Vitreoretinal Disease Rotation Requirements

First Year – Vitreoretinal Disease

Goals: 

• During the first year each resident will rotate through the vitreoretinal service for one day during a 10 week rotation. The first year residents on this service will work with the senior residents, fellows, and faculty on the service to provide “state of the art” care to the many complex patients cared for by this service. During this rotation the resident will participate in the services fluorescein conference and molecular ophthalmology conference.

Patient care

• Demonstrate beginning skills with indirect ophthalmoscopy with the 20 diopter lens with and without scleral indentation.
• Demonstrate use of basic lenses such as the Hruby, 90 diopter, 78 diopter, and three mirror contact lens to visualize retinal disease.
• Demonstrate ability to interpret fluorescein angiography for simple cases of common diseases such as central serous retinopathy and diabetic macular edema.

Medical knowledge

• Development of a core knowledge base through attendance and participation in department morning rounds, use of the American Academy of Ophthalmology Basic and Clinical Science Course, and attendance at afternoon and clinical conferences.
• Know and apply the basic and clinically supportive sciences which are appropriate to ocular surgery including retinal and vitreous anatomy, physiology, and molecular ophthalmology.
• Demonstrate a knowledge of retinal anatomy and physiology.
• Demonstrate a basic understanding of fluorescein/ICG angiography and retinal vascular disease.
• Demonstrate an understanding of the mechanisms of retinal detachment.
• Demonstrate an understanding of macular anatomy and function and diagnosis of macular disease.
• Demonstrate an understanding of the principles of laser photocoagulation.

Practice-based learning and improvement

• Participate in Journal Club.
• Participate in fluorescein conference.
• Gather essential and accurate (pre-operative) information about their patients.
• Demonstrate informed decisions about pre-operative diagnostic, intra-operative, and post-operative interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.

Interpersonal and communication skills

• Demonstrate patient communication techniques with faculty supervision.
• Teach medical students rotating through the clinic.
• Improve with feedback from healthcare professional providing 360 degree feedback.
• Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families with complex retina disease in the clinic.

Professionalism

• Develop teaching skills.
• Develop and exercise clinical and ethical decision making abilities.
• Improve with feedback from healthcare professional providing 360 degree feedback.

Systems-based practice

• Work effectively as a member of the vitreoretinal team.
• Demonstrate ability to manage heath care team with complex patients that require interaction of other services, nursing, anesthesia, social services, and other parts of the health care team.
• Management of the non-surgical low vision patient including assessment of patient needs, refraction of complex cases, referral to rehabilitative agencies.
• Use information technology to support pre-operative and post-operative patient decisions and patient education including facility with the digital image processing system.

Assessment

• Faculty summative evaluation (see e-value form).
• Faculty formative evaluation for laser (see form).
• Professionalism evaluation from clinic manager(see e-value form).

Resources

1. AAO Basic and Clinical Science Course. Section 12: Retina and Vitreous. San Francisco: American Academy of Ophthalmology, 2007.
2. Gass JDM. Stereoscopic Atlas of the Macula: Diagnosis and Treatment. St. Louis: Mosby, 1997.
3. Folk JC, Pulido JS. Laser Photocoagulation of the Retina and Choroid. Ophthalmology Monograph Number 11, American Academy of Ophthalmology, San Francisco, 1997.
4. Nussenblatt RB, Whitcup SM, Palestine AG. Uveitis: Fundamentals and Clinical Practice, 2nd Ed. Mosby: St. Louis, 1996.
5. AAO Basic and Clinical Science Course. Section 9: Intraocular Inflammation and Uveitis. San Francisco: American Academy of Ophthalmology, 2007.
6. Byer NE. The Peripheral Retina in Profile: A Stereoscopic Atlas. Torrence, CA: Criterion Press; 1982. [A must to tune your examination skills of the periphery]
7. Hilton GF, McLean JB, Brinton DA. Retinal Detachment: Principles and Practice, 2nd ed. (Ophthalmology Monograph 1). San Francisco, CA: American Academy of Ophthalmology; 1995. [Especially valuable is the Appendix on techniques of binocular indirect ophthalmoscopy]
8. Berkow JW, Flower RW, Orth DH, Kelley JS. Fluorescein Angiography and Indocyanine Green Angiography: Technique and Interpretation, 2nd ed (Ophthalmology Monograph 5). San Francisco, CA: American Academy of Ophthalmology; 1997.
9. Gass JDM. Stereoscopic Atlas of Macular Diseases, 4th Ed., Mosby, 1997. [Read sections on Diabetic Retinopathy and Age-Related Macular Degeneration. Other sections are optional, but this is a good reference for reading about conditions you see in clinics.]

Second Year – Vitreoretinal Disease

Goals: 

• During the second year the resident will rotate through the vitreoretinal service for a 10 week continuous rotation. The second year residents on this service will work with the fellows and faculty on the service to provide “state of the art” care to the many complex patients cared for by this service. The second year will do a large volume of medical retinal procedures including posterior segment laser and intravitreal injections. The second year will rotate along with the fellow to the operating room and participate in surgery for retinal detachment and vitrectomy. During this rotation the resident will participate in the services fluorescein conference and molecular ophthalmology conference.

Patient care

• Demonstrate proficiency with indirect ophthalmoscopy with scleral indentation.
• Demonstrate use of diagnostic contact lenses including pan-funduscopic lenses.
• Demonstrate performance and interpretation of fluorescein and ICG angiography.
• Demonstrate competence in posterior segment photocoagulation (indication, techniques, complications) including: diabetic focal/grid macular treatment, peripheral scatter photocoagulation (panretinal), and laser retinopexy (demarcation).
• Demonstrate electrophysiology-interpretation of ERG, EOG, VEP, dark adaptation.
• Demonstrate the use of the B-scan echography to evaluate eyes with media opacity for posterior segment pathology.
• Demonstrate effective fundus drawings of the retina with vitreoretinal relationships.
• Demonstrate cryotherapy of retinal holes and other pathology.
• Demonstrate ability to perform scleral buckling and/or pneumatic retinopexy for retinal detachment and indications, techniques, complications.
• Demonstrate ability to assist in par plana vitrectomies.

Medical knowledge

• Development of a core knowledge base through attendance and participation in department morning rounds, use of the American Academy of Ophthalmology Basic and Clinical Science Course, and attendance at afternoon and clinical conferences.
• Know and apply the basic and clinically supportive sciences which are appropriate to ocular surgery including retinal and vitreous anatomy, physiology, and molecular ophthalmology.
• Knowledge of major studies, including:
  • o Diabetic Retinopathy Study (DRS) o Diabetic Vitrectomy Study (DVS)
  • o Early Treatment of Diabetic Retinopathy Study (ETDRS)
  • o Macular Photocoagulation Study (MPS)
  • o Diabetes Control and Complications Trial (DCCT) o Branch Vein Occlusion Study (BVOS)
  • o Central Vein Occlusion Study (CVOS)
  • o United Kingdom Prospective Diabetes Study (UKPDS)
  • o Age-Related Eye Disease Study (AREDS)
  • o VEGF studies for macular degeneration
• Understanding of peripheral retinal disease and vitreous pathology.
• Indications and complications of retinal photocoagulation.
• Indications and complications of intravitreal injection, including steroid, VEGF inhibitors, antibiotics.
• Understanding of principles of retinal detachment repair.
• Diagnosis and management of endophthalmitis
• Diagnosis and management of intraocular neoplasms
• Diagnosis, treatment, complications of retinopathy of prematurity.
• Understanding of retinal vascular disease and its management
  • Arterial and venous obstructions
  • Diabetic retinopathy
  • Hypertensive retinopathy
  • Peripheral retinal vascular occlusive disease
  • Acquired retinal vascular diseases
• Understanding macular disease and its management
  • o Age-related macular degeneration (ARMD) / choroidal neovascularization
  • o Macular dystrophies
  • o Cystoid macular edema
  • o Central serous choroidopathy (retinopathy)
• Understanding and application of electrophysiology.
• Knowledge of techniques for retinal detachment repair, including: pneumatic retinopexy, scleral buckling, and vitrectomy.
• Knowledge of surgical management of diabetic retinopathy.
• Knowledge of indications for pars plana vitrectomy, including the techniques to manage: macular hole, epiretinal membranes, and proliferative vitreoretinopathy.
• Knowledge of the indications and complications for intravitreal surgical adjuncts, including gas, perfluorocarbon liquids, and silicone oil.
• Knowledge of posterior uveitis syndromes and endophthalmitis.

Practice-based learning and improvement

• OR formative feedback leading to improvement in wound construction, suture placement, peritomy construction and repair, and buckle placement.
• Demonstrate an investigatory and analytic thinking approach to pre-surgical and surgical clinical situations for vitrectomy surgery including appropriate patient selection, indications for surgery, and contraindications for this procedure.
• Gather essential and accurate (pre-operative) information about their patients.
• Make informed decisions about pre-operative diagnostic, intra-operative, and post-operative interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.
• Develop and carry out an individual pre-operative, intra-operative and post-operative management plans.

Interpersonal and communication skills

• Fine tune patient communication techniques with faculty supervision.
• Teach medical students and junior residents rotating through the clinic.
• Improve with feedback from healthcare professional providing 360 degree feedback.
• Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families in the pre-operative, intra-operative, and post-operative management of patients with macular degeneration, diabetes, and other retinal diseases.

Professionalism

• Develop teaching skills.
• Develop and exercise clinical and ethical decision making abilities.
• Improve with feedback from healthcare professional providing 360 degree feedback.

Systems-based practice

• Work effectively as a member of the vitreoretinal team.
• Demonstrate ability to manage heath care team with complex patients that require interaction of other services, nursing, anesthesia, social services, and other parts of the health care team.
• Management of the non-surgical low vision patient including assessment of patient needs, refraction of complex cases, referral to rehabilitative agencies.
• Use information technology to support pre-operative and post-operative patient decisions and patient education including facility with the digital image processing system.
• Provide health care services aimed at preventing intra-operative problems, post-operative problems and general health maintenance such as correct site surgery.
• Work with health care professionals, including those from other disciplines, to provide patient-focused care in the pre-operative and post-operative period.

Assessment

• Faculty summative evaluation (see e-value form).
• Faculty formative evaluation for laser (see form).
• Professionalism evaluation from technicians (see e-value form).
• Professionalism evaluation from OR nurses (see e-value form).

Resources

1. AAO Basic and Clinical Science Course. Section 12: Retina and Vitreous. San Francisco: American Academy of Ophthalmology, 2007.
2. AAO Basic and Clinical Science Course. Section 9: Intraocular Inflammation and Uveitis. San Francisco: American Academy of Ophthalmology, 2007.
3. Wilkinson CP, Rice TA, eds. Michels Retinal Detachment, 2nd ed. St. Louis, MO: Mosby; 1997. [Excellent sections on vitrectomy indications, techniques, and prognoses]
4. Gass JDM. Stereoscopic Atlas of the Macula: Diagnosis and Treatment. Mosby, St. Louis, 1997.
5. Folk JC, Pulido JS. Laser Photocoagulation of the Retina and Choroid. Ophthalmology Monograph Number 11, American Academy of Ophthalmology, San Francisco, 1997.
6. Scott JD. Surgery for Retinal and Vitreous Disease. Oxford: Butterworth-Heinemann; 1998. [European perspective on recent advances in management of retinal tears and detachments. Very clearly written]
7. Carr RE, Siegel. Electrodiagnostic Testing of the Visual System: A Clinical Guide. F. A. Davis: Philadelphia, 1990.
8. Fishman GA, Sokol S. Electrophysiologic Testing in Disorders of the Retina, Optic Nerve, and Visual Pathway. Ophthalmology Monograph Number 2. American Academy of Ophthalmology: San Francisco, 1990.
9. Heckenlively JR, Arden GB, Eds. Principles and Practice of Clinical Electrophysiology. Mosby: St. Louis, 1991.
10. Smith RE, Nozik RA. Uveitis: A Clinical Approach to Diagnosis and Management. 2nd Ed, Williams & Wilkins, Baltimore, 1989.
11. Nussenblatt RB, Whitcup SM, Palestine AG. Uveitis: Fundamentals and Clinical Practice, 2nd Ed. Mosby: St. Louis, 1996.
12. Graham K, Pinnolis M. 1998. AIDS and the posterior segment. Int Ophthalmol Clin. 38(1):265-280.
13. Meredith TA. Clinical microbiology of infectious endophthalmitis in Retina, Ryan SJ Ed. Mosby: St. Louis, 1989. P203-214.
14. Meredith TA. Vitrectomy for infectious endophthalmitis, in Retina, Ryan SJ Ed. Mosby: St. Louis, 1989. p2525-2538.
15. Endophthalmitis Vitrectomy study Group. 1995. Results of the Endophthalmitis for Vitrectomy Study, Arch Ophthalmol. 113:1479-1496.
16. Cohen et al. 1995. Endophthalmitis after pars plana vitrectomy. Ophthalmol. 102:705-712.
17. Roth DB, Flynn HW. 1997. Antibiotic selection in the treatment of endophthalmitis. Surv Ophthalmol. 41:395-401.

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Vitreoretinal Disease BCS lectures

• Please see the Rounds and Conferences Videos on the Video server

 

Other Vitreoretinal Disease Video Presentations

 

Please see the Rounds and Conferences Videos on the Video server

 

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