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					              2010




Irish College of Ophthalmologists

    Basic Specialist Training

        Ophthalmology

      National Programme




                                    1
                    Irish College of Ophthalmologists

           Basic Specialist Training – National Programme

                          TRAINING REGULATIONS
              1. Selection, Entry and Registration Criteria for BST


 Basic Specialist Training will be for three years with annual hospital contracts.

 Trainees must have full registration with the Irish Medical Council

 On appointment to the programme trainees will be registered with the Irish
  College of Ophthalmologists by the Hospital Manpower Manager and will receive
  a training agreement from the Irish College of Ophthalmologists

 An individual training number will be issued to each trainee on receipt of the
  appropriate fee for the structured education programme (School for Surgeons for
  Ophthalmology). This training number is essential for recognition of Basic Specialist
  Training.

 Trainees will be registered with the Irish College of Ophthalmologists. Trainees
  who wish to transfer to another rotation must apply to the Dean of Postgraduate
  Education of the ICO and the Unit Programme Director detailing the reasons for
  this request.

 SHO posts will be advertised as part of the National BST Programme with ICO
  approval. Contracts of employment will be issued by the relevant hospitals.

 The BST Regional Training Programmes include 3 rotations;
  (No. 1) Royal Victoria Eye & Ear Hospital & Sligo General Hospital
  (No. 2) Mater Hospital, University College Hospital Galway
          & Waterford Regional Hospital
  (No.3) Cork University Hospital & Mid-Western Regional Hospital, Limerick

 Entry to the programme will be by competitive interview. Regional interviews will
  be held in three locations.

 All SHO posts in the seven teaching units are recognised for basic specialist training
  (ref; ICO/EBO inspection 2007)

 Specific allocations will be determined for each trainee by the regional hospital.
  Each training position has a unique post number. It is recommended that tra inees
  spend two years in one training unit and the third year in another department.

 Maintenance of a detailed logbook by trainees is essential



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 There will be regional appraisal of the six monthly rotations using the CAPA forms
  issued by the College. National appraisals will be held annually in the offices of the
  Irish College of Ophthalmologists with the CAPA and annual assessment forms.

 Registration for the School for Surgeons for Ophthalmology takes place in the
  College on the second Monday of January and the second Monday of July. The
  annual fee for the education programme is €2,500 payable in two instalments
  (January & July).

 The Regional Manpower Managers will notify the College of the trainees appointed




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                                    Teaching Programme
                               2. Structured Specific Syllabus

 A minimum of two hours teaching per week (during the academic year) in each
  hospital will include case presentations, journal club, didactic lectures and audit.
  Attendance at the teaching programme is monitored and documented attendance at
  a minimum of 60% of postgraduate teaching is essential.

 The Ophthalmic Postgraduate Teaching Programme includes case presentations and
  a didactic lecture given by national and international invited speakers. This is
  currently held in the HSE/EA on Thursday afternoons at 4.30pm

 The structured education programme, delivered by the Irish College of
  Ophthalmologists, enhances the knowledge and skills acquired through clinical
  training posts. Full participation in this programme is mandatory for all Basic
  Surgical Trainees.

    The structured education and assessment programme has four components;
    1. Core Knowledge
    The core knowledge component is delivered via the e-based SCHOOL for
    Surgeons
    2. Technical Skills
    This component uses the very latest in high technology teaching aids for operative
    surgery
    3. Human Factors in the Surgical Arena
    This component focuses on areas of team work and leadership, interpersonal skills
    and conflict resolution, crisis management, causes and avoidance of errors, stress
    management and time management
    4. Assessment
    The CAPA Process (Competence, Assessment and Performance Appraisal) is an
    evaluation tool which is designed to assess the progress of trainees.

 Participation in the structured education programme, attendance at the six monthly
  and annual assessments and return of completed CAPA and assessment forms is
  mandatory for the certificate of completion of basic specialist training (CCBST)

 Success in the MRCSI (ophth) examination or equivalent is a requirement for
  CCBST

 Applicants to the Higher Surgical Training Programme must have a CCBST and a
  validated surgical logbook to include;
  50 cataract procedures,
  50 lasers
  50 minor procedures,

Note; Each hospital should have a dedicated teaching area with library facilities, internet access,
photocopying facilities, audio visual aids and digital projection.


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    Appendix 1;
    EDUCATIONAL OBJECTIVES FOR OPHTHALMIC
    SENIOR HOUSE OFFICERS

    To obtain a comprehensive training in the knowledge of ophthalmology, including the
    basic sciences and management of common diseases affecting the eyes.

    To attend the participate in the Teaching Programme.
    To develop communications skills and a sympathetic and caring approach to patients
    and their relatives.

    To develop skills in clinical assessment and become competent in:
   History taking
   Examination of the eyes and surrounding structures
   The use of diagnostic instruments including the direct and indirect ophthalmoscope,
    retinoscope, slit-lamp, tonometer and diagnostic fundus and contact lenses.
   To learn the concepts and principles of refraction.

    To received training in orthoptics and the examination of children with eye disorders.

    To be familiar with a number of practical procedures including syringing tear ducts,
    removal of corneal foreign bodies and minor lid procedures.

    To gain experience in ophthalmic surgery and be introduced to microsurgical techniques.

    To become familiar with the use of laser in ophthlamology.

    To be able to carry out investigative techniques including visual field assessment, ocular
    biometry and keratometry.

    To receive guidance in the counseling of patients who are partially sighted or blind and
    be aware of the support services available.
    To work towards and be encouraged to sit the Royal College of Ophthalmology
    examination leading up to the Final Fellowship.

    To develop future career plans.

    To participate in medical audit meetings.

    To understand the principles and practice of medical research.

    To acquire a knowledge of the process of management




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     Appendix 2
BASIC SPECIALIST TRAINING IN OPHTHALMOLOGY
SURGICAL PROCEDURES


Number of procedures needed

1.      Laser                  Capsulotomy
                               Pan-retinal photocoagulation
                               Peripheral iridection (YA G                         50
2.      Miscellaneous
        (a) M inor Surgery     Ectropion/Entropion                                 5
                               Incision and curettage of Meibomian
                               cyst and papillo ma                                 20
                               Electrolysis and trichiasis                          5
        (b) Lacrimal           Irrigation of lacrimal passage
                               Lacrimal p robing
                               Punctal surgery                                     12
        (c) Trau ma            Lid and facial lacerat ions                         3

3.      Strabismus             Horizontal muscle procedure                          5
4.      Cataract               Extracapsular cataract surgery
                               Phacoemulsificaiton and other intraocular procedures 50



     A Certificate of Eligibility of Entry to Higher Surgical Training (CEEHST) will be
     awarded to trainees who have competed basic specialist training, to include the above
     minimum numbers of surgical procedures, been successful in the MRCSI exam and have
     validated CAPA appraisals for a minimum of 2 years. This level of training is necessary
     for those trainees who wish to apply for the Higher Surgical Training Programme.




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Appendix 3
3. Learning Resources
STRUCTURED EDUCATION PROGRAMME

The Irish College of Ophthalmologists delivers the structured education component of the
Basic Surgical Training Programme. The structured education component goes hand in hand
with your work place training. The programme is compulsory and full participation in this
programme is mandatory for all Basic Surgical Trainees.

There are four elements to the programme:
1. SCHOOL for Surgeons for Ophthalmology
2. Surgical Simulator Tutorials
3. Human Factors in the Surgical Arena Course
4. Assessment

SCHOOL for Surgeons for Ophthalmology
SCHOOL for Surgeons for Ophthalmology – SFSFO is the online element of the training
programme. Each trainee is issued with a unique logon name and password to access the
website. Miss Yvonne Delaney, Vice-Dean is the tutor for the SFSO. The site is found at
www.schoolforsurgeons.ie

Moodles is the software package through which SCHOOL for Surgeons for Ophthalmology
- SFSFO is presented.

Trainees should access SCHOOL for Surgeons on a regular recurrent basis. The course
content of SCHOOL is as follows: - Cases will be presented which are relevant to Basic
Specialist Trainees and which are based on the type of cases encountered in the clinic and
the MRCSI (Ophth) Examination.

Journal Watch exposes trainees to relevant articles and papers in peer reviewed Journals.
Assignments are given on a regular basis and trainees are expected to submit their
assignments online by the due date. Each assignment is graded and trainees are expected to
score a minimum of 60%.

The ophthalmology journals available in full text through the Journal Portal currently
include:
- Journal of Cataract and Refractive Surgery
- Current Opinion in Ophthalmology
- Journal of Glaucoma
- Retina
- Investigative Ophthalmology and Visual Science

The site also includes RSS feeds from some of the major ophthalmology journals.




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Surgical Simulator Tutorials
The College has an EYESI surgical simulator for use during the tutorials to learn the basic
surgical skills of phacoemulsification. The simulator provides the opportunity to practice the
steps of phacoemulsification, making easier and safer the transition to live surgery.

The Tutor for the simulator is Miss Patricia McGettrick, Consultant Ophthalmic Surgeon.
Each trainee will have three supervised tutorials sessions on the simulator, each session will
last for two hours.

Human Factors Course
Human Factors is a programme of personal skills for clinical and surgical training which has
been developed by The Royal College of Surgeons in Ireland. It aims to give trainees the
personal skills and attitudes necessary for successful practice as part of a multidisciplinary
team.

The Royal College of Surgeons in Ireland has developed a programme in human factors
training to equip trainees with the personal skills and attitudes required for modern clinical
and surgical practice. The programme is based on a clearly defined syllabus. This syllabus
includes ten modules, each of which contains four tutorials. The syllabus is arranged so that
the modules can be taken in any order and a system of credits will be used to signify
satisfactory completion of individual modules. Each module is designed to be delivered over
a one day period and it is intended that each trainee will take three modules per annum.

The programme is delivered by acknowledged experts in the individual subject areas of each
module. Each module will have precise learning objectives. The training is delivered by a
combination of didactic teaching and practical work which will involve role playing and
small group discussions. Audio visual support is provided. Trainees are encouraged to find
solutions to human factor problems for themselves and they are given assignments on which
to work between modules. There is emphasis on practical application in the work place and
the assignments reflect the importance of work place application.

4. Assessment
Trainees on the basic specialist trainee programme will be assessed on an annual basis by a
panel of representatives from the College, its Manpower Committee and the training units.
The assessments provide the trainee with an opportunity to discuss their rotation and to
raise any issues from the current posting. Attendance at the annual assessment is
compulsory.

Trainees must also complete a CAPA form (Competence Assessment and Performance
Appraisal) for each six months rotation. There are two parts to the CAPA form. Part 1
should be completed by the trainee and Part 2 should be completed by the Consultant
trainer.




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It is of great importance that trainees actively engage with all the elements of the training
programme to get the maximum benefit from the structured education available. In order
that each post and rotation is recognised by the College for the purposes of basic specialist
training and the subsequent recognition of training posts for inclusion on the Register of
Medical Specialists, trainees must ensure that all the aspects of the course are completed
during each year.

The course fee is €2,500 per annum and covers all of the parts including online access,
human factors course and sessions on the surgical simulator. The fee is payable in two parts.




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Appendix 4;
Postgraduate Trai ning in Ophthal mol ogy i n Ireland
    Approved by the Council of the Irish College of Ophthalmologists January 2009

    1. National Basic Specialist Training (BST) (3 years)
    MRCSI (ophth) or equivalent
    Exit Assessment Cert ificate of Co mplet ion of Basic Specialist Train ing (CCBST)

    2. Specialist Registrati on - Di vision of Ophthalmolog y
    Currently 1 addit ional year at BST level
    Exit Assessment EBO         (Highly Reco mmended)

    3. SpR in Ophthal mic Surgery
    4 ½ Years
    Exit FRCSI (ophth)
    Specialist Registration - Division of Ophthalmic Surgery
    Cert ificate of Co mplet ion of Surg ical Training Ophthalmo logy (Issued by ISPTC)




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     Appendix 5;
The Membership of the Royal College Surgeons in Ireland Ophthalmology
Examination

Information      on      the     MRCSI        examination   is   available   at
http://www.rcsi.ie/index.jsp?1nID=93&pID=106&nID=1736




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(Appendix 6)
Basic Specialist Training in Ophthalmology Curriculum and Competencies




                          Irish College of Ophthalmologists




1.   Oculoplastic, adnexal and lacrimal procedures
2.   Cornea & External Diseases
3.   Cataract & Refraction
4.   Glaucoma
5.   Vitreoretinal Disorders incl Medical Retina
6.   Neurophthalmology
7.   Paediatric Ophthalmology & Strabismus
8.   Accident and Emergency Ophthalmology




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1. Oculoplastics

Topics - Essential Clinical Experience
To have become familiar with the following:
 Abnormal lid position; including assessment of ectropion, entropion, ptosis, tric hiasis,
   lagophthalmos and exposure.
 Abnormal lid swelling, including chalazion, stye, retention cysts, papilloma and basal cell
   carcinoma.
 The watering eye, including the distinction between excessive lacrimation and epiphora,
   blepharitis, recognition and investigation of nasolacrimal obstruction.
 Orbital swelling, including dysthyroid eye disease, distinguishing intraconal from
   extraconal space-occupying lesions, orbital cellulitis, recognition of compressive optic
   neuropathy.
 Liaison with Neurosurgeons, ENT, Endocrinologists and prosthetic service.

Core Skills
To have undertaken the following:
 Use of exophthalmometer (5 cases)
 Syringing and probing(5 cases)
 Incision and curettage for chalazion(5 cases)
 Wedge biopsy and removal of papilloma, etc. (5 cases)
 Tarsorrhaphy(2 cases)
 Electrolysis/cryotherapy for trichiasis(5 cases)
 Surgery to involutional ectropion/entropion(3 cases)

Desirable Clinical Experience
To have gained an awareness of the following:
 Sebaceous carcinoma of lid and squamous cell carcinoma
 Cicatricial malposition of the lids
 Management of ptosis and blepharospasm
 Canaliculus repair
 Dacryocystorhinostomy
 Orbital and lacrimal tumours and their treatment
 Inflammatory orbital and lacrimal diseases and their treatment
 Paranasal sinus disease
 Use of radiographs, MRI, CT scan
 Enucleation, evisceration and fitting of prosthesis
 Excenteration

Assessment throughout BST training




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2. External Eye Disease

Topics - Essential Clinical Experience
To have become familiar with the following
 Infectious external disease, including viral, bacterial and chlamydial conjunctivitis.
 The dry eye, including symptoms, assessment of reduced tear production and tear film
   stability and treatment.
 Allergic and atopic eye disease recognition and management.
 Corneal ulceration from viral and bacterial disease, marginal keratitis.
 Complications of contact lens wear.
 Corneal oedema, opacity and ectasia, indications for corneal transplantation, standards of
   care in donor eye procurement, signs of corneal graft rejection and other complications.
 Epislceritis, recognition and management.
 Anterior uveitis, including classification, differential diagnosis, systemic associations,
   investigations and treatment.
 Liaison with microbiology, immunology.

Core Skills
To have undertaken the following:
 Conjunctival sampling and corneal scraping for microbiological investigations.
 Pachometry for corneal thickness.
 Keratometry and Placido’s disc.
 Removal of corneal sutures.

Desirable Clinical Experience
To have gained an awareness of the following:
 Acanthamoeba keratitis and fungal keratitis
 Cicatricial conjunctival disease.
 Punctal occlusion
 Corneal topography and specular microscopy
 Corneal stromal dystrophies, interstitial keratitis.
 Corneal biopsy, indications.
 Chemical injury of the cornea and conjunctiva.
 Therapeutic contact lenses and their complications.
 Corneal transplantation, immunology of rejection.




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   Limbal stem cell transplantation.
   Autoimmune corneal and scleral disease including peripheral ulcerative keratitis.
   Use of immunosuppressive therapies.
   Management of pterygium.
   Conjunctival and uveal tumours.
   Aniridia and other dysgenesis.
   Fuch’s heterochromic cyclitis.


Assessment throughout BST training
Slit Lamp Biomicroscopy




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3. Disorders of Cataract & Refraction

Topics - Essential Clinical Experience
To have become familiar with the following:
 Ametropia, including hypermetropia, myopia, astigmatism and their complications.
 Accommodation problems, including spasm and presbyopia.
 Lens opacifications, including types of cataract, relationship of opacity to symptoms,
   contribution to visual loss in co-morbidities, systemic associations, cataract surgery and
   its complications.
 Pseudoexfoliation of the lens capsule, including its recognition and significance.
 Calculation of intraocular lens power, according to the patient’s needs.
 Liaison with contact lens service.

Core Skills
To have undertaken the following:
 Retinoscopy with trial lenses and subjective refraction.
 Correction of refractive error by spherical, cylindrical and multi-focal lenses.
 Lens neutralisation and use of focimeter.
 Biometry and keratometry for intraocular lens calculation.
 Surgery for routine cataract, including extracapsular extraction and phacoemulsification
   with intraocular lens insertion, management of intra-operative complications (50
   cataracts or other intraocular procedures).
 YAG laser posterior capsulotomy (20).

Desirable Clinical Experience
To have gained an awareness of the following:
 Basis of spectacle intolerance from poor dispensing or defective prescription.
 Use of logMAR charts in assessment of acuity.
 Alternatives to capsular IOL fixation.
 Combined cataract and glaucoma/corneal transplantion surgery.
 Ectropia lentis and Marfan’s syndrome.
 Contact lenses and refractive surgery.
 Therapeutic contact lenses.
 Fluidics and ultrasonics.
 Intraocular lens design and biomaterials.

Assessment throughout BST training

Assessment and Learning Methods;
Surgical Simulator – ICO
DOPS (direct observational procedure skills)
   - Biometry
   - Cataract Surgery
   - Yag Laser



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4 . Glaucoma

Topics - Essential Clinical Experience
To have become familiar with the following:
 Glaucomatous optic neuropathy, recognition and investigation.
 Glaucoma suspects, including ocular hypertension.
 Rubeotic glaucoma recognition, differential diagnosis and management.
 Hypotensive agents, topical and systemic drugs affecting intraocular pressure and their
   complications.
 Glaucoma drainage surgery, indications, complications and their treatment.
 Hypotony, including its causes and consequences.
 Liaison with glaucoma shared care schemes.

Core Skills
To have undertaken the following:
 Applanation tonometry
 Assessment of peripheral and central anterior chamber depth, including pachometry.
 Assessment of irido-corneal angle structures by gonioscopy.
 Methods of optic disc cup measurement.
 Visual field testing, including Goldmann/kinetic perimetry and automated static
   perimetry.

Desirable Clinical Experience
To have gained an awareness of the following:
 Risk factors for primary open-angle and normal-tension glaucoma
 Other secondary glaucomas, including phacolytic, pigmentary, erythroclastic, pseudo-
   exfoliative and silicone-oil glaucomas.
 Posner Schlossman syndrome.
 Chronic closed angle glaucoma.
 Malignant glaucoma
 Tonopen, Perkins and non-contact tonometry.
 Scanning laser ophthalmoscopy and nerve fibre layer analysis
 Argon laser trabeculoplasty
 Prevention of glaucoma bleb failure e.g. using anti-metabolites
 Drainage tubes and stents.
 Cycloablation.

Assessment throughout BST training




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5 Vitreoretinal disorders & Medical Retina

Topics - Essential Clinical Experience
To have become familiar with the following:
 Flashes and floaters, complications of posterior vitreous detachment and recognition of
   retinal tears.
 Vitreous haemorrhage, from retinal tears or neovascularization – initial management.
 Retinal detachment, classification, predisposition, recognition and urgency of treatment,
   recognition of proliferative vitreoretinopathy.
 Senile/acquired retinoschisis, - recognition.
 Liaison, with Low Vision services.
 Diabetic retinopathy, classification, screening strategies, management.
 Hypertensive and arteriosclerotic retinopathy, including macroaneurysms and branch
   retinal vein occlusion.
 Retinal vascular occlusions, recognition of ischaemic and exudative responses, rubeosis.
 Macular diseases, including recognition of age-related maculopathy, subretinal
   neovascularization, cystoid macular oedema, macular hole, related symptomatology and
   urgency of treatment.
 Fluorescein angiography, indications, complications and interpretation.
 Liaison with diabetologists, vascular surgeons and low vision services.


Core Skills
To have undertaken the following:
Scleral indentation with indirect ophthalmoscopy.
Retinal drawing
Cryopexy and laser (via slit-lamp and indirect ophthalmoscope delivery systems) for retinal
tear.
Assessment of macular function (Amsler Chart, Watske Allen slit beam test)
Scatter laser photocoagulation of the peripheral retina (20)
OCT


Desirable Clinical Experience
To have gained an awareness of the following:
 B-Scan ultrasound for opaque media.
 Vitreoretinal surgery, including closed intraocular microsurgery, scleral buckling and
   internal tamponade.
 Intraocular foreign body, complications and management.
 Other vasoproliferative vitreoretinopathies including sickle cell retinopathy, retinopathy
   of prematurity, Eales’ disease.
 Genetic vitreoretinal disease – Stickler syndrome, X-linked retinoschisis.
 Asteroid hyalosis
 Choroido-retinal coloboma
 Drug penetration into the eye and vitreous


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   Use of intravitreal antibiotics, including dosage and potential complications
   Fundus imaging including scanning laser ophthalmoscopy.
   Indocyanine green angiography.
   Electrodiagnostic tests and dark adaptation.
   Genetic retinal disease, retinal dystrophies, retinoblastoma.
   Differential diagnosis and treatment of malignant melanoma.
   Macular laser photocoagulation, principles and laser safety.
   Toxic maculopathy and central serous retinopathy.
   Intraocular lymphoma.
   Intermediate and posterior uveitis, toxoplasmosis, toxocara and sympathetic ophthalmia,
    retinal vasculitis.
   Coats’ disease, other telangiectasis and the retinal phakomatoses.
   AIDS-related opportunistic infections and anti-AIDS treatment.
   Low vision aids, including optic principles and fitting.



Assessment throughout BST training




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6. Neurophthalmology

Topics - Essential Clinical Experience
To have become familiar with the following:
 Swollen optic disc, differential diagnosis, recognition and evaluation of papilloedema,
   ischaemic optic neuropathy (arteritic and non-arteritic), acute optic neuritis and
   congenital optic disc anomalies.
 The atrophic optic disc, recognition and differential diagnosis, clinical evaluation of optic
   nerve function.
 Visual pathway disorders, identification of site and nature of lesion from history,
   examination and investigations, transient ischaemic attacks.
 Liaison with neurologists, neurosurgeons, endocrinologists and vascular surgeons.

Core Skills
To have undertaken the following:
 Goldmann visual fields
 Examination of the cranial nerves
 Temporal artery biopsy

Desirable Clinical Experience
To have gained an awareness of the following:
 Benign intracranial hypertension
 Compressive optic neuropathy
 Optic nerve glioma
 Chiasmal lesions
 Visual evoked responses
 Neuro-imaging including CT, MRI and carotid doppler
 Carotid endarterectomy
 Multiple sclerosis and its ophthalmic manifestations
 Higher cortical dysfunction, including the visual agnosias.

Assessment throughout BST training

Assessment and Learning Methods;
Neurophthalmology Course, Beaumont Hospital




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7. Paediatric Ophthalmology and Strabismus

Topics - Essential Clinical Experience
To have become familiar with the following:
 Concomitant strabismus, screening strategies, epicanthus, accommodative aspects,
   interpretations of orthoptic report, indications for surgery.
 Amblyopia, anisometropic, stimulus-deprivation, strabismic prevention and treatment
   using occlusions.
 Incomitant strabismus, cranial nerve palsies including diabetic mononeuropathies,
   significance of painful third nerve palsy and of pupil sparing, prediction of post-
   operative diplopia.
 Liaison with neurologists, orthoptists.
 The approach to infants, children and their parents.
 Ophthalmia neonatorum, diagnosis and management.
 Congenital nasolacrimal obstruction: recognition and management
 Ametropia in children, significance and treatment
 The apparently blind infant, normal and delayed visual maturation
 Liaison with paediatricians, geneticists.


Core Skills
To have undertaken the following:
 Eye movement evaluations
 Cover test (including alternate and prism)
 Stereo tests
 Cycloplegic refraction
 Horizontal muscle surgery
 Assessment of vision in children, fixation, preferential looking, single and linear optotype
   tests.
 Cycloplegic refraction and prescribing for children.
 Fundoscopy in children.


Desirable Clinical Experience
To have gained an awareness of the following:
 Nystagmus
 Ocular motility syndromes (Duane’s, Brown’s)
 Use of botulinum toxin
 Ocular myopathies and the neuromuscular junction
 Supranuclear eye movement disorders
 Fresnel prisms
 Oblique muscle, vertical muscle and adjustable suture surgery
 Electromyography.



                                                                                           21
   Congenital nystagmus
   Ocular albinism
   Congenital glaucoma, diagnosis and management.
   Congenital cataract, diagnosis and management including prevention of amblyopia.
   Leucocoria, differential diagnosis including retinoblastoma.
   Retinopathy of prematurity, screening and treatment.
   Genetic and developmental disorders, Leber’s amaurosis, X-linked schisis, Coats’ disease.
   Paediatric neurological diseases.
   Presentation of raised intracranial pressure in infancy and childhood.
   Ophthalmic signs of child abuse
   Orbital cellulitis presenting in children.
   Orbital tumours in children, including rhabdomyosarcoma.
   Services for the rehabilitation of the visually disabled child.


Assessment throughout BST training

Assessment and Learning Methods;
Strabismus Course, Waterford Regional Hospital




                                                                                          22
8. Accident and Emergency Ophthalmology

Topics - Essential Clinical Experience
To have become familiar with the following:
 Superficial ocular trauma: including assessment and treatment of foreign bodies,
   abrasions and minor lid lacerations
 Severe blunt ocular injury: management of hyphaema - recognition and initial
   management of more severe injury.
 Severe orbital injury: recognition and initial care of corneal and scleral wounds;
   recognition of acqueous leakage and tissue prolapse.
 Retained intraocular foreign body; anticipation from history, confirmation of X-ray and
   CT scan.
 Sudden painless loss of vision; recognition of retinal arterial occlusion, central retinal
   vein occlusion, acute ischaemic optic neuropathy, optic neuritis, urgency of treatment.
 Severe intraocular infection; recognition and initial investigation and management of
   hypopyon.
 Acute angle closure glaucoma; recognition and acute reduction of intraocular pressure.
 Liaison with Radiological department, Microbiologist, ENT and Faciomaxillary
   surgeons.

Core Skills
To have undertaken (under supervision until proficient) the following:
 Removal of superficial foreign bodies x 5 cases
 Corneal epithelial debridement x 5 cases
 Repair of minor conjunctival/lid lacerations x 5 cases
 YAG iridotomy x 5 cases

Desirable Clinical Experience
To have gained an awareness of the following:
 Eye protection and prevention of injury
 Lateral canthotomy and inferior cantholysis for retrobulbar haemorrhage
 Chemical/alkali burns of the conjunctiva and cornea

Assessment throughout BST training, 2 miniCEX assessments per annum

Assessment and Learning Methods;
Attend 20 A&E sessions (min)
Minicex 2 cases/ year




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Appendix 7;
POSTGRADUATE TRAINING IN OPHTHALMOLOGY

During the first two years of training, SHOs should become familiar with;*

Examination of the Eye Patient to Include;
Visual Acuity Assessment (adults & children)
Slit Lamp Examination
Tonometry
90/78 D Lenses
Gonioscopy/Diagnostic contact lenses
Indirect Ophthalmoscopy
Orthoptic Examination
Visual Field Examination
Corneal Topography
Electrodiagnosis
Fluorescien Angiography
OCT
GDX
Ultrasound (A-scan and B-scan)
Neuro-Imaging (MRI & CT)


Practical Optics and Refraction
Retinoscopy (adults & children)
Focimeter
Keratometry
Biometry
Jacksons Cross Cylinder
Duochrome test
Palcidos Test
Pachymetry
Low Visual Aids

Pharmacological Tests in Ophth
Tensilon Test
Tests for Horners Syndrome (Cocaine 4% & Adrenaline 0.1%)
Tests for Adies Pupil (Pilocarpine 0.1%)

*This list is a guide for trainees

Trainees are recommended to review the Curriculum of the Royal Australian and New
Zealand College of Ophthalmologists. (RANZCO)
www.ranzco.edu




                                                                              24
Appendix 8;
Recommended Textbooks to include;

   1. “American Ophthalmology Monograph Series” American Academy of
      Ophthalmology (available in all teaching units
   2. “Clinical Ophthalmology: A Systematic Approach” Jack Kanski
   3. “Practical Ophthalmology; A Manual for Beginning Residents” American Academy
      of Ophthalmology
   4. “Clinical Anatomy of the Eye” Snell
   5. “The Eye; Basic Sciences in Practice” John Forrester & Andrew Dick
   6. James C.B., Benjamin Larry:
      Ophthalmology
      Investigation And Examination Techniques
      Elsevier Health Sciences (United Kingdom), 2006
      ISBN: 9780750675864.

   7. Benjamin Larry:
      Surgical Techniques in Ophthalmology Series: Cataract Surgery - Text with dvd
      Elsevier Health Sciences (United Kingdom), 2007
      ISBN: 9781416029694




                                                                                      25
Appendix 9;
Recommended Courses and Meetings;

National Courses
1. Neuro-ophthalmology Course – Miss Patricia Logan, Beaumont Hospital (May)

2. Phaco Course – Alcon Laboratories Hemel Hempsted (March)

3. Strabismus Course – Mr. Peter Tormey, Waterford Regional Hospital (November)

4. Refractive Surgery Study Day – HSE Adelaide Road (April)

5. Ocular Pathology – Dr Susan Kennedy, HSE Adelaide Road (September)

6. OCT, Flourescine, Angiography & Medical Retina – Miss Marie Hickey-Dwyer Limerick
Regional Hospital (September)

7. Revision Courses for Postgraduate Examination
Please see http://www.rcophth.ac.uk/exams/revision-courses

8. Details on courses provided by the Royal College of Physicians in Ireland are available at;
http://www.rcpi.ie/EducationAndTraining/Pages/TrainingCourses.aspx#pdp1

9. ATLS – Advanced Trauma and Life Support (RCSI)

Each Trainee is expected to attend one National Course per year


National Meetings
Royal Academy of Medicine in Ireland (ophthalmic section)
Spring and Winter Meeting (NCHD presentations) (March & November)

Irish College of Ophthalmologists Annual Meeting (May)

International Meetings
International Paediatric Meeting, Dublin - Prof Michael O Keefe, Mater & Temple St Hospitals
International Refractive Meeting, Dublin - Prof Michael O Keefe, Mater & Temple St Hospitals
Royal College of Ophthalmologists (RCOphth)
European Society of Cataract and Refractive Surgeons (ESCRS)
American Academy of Ophthalmology (AAO)
Association of Research and Vision in Ophthalmology (ARVO) (May)




                                                                                               26
Appendix 10;
BST Rotations

For BST Training;
- a minimum of two surgical lists per week for surgical trainees
- one dedicated RSTA session
- maximum of three sessions in A&E (recommend two)
- OPD minimum of four clinics

At Basic Specialist Training proposed modules to include;
- A&E sessions
- Cataract (50 cases)
- Strabismus
- Ocular Plastics (50 lid procedures)
- Cornea
- Medical Retina (50 lasers)
- Glaucoma




The knowledge required for BST is defined in the syllabus of the MRCSI (Ophth) which is
currently under review. It is proposed to hold the examinations twice yearly, as the RCOpth
examination is now an exit fellowship at year 7.




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