**
9. Demonstrate the use of the Hess screen or describe its use if not available.
10. Demonstrate the use of the synoptophore.
11. Demonstrate the use of color vision tests (eg, Ishihara color plates; Hardy-Rand-Rittler test, Farnsworth-Munsell test).
Standard Level Goals: Year 2
A. Cognitive Skills
Optics
Spectacles
1. Describe materials index.
2. Describe the principles underlying progressive spectacle lens design.
3. Describe progressive lenses measurements.**
4. Describe spectacles specificities in children.**
Lasers
1. Describe the technology behind the excimer laser and the femtosecond laser.
2. List different wavelengths used in ophthalmic lasers.
3. Describe indications for refractive surgery.**
Aberrometry Technology
1. Explain the principles underlying Hartmann-Shack aberrometers.
2. Describe the concept of Zernicke polynomials.
Diagnostic Equipment
1. List indications for and the use of intraocular lens (IOL) calculation algorithms.**
2. List indications for the use of corneal pachymetry.**
3. List indications for the use of specular microscopy.**
4. List indications for the use of corneal tomography with anterior segment optical coherence tomography (OCT).**
5. List indications for the use of topographic/elevation corneal evaluation (ie, Pentacam, Orbscan II, Galilei).**
6. List indications for the use of accommodometer.
7. List indications for the use of laser interferometry for macular testing.**
Refraction**
1. Describe and prescribe more complex types of refractive errors, including postoperative refractive errors.
2. Describe the more advanced ophthalmic optics and optical principles of refraction and retinoscopy (eg, postkeratoplasty, post-cataract extraction).
3. Describe how to test muscle balance.
B. Technical Skills
Optics
Aberrometry Technology
1. Estimate the clinical incidence of higher-order aberrations.
Diagnostic Equipment
1. Demonstrate the use of IOL calculation algorithms.
2. Demonstrate the use of corneal pachymetry.
3. Demonstrate the use of specular microscopy.
4. Demonstrate the use of corneal tomography with anterior segment optical coherence tomography (OCT).
5. Demonstrate the use of topographic/elevation corneal evaluation (ie, Pentacam, Orbscan II, Galilei).
6. Demonstrate the use of accommodometer.
7. Demonstrate the use of laser interferometry for macular testing.
Refraction**
1. Perform more advanced refraction techniques (eg, astigmatism, complex refractions, asymmetric accommodative add).
2. Perform objective and subjective refraction techniques for more complex refractive errors, including astigmatism, irregular astigmatism (eg, keratoconus, keratectasia, post-corneal graft), and postoperative refractive error.
3. Measure the accommodative power.
4. Demonstrate the measurement of interpupillary distance (IPD).
5. Demonstrate the prescribing of multifocal lenses.
6. Demonstrate the prescribing of lenses for children.
Advanced Level Goals: Year 3
A. Cognitive Skills
1. Describe binocular balance.
2. Describe how to use more advanced techniques using trial lenses or the phoropter for more complex refractive errors, including modification and refinement of subjective manifest refractive error and more complex refractive errors (eg, advanced and irregular astigmatism, vertex distance).
B. Technical Skills
1. Evaluate binocular balance.
2. Demonstrate more advanced techniques using trial lenses or the phoropter for more complex refractive errors, including modification and refinement of subjective manifest refractive error and more complex refractive errors (eg, advanced and irregular astigmatism, vertex distance).
Very Advanced Level Goals: Subspecialist
A. Cognitive Skills
Low Vision Aid Prescribing
1. Describe the principles of low vision aids (eg, magnification, increasing contrast, learning to use functioning areas of the eye).
2. Describe cases where telescopic aids (eg, Galilean telescope, Keplerian telescop) can be of use.
B. Technical Skills
Low Vision Aid Prescribing
1. Grade high reading addition.
2. Calculate and prescribe magnifying lenses.
Other
1. Perform objective and subjective refraction techniques in the most complex refractive error, including astigmatism and postoperative refractive error.
2. Perform the most advanced techniques using trial lenses or the phoropter for more complex refractive errors, including modification and refinement of subjective manifest refractive error, cycloplegic retinoscopy and refraction, and post-cycloplegic refraction, irregular astigmatism, postkeratoplasty, and refractive surgery cases.
3. Use the keratometer for detection of subtle or complex advanced refractive error.
4. Use more advanced refraction instruments and techniques (eg, distometer, automated refractor, automated corneal topography).
5. Measure and evaluate peripheral refraction and accommodative lag.
6. Calculate and prescribe prisms for diplopia.
7. Demonstrate calculation of IOLs within the normal range of ametropias.
8. Demonstrate calculation of IOLs in children.
9. Demonstrate calculation of IOLs in highly myopic patients.
10. Demonstrate calculation of IOLs for irregular corneas (ie, keratoconus).
11. Demonstrate calculation of IOLs after corneal refractive surgery.
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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.
