Basic Level Goals: Year 1
A. Cognitive Skills
1. Describe
the definition and classification of intraocular inflammation.**
2. Describe
the basic principles of history taking:
a. Ocular
history**
i. Correlate
with possible anatomical diagnosis (eg, photophobia and anterior
uveitis; floaters and posterior uveitis)**
ii. Describe
the onset (sudden or insidious)**
iii. Describe
the duration (limited or persistent)**
iv. Describe
the course (acute, recurrent, chronic)**
v. Investigation
and treatment history**
b. Systemic
history**
i. Known
diseases, including immunosuppressed states, such as HIV, malignancy,
diabetes mellitus**
ii. Symptoms
of recent onset for (eg, fever, chills, and rigors may suggest
sepsis)**
iii. Systems
review, including all medications, past and current**
3. List
the clinical features of:
a. Anterior
uveitis**
b. Intermediate
uveitis**
c. Posterior
or panuveitis**
d. Episcleritis
and scleritis (eg, red eye, blurred vision)**
e. Anterior
segment cell and flare**
f. Keratic
precipitates (nongranulomatous or granulomatous)**
g. Posterior
synechiae**
h. Vitreous
cell and flare**
i. Vitreous
opacities**
j. Snowbank**
k Retinal
and/or choroidal lesions**
l. Retinal
vasculitic**
m. Retinal
detachment (exudative, tractional, and rhegmatogenous)**
n. Optic
disc changes (eg, optic disc edema, optic neuritis).**
4. Describe
the typical demographic features, clinical features, and differential
diagnosis of common, rapidly blinding causes for items 3a–3n above
(based on local epidemiological data). For example:
a. Anterior
uveitis
i. Infectious
(eg, bacterial, viral, protozoal, parasitic)
ii. Inflammatory
(eg, sarcoidosis,
HLA B27-associated, juvenile idiopathic arthritis, Behçet
disease, collagen vascular disease)
iii. Postsurgical
uveitis
iv. Posttraumatic
v. Fuchs
uveitis syndrome
vi. Posner-Schlossman
syndrome
b. Intermediate
uveitis
i. Pars
planitis
ii. Toxocariasis
iii. Sarcoidosis
iv. Multiple
sclerosis
c. Posterior
or panuveitis
i. Infectious
(eg, toxoplasmosis, toxocariasis, tuberculosis, acquired and
congenital ocular syphilis, acute retinal necrosis)
ii. Inflammatory
(eg, sarcoidosis, Behçet disease, Vogt-Koyanagi-Harada disease,
sympathetic ophthalmia)
iii. Postoperative
uveitis
iv. Endophthalmitis
(eg, postoperative, traumatic, endogenous, fungal, phacoanaphylactic)
d. Episcleritis
and scleritis
i. Collagen
vascular diseases (eg, rheumatoid arthritis, Wegener granulomatosis)
ii. Infection
(eg, syphilis, tuberculosis, fungal, parasitic, bacterial)
5. Describe
indications for ancillary testing in the evaluation of uveitis (eg,
fluorescein angiography [FA], indocyanine green [ICG] angiography,
optical coherence tomography [OCT], B-scan ultrasonography).
6. Describe
indications for a tailored approach (based on clinical features) to
laboratory investigations, including obtaining tissue and fluid
samples for examination and systemic imaging studies (eg, x-ray of
chest, sacroiliac joint, chest
computerized axial tomography [CT or
CAT] scan).
7. Describe
the indications and contraindications of topical steroids,
nonsteroidal anti-inflammatory drugs
(NSAIDs), and cycloplegics.
B. Technical/Surgical Skills
1. Perform
slit-lamp examination of the anterior segment to detect and evaluate
clinical features of anterior uveitis, including:**
a. Corneal
pathology (active keratitis or scars, endotheliitis,
band keratopathy)**
b. Pattern
of keratic precipitates
(nongranulomatous, granulomatous)**
c. Iris
changes (rubeosis iridis, gross iris atrophy)**
d. Anterior
chamber evaluation of cells and flare, including grading according to
standardization of uveitis nomenclature
(SUN) working group grading system**
e. Differentiate
episcleritis from scleritis**
f. Describe
the activity (active or quiescent)**
2. Perform
dilated examination of the posterior segment with slit-lamp
biomicroscopy using noncontact and contact lenses, indirect
ophthalmoscopy.**
a. Vitreous
evaluation for cells and flare, including grading of vitreous haze
according to SUN working group grading system**
b. Retina/choroid
(retinal detachment, choroidal or retinal inflammation)**
c. Retinal
vasculature (vascular inflammation)**
d. Optic
disc (swelling, pallor)**
3. Describe
the regional epidemiology of uveitis and relate this information to
the diagnosis.
4. List
the following:
a. Uveitis
in immunosuppressed individuals with active and recovered acquired
immune deficiency syndrome or pharmacologic immunosuppression (eg,
cytomegalovirus retinitis, pneumocystis (carinii) jiroveci)
b. Unusual
infectious etiologies for uveitis (eg, Lyme disease, West-Nile fever)
c. Masquerade
syndromes such as vitreoretinal lymphoma
5. Differentiate
infective from noninfective causes of uveitis.
6. Perform
pars plana evaluation and sclera depression.
7. Interpret
fluorescein angiography,
B-scan ultrasonography, and correlate clinically.
8. Provide
patient with all relevant information about proposed ancillary
testing procedures for uveitis, including risks and complications.
Standard Level Goals: Year 2
A. Cognitive Skills
1. Describe
the pathophysiology of intraocular inflammation.**
2. Describe
the principles of history taking of patients with uveitis according
to SUN.
3. Describe
the importance of being guided by clinical findings from the ocular
examination and taking a more specific history in order to generate a
list of differential diagnoses.**
4. Describe
more advanced principles of examination of patients with uveitis and
differential diagnoses of the clinical signs:**
a. Anterior
segment (eg, iris nodules, pupillary membrane, peripheral anterior
synechiae, iris bombe)**
b. Posterior
segment (eg, pars plana signs of inflammation [snowballs], retinal
detachment, retinal vasculitis, optic swelling [differentiate optic
neuritis from hyperemia],
macula [macular edema])**
5. Describe
the regional epidemiology of uveitis and relate this information to
the diagnosis.
6. Describe
the typical demographic feature, clinical features, and differential
diagnosis of:
a. Common
uveitis in immunosuppressed individuals (eg, cytomegalovirus
retinitis, endogenous endophthalmitis)
b. Masquerade
syndromes such as vitreoretinal lymphoma
7. Differentiate
serious infective from noninfective causes of uveitis. (eg, recognize
an endogenous endophthalmitis and differentiate this from an
immune-mediated uveitis, such as Behçet disease).
8. Describe
angiographic features of retinitis, choroiditis, and vasculitis.
9. Describe
the B-scan features of certain retinal, choroidal, and scleral
diseases.
10. Describe
the OCT features of macular edema.
11. Describe
the common complications of common uveitis syndromes (eg, intraocular
pressure elevation, cataract, band keratopathy, macular edema).
12. Describe
indications and contraindications for corticosteroid treatment of
uveitis (eg, topical, local, systemic), including risks and benefits
of therapy.
13. Describe
the management of common uveitic syndromes.
B. Technical/Surgical Skills
1. Perform
a more advanced examination of the anterior and posterior segment in
addition to that described for Year 1.**
a. Anterior
segment (eg, iris nodules, pupillary membrane, peripheral anterior
synechiae, iris bombe)**
b. Posterior
segment (eg, pars plana signs of inflammation [snowballs], retinal
detachment, retinal vasculitis, optic swelling [differentiate optic
neuritis from hyperemia], macula [macular edema])**
2. Recognize
and evaluate the typical demographic features, clinical features, and
differential diagnosis of common, rapidly blinding causes of uveitis
(based on local epidemiological data), as described in the curriculum
of Year 1.**
3. Administer
topical steroids, NSAIDs, and cycloplegics in the treatment of
uveitis.**
4. Interpret
the results of ancillary tests (eg, fluorescein angiography, OCT,
B-scan ultrasonography) for diagnosis.
5. Perform
a major investigational work up (eg, laboratory testing, radiologic
testing) according to epidemiologic data, history, and clinical
examination.
6. Evaluate
uveitis associated with immunosuppressed individuals (eg, active and
recovered acquired immune deficiency syndrome, pharmacologic
immunosuppression).
7. Interpret
indocyanine green angiography findings and correlate clinically.
8. Perform
posterior subtenon or transseptal
injection of corticosteroids.
9. Administer
oral corticosteroids in the treatment of uveitis.
10. Manage
side effects of immunosuppressive therapy.
11. Perform
an anterior chamber and vitreous tap for diagnostic purposes and
administer intravitreal injection antibiotics in cases of bacterial
endophthalmitis.
Advanced Level Goals: Year 3
A. Cognitive Skills
1. Describe
the more complex complications of common uveitis syndromes in
addition to that mentioned in Year 2 (eg, retinal vascular occlusion,
retinal neovascularization and vitreous hemorrhage, inflammatory
choroidal neovascularization, hypotony).**
2. Describe
indications and contraindications for corticosteroid treatment of
uveitis (eg, topical, local, systemic), including risks and benefits
of therapy.**
3. Describe
the management of common uveitic syndromes.**
4. Describe
the techniques of anterior chamber and vitreous tap and of
intravitreal injection of antibiotics in cases of bacterial
endophthalmitis.**
5. Describe
more advanced examination principles for patients with more subtle
signs of uveitis, such as:
a. Anterior
segment (eg, conjunctival ulcer, iris transillumination defects,
granuloma)
b. Posterior
segment (eg, pars plana signs of inflammation [snowbanks and
snowballs], retinal detachment [exudative, tractional,
rhegmatogenous], retinal vasculitis [periphlebitis or arteritis,
occlusive or nonocclusive], optic nerve [optic disc granuloma, optic
neuritis, disc neovascularization], macula [macular edema, choroidal
neovascularization])
6. Describe
in greater detail the angiographic features of retinitis,
choroiditis, and vasculitis.
7. Describe
indications and contraindications for commonly used immunotherapy for
uveitis in addition to corticosteroid therapy (eg, azathioprine,
cyclosporine A), including risks and benefits of therapy.
8. Describe
the clinical features and differential diagnoses for less common
forms of uveitis (eg, Whipple disease, Crohn disease).
B. Technical/Surgical Skills
1. Perform
a more advanced examination of the anterior and posterior segment,
for example:**
a. Anterior
segment (eg, conjunctival ulcer, iris transillumination defects,
granuloma)**
b. Posterior
segment (eg, pars plana signs of inflammation [snowbanks and
snowballs], retinal detachment [exudative, tractional,
rhegmatogenous], retinal vasculitis [periphlebitis or arteritis,
occlusive or nonocclusive], optic nerve [optic disc granuloma, optic
neuritis, disc neovascularization], macula [macular edema, choroidal
neovascularization])**
2. Differentiate
active from inactive disease and arterial from venous side disease.**
3. Recognize
serious infective causes from noninfective causes of uveitis.**
4. Recognize
and evaluate the typical demographic features, clinical features, and
differential diagnosis of uveitis common in the region via the
process of history taking, clinical examination, and the use of
investigative tools (such as FA, ICG, B-scan, OCT).**
5. Recognize
and evaluate the typical demographic features, clinical features, and
differential diagnosis of uveitis in:**
a. Immunosuppressed
individuals (eg, cytomegalovirus retinitis, endogenous
endophthalmitis)**
b. Masquerade
syndromes, such as vitreoretinal lymphoma**
6. Evaluate
the common complications of common uveitic syndromes (eg, glaucoma,
cataract, band keratopathy, macular edema).**
7. Administer
periocular corticosteroid injections in addition to topical
corticosteroids in the treatment of uveitis.**
8. Perform
an anterior chamber and vitreous tap for diagnostic purposes and to
give intravitreal injection of antibiotics in cases of bacterial
endophthalmitis.**
9. Administer
biologics.
10. Perform
cataract removal.
11. Perform
filtration surgery with antimetabolites.
12. Provide
patient with relevant information about possible side effects of
medications and proper monitoring of medications.
Very Advanced Level Goals: Subspecialist
A. Cognitive Skills
1. Describe
the clinical features and differential diagnoses for less common
forms of uveitis (eg, Whipple disease, Crohn disease, bilateral acute
depigmentation of the iris [BADI], diffuse unilateral subacute
neuroretinitis [DUSN], onchocerciasis).**
2. Describe
the global epidemiology of uveitis and relate this information to the
diagnosis.**
3. Describe
the management of the more complex complications of uveitis.**
4. Describe
indications for ultrasound biomicroscopy (eg, assess state of ciliary
body in hypotony), laser flare photometry and electrophysiology in
the evaluation of uveitis.**
5. Describe
indications, contraindications, and complications for
immunosuppressive therapy in uveitis (eg, use of antimetabolites,
cyclosporine, alkylating agents, biologic agents).**
6. Describe
indications, contraindications, and complications of retinal laser
photocoagulation in uveitis.**
7. Describe
indications, contraindications, and complications of intravitreal
injection of medications (eg, corticosteroids, antiviral therapy,
antibiotics, anti-VEGF, anti-mitotic agents) and drug delivery
systems (eg, for corticosteroid, ganciclovir).**
B. Technical/Surgical Skills
1. Integrate
history, clinical examination, and investigations in order to
recognize and evaluate the less common uveitis entities.
2. Administer corticosteroids in
the treatment of uveitis by various routes (eg, topical,
periocular, systemic, and intravitreal injection).
3. Perform
retinal laser photocoagulation for retinal vasculitis complicated by
retinal capillary nonperfusion and associated retinal or optic disc
neovascularization.
4. Regulate
perioperative management of the uveitic eye for cataract removal.
5. Perform
intravitreal injection of medications (eg, corticosteroids, antiviral
therapy, antibiotics, anti-VEGF, antimitotic agents) and drug
delivery systems (eg, for corticosteroid, ganciclovir).
6. Co-manage
with other subspecialist as appropriate:
a. Biopsy
of the vitreous, retina, or choroid to confirm/exclude vitreoretinal
lymphoma or other tumors/infectious causes
b. Immunosuppressive
therapy in uveitis including biologics (with or without the aid of an
immunologist) and monitor for side effects
c. Intravitreal
implants containing antiviral or corticosteroid medications
d. Ocular
complications of uveitis (eg, macular edema, cataract, glaucoma,
retinal detachment, band keratopathy, choroidal neovascularization,
hypotony).
* * *
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.
