maps to ost curriculum code (where area detail cert lrs ... · pdf filepresbyopia onset and...

Syllabus Area Detail Cert LRS Focus OST Theme OST domain

Maps to OST Curriculum code (where relevant)

Basic anatomy, physiology and optics Anatomy

Corneal Epithelium, composition and thickness profile

How the Ophthalmologist approaches their practice

Basic & Clinical sciences BSC1

Corneal stroma, composition and profileAnterior ChamberIris, Ciliary BodyPosterior ChamberPosterior Segment in relation to Refractive surgery, Retina in Myopia, Vitreous body

PhysiologyCorneal Epithelium Physiology,


Basic & Clinical sciences BSC2

Corneal Stroma, composition and thickness profile

Physiology of Healing Cornea, in particular the epithelium

Optics

Snellen optics, Ray tracing, Vertex calculation,


Basic & Clinical sciences BSC 6

Refractive Error, Hypermetropia, Myopia, Astigmatism,

1 May 2017

HypermetropiaMyopiaAstigmatism Corneal Anterior

PosteriorResidual

LenticularRetinal

Priciples of Spectacle correction

Positive and negative lensesPositive and negative cylinder format

Accommodation theory

Helmholz FinchamColeman united theoryAbberations

Presbyopia Onset and progressionPresbyopia correction

BifocalsVarifocalsMultifocal contact lenses

Abberations Lower and higher orderMathamatics of higher order

Zernicke Series CoefficientsTaylor Series, Fourier Analysis, Zonal Reconstruction

Corneal vs. whole eye aberrations and centration relativity

Visual Acuity General optical principlesSnellen ChartsLogMAR charts and principles

Pre‐op Assessment for Refractive Surgery History

History as is relevant for refractive surgery

What the Ophthalmologist is able to do

Clinical Assessment CA1

Inclusing criteriaRelative and absolute Exclusion criteria

2 May 2017

Vision questionnaire (Fraenkel‐Lawless; McAlinden)

Refractive history including contact lensesOphthalmic history

Corneal KeratoconusInfectionsTraumaRecurrent erosions

Blepharitis

Dry eyeOcular surface Disease index

AmblyopiaStrabismusGlaucomaOcular medications

General medical historyDiabetesAutoimmuneIrritable BowelFibromyalgia, chronic fatigueHIV or HepatitisMalignancyPsychiatric

Examination/Investigations Vision

Acuity at distance, intermediate and near



Refraction Objective

What the Ophthalmologist is able to do Practical Skills PS2

Auto‐refractionAberrometry ‐ undilated (Distance ‐ near)

3 May 2017

Retinoscopy (including cycloplegic retinoscopy)

SubjectiveFocimetry

Ocular dominance

Pupil



Ocular motility binocular vision


Clinical Assessment CA7 PI 12

Visual fields


Patient Investigations PI 13

Corneal Topography Topography



Placido system principleCurvature maps: axial and tangential mapsPower/radii conversionAsphericityParameters/indicesNormal Topography

TomographySlit‐lamp scanning principleelevation maps (front and back surface) Best fit surfaces

4 May 2017

Pachymetry maps (thickness progression maps)Normal front and back surfaces maps

Screening for KeratoconusTopography, tomographyPachymetry corneal thickness, epithelial thickness

Pupillometry

Aberrometry Clinical correlation and impact on visionPositive and negative impact of higher order aberrationsDilated aberrometry

Contrast sensitivity

Slit lamp Tear film



Eyelids, lid margin bulbar/tarsal conjuctivaTear film prism and break up time (TBUT)Schirmer 1b

Stains (Fluorescein, Rose Bengal, Lissamine Green)

CorneaAngle

5 May 2017

LensLOCS classification)

Tonmetry

Fundus Dilated fundus examination



Ultrasound Pachymetry Single point measurement

Minimum thicknessOther tests Optical coherence tomography (OCT)

Corneal thicknessEpithelial thicknessCorneal powerAnterior SegmentRetinal asesssment (macular and optic disc)

Endothelial MicroscopyBinocular vision as relevant to refractive surgery

Pre operative assessment for Lens based surgery History



(As for Laser refractive surgery) Examination

Consideration of regular or irregular astigmatism



Corneal scarsCorneal endothelium

Specular microscopy

Consideration of combined surgery with DMEK/DSAEK

Biometry



Multifocal intraocular lense considerations

6 May 2017

Pupil size (mesopic, photopic)Pupil shiftAngle Kappa

Quality of vision tests and quality of life testsPupil effects on subjective quality of vision/life

Theory of Laser Refractive Surgery

Principles of Excimer laser photo‐ablation


Basic & Clinical sciences

BCS 12 & PM17

PRK/LASEK/Epi‐LASIK Surface ablationPRKLASEKEpi LASEK

LASIK LASIKTechnological advancements

Broad beam to flying spot laserManual microkeratomesEye trackingCentration of refractive surgeryAblation profiles

Optical Zone diameterAsphericityWavefront‐optomisedTopography ‐ guidedPresbyopic profiles

SMILEFemtosecond laser lenticule extraction

FLExSMILE

7 May 2017

Safety calculations and corneal biomechanics

Residual stromal thicknessPachymetry errorsFlap thickness biasEcasia Risk

Model of post‐operative tensile strength

Pathology Wound Healing


Basic & Clinical sciences BSC2 BSC4

Modulation of wound healing

LASIK

Surgical Protocol including management of intraoperative complications

What the Ophthalmologist is able to do Surgical Skills

Standard operating procedure and modifications with justificationPreparation

CentrationAlignment

Patient positioningMicrokeratome checks (if manual keratome)Exposing eye

DrapeSpeculum insertionSurface marking

Suction ringMicrokeratome Head

Microkeratome lubricationMicrokeratome engagementMicrokeratome Pass

8 May 2017

Microkeratome disengagementMicrokeratome completionPatient repositioningEye tracker activationAiming beam

Suction with femtosecond laserLifting the flap

Sponge placementFlap liftTime to ablationDrying of corneal bed

AblationAiming beamFlap hinge protectionLaser activiation

Repositioning the flapRemoving the speculumimmediate post op check

Ectasia (Keratoconus)Mangement of Ectasia


Cross linkingIntra‐corneal rings and contact lensesCross linking and PRK/SMILE (Athens protocol)

Technology and theory of lens based refractive surgery


Phakic intraocular lensRefractive lens exchange

9 May 2017

Biometry



Lens power calculationsAstigmatism calculations

Corneal incision placement

What the Ophthalmologist is able to do Surgical Skills SS4

Corneal astigmatism/IOL cylinder/Total astigmatismAxial length measurementKeratometryTotal corneal power measurementEstimated lens positionIntraoperative abberometryBiometry after corneal refractive surgery ‐ formulaeIOL types

MonofocalToricMultifocalPhakic intraocular lensPiggyback

Conventional phacoemulsification surgeryFemtosecond laser cataract surgeryExtra‐capsular cataract surgery

10 May 2017

Endophthalmitis prophylaxis


Patient Management PM7

Bioptics

Cataract / Lens surgery and intra‐operative complications

Surgical Protocol including management of intraoperative complications

What the Ophthalmologist is able to do Surgical Skills SS4

Active pre operative management of ocular surface

BlepharitisHSK prophylaxisOther potential infectionsSurgical field sterilisationLacrimal apparatus infection management

AnaesthesiaCorneal incision/astigmatism management

Planarhinged

Arcuate keratotomiesOpposite clear corneal incisionon‐axis incisioncapsulorrhexisHydrodissectionPhacoemulsification

Divide and conquerChopStop and Chop

IOL implantationIOL implantation in aphakiaIntracameral subconjunctival antibiotics

11 May 2017

Sealing of sectionShield

Correction of Regular and Irregular Astigmatism Regular astigmatism

Vector analysis of regular astigmatismLaser correction: Eye tracking and cyclotorsionIOL correction: Lens tiltCorneal incisions

Irregular astigmatismAdvanced diagnostics

Thickness layer mappingAberrometryHD A

Surgical ManagementPTKTopography guidedWavefront guidedStromal topography

Phakic IOLsTechnology and theory of phakic IOLs


Biometry for phakic IOLsSulcus to sulcusWhite to white

Types of phakic IOLAnterior chamberPosterior chamberIris fixed

Conventional surgery

Phakic IOLs surgical protocol


12 May 2017

Posterior chamberIridectomyIncisionIOL upload and insertionIOL positioning

Iris fixatedIncisionEnclavationIridectomy

Angle supportedIncisionIOL insertionIridectomy

Management of complications on iris, cornea and lens

Presbyopia

Refractive surgical correction of Presbyoipa


Excimer laser for presbyopiaMultifocal profilesMonovisionModified monovision

Corneal inlaysMultifocal IOLsMonofocal IOL with monovision

Aspheric monofocal IOL and monovisionLight adjustable lens (Calhoun)

High AmetropiaCorrection of High Myopia/Hyperopia


LASIK/PRK/SMILESafety considerationsBiomechanicsLimits

Phakic IOLsRefractive Lens Exchange

13 May 2017

Post operative complications of lens based refractive surgery

Post op Follow up of Lens based surgery


Patient Management

Routine management overview guideAll Refraction

Visual AcuitySlit lamp of anterior and posterior segmentIOP

Day 1‐7Exclude the followingIOL rde‐centrationendophthalmitisretinal detachmentchoroidal effusionsuprachoroidal haemorrhagedysphotopsiaCystoid macular oedema (CMO)

Month 2‐3CMO

Lens position/tiltAberrometryCapsulorrhexis size and shapeQuality of vison, quality of life questionnaire

Month 3 and 12 monthsNight vision historyIOP measurement

14 May 2017

Retinal complicationsQuality of vison, quality of life questionnaire

Posterior capsule opacificationTear film assessment

Post op asessment and management of complications of laser refractive surgery

Routine managementDay 1, first month, 3 month and 12 monthsRoutine testing

RefractionVisual acuityTopographyTomographySlit lamp

Day 1 Epithelial defectDLKMicrofoldsInterface debrisOedemaInfections

Month 1Corneal oedemaEpithelial ingrowthVisually significant glareDry eye

3 and 12 months

15 May 2017

Dry eye diagnosis and managementNight vision complaintsRegression

Epithelial thickness changesKeratometry changesBiomechanical changes and ectasia risks

IOP measurementSatisfaction questionnaires

Retreatments

Retreatment for corneal refractive surgery


Flap liftPRKSMILE optionsSafety calculations

Retreatment for lens based refractive surgery

Lens exchange/extractionPiggyback lensBioptics/corneal refractive surgery

Good Medical Practice Compassion

How the ophthalmologist approaches their practice

Attitudes, Ethics & Responsibilities AER1

AutonomyAttitudes, Ethics & Responsibilities AER2

Considerate approach AER3Empathy AER4

16 May 2017

Confidentiality AER5Limits AER6Help AER7Multi‐source Feedback AER8Appraisal and revalidation AER9Ethical approach AER10Probity AER11Duties of a doctor AER12

Evidence based approach

How the ophthalmologist approaches their practice

Decision making, clinical reasoning &judgement DMRJ1

Quality improvement


Personal audit (theory, process, types of audit)


TheoryProcess

Types of audit used in refractive surgeryIntegration into clinical practiceStandard setting

Information ‐ provision of written information

What the Ophthalmologist is able to do Communication C4

Consent C5Complaints C9

Other aspects of clinical governance

Advertising and marketingGoverning bodiesPatient and public involvement (PPI)Laser safety and regulations

17 May 2017

Pillars of clinical governance

Clinial effectiveness and researchAuditRisk managementEducation and trainingPPIUsing information and ITStaffing and staff management

Risk management

CPD

The Ophthalmologist as a professional CPD

Outcomes analysis

Stability/Safety/Predictability/Efficacy

Define safety in laser refractive surgery: percentage loss more than one / two lines in postop BCDVA compared to preopDefine efficacy in laser refractive surgery. Cumulative Percentage of patients with UCVA‐ 6/5,6/6, 6/7.5 etcPredictability:‐ scatter plot attempted versus achieved, perfect line and regression line demonstrates if in general under or over correcting, parallel lines +/‐ 0.5 and +/‐1DStability: achieved change in refraction over time

Definition of a nomogramCalculation of a nomogramMinimum records for outcome analysis

Refractive dataUncorrected acuity and corrected acuityComplications log

Standard reporting6 graphs

18 May 2017

1

Bar chart: Cumulative postoeprative Snellen Accuity, unaided and spectacle corrected vision

2

Bar chart: % eyes vs change in corrected Snellen acuity

3

Scatterplot of Achieved vs Attempted correction with linear regression and 95% confidence intervals

4

Bar chart : % eyes vs grouped postoperative spherical equivalent refraction (give % within ± 0.5D and ±1.0 D)

5

Bar chart of pre and post op % eyes vs grouped refractive astigmatism

6

Stability of spherical equivalent refraction after surgery

19 May 2017

maps to ost curriculum code (where area detail cert lrs ... · pdf filepresbyopia onset and...

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