University of Iowa Department of Ophthalmology & Visual Sciences

Cornea/External Disease & Refractive Surgery Rotation Requirements

Faculty:

Kenneth M. Goins, MD, Course Director

Michael D. Wagoner, MD

Last Updated Dec. 12, 2009

  • First Year
  • Second Year
  • Third Year
  • Basic Science Lectures
  • Other Videos, Tests, Devices
  • Clinic Information

First Year – Cornea/External Disease & Refractive Surgery

Goals: 

  • The goal of the first year cornea rotation is to develop the resident’s knowledge and apply advanced care to patients with corneal and external disease.

Patient care

  • Manage patients with corneal problems using
    • Keratometry and keratoscopy
    • Pachymetry
    • Interpreting endothelial microscopy
    • Corneal topography
    • Wavefront aberrometry
  • Develop the ability to draw of anterior segment findings from the slit lamp biomicroscope.
  • Manage ocular infections using sampling for ocular infections.
  • Manage patients with dry eye using vital staining, tear break up time, and Schirmer tests.
  • Manage corneal epithelial defects (pressure patching and bandage contact lenses).

Medical knowledge

  • Develop an understanding of refractive surgery by attending the MARC course.
  • Understand the structure and function of the cornea, conjunctiva, sclera, eyelids and anterior segment.
  • Understand corneal optics and refraction.
  • Understand ocular microbiology and infections.
  • Understand mechanisms of ocular immunology and anterior segment inflammations.
  • Understand and apply principles of ocular pharmacology of anti-infective, anti-inflammatory, and immune modulating agents.
  • Understand basic principles of corneal topography and wavefront aberrometry.
  • Understand mechanisms of traumatic and toxic injury to the anterior segment.
  • Understand the molecular genetic basis of corneal and ocular anomalies and dystrophies.
  • Recognize corneal dystrophies and degenerations.
  • Recognize congenital anomalies of the cornea and anterior segment.
  • Understand the principles, indications, and recognize the complications of corneal surgery: penetrating keratoplasty, corneal laceration repair, pterygium excision.
  • Understand the principles of laser surgery of the cornea: femtosecond laser assisted LASIK, LASEK, PRK, PTK, and INTACS.

Practice-based learning and improvement

  • Present difficult case at morning rounds.
  • Participate in Journal Club.

Interpersonal and communication skills

  • Present difficult case at morning rounds.
  • Prepare letters for referring physicians under faculty review.

Professionalism

  • Observe the interactions of faculty when patients have severe eye disease.
  • Prepare letters for referring physicians under faculty review.

Systems-based practice

  • Review the cost considerations for refractive surgery.
  • Review the marketing of refractive surgery.

Assessment

Resources

  1. Cornea reprint collection. These basic articles are available from the cornea service secretary.
  2. Krachmer JH, Mannis MJ, Holland EJ, eds. Cornea. 2nd ed. St. Louis: Mosby; 2004. [this three volume set with separate atlas is the best single reference for reading in detail about a topic. A DVD-ROM is also available]
  3. Pepose, JS, Holland GN, Wilhelmus KR, eds. Ocular Infection and Immunity St. Louis: Mosby, 1996. [good for basic introduction to infections and immunology as well as reference for common problems]
  4. AAO Basic and Clinical Science Course. Section 8: External Disease and Cornea. San Francisco: American Academy of Ophthalmology, 2007.
  5. AAO Basic and Clinical Science Course. Section 2: Fundamentals and Principles of Ophthalmology. [sections on corneal histology, physiology and embryology] . San Francisco: American Academy of Ophthalmology, 2007.

Second Year – Cornea/External Disease & Refractive Surgery

none

Third Year – Cornea/External Disease & Refractive Surgery

Goals: 

  • The goal of the third year cornea rotation is to enhance the resident’s knowledge and apply advanced surgical and medical care to patients with corneal and external disease. The resident will develop the surgical skills necessary to transplant corneal tissue and perform refractive surgery.

Patient care

  • Develop medical and surgical management of ocular surface disorders, including but not limited to:
    • superficial keratectomy (manual)
    • pterygium excision including conjunctival grafting
    • stromal micropuncture
    • application of corneal glue
    • use of bandage contact lenses
    • punctal occlusion: temporary, permanent
    • conjunctival autograft/flap
    • amniotic membrane transplantation
    • limbal stem cell transplantation
    • Gundersen flaps
    • tarsorrhaphy
  • Diagnosis and management (surgical and photoablation) of corneal dystrophies and degenerations.
  • Develop skills to perform pterygium removal using conjunctival auotgrafts, amniotic membrane transplantation, and mitomycin C.
  • Develop skills to perform stromal micropuncture.
  • Develop skills to perform application of corneal glue.
  • Develop skills and demonstrate application of bandage contact lenses.
  • Demonstrate application of punctal plugs and permanent occlusion of punctum.
  • Develop skills to perform manual superficial keratectomy.
  • Develop skills for corneal suturing techniques including assisting on penetrating keratoplasty procedures.
  • Develop skills to perform penetrating keratoplasty.
  • Develop skills to repair corneal lacerations to perform while on the on call service.
  • Develop skills to manage infectious corneal disease in the clinic including the use of the confocal microscope and culture techniques.

Medical knowledge

  • Understanding the pathogenesis and differential diagnosis of ocular surface disorders.
  • Participation in the MARC refractive surgery course.
  • Understanding of the surgical indications, surgical techniques, diagnosis, and management of postoperative complications (especially immunologically-mediated rejection) of corneal transplantation.
  • Understanding 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 (LTK), intracorneal ring segments (INTACS), phakic intraocular lens and clear lens extraction.
  • Understanding the principles of surgical management and subsequent rehabilitation of corneal laceration.
  • Understanding of the pathogenesis, differential diagnosis, and management of non-infected corneal ulceration.
  • Understanding of the pathogenesis, differential diagnosis (bacterial, fungal, acanthamoebal, and herpetic), and therapy of microbial keratitis.
  • Understanding of the pathophysiology, medical, and surgical management of chemical injuries of the eye.
  • Understanding of the pathophysiology, medical (including immunosuppressive) and surgical therapy of autoimmune disorders of the conjunctiva, cornea, and sclera.
  • Understanding the pathophysiology and therapy of ocular allergy.
  • Knowledge of neoplastic disorders of the eyelids, conjunctiva, and cornea.
  • Understanding advanced principles of corneal topography and wavefront aberrometry.

Practice-based learning and improvement

  • Present difficult case at morning round.
  • Participate in Journal Club.
  • Prepare case for morning rounds emphasizing practice-based learning.

Interpersonal and communication skills

  • Present difficult case at morning rounds.
  • Prepare letters for referring physicians under faculty review.

Professionalism

  • Observe the interactions of faculty when patients have severe eye disease.
  • Prepare letters for referring physicians under faculty review.

Systems-based practice

  • Review the cost considerations for refractive surgery.
  • Review the marketing of refractive surgery.

Assessment

Resources

  1. Cornea reprint collection (as per 1st year list) + the following:
  2. Foster CS. Cicatricial pemphigoid. Trans Am Ophthalmological Soc 1986;84:527-663.
  3. Holland EJ, Schwartz GS. Classification of herpes simplex virus keratitis. Cornea 1999;18:144-154.
  4. Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology 1985;92:1461-1470.
  5. Kenyon KR, Tseng SC. Limbal autograft transplantation for ocular surface disorders. Ophthalmology 1989;96:709-723.
  6. Liesegang TJ. Classification of Herpes simplex virus keratitis and anterior uveitis. Cornea 1999; 18: 127-143.
  7. Wagoner MD. Chemical injuries of the eye; current concepts in pathophysiology and therapy. Surv Ophthalmol 1997;41:275-314.
  8. Krachmer JH, Mannis MJ, Holland EJ, eds. Cornea. 2nd ed. St. Louis: Mosby; 2004. Pepose, JS, Holland GN, Wilhelmus KR, eds. Ocular Infection and Immunity St. Louis: Mosby, 1996.
  9. Albert DM, Jakobiec FA (eds.). Principles and Practice of Ophthalmology: Clinical Practice. Volume 1: Section 1. Conjunctiva, Cornea, and Sclera. Philadelphia: WB Saunders, 1994. Tasman W, Jaeger EA. Duane’s Ophthalmology 2007 edition on CD ROM, Lippincott Williams & Wilkins.
  10. AAO Basic and Clinical Science Course. Section 8: External Disease and Cornea. San Francisco: American Academy of Ophthalmology, 2007.

Cornea/External Disease & Refractive Surgery BCS lectures

 

Other Cornea, External Disease, Refractive Surgery Video Presentations

 

 

Clinic Information

Secretary:

Tummy Burdick, 356-2861

Clinical Technicians:

Cornea: Connie Mullinix, Chris Rath, 356-7449

Refractive Surgery: Lisa Milder, 353-7625

Pager Numbers:

Dr. Goins: 8098

Dr. Wagoner: 4571

Fellow: 5100

Days of Clinic:

Information Needed here

Surgery Days:

Information Needed here