University of Iowa Health Care

Ophthalmology and Visual Sciences

EyeRounds.org

Medical Student Online Ophthalmology Curriculum

Author: Pavlina Kemp, MD
Resident contributors: Karam Alawa, MD; Justine Cheng, MD; Salma Dawoud, MD; Ryan Diel, MD; David Ramirez, MD

August 3, 2020


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Table of Conents


Curriculum

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Video Lectures
Watch these ahead of the assigned day
Zoom Discussion
Discussed together on the assigned day
Additional videos
Watch these ahead of or on the assigned day
Interactive Content
Do these ahead of or on the assigned day
Assignment
Due as shown (details at link above)
Day 1: Eye Exam and Eye Anatomy (35m) Orientation

Basic Eye Exam (5m)

Eye exam including slit lamp (13m)

Optics (24m)

Anatomy (25m)
Video tutorials on eye exam

Interactive Figures on Eye Exam and Anatomy

Eyes Have It Anatomy Quiz

Eyes Have It Eye Exam Quiz

Iowa Eye Exam Module (from Physical Exam Skills)

Schedule Physical Exam Skills Zoom Observations (occurring throughout the rotation)
Day 2:
Acute Vision Loss (30m)
and
Red Eye (30m)
Acute Vision Loss and Red Eye Online MedEd: Adult Ophtho (13m)

IU Cases: A B C D

Eyes for Ears Podcast

 
Corneal Transplant (2m)

Eye Guru: Dry Eye

Eye Guru: Abrasions and Ulcers

IU Cases: A B C D E

Eyes for Ears Podcast

AAO Case - Red Eye #1

AAO Case Red Eye #2

Day 3:
Chronic Vision Loss (34m)
and
Systemic Disease (32m)
Chronic Vision Loss and Systemic Disease

Cataract Surgery (11m)

Glaucoma Surgery (6m)

Intravitreal Injection (4m)

EyeGuru: Cataract

EyeGuru: Glaucoma

EyeGuru: AMD

IU Cases: A B

Eyes for Ears Podcast

Independent learning reflection (due Day 3 at 8 pm)
 

EyeGuru: Diabetic Retinopathy

IU Cases: A B

Eyes Have It Systemic Disease Quiz

AAO Case Systemic Disease #1

AAO Case Systemic Disease #2

Day 4: Mid-clerkship feedback (small groups)     Patient note #1
(due Day 4 at midnight)

Day 5:
Drugs and the Eye (27m)

Ocular and Orbital Injuries (30m)

Ocular and Orbital Injuries  

Eyes Have It Medications Quiz

TRC Pharmacology: On Campus; Off Campus.

IU Cases: A B

Eyes Have It Trauma Quiz

AAO Case - Trauma

 
Day 6: Eyelid, Lacrimal and Orbital Disease (Oculoplastics) (24m) Eyelid, Lacrimal and Orbital disease (Oculoplastics) Eyelid surgery (Blepharoplasty) (5m) IU Cases: A B  
Day 7: Neuro-Ophthalmology (34m) Neuro-Ophthalmology  

IU Cases: A B C D E F G H

Eyes for Ears Podcast

 
Day 8: Pediatric Ophthalmology: Amblyopia and Strabismus (23m) Pediatric Ophthalmology: Amblyopia and Strabismus

Strabismus surgery (6m)

Online MedEd: Peds Ophtho (16m)

IU Cases: A B

Eyes for Ears Podcast

Patient note #2 (due Day 8 at 5 pm)
Day 9: Interactive history and exam session (small groups)      
Day 10: Exam

Physical Exam Skills and Direct Observations

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Repeat each category three times:

Visual Acuity

  • near card or app
Confrontation Visual Fields

Alignment Assessment

  • Hirschberg test
Extraocular Muscle Ductions
Pupil Assessment

Penlight Assessment

  • Lids
  • Conjunctiva/sclera
  • Cornea
  • Anterior chamber depth
  • Clarity of media
Instillation of Drops

If you have a cooperative human at home, please perform these skills on them. Ideally, do this three days in a row. One time, we will plan on having the clerkship director observe your skills via Zoom for Direct Observation of Physical Exam Skills

  • Visual acuity: Eye Handbook app available in App Store, other resources also available
  • Pupils: Use a penlight or flashlight
  • Instillation of eye drops: If you have eye drops at home, use these. If not, simulate what you would do if you did have drops.
  • Direct ophthalmoscopy: Complete virtual module.

Individual learning and self-reflection

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In the setting of current events, our ophthalmology curriculum has shifted from an in-person clinical curriculum to online, necessitating increased student responsibility for their learning and time management.

In this assignment, please reflect on your approach to self-directed, individual learning.

  • How have you approached this in your pre-clinical years, how did this change in your clerkships?
  • What is your approach and plan for virtual learning currently, and how do you anticipate using these skills as a resident and attending in your future career?
  • Do you have a system that is working for you, or are there habits you would like to change?

Please target about two paragraphs of reflection, no more than approximately 500 words.

We will discuss your thoughts at our feedback session mid-rotation.


Interactive history and exam session

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Administrative goals:

Practice goals:

  • During the session: Take a history on a patient with an eye complaint and obtain physical exam information
  • After the session: Write a patient note based on your interaction

For this session, students will be paired. One student will act as a patient, and their history and physical exam will be provided to them.

The other student will act as the examiner, and start by taking a history. Then, the examiner will ask the patient for physical exam information in oral boards style. For example:

Examiner: "I will check the patient's visual acuity with a near card, by asking him to cover one eye with the palm of his hand, wear his habitual glasses and hold the near card at 14 inches away."

Patient: "The visual acuity in my right eye is 20/20, and in the left eye is 20/40."

Examiner: "I will now check the confrontation visual fields by...." etc.

Then, students will switch roles. The history and physical exam provided to the next student will be a different case.

After this is completed, students will each write a note with the information they obtained and submit as Patient Note 2.


Chief Complaint

81-year-old with sudden, painless vision loss OS.

History of Present Illness

  • Sudden black spot in the vision that spread out over the complete visual field OS over a 15-minute time frame. No pain, no diplopia, no problems in the right eye.
  • Drove directly to the ER.

POHx

  • No history of ocular surgeries or trauma
  • Mild myopia and presbyopia

PMHx

  • Coronary artery disease s/p CABG & balloon angioplasty
  • Right carotid endarterectomy (1990s)
  • Left carotid stenting (endovascular) recently with transient right hemiparesis (resolved).

FHx

  • Father had poor vision from cataracts, died of heart disease
  • Mother and brother had glaucoma

SHx: Retired school teacher, lives alone

Meds: ASA, Plavix, nitroglycerine PRN and alfalfa pills

Allergies: None

ROS: denied headaches, jaw claudication, scalp tenderness, weight loss, and loss of appetite, otherwise as in HPI or negative

EXAM

  • Visual acuity with glasses: 20/30 OD and HM OS.
  • Confrontation visual fields: Normal OD, able to see hand motions in all four quadrants OS
  • Pupils: pupils equal in light and dark, reactive, large RAPD OS
  • EOM: full OU
  • Hirschberg: Symmetric corneal light reflexes
  • Penlight exam of anterior segment: mild nuclear sclerosis cataracts OU
  • Fundus: normal OD, see photo OS (share screen with the examining student and show only the image below)


Chief Complaint

34-year-old with watery, red, irritated eyes; left more than right

History of Present Illness

  • 6-day history of watery, irritated eyes
  • Noted that the left eye was tearing, slightly blurry, and starting to get red six days ago
  • The eye gradually became increasingly red and irritated over the ensuing 2 days and the with increased crusting in the mornings.
  • There is a mild "scratchy" sensation.
  • Given antibiotic drops 3 days ago, but no improvement in symptoms
  • Left eye continued to worsen
  • 2 days ago, right eye started to get red and watery
  • One week prior to any ocular symptoms, had an upper respiratory infection which had subsided spontaneously.

POHx: Former contact lens wearer (five years ago), now only wears glasses for myopia. No eye surgery or trauma

PMHx: Healthy

PSHx: Tonsillectomy in childhood

FHx: Maternal grandmother with macular degeneration (in her 80s), paternal grandfather with recent cataract surgery

SHx: Married, works as an accountant

Meds: Daily multivitamin

Allergies: None

ROS: As in HPI, otherwise negative

EXAM

  • Visual acuity with glasses: 20/20 OD and 20/30 OS
  • Confrontation visual fields: Normal OD and OS
  • Pupils: pupils equal in light and dark, reactive, no RAPD
  • EOM: full OU
  • Hirschberg: Symmetric corneal light reflexes
  • Penlight exam of anterior segment: Evident crusting on lashes and watery discharge, OU. The conjunctiva is injected OS>OD. There is mild swelling of the eyelids, again L>R.
  • Palpable pre-auricular lymphadenopathy (LAD), L>R

    (share screen with the examining student and show only the images below when asked about penlight exam or lymphadenopathy exam)
  • Direct ophthalmoscopy: normal OD and OS


Patient Note 1

Please find an interesting case on AAO Medical Student website, the Indiana University case website, or EyeRounds, and write a patient note on this case.

Do not copy and paste into your note. If you do so, you will get reduced points. This should be your work, and you should understand all parts of your note. Write out all abbreviations.

Please include:

  1. History: History of present illness, past ocular history, past medical history, family history, social history, present medications (including eye drops)
  2. Examination: Best corrected visual acuity with/without pinhole, ocular motility, pupil exam (including size, reactivity and presence of afferent pupillary defect), confrontation visual fields, external examination, slit lamp examination, intraocular pressures, direct ophthalmoscopy.
  3. Assessment: Organized by problem if there are multiple problems
  4. Plan: Organized by problem if there are multiple problems

Patient Note 2

Please note 2 will be based on your history taking exercise.

Please include:

  1. History: History of present illness, past ocular history, past medical history, family history, social history, present medications (including eye drops)
  2. Examination: Best corrected visual acuity with/without pinhole, ocular motility, pupil exam (including size, reactivity and presence of afferent pupillary defect), confrontation visual fields, external examination, slit lamp examination, intraocular pressures, direct ophthalmoscopy.
  3. Assessment: Organized by problem if there are multiple problems
  4. Plan: Organized by problem if there are multiple problems

Project Presentation

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Prepare and present a 6 to 8 minute presentation on an ophthalmological diagnosis, which could be commonly encountered by a primary care provider or perhaps relevant to your own future career. You may use EyeRounds as the foundation for a 'patient' to present.

Suggested Format

  • PowerPoint presentation, presented to your classmates via Zoom.
  • If including a brief case report, please provide chief complaint, brief HPI, past ocular history, pertinent past medical and surgical history, pertinent family and social history. Describe key portions of the exam, with pictures if available.
  • Briefly provide key information about the diagnosis. You may choose to include: epidemiology, signs and symptoms, exam findings, diagnostic tests if applicable, management and treatment, prognosis, differential diagnosis.
  • Provide key pearls, which a primary care provider should remember if they encounter a patient with this diagnosis in their clinic.

Resources

  • Your textbooks
  • EyeRounds – this is a great resource for both information and for pictures

Due Dates

By the Wednesday at 5:00 pm, notify the course director of your chosen topic

On Friday of your rotation, present your project to your peers and instructor at the morning learning session.

Examples of appropriate topics

  • Cataract – senile, congenital or traumatic
  • Age related macular degeneration
  • Retinal detachment
  • Angle closure glaucoma
  • Primary open angle glaucoma
  • Open globe
  • Preseptal cellulitis
  • Orbital cellulitis
  • Dry eye
  • Third nerve palsy
  • Fourth nerve palsy
  • Sixth nerve palsy
  • Optic neuritis
  • Non-arteritic ischemic optic neuropathy
  • Arteritic ischemic optic neuropathy/giant cell arteritis
  • Viral conjunctivitis
  • Chalazion and hordeolum
  • Esotropia
  • Exotropia
  • Refractive, strabismic or deprivational amblyopia
  • Nasolacrimal duct obstruction
  • Fuch's endothelial dystrophy
  • Thyroid eye disease

This is not an exhaustive list – any topic covered in your Basic Ophthalmology textbook can be a good topic, or email the course director with your idea.


Ophthalmology Required Clinical Encounters

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Ophthalmology Required Clinical Encounters


Ophthalmology Clerkship Grading Policy

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Scoring Component

Value

Evaluations 10 points
(score x 2)
Written Exam 60 points
(percentage correct x 0.6)

Discussion Sessions

  • 5 pts = contributed 2 or more times
  • 4 pts = contributed 1 time
  • 3 pts = attended, but did not participate
30 points
(6 sessions each worth 5 pts)
Professionalism Loss of points
Requirements for Pass Final Score: > 70
Final Exam: ≥ 60%
Evaluation: ≥ 3.0
Clerkship Failure

Final Score: 0-69.9

Failure to complete criteria regardless of points

Attendance/Participation: Clerkship failure if more than 2 days missed

Evaluation: < 3.0

Written Exam: score < 60% (eligible for one retake)

Discussion Sessions: more than 1 missed

Required clinical encounters incomplete

 

last updated: 8/03/2020
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