Medical Knowledge

• To describe basic eyelid, lacrimal, and orbital anatomy and physiology (e.g., eyelid, orbicularis, orbital structures, meibomian glands, lacrimal glands, glands of Zeiss, Whitnall’s ligament, Muller’s muscle, Lockwood’s ligament, canaliculi, puncta, orbital bones, orbital foramina, paranasal sinuses, annulus of Zinn, arterial and venous vascular supply, lymphatics, nerves, extraocular muscles).
• To describe basic mechanisms and indications for treatment of eyelid, orbital, and lacrimal trauma.
• To recognize simple orbital trauma (e.g., orbital foreign body, retrobulbar hemorrhage).
• To recognize and treat simple trichiasis.
• To recognize blepharospasm and hemifacial spasm.
• To identify normal orbital and skull base anatomy on imaging studies (e.g,, magnetic resonance imaging, computed tomography, ultrasound).
• To describe the differential diagnosis of proptosis in children and adults.
• To describe techniques and complications of minor operating room procedures (e.g., incision and drainage of chalazia, excision of small eyelid lesions).
• To describe typical features of orbital cellulitis.

Patient care 

• To know the patient's surgical history as it pertains to chief complaint.
• To describe indications for and to perform the basic office examination techniques for the most common oculoplastic and orbital abnormalities.
• To identify indications for and to perform the basic assessment of the eyelids (e.g., eversion, double eversion) and eyebrows (e.g., margin to reflex distance, lid crease, levator function, eyelid/brow malpositions).
• To identify indications for and to perform the basic lacrimal assessment (e.g., dye testing, punctal dilation, lacrimal irrigation).
• To identify indications for and to perform the basic assessment of the orbit (e.g., Hertel exophthalmometry, inspection, palpation, auscultation).
• To identify indications for and to perform the basic socket assessment (e.g., types of implants, socket health).
• To perform minor lid procedures (e.g., removal of benign eyelid skin lesions, chalazion curretage or excision, conjunctival biopsy, full thickness lid lacerations).
• To treat complications of minor operating room procedures (e.g., incision and drainage of chalazia, excision of small eyelid lesions).
• To perform punctal plug insertion or removal.
• To recognize and treat trichiasis (e.g., epilation, cryotherapy, surgical therapy).
• To perform a simple enucleation or evisceration under supervision.
• To describe the indications for, describe the steps of and perform temporal artery biopsies
• To recognize and treat orbital trauma (e.g., intraorbital foreign body, retrobulbar hemorrhage, fracture). 

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
• answer your pager within 10 minutes of page.

Interpersonal and communication skills

• To 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."
• To present patients to the attending in a succinct but complete way
• To maintain timely and legible medical records
• To talk when you should be talking, listen when you should be listening

Practice-based learning and improvement

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

Systems based practice

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

(in addition to PGY-2 Level goals)

Medical Knowledge

• To describe more advanced eyelid, lacrimal, and orbital anatomy and physiology (e.g., lacrimal apparatus, orbital vascular anatomy).
• To describe the genetics (where known), clinical features, evaluation, and treatment of congenital eyelid deformities (e.g., coloboma, distichiasis, epicanthus, telecanthus, blepharophimosis, ankyloblepharon, epiblepharon, euryblepharon, and Goldenhar, Treacher-Collins, Waardenburg syndromes).
• To describe the clinical features, evaluation and management of congenital orbital deformities (e.g., synophthalmia, anophthalmia, microphthalmia, cryptophthalmia, hypertelorism, hypotelorism).
• To describe the genetics, clinical features, evaluation, and management of common craniosynostoses and other congenital malformations (e.g.,Crouzon, Apert).
• To recognize and describe the indications for referral for treatment congenital eyelid abnormalities (see Basic Level, above).
• To perform pre-operative and post-operative assessment of patients with simple and more serious oculoplastic and skull base disorders (e.g., multi-disciplinary procedures).
• To describe the mechanisms and indications for treatment of more advanced eyelid, orbital, and lacrimal trauma (e.g., more complicated full thickness lid laceration, chemical burns to the face).
• To describe features of, recognize, evaluate, and treat more complicated cases of nasolacrimal duct obstruction, canaliculitis, dacyrocystitis, acute and chronic dacryoadenitis, preseptal cellulitis, and orbital cellulitis.
• To recognize, evaluate and treat thyroid ophthalmopathy (e.g., epidemiology, symptoms and signs, orbital imaging, differential diagnosis, surgical, medical, and radiation indications, side effects of treatment).
• To recognize, evaluate and treat orbital inflammatory pseudotumor (e.g., epidemiology, symptoms and signs, orbital imaging, differential diagnosis, biopsy indications, choice of treatments).
• To recognize, treat, or refer blepharospasm or hemifacial spasm.
• To recognize common orbital tumors and to describe the differential diagnosis of orbital tumors in children and adults.
• To recognize and treat floppy eyelid syndrome.
• To describe the differential diagnosis of lacrimal gland mass (e.g., inflammatory, neoplastic, congenital, infectious).
• To recognize common skull base pathology (mucocele, fibrous dysplasia, sellar tumors, etc.)
   

Patient Care

• To describe indications for and to perform more advanced examination techniques for less common oculoplastic and orbital abnormalities (e.g, measurement of levator function).
• To identify indications for and to perform more advanced assessment of eyelids and eyebrows (e.g., hypoglobus, facial asymmetry, brow ptosis).
• To identify indications for and to perform more advanced lacrimal assessment (e.g., interpretation of dye testing, canalicular probing in trauma).
• To identify indications for and to perform more advanced assessment of the orbit (e.g., enophthalmus).
• To identify indications for and to perform more advanced socket assessment (e.g., extrusion of implants, anophthalmic socket complications).
• To perform more complicated minor lid procedures (e.g., larger benign skin lesions) or surgery (e.g., recurrent or multiple chalazion).
• To recognize the indications and complications and to perform more complex minor operating room or limited operating room procedures (e.g., incision and drainage of recurrent or larger chalazia, excision of moderate sized benign eyelid lesions).
• To identify common orbital pathology (e.g., orbital fractures, orbital tumors) on imaging studies (e.g, magnetic resonance imaging, computed tomography, ultrasound).
• To treat common presentations of preseptal or orbital cellulitus.
• To describe, recognize the indications and complications, and to perform the basic lacrimal procedures below:
  • Lacrimal drainage testing (irrigation, dye disappearance test)
  • Lacrimal intubation
• To describe, recognize the indications and complications, and to serve as surgical assistant for dacryocystorhinostomy (external)
• To recognize facial nerve palsy with exposure keratopathy and to indentify indications for and to perform surgical treatments for this condition (e.g. tarsorrhaphy, gold weights).
   

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
• answer your pager within 10 minutes of page.

Interpersonal and communication skills

• To 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."
• To present patients to the attending in a succinct but complete way
• To maintain timely and legible medical records
• To talk when you should be talking, listen when you should be listening

Practice-based learning and improvement

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

Systems based practice

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

Medical Knowledge

• To describe the most advanced eyelid, lacrimal, and orbital anatomy and physiology.
• To evaluate and to treat simple and more advanced eyelid, orbital, and lacrimal trauma (e.g., full thickness lid laceration, chemical burns to the face).
• To perform pre-operative and post-operative assessment and coordination of care of patients with more advanced or complex oculoplastic disorders (e.g., systemically ill patient, multi-disciplinary procedures).
•  To describe the etiology, evaluation, and medical and perform or assist with the surgical treatment of the following eyelid diseases
  • Ectropion (e.g., congenital, paralytic, involutional, cicatricial, mechanical, allergic).
  • Entropion (e.g., involutional, cicatricial, spastic, congenital).
  • Myogenic ptosis (e.g., chronic progressive external ophthalmoplegia).
  • Dermatochalasis (e.g., blepharochalasis).
  • Benign, pre-malignant, or malignant eyelid tumors (e.g., papilloma, keratoacanthoma, seborrheic keratosis, epidermal inclusion cyst, molluscum contagiosum, verruca vulgaris, actinic keratosis, basal cell carcinoma, squamous cell carcinoma, sebaceous cell carcinoma, melanoma).
  • Single or recurrent inflammatory lesions (e.g., recurrent chalazion or its mimics).
  • Facial dystonia (e.g., blepharospasm, hemifacial spasm).
  • Facial nerve palsy with exposure keratopathy (e.g. tarsorrhaphy, gold weights).
  • Complex lid and orbital trauma cases.

Patient Care

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
• answer your pager within 10 minutes of page.

Interpersonal and communication skills

• To 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."
• To present patients to the attending in a succinct but complete way
• To maintain timely and legible medical records
• To talk when you should be talking, listen when you should be listening

Practice-based learning and improvement

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

Systems based practice

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

Medical Knowledge

• To describe the basic anatomy, embryology, physiology, pathology, microbiology, immunology, genetics, epidemiology, and pharmacology of the cornea, conjunctiva, sclera, eyelids, lacrimal apparatus, and ocular adnexa.
• To describe congenital abnormalities of the cornea, sclera, and globe (e.g., Peters’ anomaly,microphthalmos, birth trauma, buphthalmos).
• To describe characteristic corneal and conjunctival degenerations (e.g., pterygium, pinguecula,Salzmann, senile plaques of the sclera, keratoconus).
• To describe, recognize, and evaluate peripheral corneal thinning (e.g., inflammatory, degenerative, dellen-related, infectious, allergic).
• To recognize the common corneal dystrophies and degenerations (e.g., map-dot-fingerprint dystrophy, Meesman’s dystrophy, Reiss-Buckler dystrophy, Francois dystrophy, Schnyder dystrophy, congenital hereditary stromal dystrophy, lattice dystrophy, granular dystrophy, macular dystrophy, congenital hereditary endothelial dystrophy, Fuchs’ dystrophy, posterior polymorphous dystrophy, Salzmann’s degeneration).
• To recognize the common corneal inflammations and infections (e.g., herpes simplex, syphilis, interstitial keratitis).
• To understand the fundamentals of corneal optics and refraction (e.g., keratoconus).
• To describe the fundamentals of ocular microbiology and recognize corneal and conjunctival inflammations and infections (e.g., Staphylococcal hypersensitivity, simple microbial keratitis,simple conjunctivitis, trachoma, ophthalmia neonatorum, herpes zoster ophthalmicus, herpes simplex keratitis and conjunctivitis).
• To recognize the basic presentations of ocular allergy (e.g., phlyctenules, seasonal hay fever, vernal conjunctivitis, allergic and atopic conjunctivitis, giant papillary conjunctivitis).
• To recognize and treat lid margin disease (e.g., Staphylococcal blepharitis, meibomian gland dysfunction).
• To describe the features of, diagnose, and treat (or refer) vitamin A deficiency (e.g., Bitot spots, dry eye, slowed dark adaptation) and neurotrophic corneal disease.
• To describe the basic differential diagnosis of the acute and chronic conjunctivitis or “red eye” (e.g., scleritis, episcleritis, conjunctivitis, orbital cellitus, gonococcal and chlamydial conjunctivitis).
• To describe the basic mechanisms of traumatic and toxic injury to the anterior segment (e.g., alkali burn, lid laceration, orbital fracture, etc.).
• To understand the mechanisms of ocular immunology and recognize the external manifestations of anterior segment inflammation (e.g., red eye associated with acute and chronic iritis).
• To describe the basic principles of ocular pharmacology of anti-infective, anti-inflammatory and immune modulating agents (e.g., indications and contraindications for topical corticosteroids and antibiotics).
• To recognize corneal lacerations (perforating and non-perforating), pterygia that may requiresurgery, corneal and conjunctival foreign bodies.
• To diagnose and treat corneal exposure (e.g., lubrication, temporary tarsorrhaphy).
• To describe the epidemiology, differential diagnosis, evaluation and management of common benign and malignant lid lesions, including pigmented lesions of the conjunctiva and lid (e.g., nevi, melanoma, primary acquired melanosis)
• To describe the epidemiology, classification, pathology, indications for surgery, and prognosis of common malpositions of the eyelids (e.g., blepharoptosis, trichiasis, distichiasis, essential blepharospasm, entropion, ectropion) and understand their relationship to secondary diseases of the cornea and conjunctiva (e.g., exposure keratopathy).
• To recognize and describe the treatment for a chemical burn (e.g., types of agents, medical therapy). 
• To describe the etiologies and treatment of superficial punctate keratitis (e.g., dry eye, Thygeson’s superficial punctate keratopathy), blepharitis, toxicity, ultraviolet photokeratopathy, contact lens related).
• To describe the symptoms and signs, testing and evaluation for, and treatment of exposure keratopathy and dry eye (e.g., Schirmer testing).
• To recognize the anterior segment manifestations of systemic disease (e.g., Wilson’s disease) and pharmacologic side effects (e.g., amiodarone vortex keratopathy).
• To recognize, list the differential diagnosis, and evaluate aniridia and other developmental anterior segment abnormalities (e.g., Axenfeld’s, Rieger’s, Peters’ anomalies and related syndromes).
• To understand the surgical indications (e.g., Fuchs’ dystrophy, aphakic/pseudophakic bullous keratopathy), surgical techniques, and recognition and management of postoperative complications (especially immunologically-mediated rejection) of corneal transplantation (e.g, penetrating, lamellar). 
   

Patient Care

• To perform external examination (illuminated and magnified) and slit lamp biomicroscopy, including drawing of anterior segment findings.
• To administer topical anesthesia, as well as special topical stains of the cornea (e.g., fluorescein dye and Rose Bengal).
• To perform simple tests for dry eye (e.g., Schirmer test).
• To perform punctal occlusion (temporary or permanent) or insert plugs.
• To perform simple corneal sensation testing (e.g., cotton tip swab).
• To perform tonometry (e.g., applanation, tonopen, Schiotz, pneumotonometry).
• To perform techniques of sampling for viral, bacterial, fungal, and protozoal ocular infections (e.g., corneal scraping and appropriate culture techniques).
• To manage corneal epithelial defects (e.g., pressure patching and bandage contact lenses).
• To perform removal of a conjunctival or corneal foreign body (e.g, rust ring).
• To perform epilation.
   

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
• answer your pager within 10 minutes of being paged.

Interpersonal and communication skills

• To 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."
• To present patients to the attending in a succinct but complete way
• To maintain timely and legible medical records
• To talk when you should be talking, listen when you should be listening

Practice-based learning and improvement

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

Systems based practice

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

(In addition to PGY-2 Level goals)

Medical Knowledge

• To describe the more complex anatomy, embryology, physiology, pathology, microbiology, immunology, genetics, epidemiology, and pharmacology of the cornea, conjunctiva, sclera, eyelids,lacrimal apparatus, and ocular adnexa.
• To describe the more complex congenital abnormalities of the cornea, sclera, and globe (e.g.,hamartomas and choristomas).
• To describe, recognize, evaluate, and treat peripheral corneal thinning (e.g., inflammatory, degenerative, dellen-related, infectious, allergic).
• To recognize the common conjunctival neoplasms (e.g., benign, malignant tumors).
• To recognize and treat less common corneal or conjunctival presentations of degenerations (e.g., inflamed or atypical pterygium, band keratopathy).
• To describe the epidemiology, differential diagnosis, evaluation, and management of Bitot’s spots.
• To describe the epidemiology, differential diagnosis, evaluation, and management of Thygeson’s superficial punctate keratopathy.
• To understand more complex corneal optics and refraction (e.g., irregular astigmatism).
• To correlate the concordance of the visual acuity with the density of media opacity (e.g., cataract) and to evaluate the etiology of discordance between acuity and media examination findings.
• To describe more complex ocular microbiology and describe the differential diagnosis of more complicated corneal and conjunctival infections (e.g., complex or atypical bacterial fungal, Acanthamoeba, viral, or parasitic keratitis).
• To describe differential diagnosis, evaluation, and treatment of interstitial keratitis (e.g., syphilis, viral diseases, inflammation).
• To describe more complex differential diagnosis of the “red eye” (e.g., autoimmune and inflammatory disorders causing scleritis, episcleritis, conjunctivitis, orbital cellulitis).
• To describe key features of trachoma, including epidemiology, clinical features and staging, complications (e.g, cicatricization), prevention (e.g., facial hygiene), and topical and systemic antibiotic treatment (especially in hyperendemic regions) and surgery (e.g., tarsal rotation).
• To describe more complex mechanisms of traumatic and toxic injury to the anterior segment (e.g., long-term sequelae of acid and alkali burn, complex lid laceration involving the lacrimal system, full-thickness laceration).
• To describe the differential diagnosis and the external manifestations of more complex anterior segment inflammation (e.g., acute and chronic iritis).
• To describe the more complex principles of ocular pharmacology of anti-infective, antiinflammatory and immune modulating agents (e.g., use of topical non-steroidal and steroidal agents, topical cyclosporine).
• To recognize and treat large or atypical pterygia that may require surgery.
• To describe and treat corneal and conjunctival foreign bodies.
• To diagnose and describe the treatment of severe corneal exposure (e.g., lubrication, temporary tarsorrhaphy)
• To recognize and treat common malpositions of the eyelids (e.g., entropion, ectropion, and ptosis) as they apply to secondary corneal disease.
• To recognize and treat recurrent corneal erosions.
• To recognize and treat foreign body, animal, and plant substance injuries.
• To recognize, evaluate, and treat chronic conjunctivitis (e.g., chlamydia, trachoma, molluscum contagiosum, Parinaud’s oculoglandular syndrome, ocular rosacea).
• To describe the epidemiology, clinical features, pathology, evaluation, and treatment of ocular cicatricial pemphigoid.
• To recognize, evaluate, and treat the ocular complications of severe diseases, such as chronic exposure keratopathy, contact dermatitis, and Stevens-Johnson syndrome.
• To describe the epidemiology, clinical features, pathology, evaluation, and treatment of peripheral corneal thinning or ulceration (e.g., Terrien’s marginal degeneration, Mooren’s ulcer, rheumatoid arthritis-related corneal melt).
• To understand ocular surface transplantation, including conjunctival autograft/flap, amniotic membrane transplantation, limbal stem cell transplantation.
• To understand the surgical indications (e.g., Fuchs’ dystrophy, aphakic/pseudophakic bullous keratopathy), surgical techniques, and recognition and management of postoperative complications (especially immunologically-mediated rejection) of corneal transplantation (e.g, penetrating, lamellar).
• To understand the preoperative assessment, patient selection, surgical management, and postoperative care of refractive surgical techniques, including keratotomy (radial, astigmatic), photoablation (photorefractive, phototherapeutic, LASIK), corneal wedge resection, thermokeratoplasty, intracorneal rings, phakic intraocular lens and clear lens extraction. 
   

Patient Care

• To perform more advanced techniques, including keratometry and pachymetry.
• To understand the indications for and techniques for performing stromal micropuncture.
• To understand the indications for and techniques for application of corneal glue.
• To assist in more complex corneal surgery (e.g., penetrating keratoplasty and phototherapeutic keratectomy).
• To perform more advanced tests for dry eye (e.g., modified Schirmer tests, assessment of tear break up time, fluorescein dye testing, Rose Bengal dye).
• To perform a more complex pterygium excision, including conjunctival grafting.
  

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
• answer your pager within 10 minutes of being paged.

Interpersonal and communication skills

• To 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."
• To present patients to the attending in a succinct but complete way
• To maintain timely and legible medical records
• To talk when you should be talking, listen when you should be listening

Practice-based learning and improvement

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

Systems based practice

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

Medical Knowledge

• To describe the epidemiology of primary open angle glaucoma (POAG).
• To perform evaluation of POAG.
• To describe the mechanics of aqueous humor dynamics and the anatomy of the anterior chamber and its angle.
• To describe basic tonometry.
• To describe optic nerve and nerve fiber layer anatomy in glaucoma.
• To describe fundamentals of perimetry, including kinetic and automated static perimetry.
• To describe principles, indications, and basic techniques of gonioscopy, including normal and abnormal findings.
• To describe principles of medical management, including indications for and side effects of treatment options (e.g., topical and systemic medications) for simple glaucoma (e.g., POAG, primary angle closure glaucoma).
• To describe and recognize normal tension glaucoma (“low tension glaucoma”).
• To describe the features of and recognize primary and secondary angle closure glaucoma and aqueous misdirection.
• To describe the clinical features of and to recognize hypotony (e.g., Seidel test for transconjunctival leakage).
• To list the main results of the major clinical trials in glaucoma (e.g., Glaucoma Laser Trial, Normal Tension Glaucoma Study, Advanced Glaucoma Intervention Study, Ocular Hypertension Treatment Study, Early Manifest Glaucoma Trial and Collaborative Initial Glaucoma Treatment Study).

Patient Care

• To perform basic tonometry (e.g., applanation, tonopen, icare, pneumotonometer) and recognize the pitfalls and artifacts of the testing.
• To perform basic gonioscopy (e.g., recognize angle structures, identify angle closure).
• To perform stereo examination of the optic nerve, using 90 diopter or other lens.
• To interpret manual (e.g., Goldmann) and automated (e.g., Humphrey, Octopus) visual fields in routine glaucoma.
• To interpret optic nerve imaging studies, such as Ocular Coherence Tomography

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
• answer your pager within 10 minutes of being paged.

Interpersonal and communication skills

• To 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."
• To present patients to the attending in a succinct but complete way
• To maintain timely and legible medical records
• To talk when you should be talking, listen when you should be listening

Practice-based learning and improvement

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

Systems based practice

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

(in addition to PGY-2 Level goals)

Medical Knowledge

• To describe the epidemiology and perform screening for routine and more advanced primary and secondary open angle glaucoma.
• To describe the treatment of disturbances of aqueous humor dynamics.
• To describe the more complex etiologies for, evaluation of, and treatment of glaucoma (e.g., angle recession, inflammatory, steroid-induced, pigmentary, pseudoexfoliative, phacolytic, neovascular, post-operative, malignant, lens particle glaucomas; plateau iris; glaucomatocyclitic crisis; iridocorneal endothelial syndromes; aqueous misdirection).
• To describe more advanced tonometric and tonographic (if applicable) methods (e.g., diurnal curve).
• To describe more advanced optic nerve and nerve fiber layer anatomy in primary and secondary glaucoma and to recognize typical and atypical features associated with glaucomatous cupping (e.g., rim pallor, rapid progression, central acuity loss, hemianopic or other non-glaucomatous types of visual field loss).
• To describe more advanced forms of perimetry (e.g., kinetic and automated static visual fields) and perimetry strategies (e.g., threshold testing, supra-threshold testing, special algorithms).
• To describe the principles, indications, and more advanced anatomic findings and gonioscopic features of primary and secondary glaucomas (e.g., plateau iris, appositional closure).
• To describe the principles of medical management of more advanced glaucomas (e.g., advanced POAG, secondary open and closed angle glaucomas, normal tension glaucoma)
• To describe the features of, recognize, and treat primary angle closure glaucoma and aqueous misdirection.
• To describe the clinical features of, recognize, and treat less common etiologies of ocular hypotony.
• To describe the results and apply the conclusions to clinical practice of the major clinical trials in glaucoma (e.g., Glaucoma Laser Trial, Normal Tension Glaucoma Study, Advanced Glaucoma Intervention Study, Ocular Hypertension Treatment Study, Early Manifest Glaucoma Trial and Collaborative Initial Glaucoma Treatment Study).
• To recognize and treat the various adult secondary glaucomas.
• To describe the features of primary infantile and juvenile glaucomas.
• To describe and apply specific medical treatments of more advanced glaucoma.
• To describe the principles of laser treatments of glaucoma (e.g., indications, techniques, and complications, use of various types of laser energy, spot size, laser wavelengths).
• To describe the surgical treatment of glaucoma: (e.g., trabeculectomy, combined cataract and trabeculectomy, glaucoma drainage devices, MIGS, and cyclodestructive procedures, including indications, techniques, and complications).

Patient Care

• To perform argon or YAG laser peripheral iridotomy for routine angle closure glaucoma.
• To perform laser trabeculoplasty for uncomplicated glaucoma.
• To perform cyclophotocoagulation.
• To perform routine first surgical glaucoma procedure.
• To describe and manage a flat anterior chamber.
• To perform routine revision of filtering blebs.
• To recognize and treat glaucoma surgery bleb complications.

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
• answer your pager within 10 minutes of being paged.

Interpersonal and communication skills

• To 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."
• To present patients to the attending in a succinct but complete way
• To maintain timely and legible medical records
• To talk when you should be talking, listen when you should be listening

Practice-based learning and improvement

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

Systems based practice

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

Retina Educational Goals and Objectives

PGY-2 Goals & Objectives

1)  Medical Knowledge: To describe and demonstrate basic understanding of:

o   Basic principles of retinal anatomy and physiology (layers of the retina, retinal physiology).

o Fluorescein angiography as applied to retinal disease (e.g., phases of the

angiogram, indications)

o   Etiologies and mechanisms of retinal detachment

o   Macular anatomy and function and typical features of common macular disease (e.g., age-related macular degeneration, macular hole, macular dystrophies)

o   Basic principles of laser photocoagulation.

o   Posterior Segment Trauma: Commotion retinae, traumatic choroidal rupture, and Purtscher's retinopathy

o   Retinalvascular disease (e.g., branch, hemi- or central retinal vein and artery occlusion)

o   Retinitis pigmentosa

o   Posterior vitreous detachments

2)  Patient Care: To Perform:

o   Indirect ophthalmoscopy

o   Slit lamp biomicroscopy with the +78, +90 lenses

o  Interpretation of basic fluorescein angiography in common retinal disorders (e.g., diabetic  retinopathy, cystoid macular edema)

        o  Interpretation of OCT and fundus imaging

        o  Performance d interpretation of B scan ultrasound

3) 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

o   To work with the faculty, staff, fellow and other residents on the service to determine your responsibilities

o  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 H you leave the clinical care area make sure that other members of the service know where you are and why

• Answer your pager within 10 minutes of being paged.

4) Interpersonal and Communication Skills:

• To communicate your name and role on the service to patients and their families.

o   "Hello, I'm Dr. Resident; I'm a resident working with Dr. Attending today. I’ll start your eye exam for Dr. Attending, and enter some notes in the computer; then Dr. Attending will join us."

• To present patients to the attending in a succinct but complete way
• To enter data from the history and physical examination into the electronic medical records. As the "Progress Note" of the EMR is formatted to become the report sent to the referring MD, it should be composed with good grammar, and not contain abbreviations.
• If a fluorescein angiogram or an OCT is available for interpretation, the resident is expected to enter their interpretation of the study into the EMR
• To talk when you should be talking, listen when you should be listening

5)  Practice Based Learning and Improvement:

• To learn to recognize feedback from faculty, fellows, fellow residents, patients and students
• To accept that feedback constructively and work to improve based on it
• To accept your role as a teacher as well as a learner. Work to educate students, fellow residents, faculty, staff and patients
• To read on a daily basis, and when queried, to be prepared to discuss the previous days reading. The reading should include the above listed topics, and may include topics from interesting cases seen in clinic. Reading material should include the BCSC book and supplemented with other literature

6)  Systems Based Practice

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

PGY-3 Goals & Objectives

(In addition to PGY·2 Level goals)

1)  Medical Knowledge

• Fundamentals:  to describe and demonstrate understanding of:

• Advanced retinal anatomy and physiology

• Diagnostic Studies:  to describe the principles behind and indications for:

        o   fluorescein/indocyanine green (ICG) angiography as applied to retinal vascular and other diseases (e.g., phases of the angiogram, indications)

                    o   ocular coherence tomography

                    o   8-scan ultrasonography

                    o   basic electrophysiological tests (e.g., electroretinogram [ERG], electro-oculogram [EOG], visual evoked potential (VEP), dark adaptation).

• Peripheral Retinal Disease: to describe and demonstrate basic understanding of the signs of and treatment for:

• peripheral retinal disease and vitreous pathology (e.g., vitreous hemorrhage, retinal breaks).
• peripheral retinal degenerations:  lattice degeneration, pavingstone degeneration and indications for prophylactic treatment
• various types of retinal detachment (e.g., exudative, rhegmatogenous, tractional)
• retinoschisis (e.g. juvenile, senile)
• choroidal detachment

• Macular Disease:  to describe and demonstrate basic understanding of the signs of and treatment for:

o   age-related macular edema

o   Choroidal neovascularization (e.g., ARMD, histoplasmosis)

o   High myopia

o   Macular dystrophies

o   Macular pucker (e.g., epiretinal membrane)

o   Macular holes

o   Cystoid macular edema

o   Central serous Choroidopathy (retinopathy)

o   Optic pit and secondary serous detachment

o   Parafoveal telangiectasia

• Retinal Inflammatory Diseases: to describe and demonstrate basic understanding of the signs of and treatment for:

• Serpiginous Choroidopathy
• AMPPE
• Birdshot Choroidopathy
• PIC
• Multifocal choroiditis
• Retinal vasculitis

•    Retinal Infectious Diseases: to describe and demonstrate basic understanding of the signs of and treatment for:

o   ARN

o   Toxoplasmosis

o   Acute Bacterial Endophthalmitis

o   Fungal Endophthalmitis

o   Syphilis

• Hereditary Retinal and Choroidal Diseases: to describe and demonstrate basic understanding of the signs of and treatment for:

• Gyrate atrophy
• Choroideremia
• Retinitis pigmentosa
• Cone dystrophies
• Stargardt's disease
• Best's disease
• Congenital stationary night blindness

• Hereditary Retinal and Choroidal Diseases: to describe and demonstrate basic understanding of the signs of and treatment for:

o   Phenothiazine

o   Hydroxychloroquine/chloroquine toxicity

                        o   Tamoxifen

• Retinal Vascular Diseases: to describe and demonstrate basic understanding of the signs of and treatment for:

• Arterial and venous obstructions
• Diabetic retinopathy
• Hypertensive retinopathy
• Peripheral retinal vascular occlusive disease
• Acquired retinal vascular diseases
• Ocular ischemic syndrome
• Sickle cell retinopathy

• Principles of surgery: to describe indications for and complications of:

• retinal detachment repair (e.g., pneumatic retinopexy, scleral buckling, vitrectomy).
• surgical vitrectomy (e.g., mechanics, instruments, indications, and technique).
• special vitreoretinal techniques
• Macular hole repair
• Epiretinal membrane peeling
• Complex vitrectomy for proliferative vitreoretinopathy
• Use of heavy liquids and intraocular gases (e.g., perfluorocarbons)
  • laser photocoagulation for conditions including
• diabetic macular edema
• diabetic retinal neovascularization
• other causes of retinal neovascularization
• retinal tears

• Major studies in retinal diseases:  describe the findings of studies including:

• Diabetic Retinopathy Study (DRS)
• Early Treatment of Diabetic Retinopathy Study (ETDRS)
• Macular Photocoagulation Study (MPS)
• Diabetes Control and Complications Trial (DCCT)
• o Branch Vein Occlusion Study (BVOS)
• Central Vein Occlusion Study (CVOS)
• Comparison of AMD Treatment Trials (CATT)
• Standard Care Versus Corticosteroid for Retinal Vein Occlusion (SCORE)
• Collaborative Ocular Melanoma Study (COMS)
• Diabetic Retinopathy Vitrectomy Study (DRVS)
• Endophthalmitis Vitrectomy Study (EVS)
• Age-Related Eye Disease Study (AREDS)
• Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal
  • Neovascularization in AMD (ANCHOR)
• Minimally classic/occult trial of the Anti-VEGF antibody Ranibizumab In the treatment of Neovascular AMD (MARINA)

2)  Patient Care:  To perform:

o   indirect ophthalmoscopy with scleral indentation

o   ophthalmoscopic examination with contact lenses, including pan-funduscopic lenses

o   interpretation of fluorescein and ICG angiography

o   interpretation of retinal imaging technology (e.g., ocular coherence tomography)

o   interpretation of basic ocular imaging techniques (e.g., B-scan echography, nerve fiber layer analysis)

o   fundus drawings of the retina, showing complex vitreoretinal relationships and findings

o   surgical assisting with scleral buckling

o   surgical assisting with vitrectomy

3)  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

o   To work with the faculty, staff, fellow and other residents on the service to determine your responsibilities

o   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.  When you leave the clinical care area make sure that other members of the service know where you are and why

• answer your pager within 10 minutes of being paged.

4)  Interpersonal and Communication skills

• To communicate your name and role on the service to patients and their families.

o    "Hello, I'm Dr. Resident; I'm a resident working with Dr. Attending today. I will start

your eye exam for Dr. Attending, and enter some notes in the computer. Dr. Attending will join us."

• To present patients to the attending in a succinct but complete way

• To enter data from the history and physical examination into the electronic medical records. As the "Progress Note" of the EMR is formatted to become the report sent to the referring MD, it should be composed with good grammar, and not contain abbreviations.

• a fluorescein angiogram or an OCT is available for interpretation, the resident is expected to enter their interpretation of the study into the EMR.

• To talk when you should be talking, listen when you should be listening

5)  Practice-Based Learning and Improvement

• To learn to recognize feedback from faculty, fellows, fellow residents, patients and students

• To accept that feedback constructively and work to improve based on it

• To accept your role as a teacher as well as a learner. Work to educate students, fellow residents, faculty, staff and patients

• To read on a daily basis, and when queried, to be prepared to discuss the previous days reading. The reading should include the above listed topics, and may include topics from interesting cases seen in clinic. Reading material should include the BCSC book and supplemented from "The Retina" textbook for which an on-line version can be made available to you.

6)  Systems Based Practice

• To work for the benefit of your patients to communicate with other health care provider

• To act as an advocate for your patient within the health care system

• To become aware of the costs of diagnostic and therapeutic interventions. Consider these costs as you recommend and prescribe these interventions.

Medical Knowledge

• To describe the neuro-anatomy of the visual pathways.
• To describe the neuro-anatomy of the cranial nerves.
• To describe the pupillary and accommodative neuro-anatomy.
• To describe ocular motility and related neuronal pathways.
• To describe the typical features, evaluation, and management of the most common optic neuropathies (e.g., demyelinating optic neuritis, ischemic optic neuropathy [arteritic and nonarteritic], toxic or nutritional optic neuropathy, Leber’s hereditary optic neuropathy, ethambutol toxicity, neuroretinitis, and compressive, inflammatory, infiltrative, and traumatic optic neuropathies).
• To describe the typical features, evaluation, and management of the most common ocular motor neuropathies (e.g., third, fourth, sixth nerve palsy).
• To describe the typical features of cavernous sinus and superior orbital fissure syndromes (e.g., infectious, vascular, neoplastic, inflammatory etiologies).
• To describe the typical features, evaluation, and management of the most common causes of nystagmus (e.g., congenital motor and sensory, downbeat, upbeat, gaze-evoked, drug-induced).
• To describe the typical features, evaluation, and management of the most common pupillary abnormalities (e.g., relative afferent pupillary defect, anisocoria, Horner syndrome, third nerve  palsy, Adie’s tonic pupil).
• To describe the typical features, evaluation, and management of the most common visual field defects (e.g., optic nerve, optic chiasm, optic radiation, occipital cortex).
• To describe the epidemiology, clinical features, evaluation, and management of ocular myasthenia gravis.
• To describe the epidemiology, clinical features, evaluation, and management of carotid-cavernous fistula.
• To describe the epidemiology, differential diagnosis, evaluation and management of congenital optic nerve abnormalities (e.g., optic pit, disc coloboma, papillo-renal syndrome, morning glory syndrome, tilted disc, optic nerve hypoplasia, myelinated nerve fiber layer, melanocytoma, disc drusen, Bergmeister’s papilla).

Patient Care

(in addition to PGY-2 level goals listed for the Inpatient Consult Service)

Medical Knowledge

• To describe typical and atypical features, evaluation, and management of the most common optic neuropathies (e.g., papilledema, optic neuritis, ischemic, inflammatory, infectious, infiltrative, compressive, and hereditary optic neuropathies).
• To describe typical and atypical features, evaluation, and management of the more complex supranuclear and internuclear palsies and less common ocular motor neuropathies (e.g., progressive supranuclear palsy and internuclear ophthalmoplegia).
• To describe typical and atypical features, evaluation, and management of the more complex and less common forms of nystagmus (e.g., rebound, convergence, retraction).
• To describe typical and atypical features, evaluation, and management of the more complex and less common pupillary abnormalities (e.g., light-near dissociation, pharmacologic miosis).
• To describe typical and atypical features, evaluation, and management of the more complex and less common visual field defects (e.g., lateral geniculate, monocular temporal crescent).
• To describe more advanced aspects of visual field indications, selection, and interpretation (e.g., artifacts of automated perimetry, testing and thresholding strategies).
• To describe neuro-ophthalmic aspects of common systemic diseases (e.g., hypertension, diabetes, thyroid disease, myasthenia gravis, temporal arteritis, systemic infections and inflammation).
• To describe neuro-ophthalmologic findings in trauma (e.g., traumatic optic neuropathy, traumatic brain injury).
• To describe typical features of inherited neuro-ophthalmologic diseases (e.g., Leber’s hereditary optic neuropathy, autosomal dominant optic atrophy, spinocerebellar degenerations).
• To recognize, evaluate, and treat ocular myasthenia gravis.
  
   

 Patient Care

• To describe the indications for and understand how to interpret the results of tests for myasthenia gravis. (e.g. sleep test, ice test, Tensilon test, prostigmine test)
• To perform a detailed cranial nerve evaluation (e.g, testing of trigeminal and facial nerve function).
• To describe the more advanced interpretation of neuro-radiologic images (e.g., indications and interpretation of orbital tumors, thyroid eye disease, pituitary adenoma, optic nerve glioma, optic nerve sheath meningioma).
• To describe the evaluation, management, and specific testing (e.g., stereopsis, mirror test, redgreen testing) of patients with “functional” visual loss (e.g., recognize non-organic spiral or tunnel visual fields).
• To describe the indications for, to perform, and to list the complications of temporal artery biopsy.

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
• answer your pager within 10 minutes of being paged.

Interpersonal and communication skills

• To 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."
• To present patients to the attending in a succinct but complete way
• To maintain timely and legible medical records
• To talk when you should be talking, listen when you should be listening

Practice-based learning and improvement

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

Systems based practice

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

(in addition to PGY-3 level goals)

Medical Knowledge 

• To describe typical and atypical features, evaluation, and management of the most advanced and least common optic neuropathies (e.g., chronic or recurrent optic neuritis, and posterior ischemic, autoimmune, toxic/nutritional).
• To describe typical and atypical features, evaluation, and management of the most complex and least common ocular motor neuropathies and their mimics (e.g., progressive supranuclear palsy).
• To describe typical and atypical features, evaluation, and management of the most complex and least common forms of nystagmus (e.g., surgical treatment options, using the null point in either prism or surgical therapy).
• To describe typical and atypical features, evaluation, and management of the most advanced and least common pupillary abnormalities (e.g., pupil findings in coma, transient pupillary phenomenon).
• To describe typical and atypical features, evaluation, and management of the most complex and least common visual field defects (e.g., combination or bilateral lesions, cortical visual impairment).
• To describe the most advanced aspects of visual field indications, selection, and interpretation (e.g., variability in automated perimetry, application of specific testing and thresholding strategies for different patient populations with different neuro-ophthalmic conditions, different testing abilities (e.g., young or old age, mental status, hand-eye coordination, reaction time).
• To describe, evaluate, and treat the neuro-ophthalmic aspects of systemic diseases (e.g., malignant hypertension, diabetic papillopathy, toxicity of systemic medications, pseudotumor cerebri).
• To describe, evaluate, and treat the neuro-ophthalmologic manifestations of trauma (e.g., corticosteroid or surgical therapy in traumatic optic neuropathy).
• To describe, evaluate, and provide appropriate genetic counseling for neuro-ophthalmologic diseases (e.g., Leber’s hereditary optic neuropathy, chronic progressive external ophthalmoplegia, von Hippel-Lindau syndrome).
• To recognize, evaluate, and treat (or refer) more complex forms of nystagmus.
• To recognize, evaluate, and treat (or refer) transient monocular or binocular visual loss.

Patient Care

• To perform and interpret the results of tests for myasthenia gravis, and to recognize and treat the complications of the procedures.
• To perform and interpret the complete cranial nerve evaluation (e.g., testing of trigeminal and facial nerve function) and basic neurologic exam in the context of neuro-ophthalmic localization and disease.
• To interpret neuro-radiologic images in neuro-ophthalmology (e.g., interpretation of orbital imaging for orbital pseudotumor and tumors, thyroid eye disease, intracranial imaging modalities and strategies for tumors, aneurysms, infection, inflammation, and ischemia), and to appropriately discuss, in advance of testing, the localizing clinico-radiologic features with the neuroradiologist in order to obtain the best study and intrepretation of the results.
• To recognize patients with “functional” visual loss (non-organic visual loss) and provide appropriate counseling and follow-up.

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
• answer your pager within 10 minutes of being paged.

Interpersonal and communication skills

• To 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."
• To present patients to the attending in a succinct but complete way
• To maintain timely and legible medical records
• To talk when you should be talking, listen when you should be listening

Practice-based learning and improvement

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

Systems based practice

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

Medical Knowledge

• To describe basic examination techniques for strabismus (e.g., ductions and versions, cover and uncover testing, alternate cover testing, prism cover testing).
• To describe basic visual development and visual assessment of the pediatric ophthalmology patient (e.g., central, steady, maintained fixation; illiterate E, Allen cards, Landolt C rings).
• To describe basic anatomy and physiology of strabismus (e.g., innervation of extraocular muscles,primary actions, comitant and incomitant deviations, overaction and underaction, restrictive and paretic, saccades and pursuit movements).
• To describe basic sensory adaptations for binocular vision (e.g., normal and anomalous retinal correspondence, suppression, horopter, Panum’s area, fusion, stereopsis).
• To describe and recognize pseudostrabismus.
• To describe basics of binocular sensory testing (e.g., Titmus stereo testing, Randot stereo testing, Worth 4-dot, Bagolini lenses, afterimage testing).
• To describe different etiologies of amblyopia (e.g., deprivation, ametropic, strabismic,anisometropic, organic).
• To describe etiologies of esotropia (e.g., congenital, comitant and incomitant, accommodative and non-accommodative, decompensated, sensory, neurogenic, myogenic, neuromuscular junction, restrictive, nystagmus blockage syndrome, spasm of the near, monofixation syndrome, consecutive).
• To describe etiologies of exotropia (e.g., congenital, comitant and incomitant, decompensated, sensory, neurogenic, myogenic, neuromuscular junction, restrictive, basic, divergence excess, exophoria, convergence insufficiency).
• To describe various strabismus patterns (e.g., A or V pattern).
• To describe etiologies, evaluation, and management of vertical strabismus (e.g., neurogenic, myogenic, neuromuscular junction, oblique overaction, dissociated vertical deviation, restrictive).
• To describe non-surgical treatment of strabismus.
• To describe different forms of childhood nystagmus.
• To describe features, classification, and treatment indications for retinopathy of prematurity.
• To describe etiologies and types of pediatric cataracts.
• To describe and recognize ocular findings in child abuse (e.g., retinal hemorrhages) and appropriately refer to child protective services or other authorities.
• To describe common hereditary or congenital ocular motility or lid syndromes (e.g., Duane syndrome, Marcus Gunn jaw winking, Brown syndrome).
• To describe typical features of retinoblastoma.
• To describe basic features of dyslexia.
• To describe basic evaluation of decreased vision in infants and children (e.g., retinopathy of prematurity, hereditary retinal disorders, congenital glaucoma, measles, vitamin A deficiency).
• To describe identifiable congenital ocular anomalies (e.g., microphthalmia, persistent fetal vasculature).
• To describe ocular findings in inherited, metabolic disorders
  • Mucopolysaccharidoses (e.g., Hurler syndrome, Scheie syndrome, Hunter syndrome, San Fillipo syndrome, Morquio syndrome, Sly syndrome).
  • Lipidoses (e.g., Tay-Sachs disease, Sandhoff, Niemann-Pick, Krabbe’s, Gaucher’s, Fabry’s, metachromatic leukodystrophy).
  • Aminoacidurias (e.g., homocystinuria, cystinosis, Lowe, Zellweger).
• To describe ocular findings in chromosomal abnormalities (e.g., Trisomy 21, Trisomy 13, Trisomy 18, Short arm 11 deletion, Long arm 13 deletion, Cri du Chat, Turner).
• To describe recognizable causes of blindness in infants (e.g., albinism, optic nerve hypoplasia, achromatopsia, Leber’s congenital amaurosis, retinal dystrophy, congenital optic atrophy).
• To describe etiology, evaluation, and management of congenital infections (e.g., toxoplasmosis, rubella, cytomegalovirus, syphilis, herpes).
• To describe and recognize the common causes of pediatric uveitis.

Patient Care

• To perform an extraocular muscle examination based on knowledge of the anatomy and physiology of ocular motility.
• To assess ocular motility using ductions and versions testing.
• To perform basic measurement of strabismus (e.g., Hirschberg, Krimsky, cover testing, prism cover testing, simultaneous prism cover test, alternate cover testing, Parks-Bielschowsky three-step test, Maddox rod testing, double Maddox rod testing).
• To perform assessment of vision in the neonate, infant, and child.
• To recognize and apply in a clinical setting the following skills in the ocular motility examination (simple, advanced)
  • Stereoacuity testing
  • Accommodative convergence/accommodation ratio (e.g., heterophoria method, gradient method)
  • Tests of binocularity and retinal correspondence
  • Cycloplegic refraction (retinoscopy)
  • Anterior and posterior segment examination
  • Basic and advanced measurement of strabismus
  • Cover test measurement
  • Assessment of vision
    • Teller acuity cards
    • Fixation preference test
    • Standard subjective visual acuity tests
    • Induced tropia test 
• To perform extraocular muscle surgery including:
  • Recession
  • Resection
  • To assist a primary surgeon performing
  • Muscle weakening (e.g., tenotomy) and strengthening (e.g., tuck) procedures
  • Transposition
  • Use of adjustable sutures 

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
• answer your pager within 10 minutes of being paged.

Interpersonal and communication skills

• To 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."
• To present patients to the attending in a succinct but complete way
• To maintain timely and legible medical records
• To talk when you should be talking, listen when you should be listening

Practice-based learning and improvement

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

Systems based practice

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

(in addition to PGY-2 Level goals)

Medical Knowledge

• To describe and perform the most advanced strabismus examination techniques (e.g., complicated prism cover testing in multiple cranial neuropathy, patients with nystagmus, dissociated vertical deviation, double Maddox rod testing).
• To perform the most advanced techniques for assessment of visual development in complicated or non-cooperative pediatric ophthalmology patients (e.g., less common objective measures of visual acuity, electrophysiologic testing).
• To apply the most advanced knowledge of strabismus anatomy and physiology (e.g., spiral of Tillaux, secondary and tertiary actions, spread of comitance) in evaluation of patients.
• To describe clinical application of the most advanced sensory adaptations (e.g., anomalous head position, anomalous retinal correspondence).
• To recognize and treat the most complicated etiologies of amblyopia (e.g., refraction noncompliance, patching failures, pharmacologic penalization).
• To recognize and treat the most complex etiologies of esotropia (e.g., optical, prism-induced, postsurgical/consecutive).
• To recognize and treat the most complex etiologies of exotropia (e.g., supranuclear, paralytic pontine exotropia, consecutive).
• To recognize and treat the most complex strabismus patterns (e.g., aberrant regeneration, postsurgical, thyroid ophthalmopathy and myasthenia gravis).
• To recognize and treat the most complex etiologies of vertical strabismus (e.g, skew deviation, postsurgical, restrictive).
• To apply non-surgical treatment (e.g., patching, atropine penalization) of more complicated forms of amblyopia (e.g., non-compliant, patching failures).
• To recognize, evaluate, and treat the most complex forms of childhood nystagmus (e.g., sensory, spasmus nutans, associated with neurologic or systemic disease).
• To recognize and treat (or refer for treatment) complex retinopathy of prematurity (e.g., stages, treatment indications, retinal detachment).
• To recognize and treat (or refer for treatment) uncommon etiologies and types of pediatric cataracts (e.g., congenital, traumatic).
• To recognize and appropriately evaluate the more complex hereditary ocular syndromes (e.g., bilateral Duane syndrome, Mobius syndrome).
• To recognize and treat (or refer for treatment) patients with complicated retinoblastoma (e.g., bilateral cases, monocular patient, treatment failure, pineal involvement).
• To recognize and evaluate the less common congenital ocular anomalies (e.g., unusual genetic syndromes).
• To apply the most advanced principles of binocular vision and amblyopia (e.g., physiology of binocular vision, diplopia, confusion and suppression, normal and abnormal retinal correspondence, classification and characteristics of amblyopia).
• To recognize and treat complex pediatric retinal disease (e.g., inherited retinopathies, retinopathy of prematurity).
• To recognize and treat complex pediatric glaucoma.
• To recognize and treat complex pediatric cataracts and anterior segment abnormalities (including surgical implications, techniques, and complications).
• To recognize and treat complex pediatric eyelid disorders (e.g., lid lacerations, lid tumors).
• To recognize and treat (or refer) pediatric orbital disease (e.g., orbital tumors, orbital fractures, rhabdomyosarcoma, severe congenital orbital malformations).
   

Patient Care

• To perform a more advanced extraocular muscle examination based on knowledge of the anatomy and physiology of ocular motility.
• To assess more advanced ocular motility problems (e.g., bilateral or multiple cranial neuropathy, myasthenia gravis, thyroid eye disease).
• To apply Hering’s and Sherrington’s laws in more advanced cases (e.g., pseudoparesis of the contralateral antagonist, enhancement of ptosis in myasthenia gravis)
• To perform more advanced measurements of strabismus (e.g., double Maddox rod testing, Lancaster red green testing, synoptophore or amblyoscope).
• To perform assessment of vision in more difficult strabismus patients (e.g, uncooperative child, mentally impaired, nonverbal or preverbal).
• To perform basic extraocular muscle surgery
  • To exercise surgical judgement for the indications and contraindications for strabismus surgery
  • To perform pre-operative assessment, intraoperative techniques and to describe intraoperative and post-operative complications of strabismus surgery
  • To perform the following strabismus surgeries
    • Recession
    • Resection
    • Muscle weakening (e.g., tenotomy) and strengthening (e.g., tuck) procedures
    • Transposition
    • Use of adjustable sutures
  • To manage the complications of strabismus surgery (e.g., slipped muscle, anterior segment ischemia).

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
• answer your pager within 10 minutes of being paged.

Interpersonal and communication skills

• To 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."
• To present patients to the attending in a succinct but complete way
• To maintain timely and legible medical records
• To talk when you should be talking, listen when you should be listening

Practice-based learning and improvement

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

Systems based practice

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

PGY-2 Goals & Objectives

Medical Knowledge

• To describe the indications, evaluation and management, and intra- and post-operative complications of cataract surgery and other anterior segment procedures.
• To formulate the differential diagnoses of cataract and evaluate the normal and abnormal lens.
• To describe the less common causes of lens abnormalities (e.g., spherophakia, lenticonus, ectopia lentis).
• To describe the pre-operative evaluation of the cataract patient, including:
  • The systemic diseases of interest or relevance to cataract surgery.
  • The relationship of external and corneal diseases of relevance to cataracts and cataract surgery (e.g., lid abnormalities, dry eye).
  • The relationships of glaucoma and capsular opacities related to cataract surgery
• To describe glare analysis testing for cataract surgery.
• To describe the use of A and B scan ultrasonography in cataract surgery.
• To describe the instruments and techniques of cataract extraction, including extracapsular surgery and phacoemulsification (e.g., trouble-shooting the phacoemulsification machine, altering the machine parameters).
• To describe the types, indications and techniques for anesthesia for cataract surgery (e.g., topical, local, general).
• To describe indications, techniques, and complications of surgical procedures, including
  • Extracapsular surgery
  • Intracapsular surgery
  • Phacoemulsification
  • Paracentesis
• To describe the indications for, principles of, and techniques of YAG laser capsulotomy.
• To describe history and techniques of basic IOL implantation.
• To correlate the level of visual acuity with the lens opacities.
• To describe the common complications of cataract and anterior segment surgery (e.g., intraocular pressure elevation, hyphema, endophthalmitis, cystoid macular edema, retinal detachment, intraocular lens dislocation, lens-induced glaucoma and uveitis).

Patient Care

• To perform the complete pre-operative ophthalmologic examination of cataract patients.
• To perform optimum refraction of the post-cataract surgery patient.
• To develop and exercise clinical and ethical decision-making in cataract patients.
• To develop good patient communication techniques regarding cataract surgery.
• To perform routine and advanced cataract surgery and intraocular lens (IOL) placement.
• To manage basic and advanced clinical and surgical cataract problems.
• To effectively diagnose and manage intraoperative and post-operative complications of cataract surgery.
• To perform local injections of corticosteroids, antibiotics, and anesthesia.
• To implement the basic preparatory procedures for cataract surgery (e.g, obtaining informed consent, identification of instruments, sterile technique, gloving and gowning, prep and drape, other pre-operative preparation).
• To perform extracapsular surgery in a practice setting (e.g, animal or practice lab) and then in the operating room under supervision, including mastery of the following skills:
  • Wound construction
  • Anterior capsulotomy/capsulorrhexis
  • Instillation and removal of viscoelastics
  • Extracapsular technique
  • Beginning phacoemulsification-techniques (e.g., sculpting, divide & conquer, phaco-chop)
  • Irrigation and aspiration
  • IOL implantation (e.g., anterior and posterior, special IOLs)
• To perform paracentesis of the anterior chamber.
• To use the operating microscope for basic cataract surgery.
• In addition to performing the appropriate steps in cataract surgery, to assist in cataract surgery and perform more advanced steps in patient preparation and anesthesia.
• To describe the more advanced applications of viscoelastics in surgery (e.g., control of iris prolapse, elevation of dropped nucleus, viscodissection).
• To recognize and refer or treat common post-operative complications of cataract surgery (e.g., endophthalmitis, elevated intraocular pressure, cystoid macular edema, wound leak, uveitis).
• To perform basic post-operative evaluation of the cataract patient. 

PGY-4 Level goals (in addition to PGY-3 level goals)

Medical Knowledge 

• To define the more complex indications for cataract surgery (e.g. better view of posterior segment), describe the performance of and describe the complications of more advanced anterior segment surgery (e.g., pseudoexfoliation, small pupils, mature cataract, hard nucleus, black cataract, posttraumatic, zonular dehiscence), including more advanced procedures (e.g., secondary IOLs and indications for specialized IOLs, capsular tension rings, iris hooks, use of capsular staining).
• To describe the indications for, techniques of, and complications of cataract extraction in the context of the subspecialty disciplines of glaucoma (e.g., combined cataract and glaucoma procedures, glaucoma in cataractous eyes, cataract surgery in patients with prior glaucoma surgery), retina (e.g., cataract surgery in patients with scleral buckles or prior vitrectomy), cornea (e.g., cataract extraction in patients with corneal opacities), ophthalmic plastic surgery (e.g., ptosis following cataract surgery), and refractive surgery (e.g., cataract surgery in eyes that have undergone refractive surgery).
• To independently evaluate complications of cataract and IOL implant surgery (e.g., posterior capsular tears, choroidal effusions).
• To describe the instruments and techniques of cataract extraction including extracapsular surgery and phacoemulsification (e.g., trouble-shooting the phacoemulsification machine, altering the machine parameters).
• To understand indications for and technique of intracapsular surgery (e.g., rare cases may require this procedure or patients may have had the procedure performed previously).
• To describe indications for and instrumentation and techniques used to implant foldable and nonfoldable IOLs.
• To describe the evaluation and management of common and uncommon causes of post-operative endophthalmitis.
• To perform repositioning, removal or exchange of IOLs.
• To assist in the teaching and supervision of basic and standard level learners (i.e., first and second year residents).
• To describe the government and hospital regulations that apply to cataract surgery. 

Patient Care 

• To describe the indications for, mechanics of, and performance of A scan ultrasonography and calculation of IOL power.
• To perform phacoemulsification in a practice setting (e.g, animal or practice lab) and then in the operating room, including mastery of the following skills:
  • Wound construction
  • Anterior capsulotomy/capsulorrhexis
  • Viscoelastics
  • Intracapsular, extracapsular and phacoemulsification-techniques (e.g., sculpting, divide & conquer, phaco-chop, stop and chop)
  • Instrumentation and techniques of irrigation and aspiration
  • IOL implantation (e.g., anterior and posterior, special IOLs)
  • IOL repositioning, removal or exchange
• To perform implantation of foldable and non-foldable IOLs.
• To perform intraoperative and postoperative management of any event that may occur during or as a result of cataract surgery, including:
  • Vitreous loss
  • Capsular rupture
  • Anterior or posterior segment bleeding
  • Positive posterior pressure
  • Choroidal detachments
  • Expulsive hemorrhage
  • Elevated intraocular pressure
  • Use of topical and systemic medications
  • Astigmatism
  • Post operative refraction (simple and complex)
  • Corneal edema
  • Wound dehiscence
  • Hyphema
  • Residual cortex
  • Dropped nucleus
  • Uveitis and cystoid macular edema (CME)
  • Elevated intraocular pressure and glaucoma

PGY-3 level goals

Medical Knowledge

• To describe the more advanced principles of optics and refraction.
• To list the indications for and uses of more advanced low vision aids.
• To identify the key examination techniques and management of the less common surgical problems in the subspecialty areas of glaucoma (e.g., secondary open angle and closed angle glaucoma), cornea (e.g., fungal and other less common microbial keratitis, corneal transplantation), ophthalmic plastic surgery (e.g., extensive benign and common lid lesions, ptosis), retina (e.g., simple retinal detachment, mild to moderate proliferative and non-proliferative diabetic retinopathy and laser treatments), and neuro-ophthalmology (e.g., less common optic neuropathy, supranuclear palsies, myasthenia gravis,more complex visual field defects).
  
   

Patient Care

• To perform more advanced anterior segment (e.g., more complex refractions, including contact lens and post-operative refractions, intermediate retinoscopy, including moderate astigmatism, examination of young children, intermediate techniques of slit lamp biomicroscopy) and posterior segment examination skills (e.g., more advanced techniques of dilated fundus examination, including scleral depression, use of magnification and lenses to diagram and describe retinal lesions).
• To recognize and treat ocular emergencies (e.g, central retinal artery occlusion, giant cell arteritis,chemical burn, acute angle closure glaucoma, endophthalmitis, traumatically open globe), as well as the short and long term complications of these disorders.
• To perform more advanced external and adnexal surgical procedures (e.g.,, simple ectropion and simple entropion repair, removal of small, localized, and benign lid lesions, pterygium excision).
• To perform common anterior segment surgery (e.g., cataract extraction, trabeculectomy, peripheral iridectomy).
• To recognize, and refer if indicated, some major genetic ocular disorders (e.g., neurofibromatosis I and II, tuberous sclerosis, von Hippel Lindau syndrome, retinoblastoma, retinitis pigmentosa).
• To recognize more complex and difficult ophthalmic histopathology findings.
  
   

PGY-4 level goals

Medical Knowledge

• To describe the advanced principles of optics and refraction (e.g., pre- and post-refractive surgery,higher order aberrations).
• To list the indications for and uses of advanced low vision aids.
• To identify the key examination techniques and management of complex but common medical and surgical problems in the subspecialty areas of glaucoma (e.g., complicated or post-operative primary and secondary open and closed angle glaucoma), cornea (e.g., unusual or rare types of microbial keratitis), ophthalmic plastic surgery (e.g., less common and more complex lid lesions, re-operation or complex or recurrent ptosis), retina (e.g., complex retinal detachment, tractional retinal detachments and severe proliferative diabetic retinopathy, proliferative vitreoretinopathy), and neuroophthalmology (e.g., unusual optic neuropathy, neuroimaging, supranuclear palsies, uncommon visual field defects).
  
   

Patient Care

• To perform the most advanced anterior segment (e.g., complex refractions, advanced retinoscopy,advanced slit lamp biomicroscopy) and posterior segment examination skills (e.g., drawings of retinal detachments; interpretation of macular disorders with slit lamp biomicroscopy).
• To manage or supervise the more junior trainees (e.g., medical students or medical residents) in the management ocular emergencies (e.g, central retinal artery occlusion, giant cell arteritis, chemical burn, angle closure glaucoma, endophthalmitis).
• To perform more advanced external and adnexal surgical procedures (e.g., lacrimal gland procedures,complex lid laceration repair, e.g., canalicular and lacrimal apparatus involvement).
• To perform and treat complications of common anterior segment surgery, (e.g., cataract extraction,trabeculectomy, peripheral iridectomy).
• To recognize and evaluate the major genetic ocular disorders (e.g., neurofibromatosis I and II, tuberous sclerosis, von Hippel Lindau syndrome, retinoblastoma, retinitis pigmentosa).
• To recognize uncommon or rare but classic ophthalmic histopathology findings.

PGY-3 Level Goals (In addition to PGY-2 level goals)

Medical Knowledge

• To identify the principles and indications for retinoscopy.
• To describe more complex types of refractive errors, including post-operative refractive errors.
• To describe the more advanced ophthalmic optics and optical principles of refraction and retinoscopy (e.g., post-keratoplasty, post-cataract extraction).
  
   

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 more advanced refraction techniques (e.g., astigmatism, complex refractions, asymmetric accommodative add).
• To perform objective and subjective refraction techniques in more complex refractive errors, including astigmatism and post-operative refractive error.
• To perform more advanced techniques of retinoscopy for detecting simple and complex refractive error.
• To describe and 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 (e.g., advanced and irregular astigmatism, vertex distance).
• To use the keratometer for detection of more advanced refractive error.
  
   

PGY-4 level goals (In addition to PGY-3 level goals)

Medical Knowledge 

• To describe the most complex types of refractive errors, including post-operative refractive errors , post-keratoplasty, and refractive surgery.
• To describe the most advanced ophthalmic optics and optical principles of refraction and retinoscopy, including higher order aberrations
  
   

Patient Care

• To perform the most advanced refraction techniques (e.g., irregular astigmatism, pre- and postrefractive surgery).
• To perform objective and subjective refraction techniques in the most complex refractive error, including astigmatism and post-operative refractive error.
• To utilize the most advanced ophthalmic optics and optical principles for refraction and retinoscopy, including higher order aberrations.
• To 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, post-keratoplasty, and refractive surgery cases.
• To use the keratometer for detection of subtle or complex advanced refractive error.
• To use more advanced refraction instruments and techniques (e.g., distometer, automated refractor, corneal topography).
   

Medical Knowledge

• To describe the advanced principles of optics and refraction (e.g., pre- and post-refractive surgery,higher order aberrations).
• To list the indications for and uses of advanced low vision aids.
• To identify the key examination techniques and management of complex but common medical and surgical problems in the subspecialty areas of glaucoma (e.g., complicated or post-operative primary and secondary open and closed angle glaucoma), cornea (e.g., unusual or rare types of microbial keratitis), ophthalmic plastic surgery (e.g., less common and more complex lid lesions, re-operation or complex or recurrent ptosis), retina (e.g., complex retinal detachment, tractional retinal detachments and severe proliferative diabetic retinopathy, proliferative vitreoretinopathy), and neuroophthalmology (e.g., unusual optic neuropathy, neuroimaging, supranuclear palsies, uncommon visual field defects).
  
   

Patient Care

• To perform the most advanced anterior segment (e.g., complex refractions, advanced retinoscopy,advanced slit lamp biomicroscopy) and posterior segment examination skills (e.g., drawings of retinal detachments; interpretation of macular disorders with slit lamp biomicroscopy).
• To manage or supervise the more junior trainees (e.g., medical students or medical residents) in the management ocular emergencies (e.g, central retinal artery occlusion, giant cell arteritis, chemical burn, angle closure glaucoma, endophthalmitis).
• To perform more advanced external and adnexal surgical procedures (e.g., lacrimal gland procedures,complex lid laceration repair, e.g., canalicular and lacrimal apparatus involvement).
• To perform and treat complications of common anterior segment surgery, (e.g., cataract extraction,trabeculectomy, peripheral iridectomy).
• To recognize and evaluate the major genetic ocular disorders (e.g., neurofibromatosis I and II, tuberous sclerosis, von Hippel Lindau syndrome, retinoblastoma, retinitis pigmentosa).
• To recognize uncommon or rare but classic ophthalmic histopathology findings.

PGY-4 level goals (In addition to PGY-3 level goals)

Medical Knowledge 

• To describe the most complex types of refractive errors, including post-operative refractive errors , post-keratoplasty, and refractive surgery.
• To describe the most advanced ophthalmic optics and optical principles of refraction and retinoscopy, including higher order aberrations
  
   

Patient Care

• To perform the most advanced refraction techniques (e.g., irregular astigmatism, pre- and postrefractive surgery).
• To perform objective and subjective refraction techniques in the most complex refractive error, including astigmatism and post-operative refractive error.
• To utilize the most advanced ophthalmic optics and optical principles for refraction and retinoscopy, including higher order aberrations.
• To 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, post-keratoplasty, and refractive surgery cases.
• To use the keratometer for detection of subtle or complex advanced refractive error.
• To use more advanced refraction instruments and techniques (e.g., distometer, automated refractor, corneal topography).
   

PGY-4 Level goals (in addition to PGY-3 level goals)

Medical Knowledge 

• To define the more complex indications for cataract surgery (e.g. better view of posterior segment), describe the performance of and describe the complications of more advanced anterior segment surgery (e.g., pseudoexfoliation, small pupils, mature cataract, hard nucleus, black cataract, posttraumatic, zonular dehiscence), including more advanced procedures (e.g., secondary IOLs and indications for specialized IOLs, capsular tension rings, iris hooks, use of capsular staining).
• To describe the indications for, techniques of, and complications of cataract extraction in the context of the subspecialty disciplines of glaucoma (e.g., combined cataract and glaucoma procedures, glaucoma in cataractous eyes, cataract surgery in patients with prior glaucoma surgery), retina (e.g., cataract surgery in patients with scleral buckles or prior vitrectomy), cornea (e.g., cataract extraction in patients with corneal opacities), ophthalmic plastic surgery (e.g., ptosis following cataract surgery), and refractive surgery (e.g., cataract surgery in eyes that have undergone refractive surgery).
• To independently evaluate complications of cataract and IOL implant surgery (e.g., posterior capsular tears, choroidal effusions).
• To describe the instruments and techniques of cataract extraction including extracapsular surgery and phacoemulsification (e.g., trouble-shooting the phacoemulsification machine, altering the machine parameters).
• To understand indications for and technique of intracapsular surgery (e.g., rare cases may require this procedure or patients may have had the procedure performed previously).
• To describe indications for and instrumentation and techniques used to implant foldable and nonfoldable IOLs.
• To describe the evaluation and management of common and uncommon causes of post-operative endophthalmitis.
• To perform repositioning, removal or exchange of IOLs.
• To assist in the teaching and supervision of basic and standard level learners (i.e., first and second year residents).
• To describe the government and hospital regulations that apply to cataract surgery. 

Patient Care 

• To describe the indications for, mechanics of, and performance of A scan ultrasonography and calculation of IOL power.
• To perform phacoemulsification in a practice setting (e.g, animal or practice lab) and then in the operating room, including mastery of the following skills:
  • Wound construction
  • Anterior capsulotomy/capsulorrhexis
  • Viscoelastics
  • Intracapsular, extracapsular and phacoemulsification-techniques (e.g., sculpting, divide & conquer, phaco-chop, stop and chop)
  • Instrumentation and techniques of irrigation and aspiration
  • IOL implantation (e.g., anterior and posterior, special IOLs)
  • IOL repositioning, removal or exchange
• To perform implantation of foldable and non-foldable IOLs.
• To perform intraoperative and postoperative management of any event that may occur during or as a result of cataract surgery, including:
  • Vitreous loss
  • Capsular rupture
  • Anterior or posterior segment bleeding
  • Positive posterior pressure
  • Choroidal detachments
  • Expulsive hemorrhage
  • Elevated intraocular pressure
  • Use of topical and systemic medications
  • Astigmatism
  • Post operative refraction (simple and complex)
  • Corneal edema
  • Wound dehiscence
  • Hyphema
  • Residual cortex
  • Dropped nucleus
  • Uveitis and cystoid macular edema (CME)
  • Elevated intraocular pressure and glaucoma