Glaucoma Rotation Requirements

First Year – Glaucoma

Goals:  The goal of the first year glaucoma rotation is to develop the resident’s knowledge and apply advanced care to patients with glaucoma.  The residents will be given a checklist and the resident will “sign off” topics and procedures as they advance through this rotation. 

Patient care

• Demonstrate competence in the estimation of IOP.
• Demonstrate competence in the performance of kinetic and static perimetry.
• Demonstrate competence in the performance of gonioscopy.
• Demonstrate competence in the performance of stereo examination of the optic nerve using 90 diopter lens, past photos, and OCT.
• Demonstrate competence in the performance of interpretation of Goldmann and Humphrey visual fields. {Background Reading about Perimetry available from the Imaging and Perimetry Society}

Medical knowledge

• Understand the epidemiology and screening of primary open angle glaucoma.
• Understand aqueous humor dynamics. (Basic information available from MedRounds.org)
• Understand the technique and instrumentation of tonometry and tonography. (Background information may be viewed at MedRounds.org) (more on tonometry)
• Understand optic nerve and nerve fiber layer anatomy and how disease affects visual field function.
• Understand the techniques and indications for kinetic and automated static perimetry.
• Understand the techniques and indications for gonioscopy. (In-depth coverage at gonioscopy.org)
• Understand the principles of the medical management of primary open angle glaucoma, normal tension glaucoma, primary angle closure glaucoma, aqueous misdirection, and hypotony.
• Discuss the results of
  • Glaucoma Laser Trial
  • Normal Tension Glaucoma Study
  • Advanced Glaucoma Intervention Study
  • Ocular Hypertension Treatment Study

Practice-based learning and improvement

• Participate in daily practice based learning rounds.
• Present difficult cases 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 glaucoma.
• Prepare letters for referring physicians under faculty review.
• Faculty feedback on professionalism.
• Clinic technician feedback on professionalism (360 degree).

Systems-based practice

• Review the cost considerations for glaucoma with an emphasis on cost and compliance on treatment of glaucoma.

Assessment

• Faculty summative evaluation (see e-value form).
• Competence in estimation of IOP (see form).
• Faculty competency checklist (see form).
• Professionalism evaluation from technicians (see e-value form).

Resources

1. Alward WLM. Glaucoma: The Requisites in Ophthalmology. St. Louis: Mosby, 2000.
2. AAO Basic and Clinical Science Course. Section 10: Glaucoma. San Francisco: American Academy of Ophthalmology, 2007.
3. Alward WLM. Color Atlas of Gonioscopy. 2nd ed. San Francisco: American Academy of Ophthalmology, 2001.
4. Anderson DR, Patella VM. Automated Static Perimetry. 2nd ed. St Louis: Mosby, 1999.

Second Year – Glaucoma

Goals:  The goal of the second year glaucoma rotation is to develop the resident’s knowledge and apply advanced medical and surgical care to patients with glaucoma.  The residents will be given a 55 item competency checklist and the resident will “sign off” topics and procedures as they advance through this rotation. 

Patient care

• Demonstrate continued competence in the performance of gonioscopy.
• Demonstrate continued competence in the performance of stereo examination of the optic nerve using the 90 diopter lens, past photos, and OCT.
• Demonstrate continued competence in the performance of interpretation of Goldmann and Humphrey visual fields.
• Demonstrate competence in the performance of laser procedures such as: YAG posterior capsulotomy, laser peripheral iridotomy, argon laser trabeculoplasty, and cyclophotocoagulation.
• Demonstrate competence in the performance and postoperative care for trabeculectomy and seton tubes.
• Demonstrate competence in the management of a flat chamber.
• Demonstrate competence in the revision of filtering blebs.

Medical knowledge

• Understand the epidemiology and screening of primary open angle glaucoma.
• Understand the aqueous humor dynamics. (Basic information available from MedRounds.org)
• Understand the technique and instrumentation of tonometry and tonography. (Background information may be viewed at MedRounds.org)
• Understand optic nerve and nerve fiber layer anatomy and how disease affects visual field function.
• Understand the techniques and indications for kinetic and automated static perimetry.
• Understand the techniques and indications for gonioscopy. (In-depth coverage at gonioscopy.org)
• Understand the principles of the medical management of primary open angle glaucoma, normal tension glaucoma, primary angle closure glaucoma, aqueous misdirection, and hypotony.
• Discuss the results of
  • Glaucoma Laser Trial
  • Normal Tension Glaucoma Study
  • Advanced Glaucoma Intervention Study
  • Ocular Hypertension Treatment Study

Practice-based learning and improvement

• Participate in daily practice based learning rounds.
• 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 glaucoma.
• Prepare letters for referring physicians under faculty review.
• Faculty summative feedback on professionalism.
• Clinic technician feedback on professionalism (360 degree).

Systems-based practice

• Review the cost considerations for glaucoma with an emphasis on cost and compliance on treatment of glaucoma.

Assessment

• Faculty summative evaluation (see e-value form).
• Faculty summative professionalism evaluation (see e-value form).
• Faculty competency checklist (see form).
• Professionalism evaluation from technicians (see e-value form).
• Professionalism evaluation from OR nurses (see e-value form).
• Residents are given an oral examination at the end of their second year.

Resources

1. Alward WLM. Glaucoma: The Requisites in Ophthalmology. St. Louis: Mosby, 2000.
2. AAO Basic and Clinical Science Course. Section 10: Glaucoma. San Francisco: American Academy of Ophthalmology, 2007.
3. Alward WLM. Color Atlas of Gonioscopy. 2nd ed. San Francisco: American Academy of Ophthalmology, 2001.
4. Anderson DR., Patella VM Automated Static Perimetry. 2nd ed. St Louis: Mosby, 1999.
5. Kwon,YH, Master Techniques in Glaucoma Surgery DVD, MedRounds Publications, 2007.

Glaucoma BCS lectures

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

Introduction, Epidemiology, Screening -- Kwon
Anatomy, Physiology, Tonometry, Tonography -- Kwon
Optic Nerve, Nerve fiber layer -- Greenlee
Laser treatment -- Greenlee
Gonioscopy -- Alward
Secondary Open Angle Glaucoma -- Alward
Perimetry: principles and kinetics -- Fingert
Perimetry: automated -- Greenlee
POAG / OHT / NTG -- Kwon
PACG (pupillary block, plateau, aqueous misdirection) -- Kwon
Secondary Angle Closure -- Alward
Secondary with both open & closed mechanism -- Alward
Medical management algorithm, pharm, compliance -- Fingert
Specific medical treatment -- Fingert
Primary infantile glaucoma -- Alward
Other glaucomas of infancy & childhood -- Alward
Surgical treatment: trabulectomy, combined -- Kwon
Surgical treatment: seton, cycloablation -- Kwon
Hypotony -- Greenlee
Genetics of Glaucoma -- Fingert
Boards / OKAP review -- Piette

 

Other Glaucoma Video Presentations

Gonioscopy.org

Ahmed Seton (11:40, Windows Media, wmv file) -- Kwon

Baerveldt Seton (11:10, mpeg) -- Kwon

Tube Extender (4:20, mpeg) -- Kwon

Cyclodialysis Cleft Repair: Cyclopexy (5:20, mpeg) -- Kwon

Scleral Window for Nanophthalmos (3:52, mpeg) -- Kwon

Mitomycin C Trabeculectomy (8:40, mpeg) -- Kwon

Combined Mitomycin C Trabeculectomy and Trabeculotomy (7:40, mpeg) -- Kwon

Site Combined Mitomycin C Trabeculectomy & Phaco IOL (10 min, mpeg) -- Kwon

Post Operative Management

• Mitomycin C Trabeculectomy Post Op Management, Uncomplicated (4:20, mpeg) -- Kwon
• Mitomycin C Trabeculectomy Post Op Management, Bleb Leak (4:10, mpeg) -- Kwon
• Mitomycin C Trabeculectomy Post Op Management, Bleb Leak with Hypotony and Choroidal Effusion (4:10, mpeg) -- Kwon
• Mitomycin C Trabeculectomy Post Op Management, Initial Bleb Leak with Subsequent Bleb Encapsulation (6:20, mpeg) -- Kwon
• Mitomycin C Trabeculectomy Post Op Management, Hypotony & Shallow Anterior Angle following Laser Suturelysis (5:55, mpeg) -- Kwon

Also see the Rounds and Conferences Videos on the Video server

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Tests and Devices

Goldmann Tonometry (Video, mpeg)

Goldmann Perimetry

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Clinic Information

Glaucoma Secretary:

Val Bell, Phone 6-3938

Glaucoma Clinical Technicians:

Becky Meyer, COA and Joan Snyder, COA. Phone 6-1216

Pager Numbers:

Glaucoma Fellow: 4651

Dr. Alward 3742

Dr. Fingert 4940

Dr. Greenlee 8009

Dr. Kwon 3579

Days of Clinic:

Information Needed here

Surgery Days:

Information Needed here

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