Optometry | OphEd

Optometry Service

Overview

The rotations through the Optometry Service at the UPMC VIsion Institute provide residents with the opportunity to learn by providing care to a diverse patient population with a broad range of ophthalmic concerns.

Services include

routine eye exams and refraction
routine and specialty contact lens fitting
low vision evaluation
orthoptic measurement and prescription of prism lenses
screening and ongoing treatment for patients with
- cataract
- glaucoma
- diabetes

Curriculum

Residents can expect an environment of supervised autonomy that emphasizes the role of the resident as the primary eyecare provider.

A strong emphasis is placed on teaching and residents can expect to teach and be taught by all members of the optometry team including themselves, their peers, faculty, staff and patients.

While working on the optometry service residents will have the opportunity to develop and refine skills including

taking a thorough and focused ophthalmic history
performing a complete ophthalmic exam including
- afferent examination (visual acuity, pupil exam and visual fields)
- retinoscopy and refraction
- ocular motility
- examination of external, anterior and posterior structures of the eye
forming and narrowing a differential diagnosis
creating and implementing a plan for further diagnosis and treatment
ordering and interpreting ophthalmic diagnostic studies
communicating with and counseling patients
corresponding with patients’ families and other health care providers
presenting patients in a thorough and focused manner

Clinical experiences begin at 8 am each weekday and continue until the last patient is discharged.

Clinic care may be followed by a post-clinic wrap-up session during which the day’s patients and the important points they illustrated are reviewed.

Wrap-up session is generally finished by 6:30 pm.

Expectations

All residents on the service are expected to

read and become familiar with the Educational Goals and Objectives for the rotation
arrive on time for clinical experiences.
provide courteous care to patients.
take thorough histories and perform complete examinations
work as part of the team sharing work with the technical staff as needed
work closely with medical students and other trainees rotating with the service
complete timely, thorough and accurate documentation using the electronic health record
when necessary complete correspondence with patients’ other health care team
treat the technical and administrative staff with courtesy and respect
complete preliminary interpretations for all studies the resident has seen
when necessary, provide post encounter care for the patient by checking labs, filling out forms and corresponding with patients
read on a daily basis while on the service concentrating on topics brought to the forefront during clinical experiences

Optometry Educational Goals and Objectives

Overall Goals

Patient Care

To take complete histories in an efficient, respectful manner
To perform thorough examinations in an efficient manner
To think through and formulate possible differential diagnoses
To develop an appropriate management plan; in appropriate circumstances initiate it
To demonstrate appropriate hygiene by washing before and after every patient contact

Medical Knowledge

To establish good reading habits early. Plan to read every day. Stick to your plan.
To Apply your what you've read as you talk to, examine, diagnose and treat your patients.
When you are exposed to a new diagnosis in a clinical situation, read about it as soon as possible.

Professionalism

To treat patients with respect and compassion at all times
To treat clinical and administrative staff with respect
To treat medical students with respect and strive to create an atmosphere conducive to education
To arrive on-time for clinical experiences
To prepare in advance for surgical experiences
To work to become part of the clinical team
- To work with the faculty, staff, fellow and other residents on the service to determine your responsibilities
- To remain flexible and offer to help out with the responsibilities of others when you can
To remain visible and available to participate in clinical care throughout the clinical session. If you leave the clinical care area make sure that other members of the service know where you are and why
To answer your pager within 10 minutes of receiving page

Interpersonal and Communications Skills

communicate your name and role on the service to patients and their families
- "Hello, I'm Dr. Resident, I'm a resident working with Dr. Attending today."
present patients to the attending in a succinct but complete way
maintain timely and legible medical records
talk when you should talk, listen when you should listen

Practice Based Learning and Improvement

learn to recognize feedback from faculty, fellows, fellow residents, patients and students
accept that feedback constructively and work to improve based on it
accept your role as a teacher as well as a learner. Work to educate students, fellow residents, faculty, staff and patients

Systems Based Practice

work for the benefit of your patients to communicate with other health care providers
act as an advocate for your patient within the health care system
become aware of the costs of diagnostic and therapeutic interventions. Consider these costs as you recommend and prescribe these interventions.

In addition, to these goals please see the topic and level specific medical knowledge and patient care goals below.

Fundamentals

PGY-1 level goals

Medical Knowledge

To describe the basic principles of optics and refraction.
To list the indications for and to prescribe the most common low vision aids.

Patient Care

To perform the basic anterior segment (e.g., basic refraction, basic retinoscopy, slit lamp biomicroscopy) and posterior segment examination skills (e.g., dilated fundus examination, use of magnification and lenses, 90 Diopter lens, three mirror Goldmann contact lens) and to understand and use basic ophthalmic instruments (e.g., tonometer, lensometer).

Retinoscopy and Refraction

PGY-1 Level Goals

Medical Knowledge

To identify the principles and indications for retinoscopy.
To describe the major types of refractive errors.
To describe basic ophthalmic optics and optical principles of refraction and retinoscopy.
To describe the indications for and to use trial lenses or a phoropter for simple refractive error.
To describe the basic principles of a keratometer.

Patient Care

To perform the technique of retinoscopy.
To identify media opacities with retinoscopy.
To perform an integrated refraction based upon retinoscopic results.
To perform elementary refraction techniques (e.g., for myopia, hyperopia, accommodative add)
To perform objective and subjective refraction techniques for simple refractive error. To perform retinoscopy for detecting simple refractive errors.

Low Vision

PGY-1 Level Goals

Medical Knowledge

To describe low vision assessment techniques (e.g., Early Treatment of Diabetic Retinopathy Study charts, Sloane charts).
To describe significant co-morbidities that impact low vision rehabilitation.
To describe various low vision aids.
To describe the optics of low vision devices.
To be sensitive to psychological and emotional aspects of visual impairment.
To describe challenges commonly encountered by individuals with visual impairments.
To prescribe simple but appropriate rehabilitative therapies and optical devices to help the patient meet his/her goals. (e.g., magnification, illumination).
To describe functional implications of various visual system pathologies and diseases.
To describe visual field enhancing techniques for hemianopic field loss.
To describe the difference between visual acuity testing at both distance and near and contrast sensitivity testing.
To describe the evaluation of and rationale for licensing automobile drivers who are visually impaired.
To describe evaluation of visual acuity and visual field for disability determination.
To recognize significant co-morbidities that impact low vision rehabilitation.
To recognize and describe clinical applications, indications, and limitations of the various low vision aids (e.g., closed circuit television, magnification, large print, Braille, computers with artificial speech).
To describe the more advanced optics of low vision devices.

Patient Care

To prescribe rehabilitative therapies and optical devices to help the patient meet his/her goals.
To apply and prescribe visual field enhancing techniques for hemianopic field loss.
To perform evaluation of vision assessment in licensing drivers who are visually impaired.
To evaluate visual acuity and visual field for disability determination.
To demonstrate low vision devices and educate low vision patients on the uses and limitations of these devices.