1

WEST AFRICAN COLLEGE OF SURGEONS

FACULTY OF OPHTHALMOLOGY

TRAINING CURRICULUM FOR THE

MEMBERSHIP AND FELLOWSHIP PROGRAMME

THE MEMBERSHIP PROGRAMME

This will commence in October 2014.

TABLE OF CONTENTS
Preamble -

A.Mission statement B.Outcome objectives of the membership programme

C.Core competencies C.1 Patient care
C.2 Medical Knowledge
C.3 Practice-based learning and improvement
C.4 Interpersonal and Communication skills C.5 Professionalism C.6 Systems-Based Practice C.7 Surgical skills
C.8 Population-based care D. CANDIDATES SELECTION CRITERIA
E. PROGRAMME OBJECTIVES F. TRAINING PROGRAMME
G.COURSE DURATION
H. COURSE TIMETABLE
I.DETAILS OF TIMETABLE
J. PROGRAMME DELIVERY
K. PROPOSED ASSESSMENT METHODS
L. BASIC SCIENCE CURRICULUM
M. CLINICAL SCIENCE CURRICULUM
N. BASIC OPHTHALMOLOGY COURSE CURRICULUM
O. CURRICULUM FOR THE EXTERNAL POSTINGS
ENT
NEUROLOGY & NEUROSURGERY
APPENDICES

PREAMBLE
Globally, and particularly in sub Saharan Africa, there is a crisis in human resources for
health of all cadres.1
Ophthalmologist per million population in sub-Saharan Africa ranges between 1 to 3.1
compared to 79 in developed countries.2
The worlds population is ageing which is a major risk factor for blinding diseases 3. To
meet these challenges through the production of a middle level health specialist
manpower for the countries of the West Africa sub region, the West African College of
Surgeons (WACS) requested its faculties to develop the membership cadre and its
relevant curriculum.
The Faculty of ophthalmology had successfully over the last eighteen years through the
two- year diploma in ophthalmology programme, produced over two hundred diplomates
who have been sole providers of eye care services in Sierra Leone and Liberia and most
of the cataract surgical services in many of the Anglophone countries of the sub-region.
In Francophone countries, the Diploma in ophthalmology template was also used for the
design of the Diplome dtudes Superieures Specialisees dOphtalmologie (DESSO)
programme whose graduates are accepted into the CES programme; a two stage training
approach.
The faculty, in the development of the membership component of this curriculum, has
therefore drawn on these prior experiences, the wider global ophthalmology training
direction and resources and responded to the directives of the WACS Council.
In addition, the faculty has placed increased emphasis on a high quality surgical
competence in order to adequately and primarily address cataract, the regions leading
cause of blindness.
In order to maximally utilise the existing training opportunities and resources and provide
a wide and varied exposure to residents, the curriculum recommends the concept of a
network of training facilities, made up of teaching hospitals, high volume centres, other
service delivery centres and practical experiences in Primary health care and community
health services.
Since the membership is an exit step, the anticipated increase in numbers produced and
their equitable distribution will meet the needs of the population of the sub region.

Chen et al The Lancet vol 364 Issue 9449 doi:10.1016/SO140-6736(04)17482-5

Resnikoff S., Felch W., Gauthier T-M., Br J Ophthalmol -2011-301378
3
Resnikoff S, Pascolini D.,Etyaale D., et al, Global data on visual impairment in the year 2002 Bull World
Organisation 2004, 82: 844-51
2

A.MISSION STATEMENT
Based on a human rights and equity approach to health and the development of human resources
for health for universal coverage in West Africa, our mission is to produce a comprehensive
Ophthalmologist as the leader of the eye care team who will deliver population and patient
centred high quality comprehensive integrated eye care services.

B. OUTCOME OBJECTIVES OF THE MEMBERSHIP PROGRAMME

1. To produce a specialist that can deliver ophthalmic care in response to our population
needs.
2. To produce a specialist in Ophthalmology with the requisite amount of knowledge, skills
and attitudes, who is capable of independent specialist practice.
3. He/she should be able to contribute to his specialty through publications and is also
expected to participate in the training of all other eye care workers at all levels under
him/her.
4. Such a specialist at the end of his training should be capable of critically reviewing new
development and research findings in science and medicine as they apply to
ophthalmology and the delivery of eye health services.

C.CORE COMPETENCIES
Core competencies and sub-competencies are the driving force of the training programme
In addition to the specialized cognitive and technical skills described in this curriculum, several
generic core competencies are expected of ophthalmic, as well as other medical specialists.
These general core competencies include the following:
C.1 Patient care
C.2 Medical knowledge
C.3 Practice-based learning and improvement
C.4 Interpersonal and communication skills
C.5 Professionalism
C.6 Systems-based practice
C.7 Surgical skills
C.8 Population based care
C.1 Patient Care
Trainees (residents) must be able to provide patient care that is compassionate, appropriate,
and effective for the treatment of health problems and the promotion of health. Residents are
expected to:
a. Communicate effectively and demonstrate caring and respectful behaviours when
interacting with patients and their families
b. Gather essential and accurate information about their patients
c. Make informed decisions about diagnostic and therapeutic interventions, based on patient
information and preferences, up-to-date scientific evidence, and clinical judgment
d. Develop and carry out patient management plans
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e. Counsel and educate patients and their families

f. Use information technology to support patient care decisions and patient education
g. Perform competently the medical and invasive procedures considered essential for the
area of practice
h. Provide health care services aimed at preventing health problems or maintaining health;
i. Work with health care professionals, including those from other disciplines, to provide
patient-focused care.
C.2 Medical Knowledge
Residents must demonstrate knowledge about established and evolving biomedical, clinical, and
cognate (e.g. epidemiological and social-behavioural) sciences and the application of this
knowledge to patient care. Residents are expected to:
a. Demonstrate an investigatory and analytic thinking approach to clinical situations;
b. Know and apply the basic and clinically supportive sciences which are appropriate to
ophthalmology
C.3 Practice-based Learning and Improvement
Residents must be able to investigate and evaluate their patient care practices, appraise and
assimilate scientific evidence, and improve their patient care practices. Residents are expected to:
a. Analyze practice experience and perform practice-based improvement activities using
a systematic methodology
b. Locate, appraise, and assimilate evidence from scientific studies related to their
patients health problems
c. Obtain and use information about their own population of patients and the larger
population from which their patients are drawn
d. Apply knowledge of study designs and statistical methods to the appraisal of clinical
studies and other information on diagnostic and therapeutic effectiveness
e. Use information technology to manage information, access on-line medical
information; and support their own education
f. Facilitate the learning of students and other health care professionals.
C.4 Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in
effective information exchange and teaming with patients, patients families, and professional
associates. Residents are expected to:
a. Create and sustain a therapeutic and ethically sound relationship with patients
b. Use effective listening skills and elicit and provide information using effective
nonverbal, explanatory, questioning, and writing skills
c. Work effectively with others as a member or leader of a health care team or other
professional groups.
C.5 Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities,
adherence to ethical principles, and sensitivity to a diverse patient population. Residents are
expected to:
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a. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of

patients and society that supersedes self-interest; accountability to patients, society,
and the profession; and a commitment to excellence and on-going professional
development
b. Demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed consent,
and business practices
c. Demonstrate sensitivity and responsiveness to patients culture, age, gender, and
disabilities.
C.6 Systems-based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and system
of health care and the ability to effectively call on system resources to provide care that is of
optimal value. Residents are expected to:
a. Understand how their patient care and other professional practices affect other health
care professionals, the health care organization and the larger society, and how these
elements of the system affect their own practice;
b. Know how types of medical practice and delivery systems differ from one another,
including methods of controlling health care costs and allocating resources
c. Practice cost-effective health care and resource allocation that do not compromise
quality of care
d. Advocate for high quality patient care and assist patients in dealing with system
complexities
e. Know how to partner with health care managers and health care providers to assess,
coordinate, and improve health care and know how these activities can affect system
performance.
f. Professional attitudes and conduct require that trainees must also have developed a
style of care which is:
i.
Humane (reflecting compassion in providing bad news, if necessary; the
management of the visually impaired; and recognition of the impact of visual
impairment on the patient and society);
ii. Reflective (including recognition of the limits of his/her knowledge, skills and
understanding);
iii. Ethical;
iv.
Integrative (including involvement in an inter-disciplinary team for the eye
care of children, the handicapped, the systemically ill, and the elderly); and
v.
Scientific (including critical appraisal of the scientific literature, evidencebased practice and use of information technology and statistics).
C.7 Surgical skills
Residents are to demonstrate ability to perform surgeries expected of them at each level safely
and where there are complications to manage these in a way that limits damage to ocular tissue
and function. Residents are expected to
a. Demonstrate complete control and mastery of the operating microscope and all procedure
specific equipment

b. Be familiar with the names of instruments and be confident with their use with no
awkward movements during operations
c. Demonstrate respect for tissue by consistently handling tissues appropriately with
minimal damage,
d. Show economy of movement with maximum efficiency by planning the course of the
operation, anticipating potential problems and taking appropriate action

C.8 Population based Care

The Resident must demonstrate the ability and commitment to address eye care needs in the
population. Residents are expected to know how to
a. Assess local eye care needs and resources
b. Formulate and manage eye care programmes
c. Mobilize the community and mobilise resources for implementation of the eye care
programme
d. Integrate eye care into health and health- related delivery services and the supporting
health systems
e. Collect data and apply health information as it relates to the population
f. Design and implement a people-centred approach in eye health programmes

D. CANDIDATES SELECTION CRITERIA

A Medically qualified candidate who has
1. Fully registered in his/her country of practice
2. Completed at least two years Post qualification as a Medical Doctor at the time of entry.
3. Passed Primary examination within the last five years would have an advantage or latest
within the first year of the programme.
Candidates who have not passed the primary within the first year of commencement
would be required to withdraw from the programme.
4. The Candidate should register with the West African College of Surgeons on entry into
the programme.
5. The Candidate should be a maximum of 40 years of age on entry.

E. PROGRAMME OBJECTIVES
The programme aims to train Specialists with
1. Intellectual knowledge
2. Community Orientation
3. Task Orientation
a. Clinical Skills
b. Surgical Skills
c. Optical Skills
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d. Quality Assurance
e. Managerial skills
f. Training skills
g.Research skills

F.

TRAINING PROGRAMME
The learning objectives for candidates in the Membership programme in Ophthalmology
are designed to emphasize recall of information (bank of knowledge) , understanding and
application of basic sciences (e.g. anatomy, physiology, biochemistry, embryology,
pharmacology) to the practice of Ophthalmology.
Candidates in the programme are expected to learn how to apply pathogenetic
mechanisms to clinical problems, ordering and interpreting clinical, laboratory, and
imaging information, development of a differential diagnosis, implementation of a
reasonable and appropriate therapeutic medical and/or surgical plan, and anticipation,
recognition, and treatment of complications.
Candidates completing the membership programme are expected to demonstrate a
depth of knowledge and understanding expected of an independent Specialist
not sub-specializing in the field of ophthalmology.

G. COURSE DURATION
Three years

H.COURSE TIMETABLE
H.1

Level 1
a. Basic Ophthalmology Course
b. Clinical Ophthalmology c. 1st year leave
-

H.2 Level 2
a. Other Specialty postings st
b. 1 Surgical posting at high volume surgical centre
c. Public health for eye care (PHEC/ CEH) course
and research skills(5 weeks)
d. Rural posting, operational research and a Publishable
Paper from the posting e. Clinical Ophthalmology f. 2nd year annual leave
H.3

2 months
9 months
1 month

2 months
3 months

1.25mths

3 months
2 months
1 month

2 months

Level 3

a.

2nd Posting to high volume surgical centre

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b. Clinical Ophthalmology c. 2nd year annual leave

d. Revision and exams 4 weeks

7 months
1.5 months
1.5 months

PROPOSED STRUCTURE FOR MEMBERSHIP

Overview of Membership Training Programme
Level 1

Year 1

9 Months

1
month

Clinical Ophthalmology 1

Leave

2 Months
Postings
Basic
Course

level 2

Year 2
2 months

3 Months

1 month

1.25 months

3
months

2 months

PHEC

Rural
posting

Clinical
Ophthalmology
2

Postings

Short
Postings

Annual
Surgical posting 1 Leave
level 3

Year 3
2 months

7 months

1.5 month 1.5 months

Postings
Surgical
Posting 2

Clinical
Ophthalmology 3

Annual
Leave

Revision and
exams

NB:The posting blocks drawn above are not to scale and are for illustration
purposes only
The Membership levels approximate but are not exact to one academic year.
The candidates and training institutions need not follow the exact sequence of postings at each level,
but all the postings must be completed in order to move to the next training level.

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Basic Course at level 1 MUST be done within 6 months of commencing the training programme.

Leave periods (Vacation) can be taken at any time in the year convenient to institution and candidate

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I. DETAILS OF TIMETABLE
I.1 LEVEL 1: Expected Outcomes
I.1. a. BASIC OPHTHALMOLOGY COURSE ( 2 months):

At the end of this posting, the Resident should have adequate knowledge and skills in :
i. Basic Science (Anatomy, Physiology, Biochemistry, Genetics, pharmacology
& Pathology as related to Ophthalmology)
ii. General Clinical Ophthalmology
iii. Basic Clinical examination skills
iv. Basic Optics/Refraction - Principles and skills
v. Basic Microsurgical Skills (Wet lab)
This 2-month posting should be done within the first Six months of entry.
I.1.b CLINICAL OPHTHALMOLOGY 1 ( 9 months)
At the end of this posting, the Resident should have acquired basic knowledge of clinical
ophthalmology, management of common eye disorders and proficiency in refraction
skills.
This 9 month posting shall be at the base hospital. It shall include special attention to
Optics/Refraction alongside with the medical/surgical Ophthalmology clinical exposure.
This should include Lectures/ discussions etc in the training centre.

I.2
LEVEL 2
At the end of this level, the Resident should:
i. Be proficient in refraction and performed as many cases as stipulated in the Logbook.
ii. Be proficient in Surgery and performed as many cases as stipulated in the logbook.
iii. Be proficient in diagnosing and managing common clinical disorders
I.2.a OTHER SPECIALTY POSTINGS (2months)
These shall be in the following specialties
i.
Neurosurgery 1 month
ii. Neurology 2 weeks
iii. ENT
- 2 weeks
The Residents are expected to appreciate the clinical presentation and management of cases
in these specialties which have ophthalmic manifestations.
I.2.b - 1ST POSTING AT HIGH VOLUME SERVICE DELIVERY CENTRE (3months)
At the end of this posting, the Resident should understand high volume service delivery
systems and be able to perform high quality Cataract Surgery with minimal supervision.
The training centre should ideally be able to provide high volume surgical services but if not
available, the Resident should be posted to a high volume centre of which the Institution is
part of the network.
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I.2.c - PUBLIC HEALTH FOR EYE CARE (PHEC/ CEH) AND RESEARCH SKILLS
COURSES 5 weeks
At the end of this posting, the Resident should be equipped to apply the principles of
community eye health management and control of eye diseases with public health
dimension. He /she must have acquired teaching and research skills with emphasis on
Public health research and translation into policy and practice.
These courses are to be carried out at designated centres in the sub region.
I.2.d. - RURAL POSTING 3 months
The rural posting is supposed to be a way of rendering quality eye care service to the rural people
while consolidating the core competencies and sub-competencies of the membership. During the
posting, the resident will get a full understanding of health systems, assessment, integration and
strengthening of eye health systems.
I.2.e. CLINICAL OPHTHALMOLOGY POSTING 2 (2months)
At the end of this posting, the Resident should be able to have more advanced
diagnostic skills and make more complex management decisions
This shall be done in base hospital

I.3
LEVEL 3
I.3.a - 2ND POSTING TO HIGH VOLUME SERVICE DELIVERY CENTRE 2 months
At the end of this posting, the Resident should consolidate his skills in high volume
service delivery systems and be able to perform high quality Cataract, Glaucoma and
other ocular surgeries as listed in the logbook without supervision.
I.3.b Clinical Ophthalmology 3 (7 months)
At this stage the Resident should be able to work independently and assist in the
training of Junior Residents, Medical students and general health workers.

J. Programme Delivery
J.1 . Models of Learning
a. Organized courses
b. Work-based experiential learning
c. Local postgraduate meetings
d. Independent self-directed learning
e. Appropriate off-the-job education

These activities of Teaching, Training and Assessment would be achieved through a

detailed programme as below:
a.Tutorials/seminars
Weekly
b.Lectures(Daily during the
Clinical Ophthalmology course, otherwise)
c.Grand Round d.Journal club
e.Refraction clinics
f.Case presentations
g.Clinical meetings/ Audits
h. Investigation days
i.Hands-on surgical training ( as evidenced by Surgical logbook),
j. Hands-on clinical training,
k.Wet-lab
l. E-learning methods,
m.Video-conferencing
n.Groupwork
o.OTHERS:
a. At least half-day per resident per week for self study.
b. Monthly assessment of logbooks
c. Supervision of dissertation by trainers
d. End of Posting/Rotation Assessments
e. End of Level Examination(mock examination- Institution based)
a. Essays/ SAQs
b.Clinicals
c.Orals

Monthly
Monthly
Biweekly
2x/week
Weekly/ clinic
Quarterly
Weekly

Feedback
J.2. Appraisal of the Trainers and the training process
Internal quarterly appraisals of the training process using a structured appraisal format.
This should be done by each training department at the base level and in each training
facilities network.
J.3. Feedback During the training programme
Regular and timely feedback on performance is essential for successful work-based experiential
learning.
Specific details of who should give feedback and the timing in relation to training placements
will be the responsibility of the Residency Training Co-ordinators and HODs.
Feedback should include the following important elements:

a. An initial appraisal meeting shortly after the start of a training placement to establish
learning goals
b. An interim appraisal meeting to discuss progress against the learning goals
c. An appraisal meeting towards the end of the training placement to agree which learning
goals have been achieved.
d. Structured written feedback from clinical supervisors to the Residency Training Coordinator.
e. Appropriately structured written feedback from other departmental staff (multi-source
feedback) at whatever posting the Resident is undergoing. This should include members
of the eye care team, medical staff in relevant directorates e.g. radiology, pathology,
anaesthesia and managerial staff.
f. Feedback from patients and carers obtained from patient surveys etc.
g. Feedback from College examinations, if a trainee has been unsuccessful.
h. Feedback from the Resident on his/her training process.
The results of such feedback will form part of the Residents portfolio.
J.4. Supervision of the trainee throughout the training programme
The overall supervision of the Resident lies with the Residency Training Co-ordinator.
Trainees will work to a level of clinical supervision commensurate with their clinical experience
and level of competence. This will be the responsibility of the relevant clinical supervisor.
Centres are encouraged to allocate personal tutors to each Resident in addition to the Clinical
supervisor and Residency training co-ordinator.
J.5. Governance
This curriculum is a document of the WACS, one of the providers as identified in the above
definition of governance. It is hoped that the WACS will, in its relationship with government,
professional and regulatory bodies, positively influence the decision- making processes as
regards the membership programme and cadre. Specific to the membership programme, the
major stakeholders are the training centers who employ the residents, WACS and the training
facilities to which they are posted. It is imperative therefore that there is joint vision between the
WACS and the employment cum training facilities. Examples of this are; the WACS will be
required to inform the training centers to offer employment to residents who have fulfilled the
selection criteria, to release residents and support training activities outside their institutions. The
administration at the benefitting primary health facilities will fund activities in their facilities.
The design of the programme has addressed public accountability through its feedback
processes, quality through its training methodology, and supervisory mechanisms, hopefully
equity through selection, increased production and government policy on deployment. Exposure
to participation and voice of the health services at different levels is captured in the postings to
these levels as well as by the feedback mechanism. Competency in governance will be included
in the module on public health. Accountability, and quality of trainers is addressed through the
trainers appraisal system by self, peers and residents. The accountability to donors and aid
effectiveness by donors will need to be addressed through a structured project management
process.
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Sustainability will be ensured by the WACS through its existing mechanisms for all training
programmes. However indicators for and collection, analysis and utilisation of data on the
management and effectiveness of resources will be required as part of a comprehensive
monitoring and evaluation process of the membership programme. This will require having in
place an adequate HRH information system (HRIS), HRH research and the requisite capacity
building. Fortunately in the West African sub region, a suite of four, free, open source software
iHRIS (Annex z) can be accessed and implemented with support from the West African
Health Organisation (WAHO) and the Capacity Plus project. 4
K. Proposed assessment methods
a. Competence in patient management and health promotion and disease prevention
(Assessment method: Case based Discussion (CbD).
b. Resident clinical skills (Assessment method: Clinical Rating Scale (CRS) and
Objectively Structured Clinical Examination (OSCE)
c. Procedural skills (Assessment method: Direct Observation of Procedural Skills
(DOPS)
d. Most of the Attitudes, Ethics & Responsibilities and Communication skills
(Assessment method: Multiple Source Feedback (MSF) where appropriate persons are
approached to give feedback on the residents performance.
e. Technical skills (Assessment method: Objectively Structured Assessment of
Technical Skills (OSATS)
f. Log Books (Assessment method for surgeries, examination procedures, refraction,
technical procedures) will be kept by each resident and regularly assessed by trainers
g. An exit exam at the end of level 3.
h. Inter-level assessments to evaluate the Residents progress and counsel accordingly
i. Adequate preparation of Residents for the exit exam which would include revision
process and mock exams in the preceding 6weeks to the exams.

L. The Exit Exams

L.1 Eligibility
a. Passed Primaries
b. At least three years of training with complete portfolio by the time of the exam.
c. Evidence of attendance of an Update Course

L.2 Examination Process

a. Theory Paper (Paper I MCQ, Paper II Optics and Refraction, Paper III Medical
and Surgical Ophthalmology with Community Ophthalmology)
b. Clinical Examination Short Cases (OSCE), Long Cases, Refraction
c. Orals - Cases seen, scenarios, questions on portfolio
(Candidates are to come to the examination with their Portfolios)

Detailed Curriculum

1.BASIC SCIENCE CURRICULUM for the primary

examination
Anatomy
All trainees must understand and apply knowledge of the anatomy of the eye, adnexae, visual
pathways and associated aspects of head, neck and neuro anatomy. It extends to applied anatomy
relevant to clinical methods of assessment and investigation relevant to ophthalmic practice.
They must be able to use this knowledge when interpreting clinical investigations and in the
practice of ophthalmic surgery.
The Orbit and adnexae: Osteology, orbital foramina, eyelids, conjunctiva, lacrimal system,
extraocular muscles, intraorbital nerves, vessels, orbital fascia
Ocular anatomy: Conjunctiva, cornea, sclera, limbus and anterior chamber angle, iris and pupil,
lens and zonule, ciliary body, choroid, retina, vitreous, optic nerve
The Cranial Cavity: Osteology of the skull, meninges, vascular supply, foramina, cranial fossae,
pituitary gland and its relations
Central Nervous System: Cerebral hemispheres and cerebellum including microscopic anatomy
of visual cortex, cranial nerves, spinal cord, vascular supply, visual pathways, control of eye
movement, autonomic regulation of eye.
Head and neck: Nose, mouth, paranasal sinuses, face and scalp, pharynx, soft palate, larynx,
trachea, major arteries and veins, lymphatic drainage of the head and neck
Cardiovascular system: Gross anatomy of the heart, and major blood vessels. Microscopic
anatomy of arteries, veins and capillaries
Physiology
All trainees must understand and apply knowledge of the physiology of the eye, adnexae and
nervous system, including related general physiology. This includes the applied physiology
relevant to clinical methods of assessment in ophthalmic practice. They must be able to use this
knowledge when interpreting clinical symptoms, signs and investigations and in the practice of
ophthalmic medicine and surgery.
General principles including:
Maintenance of homeostasis: Characteristics of control systems - nervous and hormonal
Body fluids - volume, osmolarity, osmotic and oncotic pressure, and electrolyte (including H+)
concentrations
Excitable tissues nerve and muscle: Structure and function of nerve cell,
membrane potential, action potential, nerve conduction, synapse, the motor unit, muscle

Blood: Plasma composition and functions, cell types, immune mechanisms, blood groups,
haemoglobin and red and white cell formation and destruction, anaemias, clotting and
fibrinolysis
Cardiovascular system: Pressure resistance and flow in blood vessels, blood pressure
And blood flow, the activity of the heart and its control, cardiac output, control
Mechanisms within the CVS, transcapillary exchange, tissue fluid formation
Respiratory system: Structure, lung volumes, composition of respiratory gases, lung
mechanics, gas exchange in the lung, carriage of O2 and CO2 in blood, ventilation
perfusion relationships, chemical and neural control of ventilation
Nervous system and special senses: Receptors, synapses, afferent pathways, efferent pathways,
cerebral cortex, control of movement, hearing, pain and its control, autonomic nervous system,
cholinergic transmission, adrenergic transmission
Endocrinology: Hormonal control, hypothalamus, pituitary, thyroid / parathyroid, adrenals,
pancreas
Nutrition: Dietary requirements, absorption, vitamins
Kidney and adrenal cortex: Glomerular and tubular function, osmolality and pH of body
Fluids
Ocular physiology including:
Physiology of tear production and control and the lacrimal drainage system
Physiology of aqueous production and drainage including principles of intraocular pressure
measurement
Physiology and biochemistry of the cornea
Lens metabolism
Physiology of the vitreous
Retinal physiology including phototransduction
Retinal pigment epithelium
Choroid
Blood ocular barrier
Physiology of vision including:
Visual acuity
Accommodation
Pupillary reflexes
Light detection
Dark adaptation
Colour vision
Electrophysiology of the visual system
Visual fields
Contrast sensitivity

Eye movements
Stereopsis
Motion detection
Visual perception
Magnocellular and parvocellular pathways

Biochemistry and cell biology

All trainees must understand and apply knowledge of the basic biochemistry and cell biology.
This includes in particular those aspects relevant to common eye diseases. They must be able to
use this knowledge when interpreting clinical symptoms, signs and laboratory investigations and
in the practice of ophthalmic medicine and surgery.
Biochemistry of the cell: Organelles, plasma membranes, cytoskeleton,
nucleus (DNA, RNA), transport mechanisms, cell-cell communications,
cell-matrix interactions
Signalling: Growth factors, cytokines, hormones, eicosanoids, receptors, signal transduction,
intracellular signalling pathways (e.g. second messengers)
Cellular processes: Cell cycle, protein synthesis (transcription, translation, post-translational
modification), nucleic acid synthesis, proliferation, migration, apoptosis, metabolic processes
Connective tissue and extracellular matrix: Extracellular matrix molecules, composition
of ocular extracellular matrices, synthesis/degradation, cell-matrix interactions
Biochemical and molecular biological techniques: Examples include: gene cloning, polymerase
chain reaction, in-situ hybridisation, immuno-localisation, ELISA assays, Western, Northern and
Southern blotting.
Biochemistry and cell biology of ocular tissues: Cornea, sclera, ciliary body, lens, vitreous,
retina, choroid.
Active oxygen species: Free radicals and H2O, scavengers, lipid peroxidation,
phospholipase A
Pathology
All trainees must understand and apply knowledge of pathology, especially the specialist
pathology of the eye, adnexae and visual system. This includes histopathology, microbiology and
immunology and other branches of pathology. They must be able to use this knowledge when
interpreting clinical symptoms, signs and investigations and in the practice of ophthalmic
medicine and surgery.
Acute inflammation: Chemical mediators, cellular mechanisms
Wound healing
Chronic inflammation: Types, granulomata, immune mechanisms, ulceration, specific examples

Immunological mechanisms: Types of hypersensitivity reaction

Graft rejection
Degenerations: Examples: amyloidosis, calcification
Ageing and atrophy
Hypertrophy, hyperplasia and metaplasia
Vascular disorders: Atheroma, thrombosis (and homeostatic clotting mechanisms
embolism (including pulmonary embolism), ischaemia and infarction, congestion and
oedema, angiogenesis, hypertension, aneurysms, diabetic microangiopathy
Shock
Neoplasia: Definition, terminology, concepts; benign and malignant tumours;
carcinogenesis; gene control including regulation of apoptosis; oncogenes; geographical
and environmental factors; pre-neoplastic conditions; effects of irradiation and cytotoxic
drugs

BASIC OCULAR PATHOLOGY

With an emphasis on:
Cornea endothelial dysfunction and corneal dystrophies
Glaucoma
Cataract
Diabetes
Age Related Macular Degeneration
Retinal vascular occlusion
Ocular neoplasia
Retinal detachment and Proliferative Vitreo-retinopathy
MICROBIOLOGY:
The biological and clinical behaviour of the micro-organisms responsible for infections
Elementary principles of microbial pathogenesis: Concepts of colonisation, invasion, endotoxins,
exotoxins, virulence and pathogenicity etc.
Gram staining and classification
Commensal eye flora
Viruses: Classification, structure and replication, antiviral agents, laboratory methods of viral
detection; viral infections of the eye.
Prions
HIV and AIDS
Fungi: Classification, factors which predispose to fungal infection, antifungal agents.
Toxoplasmosis, Chlamydia, Acanthamoeba, helminthic infections

Principles of sterilization: Disinfection and asepsis and the application of these to current
practice and practical procedures
Antimicrobials: Spectrum of activity, mode of action, pharmacokinetics and resistance
IMMUNOLOGY
Principles of immunology e.g. non-specific resistance, genetic basis of immunity, cellular and
humoral mechanisms
Host defence mechanisms with particular reference to the eye
Mechanisms of immunologically-induced tissue damage with special reference to the eye
Role of soluble mediators (cytokines and chemokines) in regulation of inflammatory responses
MHC antigens, antigen presenting cells and antigen processing
Transplantation immunology (with particular reference to the cornea)
Immunodeficiency and immunosuppression
Tissue regulation (with particular reference to the eye) of inflammatory responses)

Growth and senescence

All trainees must understand and apply knowledge of growth, development and senescence, and
the anatomical, physiological and developmental changes which occur during embryogenesis,
childhood and ageing relevant to ophthalmic practice. They must be able to use this knowledge
when interpreting clinical symptoms, signs and investigations and in the practice of ophthalmic
medicine and surgery.
Embryology: General embryology especially at early stages; embryology of the eye, orbit,
adnexae and visual pathways; the embryological origins of congenital malformations of the eye.
Child development: key milestones in childhood development especially regarding the visual and
central nervous systems.
Senescence: the process of ageing and degeneration.
Therapeutics
All trainees must understand and apply knowledge of clinical therapeutics relevant to ophthalmic
practice. They must be able to use this knowledge when prescribing for a patient. They must
understand the therapeutics used in general medicine and surgery to a basic standard. They must
be aware of the possible ocular effects of systemic medications and systemic effects of ocular
medications.
PHARMACOLOGY
Pharmacokinetics and pharmacodynamics: General and specific to ocular tissues Drug-receptor
interactions
Mechanisms of drug actions (including receptor pharmacology and biochemical
pharmacology)
Mechanisms of drug toxicity
Specific classes of pharmacological agents: Examples include catechol aminergics,
cholinergics, serotonergics and histaminergics, eicosanoids
Pharmacology of drugs used in inflammation and immunosppression
Pharmacology of drugs used in glaucoma
Local anaesthetics

Analgesics
Clinical Genetics
All trainees must understand and apply knowledge of clinical genetics relevant to ophthalmic
practice. They must be able to use this knowledge when advising patients about patterns of
inheritance. They must recognise when it is appropriate to refer a patient for genetic counseling.
They must recognise when it is important to offer a consultation with family members.
Organisation of the genome: Genes, chromosomes, regulation of transcription
Mendelian genetics: General principles
Population genetics: General principles
Cytogenetics: Aneuploidy, deletions, translocations, mosaicism, chimerism
Genetic basis of eye conditions: Genes involved in ocular disorders or systemic disorders with an
ocular phenotype
Investigative and research techniques: Linkage analysis, candidate genes, twin studies,
association studies
Gene therapy: General principles

Suggested reading list for Primary Examination

This list is not designed to be exhaustive. Similarly, only some sections in these books are
directly relevant to the examination.
1. The Eye: Basic Sciences and Practice. Forrester JV, Dick AD, McMenamin P, Lee WR.
WB Saunders 2003. ISBN: 0-7020-2541-0
2. MCQ companion to the Eye. Basic Sciences in Practice. Galloway PH, Forrester JV,
Dick AD, Lee WR. WB Saunders 2001. ISBN: 0702025666
3. American Academy of Opthalmologists. Basic and Clinical Science Course. ISBN: 156055-570-X
4. Volume 1. Update on general medicine.
5. Volume 2. Fundamentals and principles of ophthalmology
6. Volume 4. Ophthalmic pathology and intraocular tumours.
7. Adlers Physiology of the Eye. Ed. Hart WM. Mosby 2003. ISBN: 0-323-01136-5
8. Clinical Anatomy of the Eye. Snell RS, Lemp MA. Blackwell Scientific Publications
1998. ISBN: 063204344X
9. Clinically orientated anatomy. Moore KL, Dalley AF. Lippincott Williams and Wilkins
2005. ISBN: 0781736390.
10. Pathology for Surgeons in Training: An A-Z revision text. Gardner DL and Tweedle
DEF. Arnold 2002. ISBN: 0340759046
11. Ocular Pathology, 5th ed. Yanoff M and Fine BS. Mosby 2002. ISBN: 0323014038
12. Medical Microbiology. Greenwood D, Slack R, Peutherer J. Churchill Livingstone 2002.
ISBN 0443070776
13. Medical pharmacology at a glance. Neal MJ. Blackwell Publishing 2002. ISBN:
0632052449
14. Clinical Ocular Pharmacology. Jaanus SD, Barlett JD. Butterworth-Heinemann 2001.
ISBN: 0750670398

15. Genetics for Ophthalmologists: The molecular genetic basis of ophthalmic disorders.
Black GCM. Remedica Publishing 2002. ISBN: 190134620X
16. Biochemistry of the eye. Whikehart R. Butterworth-Heinemann 2003. ISBN: 0750671521

2.CURRICULUM FOR BASIC OPHTHALMOLOGY COURSE

Course Timetable
Since the basic medical training in ophthalmology is minimal and in recognition of the
objectives set, the length of the course will be two months with an examination at the end.
SUMMARY TABLE
Module I:
Basic sciences and clinical Foundations of ophthalmology
Module II:

Basic Refraction/Optics+practicals

Module III:

Clinical Foundations of Ophthalmology+clinical posting

Module IV:

Basic microsurgical skills including wet/dry lab

Revision and examinations

TOTAL

2 months

Objectives of the Course

At the end of the course new residents should be able to do the following:
Educational
1.
2.
3.
4.

Understand the pathogenesis of ocular conditions

Understand the clinical features of common ocular conditions
Diagnose the common eye conditions
Understand the basic optics of ophthalmic instruments

Task Oriented
Clinical Skills
Medical:
Diagnose and manage common ocular disorders
Have Basic skills in:
- Basic eye examination
- Assessment of visual acuity, distance and near

Direct ophthalmoscopy
Slit lamp examination
Tonometry
Retinoscopy
Perimetry and assessment of ocular motility
Swab- taking and gram staining
Indirect ophthalmoscopy
Gonioscopy
Exophthalmometry
Skin snipping and examination for microfilaria in endemic areas

Surgical Skills
Know and be able to perform the
- Types of conjunctival flaps
-Types of sutures and indications for their use
-The various suturing techniques
-The various types of anterior capsulotomy
-The various types of graft
- Administering sub conjunctival injections
- Retrobulbar injection
- Facial nerve/and lid block

2. Course Content
A: BASIC SCIENCES
Basic clinical medicine requires a clear understanding of the basic sciences which
should be taught with a clinically oriented and whenever possible an integrated approach.
The applied basic sciences relevant to the membership/Fellowship course are:
1. Anatomy including Embryology
2. Physiology and Biochemistry
3. Pathology including immunology and patterns of disease
4. Genetics
5. Pharmacology
THE BONY ORBIT AND PARANASAL SINUSES
ANATOMY
The Bony Orbit
- The roof of the Orbit, structure, relations
- The medial wall, structure, relations
- The floor, structure, relation
- The lateral wall, structure, relations
- Fissures and Canals
- Superior orbital fissure
- Inferior orbital fissure

Anterior and posterior ethmoidal fissure

Optic foramina
Surface Anatomy The orbital margin

The Paranasal Sinuses

Maxillary sinus
Frontal sinuses
Ethmoidal sinuses
Spheniodal Air sinuses
Nerve supply
Lymphatic Drainage.

PATHOLOGY OF THE ORBIT

Orbital Inflammation
Orbital Cellulitis
Orbit Pseudotumours
Dysthroid Eye Disease
Burkitts Lymphoma and other tumours of the orbit.
Paranasal inflammations and tumours.
THE OCULAR APPENDAGES

ANATOMY
Eyelids
Structure, glands, etc
Palpebral ligaments (Medial and Lateral)
Orbital Septum/ Relations
Blood Vessels of the Lids
Orbicularis Oculi/ Relations
Actions of muscles
Nerve Supply
The Eyebrows

Conjunctiva
Palpebral
Fornices
Bulbar
Structure of the conjunctiva
Arteries, Veins, Lymphatic drainage and nerve supply of the conjunctiva

The caruncle and plica semilunaris

The Lacrimal Apparatus

The Lacrimal Gland
- Structure
- Vessels, Lymphatics and Nerves
The Puncta, Lacrimal canaliculi
The Lacrimal Sac
- Relations
The Nasolacrimal Duct
Structure and relations

PHYSIOLOGY OF THE EYELIDS

Secretions of the Eyelids
Normal Movements of the Eyelids
- Opening
- Closure
- Blinking
PHYSIOLOGY: THE LACRIMAL APPARATUS
The Tear Film and its functions
Composition of Tear
Secretion of Tears (Basic and Reflex Secretion)
Drainage of Tears
PATHOLOGY OF THE EYELIDS AND CONJUNCTIVA
The Eyelids
Inflammations - Acute
- Chronic
Including stye, chalazion, trachoma, leprosy
Tumours
- Benign
- Malignant
The Conjunctiva
Conjunctivitis - Infective :
- Bacteria
- Viral
- Chlamydial
- Parasitic Loaloa)
- Allergic, vernal
Degenerations
- Pterygium
- Pinguecula
Tumours

- Benign

-Malignant

ANATOMY OF THE CORNEA AND SCLERA

Structure, Vessels and Nerves of the Cornea and Sclera.
PHYSIOLOGY AND BIOCHEMISTRY OF THE CORNEA
Corneal Metabolism
Permeability and transport of Drugs
Factors affecting drug penetration
- Drug Solution
- Chemical structure of the solute and solvent
- Molecular weight and concentration of transported molecules
- pH and osmolarity of Solutions
- Surface tension reducing agents
- Layers of the corner
Corneal Transparency
- Physical Factors
- Mechanisms that preserve corneal dehydration:
Anatomic integrity of endothelium and epithelium
Electrolyte and osmotic balances
Evaporation of water through the anterior surface
Intraocular pressure
- Effects of swelling on corneal transparency
Healing of corneal wounds
PATHOLOGY OF THE CORNEA
Corneal Ulcers/Keratitis
Bacterial
Viral
Fungal
Parasitic (e.g. Microfilaria in Onchocerciasis)
Moorens Ulcer
Nutritional
Corneal Opacification
Degeneration of the Cornea
Keratoconus, corneal dystrophies and corneal endothelial decompensation
THE LENS
ANATOMY

- Structure of the lens

- The Ciliary zonule
PHYSIOLOGY AND BIOCHEMISTRY
Biochemistry of the lens
Clinical modification of lens proteins in Ageing and Cataract
Accommodation
- Mechanism of Accommodation and Refraction
- Depth of Field and Depth of focus
- Relationship between Accommodation and Convergence
PATHOLOGY
Age-related cataract
Pseudo-exfoliation
Congenital Cataract
Lens-induced reactions
Complications of Couching
THE UVEAL TISSUE
ANATOMY
Structure, Vessels, and Nerves of the Iris, Ciliary Body and the Choroid.

PATHOLOGY
Inflammations of the choroid
Uveal Naevi and Malignant Melanoma
Tumours metastic to the eye e.g. from breast and lung
PHYSIOLOGY OF THE PUPIL
Review Pharmacology of the pupil
Cholinergic/anticholinergic drug
Sympathomimetic and sympatholytic drugs
Pupillary reaction to light, accommodation, convergence
Pupillary Defects: Afferent and Efferent

THE AQUEOUS HUMOUR CHAMBERS

ANATOMY
Anterior and Posterior Chambers and Anatomy of the angle and the trabecular meshwork.

PHYSIOLOGY OF AQUEOUS HUMOUR

The Ciliary Epithelia
Blood aqueous Barrier
Aqueous Humour Formative Mechanism:
- Active Secretion
- Ultra Filtration
- Carbonic anhydrase inhibition
- Control of Aqueous Formation
Aqueous Humour Composition
- Exchange of substance between aqueous and surrounding tissues
- Osmolarity
- Electrolytes
THE INTRAOCULAR PRESSURE
Factors affecting the Intraocular Pressure (IOP):
- Resistance to flow and facility of flow
- Osmotic Pressure
- Drainage of aqueous (Trabecular/Uveoscleral out-flow)
- Episcleral venous pressure
- Ocular rigidity
Measurement of intraocular pressure (IOP).
PATHOLOGY: GLAUCOMA
- Primary Open Angle Glaucoma (POAG)
- Primary Angle Closure Glaucoma (PACG)
- Secondary Angle Closure Glaucoma (SOAG)
Congenital Glaucoma
Tissue changes caused by Glaucoma Optic Nerve
-Apoptosis
ANATOMY AND PHYSIOLOGY OF THE VITREOUS
Embryology and Anatomy
Physical Properties of the vitreous
Molecular structure of the Vitreous
Changes in Vitreous Volume
Chemical composition of the Vitreous and exchange of substances
Vitreous substitution
THE RETINA
ANATOMY
- Structure

- Blood Supply

PHYSIOLOGY AND BIOCHEMISTRY

Blood-retinal Barrier
Visual Pigments
Bleaching of Visual Pigments; Visual Cycle, Photoreceptor renewal
Carbohydrate Metabolism
Neurotransmitters in the Retina
Nutrition and the Retina
The Electrical Phenomena in the Retina
Electroretinogram (ERG) Pattern
Electro-oculogram (EOG)
Physiologic basis
Visual Adaptation
- Dark adaptation and Regeneration of Rhodopsin
- Light adaptation
Colour vision
- Wavelength discrimination
- Trichromacy of colour vision
PATHOLOGY OF THE RETINA
Retinal Inflammatory Disease
- Onchocerciases
- Toxoplasmosis
- Toxocariasis
and other Chorioretinal inflammations.
Retinal Vascular Disorders
- Diabetic retinopathy
- Sickle cell disease
- Hypertension (+Toxaemia of pregnancy)
- Retinal artery and vein occlusion
Retinal Detachment
Other retinal disorders
Diseases of the Retinal periphery
Diseases of the macula including age related macular degeneration
Chorioretinal Degenerations
Retinoblastoma

VISUAL ACUITY
The form sense discrimination between stimuli of varying intensity and position
Definition of Visual Acuity
Measurement (Distance and Near)
Factors influencing Visual Acuity
- Refractive Error
- Luminance
- Contrast
- Pupil Size
- Exposure duration
- Perception
- Target and eye movement
- Ageing
Methods of assessment eg Snellens, log mar
ANATOMY OF THE EXTRAOCULAR MUSCLES
The Extrinsic Muscles
- Structure
The Extraocular Muscles
- 4 Recti
- 2 Obliques
- 1 Levator Palpebrae superioris
- Relations, Nerves, Blood Supply, Actions
The Tenons Capsule (or Fascia Bulb)
The Orbitat fat:
- Apertures at the base of Orbit through which Orbital fat may herniate.
PHYSIOLOGY OF THE EXTRAOCULAR MUSCLES
Anatomic Relations, Extraocular muscles and Orbit
The Conjugate eye movements
The non-conjugate eye movements
Binocular Vision
Binocular single vision and stereopsis
Monocular cues
Clinical Assessment of Binocular movements

ANATOMY - CRANIAL NERVES

Origin, Course and Relations
Nucleus and connections of
the Oculomotor Nerve (III)
the Trochlear (IV)
the Abducens (IV)
the Trigeminal (V)
the Gasserian Ganglion
the Facial Nerve (VII)
Sympathetic and Parasympathetic Nerves
ANATOMY - THE ORBITAL VESSELS
The Ophthalmic Artery:
- Course, relations, branches
The veins that drains the Face and the Orbit:
- Superior Ophthalmic veins: Tributaries
- Angular Vein: Tributaries
- Cavernous sinus: Tributaries
Lymphatics of the Orbit

ANATOMY AND PHSIOLOGY - THE VISUAL PATHWAYS

The Optic Nerve (II)
- Course and Relations
- Structure of the Optic Nerve
The Optic Chiasma
- Relations
The Optic Tracts
- Course and relations
The Lateral Geniculate Bodies
Blood supply of the Visual Pathway
PATHOLOGY - THE OPTIC NERVE
- Inflammation
- Optic Atrophy
- Papilloedema
- Neoplasia

EMBRYOLOGY
Development of the eye and adnexae
Congenital abnormalities
GENERAL PATHOLOGY
Pathogenesis of Disease
Multifactorial Causation
Inflammatory Reaction
- Elements of the Inflammatory Reaction
- Infections and non-infectious agents of Inflammation
Granulomatous and Non-granulomatous
- Cellular sequelae of inflammation (Healing and Repair)
Trauma: Ophthalmic wound healing
- Cellular components
- Healing in specific tissues
- Surgical Trauma
- Non-surgical Trauma
Principles of Immunology
Mechanisms of Immune Reactivity (Types 1 to V reactions)
Basic Genetics
- Pattern of Disease inheritance
Multisystem Disease
Ageing, Atrophy and Degeneration
Hypertrophy, hyperplasia and metaplasia
Neoplasia - Benign
Malignant
MICROBIOLOGY
Infective organisms of the eye
Conjunctival Swab/Corneal Scraping for Gram Staining and Culture
Principles of Sterilisation
PHARMACOLOGY
Review of Principles of Pharmacology
- Pharmacokinetics
- Eye Drops
- Ointments
- Periocular injections
- Systemic Therapy

Pharmacodynamics

Cellular Pharmacotherapeutics
- Cholinergic Agents
- Muscarinic drugs
- Nicotinic drugs
- Adrenergic Agents
- Alpha adrenergic agents
- Beta adrenergic agents
- Beta adrenergic antagonists
- Carbonic anhydrase inhibitors
- Osmotic agents
- Actions and uses
- Agents
- Intravenous and oral
Anti-inflammatory agents
- Glucocorticoids
- Non-steroidal anti-inflammatory agents
- Antihistamines and sodium chromoglycate
- Antimetabolites
- Antibiotics
- Antibacterial agents
- Antifungal agents
- Antiviral agents
- Local Anaesthetics
Ocular Toxicology (To be treated with various drugs)
B: OPTICS AND REFRACTION
I

PHYSICAL AND GEOMETRIC OPTICS

1. Properties of light
(a) Electromagnetic Spectrum
(b) Wave theory
(c) Particle theory
2.

Refraction
(a) Laws of refraction (Snells Law)
(b) Refraction at a plane surface
(c) Refraction at curved surface
(d) Critical angle and total internal reflection

3. Prisms
Definition
Notation of prisms
Uses in Ophthalmology (diagnostic and therapeutic)
Types of prisms

II.

4.

Spherical Lenses
Cardinal points
Formation of the image
Vergence power (dioptric power)
Magnification
Spherical decentration and prism power

5.

Astigmatic Lenses
Cylindrical lenses
Maddox rod
Toric lenses
Conoid of Sturm
Jackson Cross cylinder

6.

Notation of Lenses
Spectacle prescribing
Simple transposition
Transposition of Lens Prescription

7.

Identification of Unknown Lenses

Neutralisation
Focimetry

8.

Aberration of Lenses
Spherical aberration
Chromatic aberration
Correction of aberration relevant to the eye
Duochrome test

CLINICAL OPTICS
1. Optics of the eye
2. Pupillary response and its effect on the resolution of the optical system (StileCrawford Effect)
3. Visual acuity
4. Emmetropia
5. Ametropia
Myopia
Hypermetropia
Astigmatism
Prevalence
Inheritance
Changes with age
Surgically induced
Correction of ametropia
Spectacle lenses

Contact lenses
Anisometropia
Aniseikonia
6. Aphakia (including problem of spectacle correction)
7. Presbyopia
8. Spectacle magnification
9. Effective power of lenses
10. Intra-ocular lenses; types
11. Keratometry and assessment of IOL requirements
12. Low vision devices
High reading addition
Magnifying lenses
III.

CLINICAL REFRACTION
1. Theory of refraction
2. Retinoscopy
3. Measurement of IPD (Near & Far), BVD,Segment height
4. Measurement of refraction
5. Decentration of lenses and prismatic effect
6. Best form lens
7. Prescribing multifocal lenses
8. Prescribing for children
9. Cycloplegic refraction

IV. THEORY OF INSTRUMENTS

1. Direct Ophthalmoscope
2. Indirect Ophthalmoscope
3. Retinoscope
4. Focimeter
5. Simple magnifying glass (Loupe)
6. Slit-Lamp Microscope-including methods of examination
7. Stereo-tests
8. Applanation tonometry
9. Lenses used for fundus examination
Biomicroscopy (+ 78,+90D lens, Hruby lens, etc)
10. Keratometer
11. Gonioscope and 3 mirror lens

C: CLINICAL OPHTHALMOLOGY
Clinical ophthalmology consists of two sections:
i.
Foundations of Clinical Ophthalmology
ii.
Hospital- Based Practice
I

Foundations of Clinical Ophthalmology

Lectures
Clinical Demonstration
Teaching Ward Rounds
Tutorials
Assessment
1.

2.

History- Taking and Examination of the Eye

A. History
Chief Complaint
Course of Chief Complaint
Associated Complaints
Other Medical Illness
Family History
B.

Examination of the Eye

(i) Diffuse Light
Facial Examination
Orbital examination
Lid Examination
Movement
Lid margin
External Eye Examination
Pupil
Lens
(ii) Ophthalmoscopy
(iii) Slit Lamp Examination
(iv) Tonometry
- Schiotz
- Applanation
(v)
Gonioscopy (optional)

C.

Visual Function Tests

Visual Acuity - Distance
- Pinhole examination
Near Vision
Colour Vision Tests Ishihara
Visual Field Tests
- Confrontation
- Perimetry
- Scotometry

Diseases of the Eyelids

Congenital Ptosis
Infections
- Styes
- Blepharitis

Injuries
Lid Closure Defects
- Entropion
- Ectropion
- Lagophthalmos
- Chalazia and other lid swellings
3.

Disease of the Conjunctiva

Infections
- Ophthalmia Neonatorum
- Bacterial
- Viral; herpetic and measles,,
- Chlamydial; trachoma
- Parasitic
Vernal Conjunctivitis and other allergy
Pterygium
Injuries
- Laceration
- Chemical Burns
Tumours

4.

Diseases of the Cornea and Sclera

Corneal Ulcers/Keratitis
- Bacterial, Viral, Fungal, Parasitic, Nutritional,
Traditional Eye Medications
Trauma
- Foreign Bodies, abrasions
- Laceration
Moorens Ulcer

5.

Glaucoma
Diagnostic Methods
- Tonometry
- Disc Assessment
- Perimetry
- Gonioscopy (optional)
Congenital Glaucoma
Primary Open Angle Glaucoma
Primary Closed Angle Glaucoma
Secondary Glaucomas
Management of Glaucomas
- Chemotherapy
- Surgical
- Others
5.

Ocular Injuries

Contusion
Penetrating
Intraocular Foreign Body
Burns
- Thermal
- Chemical
Orbital Fractures
7.

Uveal Diseases
Uveitis
Tumours

8.

Retinal Diseases
Vascular
- Hypertensive Retinopathy
- Diabetic Retinopathy
- Sickle Cell Retinopathy
- Retinal Artery Occlusions
- Retinal Vein Occlusions
Retinal Degenerations
- Peripheral
- Age related
Retinal Detachments
Toxic Retinopathies
Tumours
- Retinoblastoma

9.

Basic Neuro-Ophthalmology
Anatomy
Pupillary Abnormalities
Oculo-Motor Paralysis
Visual Field Defects

10.

Systemic Diseases and the Eye

Hypertension
Sickle cell disease
Malaria
Hereditary Disorders
- Albinism
- Phakomatosis (Neuro-ectodermal Disorders)
Infections
- Leprosy
- Onchocerciasis
- Trachoma
- Tuberculosis
- Measles

- Rubella
- HIV/AIDs
Nutritional Eye Disease
- Vitamin A Deficiency
Endocrine Diseases
- Diabetes Mellitus
- Dysthyroid Eye Disease
D: BASIC MICROSURGICAL SKILLS
1.
USE OF THE OPERATING MICROSCOPE

What is an operating microscope

-Structure of the microscope
*The body
*The binoculars
*The objective lens
-Important features of a microscope
*The field of vision
*Lighting
*The working space
*The eye to field distance
*Mechanical focusing
*Variable magnification
*Zoom
*Other features
-Types
-Adjustment to the microscope
*The surgeon
*The eye piece setting
*The focusing control
*The Magnification

11.

FOUNDATIONS OF OPHTHALMIC SURGERY

Sterilisation and Sterile Techniques
-Postoperative Infections
Anaesthesia for eye surgery
- Local
- Retrobulbar, Periocular, Facial
- General
Ophthalmic Sutures and Other Consumables
-Types of sutures
- Surgical Management of common problems
-Care of Eye instruments, Theatre Equipment and other equipment
-Suturing techniques

III.WET/DRY LAB
-Suturing
-Step surgery
-Full ECCE+ PCIOL insertion/SICS+PCIOL
-Skills evaluation

END-OF-COURSE EXAMINATION
Examination Format:
-

Written Examination
Paper1: MCQ-100 questions in 2 hours
- Basic Sciences
(25 questions)
- Optics
(25 questions)
- Clinical ophthalmology (50 questions)
Paper II(Clinical/Surgical Ophthalmology): Essays in 3 hours
Paper 111(Optics) :
Essay in 3 hours
-

Clinical Examination
Case for Refraction OSCE
Long case(one)
-

- 5 questions
- 5 questions

30 minutes, 15 minutes with examiners

30 minutes, 15 minutes with the examiner

Viva Voce
Questions in all aspects of general ophthalmology to cover the subspecialities.
Duration: 30 minutes

CRITERIA FOR PASS

1.
At least 50% is the pass mark
2.
Pass in refraction
3.
Pass overall
4.
Pass in clinicals

3. CLINICAL SCIENCE CURRICULUM

Optics and refraction
All trainees must understand and apply knowledge of optics, ultrasound and electromagnetic
wavelengths relevant to ophthalmic practice. They must have a basic understanding of medical
physics. They must be able to use this knowledge when interpreting clinical symptoms, signs and
investigations and in the practice of ophthalmic medicine and surgery.
PHYSICAL AND GEOMETRIC OPTICS:
Properties of light: Electromagnetic spectrum, wave theory, particle theory, diffraction,
interference, resolution, polarisation, scattering, transmission and absorption, photometry, lasers
Reflection: Laws of reflection, reflection at a plane surface, reflection at curved surfaces
Refraction: Laws of refraction (Snells Law), refraction at a plane surface, refraction at curved
surfaces, critical angle and total internal reflection
Prisms: Definition, notation of prisms, uses in ophthalmology (diagnostic and therapeutic), types
of prism
Spherical lenses: Cardinal points, thin lens formula, thick lens formula, formation of the image,
vergence power (dioptric power), magnification, spherical decentration and prism power, lens
form
Astigmatic lenses: Cylindrical lenses, Maddox rod, toric lenses, Conoid of Sturm, Jacksons
cross cylinder Notation of lenses: Spectacle prescribing, simple transposition, toric transposition
Identification of unknown lenses: Neutralisation, focimeter, Geneva lens measure
Aberrations of lenses: Correction of aberrations relevant to the eye, Duochrome test
CLINICAL OPTICS
Optics of the eye: Transmittance of light by the optic media, schematic and reduced eye, StilesCrawford effect, visual acuity, contrast sensitivity, catoptric images, emmetropia,
accommodation, Purkinje shift, pinhole.
Ametropia: Myopia, hypermetropia, astigmatism, anisometropia, aniseikonia, aphakia
Accommodative problems: Insufficiency, excess, AC/A ratio
Refractive errors: Prevalence, inheritance, changes with age, surgically induced
Correction of ametropia: Spectacle lenses, contact lenses, intraocular lenses, principles of
refractive surgery
Problems of spectacles in aphakia: Effect of spectacles and contact lens correction on
accommodation and convergence, effective power of lenses, back vertex distance, spectacle
magnification, calculation of intraocular lens power, presbyopia
Low visual aids: High reading addition, magnifying lenses, telescopic aids - Galilean telescope
Instrument technology
All trainees must understand and apply knowledge of instrument technology relevant to
ophthalmic practice. They must be aware of the limitations of technology and the risks involved
in their use. They must be able to maintain an understanding of new developments in relevant
technologies.
Direct and indirect ophthalmoscopes
Retinoscope

Focimeter
Simple magnifying glass (Loupe)
Lensmeter
Automated refractor
Slit-lamp microscope
Applanation tomography and tonometry
Keratometer
Specular microscope
Operating microscope
Zoom lens principle
Corneal pachometer
Lenses used for fundus biomicroscopy (panfunduscope, gonioscope Goldmann lens, Hruby lens,
90D lens, etc.)
Fundus camera
Lasers
Fields machines (Goldmann, Humphrey)
Retinal and optic nerve imaging devices (OCT, SLO, GDx)

4.CLINICAL OPHTHALMOLOGY
All candidates must understand and apply knowledge of medicine and surgery relevant to
ophthalmic practice. They must understand the principles underlying contemporary ophthalmic
practice and medical and surgical innovations. They must be aware of the breadth of
ophthalmology and the sub-specialties within ophthalmology.
The scope of contemporary clinical ophthalmology is broad and the following list is indicative
rather than exhaustive.
o Clinical anatomy
o Lacrimal problems secretory and drainage systems.
o Orbital inflammation
o Paranasal sinus disease
o Orbital neoplasia
o Orbital malformations
External eye disease
o Clinical anatomy
o Dry eye syndromes
o Conjunctival infection
o Conjunctival inflammatory, degenerative and neoplastic disease
o Scleral and episcleral disease
o Allergic eye disease
o Abnormalities of tear film
Eyelid disorders
o Clinical anatomy
o Blepharitis and Meibomian gland dysfunction
o Malpositions: entropion, ectropion and ptosis
o Lid tumours

Corneal disease
o Clinical anatomy, physiology and immunology
o Keratitis
o Corneal dystrophies and degenerations
o Corneal ectasias
o Clinical anatomy, physiology and biochemistry
o Cataract
o Abnormalities of lens shape and position
Uveal disease
o Clinical anatomy, physiology and immunology
o Uveitis
o Primary and secondary uveal tumours
o Choroidal effusion
Medical retinal disease
o Clinical anatomy, physiology and immunology
o Vascular retinopathies
o Macular degeneration
o Hereditary retinal disease
o Retinal infection
Glaucoma
o Clinical anatomy, physiology and pharmacology
o Classification of glaucomas
Ocular motility and strabismus
o Clinical anatomy and physiology
o Binocularity
o Strabismus
o Myopathies
o Developmental anomalies of binocularity, including amblyopia
Neuro-ophthalmology
o Clinical anatomy and physiology
o Optic nerve disease
o Visual pathway disorders
o Pupil abnormalities
o Nystagmus
o Headache
o Diplopia
o Ptosis
o Cranial nerve palsies particularly IInd, IIIrd, IVth, Vth, VIth and VIIth
Paediatric ophthalmology
o Clinical anatomy and embryology
o Child development and developmental delay
o Congenital abnormalities
o Cataract, glaucoma and retinal disease in children
o Retinopathy of prematurity
o Non-accidental injury

o Assessment of the apparently blind baby/child

o Systemic syndromes
Intraocular tumours
o Primary intraocular neoplasia
o Secondary intraocular tumours
o Non-metastatic effects of neoplasia
Surgical ophthalmology
o Anaesthesia local and general
o Surgical anatomy
o Sterilization of instruments and equipment
o Sutures and other materials used in ophthalmic surgery
o Principles of wound design, construction and healing
o Principles of wound closure, appropriate use of different suture materials and needle design
o Intraocular lenses
o Management of trauma
o Cataract surgery
o Endophthalmitis
o Surgery for glaucoma
o Vitreo-retinal surgery
o Strabismus surgery
o Oculoplastic surgery
o Corneal surgery
o Enucleation
o Nasolacrimal and orbital surgery
o Laser surgery cornea, iris, vitreous, retina
o Complications of surgery general and specific
o Use of human tissue for surgery (eye banking)
5. COMMUNITY OPHTHALMOLOGY CEH curriculum
Four Modules:
Module I Basic Epidemiology for needs assessment in Eye
Module II Control of diseases
Modules III - Planning
Module IV - I nformation, Health Education & Communication
( Available at the WACS Secretariat)
6. RURAL POSTING
The trainee will be the manager of the eye care team in the region/district of a population of
250,000-500,000.
Generally, his duties will include the following:
a. Clinical and surgical duties
b. Training of ophthalmic assistants and integrated eye workers.

c. Community eye care, including an awareness of community eye problems and provision of
eye care services to both rural and urban population.
d. Organisation and administration of regional/district eye care services within the health system
e. Data management and application to local needs and conditions.
f.Linkages inter sectoral and services to irreversibly blind and low vision children and adults.

Specific expected Outcomes of the rural posting

1. Service delivery: A minimum of 75 cataract surgeries should be done, about 600 patients seen
in the outpatient clinic and a further 1,000 seen on community outreach basis.
2. Operational research: He/She should have collected data for writing up a publishable paper.
This paper should be included in the trainees Portfolio .
3. At the end of this posting, the trainee is expected to have acquired the skills in the setting up
and running of services for the eye health component of primary health care as well as the
training of Primary level and community eye care workers or a secondary health centre.
4. During the rural posting the trainee is supposed to be able to perform and exhibit the
following:
Community-Oriented
i. Assessment of local eye care needs and resources
ii. Formulation and management of eye care programmes
iii. Mobilisation of resources and the community for implementation of the eye
care programme
iv.Integration of eye care into health and health- related delivery services
v.Data collection and application.
Educational
i.

Diagnose and manage all the common eye conditions and the majority of blinding
disorders

ii. Perform the majority of basic eye operations including cataract, glaucoma and lid
surgery
iii. Play an effective leadership role within the regional/district health regions
iv. Act as prevention of blindness managers for same

v.

Organise training for health and health related workers

Train ophthalmic nurses and ophthalmic medical assistants

Train integrated eye care worker

Train trainers of community-based workers (health and non- health)

Conduct of workshops for implementation of eye care programmes at district

level

Managerial Skills
i. Formulation and management of eye care programmes
ii.Familiarisation with government rules, regulations and policies of health delivery
iii.Personnel and resources management
iv.Supervision and support of all eye health workers using the team approach
v.Data collection and application
vi.Report writing
vii.Advocacy on eye health issues
viii.Linkages with services for the irreversibly blind and low vision children and adults

Commencement: 2015/2016 with the membership programme commencing in 2014

Posting location
This 3 month rural posting shall be carried out in an identified primary level centre as arranged
by the training institution.
Every accredited centre will provide as part of the requirements for the membership
accreditation, a centre or group of centres that they work with (evidenced by an MOU) in the
training and fulfilment of the rural posting requirement of the membership programme, or rural
outreach posts of the base institution

Organisation of the rural posting

This rural posting will be organized by the primary training institution through a team of trainers
including:
1. Consultant in Charge of secondary facility (If the position and person exists and is available)

2. Rural posting supervisor ( which may be individualized per trainee).This could also be the
consultant in charge of outreach activities in the department of the primary institution where
there arent many consultants or consultants in the primary institution could be rota-ed for
weekly coverage of the rural clinic during the period of the posting
3. Residency training coordinator (In charge of the Ophthalmology training programme in the
institution)
4. Head of Department ( In Charge of the entire department and external relationships with the
international bodies supporting projects, Federal governments departments who can facilitate
the rural posting, state governments and ministry of health and others and local government
and their primary health care agencies)
Posting timetable
This will be drawn up by the resident after hes been informed of where hell be doing his rural
posting.
The individual trainees posting involves:
a. Setting of goals and objectives based on the community hes going to and
what he is expected to achieve
b. Production of trainees work time table( days of surgery, clinic, community
visits/supervision, community training, advocacy etc).This should be prepared
ahead of time.
Feedback to department
Regular and timely feedback on performance is essential to ensure the trainee is performing up to
standard.
Supervision
-The overall supervision of the rural posting lies with the primary training institution, the
consultant in charge of the rural clinic, clinical/community ophthalmology or rural posting
supervisor, the Residency Training Co-ordinator and the Head of Department.

-The publishable paper should be supervised by two Fellows of not less than three years or two
years postqualification or Members of not less than five years post qualification

Completion of the rural posting

For a candidate to be said to have successfully completed the rural postings, he should have
completed the following:
1. The stipulated duration
2. The completed research
3. The rural portfolio with feed backs
4. Report including budget and especially the Log book with evidence of the cataract operation
surgery (catops)log books and analysis of the catops forms of the posting by the residents (a
template will be provided preferably a narrative)
5. Signed discharge by the consultant in charge of the rural facility if there is one present, the
rural posting supervisor/ community outreach supervisor, residency training coordinator and
HOD

Proposed assessment methods

1. During the rural posting with the consultant in charge if any, in clinic and theater
Competence in patient management and health promotion and disease prevention is assessed
using Case based Discussion (CbD).
a. Clinical Rating Scale (CRS) and Objectively Structured Clinical Examination (OSCE)
will be used to assess the residents clinical skills.
b. Procedural skills will be assessed by Direct Observation of Procedural Skills (DOPS)
c. Most of the Attitudes, Ethics & Responsibilities and Communication skills will be
assessed using Multiple Source Feedback (MSF) where appropriate persons are
approached to give feedback on the residents performance.
d. Technical skills will be assessed using Objectively Structured Assessment of Technical
Skills (OSATS)
e. Log Books (for surgeries, examination procedures, refraction, technical procedures) will
be kept by each resident and regularly assessed by trainers

g. By a publishable paper ( Part of the rural posting portfolio)

h. By Rural posting portfolio ( Main submission to Faculty)

Sustainability
If, at the end of the rural posting theres no other trainee to be posted the centre the base
hospital trainees should now be rota-ed to ensure regular coverage of the clinic or a member
could be permanently posted to the clinic.
1. The rural eye care surgical facilities created should consider having a primary consultant eye
physician and surgeon (ophthalmic surgeon) employed to work there by the state or federal
government through a primary employment or seconded from a federal government
institution.
2. The collaboration of the centres with the state or federal government hospital should be
documented with responsibilities clearly spelt out for each member of the eye care team and
the trainee.
3. Stipends for participating in the training and supervision of the rural posting ( with evidence )
should be given to the training team ( the HOD, residency training coordinator, the rural
posting supervisor or the community outreach supervisor, the consultant covering the rural
eye care facility).
4. Stipends(rural posting allowance) should be given to trainees and other members of the eye
care team(the optometrist, the ophthalmic nurse) that offer approved services in the
designated rural facilities.

JOB DESCRIPTION
Rural Posting Supervisor
1. This is the Consultant that supervises the Rural Posting activities of the Resident in
the Posting.
2. Should be a Consultant chosen/assigned to the trainee by the Departmental
Board/HOD. It could rotate from one Consultant to another or depend on which Consultant is
assigned to be in charge of Outreach centers.

3. It should preferably not be the Residency Training Coordinator but this is subject to
the Departmental Board / peculiar prevailing circumstance.
4. To drive the commencement of the rural posting pending when the management
system is put in place, the department or primary/base

hospital could utilize a percentage of

money generated from the rural posting to fund the travel costs of the Rural Posting Supervisor.
They could also appeal to their Management for support.
The Residency training coordinator:
1. Will provide the resident with the information on the rural area he will be going to and
also the profile of the area
2. Successful completion and passing of the CEH module is a prerequisite for going for
the rural posting.

THE PUBLISHABLE PAPER TO BE WRITTEN BY THE TRAINEE

1. As regards Operational Research topics, the rural area should generate the questions
the trainees would seek to answer with the research. In other words, the trainees would find out
the eye problems/ eye care challenges of the community and try to solve it through a research.
2. Also, The research write up would include sections on
Policy Change How the Resident intends his/her findings to be disseminated and
translated into Policy change and practice.

Since the Research sought to meet a need of the community, the answers from the
research should be given back to the community as policy change.
3. The whole write up should not exceed 40pages which should cover from Introduction

to Conclusion.
The research topics should be: Community- based research preferably or Clinical studies.
They should be Prospective studies. They may or may not be operational research or health
systems research.

7. PATIENT INVESTIGATION (PI)

The resident will be expected to acquire the knowledge on how to investigate
patients/interpretation of results during the clinical ophthalmology postings in base hospitals.

A. Orthoptic assessment
All candidates must be able to perfrom simple orthoptic assessment, where appropriate, and
interpret the findings. They must understand the limitations of the investigations and the
implications of positive or negative test results. They must be aware of the cost and resources
involved.
lying basic science of the tests
that make up a typical orthoptic report, including:
o Quantitative and qualitative assessment of vision (children & adults)
o Cover, cover-uncover test and alternate cover test
o Assessment of ocular movements
o Measurement of deviation
o Assessment of fusion, suppression and stereo-acuity.
o Knowledge of Hess Chart/Lees Screen, field of BSV and uniocular fields of fixation
B. Assessment of corneal shape, structure and thickness
All candidates must be able to order and interpret investigations to assess the cornea, although
availability of equipment will vary in different units. They must be able to order and interpret
basic tests. They must be able to interpret more complex investigations and be aware of
specialised techniques. They must understand the purpose and limitations of the investigations
and the implications of a positive or negative test result. They must be aware of the possible
discomfort, distress and risks that the patient may be exposed to with the test as well as the cost
and resources involved.
contemporary tests that are used in corneal practice, including:
o Keratometry
o Corneal topography
o Pachymetry
o Optical coherence tomography
o Specular and confocal microscopy
o Wavefront analysis
C. Biometry
All candidates must be able to order and interpret appropriate biometry investigations,
particularly in relation to decision making in cataract surgery. They must understand the
limitations of the investigation and the implications of an unusual result. They must be aware of
the possible discomfort and distress and risks to which the patient may be exposed during the test
as well as the cost and resources involved.
contemporary tests that are used in ophthalmic practice, including
o Keratometry
o Axial length measurement
o IOL power calculation
o A constants
o Sources of biometric error
o Choice of post-operative refractive error
o Refractive error

D. Fields (automated, Goldmann)

All candidates must be able to order and interpret appropriate visual field investigations. They
must understand the limitations of the investigation and the implications of a positive or negative
test result. They must be aware of the possible discomfort and distress and risks to which the
patient may be exposed during the test as well as the cost and resources involved.
contemporary tests that are used in ophthalmic practice, including
o Humphrey and other automated perimeters and the common forms of statistical analysis
generated
o Goldmann perimetry
E. Retinal and optic nerve imaging
All candidates must be able to order and interpret retinal and optic nerve investigations that
require some form of image capture and analysis. They must be aware of new techniques as they
are developed. They must understand the limitations of the investigations and the implications of
a positive or negative test result. They must be aware of the possible discomfort, distress and
risks that the patient may be exposed to involved with the test as well as the cost and resources
involved.
contemporary tests that are used in retinal practice, including:
o Retinal photography
o Optical coherence tomography
o Scanning laser ophthalmoscopy
F. Ocular angiography
All candidates must be able to order, describe and interpret ocular angiograms. They must
understand the purpose and limitations of the investigation and the implications of a positive or
negative test result. They must be aware of the possible discomfort, distress and risks that the
patient may be exposed to involved with the test as well as the cost and resources involved.
contemporary angiographic tests that are used in retinal practice, including: Fluorescein and
indocyanine green angiography
G. Ultrasonography
All candidates must be able to order and interpret appropriate ocular, orbital and other relevant
ultrasound measurements and images. They must understand the limitations of the investigation
and the implications of a positive or negative test result. They must be aware of the possible
discomfort and distress to which the patient may be exposed during the test as well as the cost
and resources involved.
contemporary ultrasound tests that are used in ophthalmic practice, including:
o A and B scans
o Ultrasound biomicroscopy
o Doppler ultrasound

H. Radiology and other neuro-imaging

All candidates must be able to order and interpret appropriate radiological and related
investigations. They must understand the limitations of the investigation and the implications of
a positive or negative test result. They must be aware of the possible discomfort and distress and
risks to which the patient may be exposed during the test as well as the cost and resources
involved.
contemporary tests that are used in radiological practice, of relevance to the practice of
ophthalmology, including:
o Plain skull and chest X ray
o Orbital and neuro-CT scans
o Orbital and neuro-MRI scans
o Neuro-angiography
I. Ocular Electro-diagnostic tests
All candidates must be able to order and interpret appropriate electrodiagnostic tests. They must
understand the limitations of the investigation and the implications of a positive or negative test
result. They must be aware of the possible discomfort and distress and risks to which the patient
may be exposed during the test as well as the cost and resources involved
contemporary tests that are used in ophthalmic practice, including:
o Electroretinography
o Electrooculography
o Visually evoked potentials

J. Biochemistry
All candidates must be able to order and interpret appropriate biochemical investigations and
recognise when further action is required. They must understand the limitations of the
investigation and the implications of a positive or negative test result. They must be aware of the
possible discomfort and distress and risks to which the patient may be exposed during the test as well
as the cost and resources involved.
contemporary tests that are used in ophthalmic practice, including
o Liver and renal function tests
o Blood glucose
o Cardiac enzymes
o Acid-base balance
o Blood gases
o Thyroid function tests
K. Haematology
All candidates must be able to order and interpret appropriate haematology investigations and
recognise when further action is required. They must understand the limitations of the
investigation and the implications of a positive or negative test result. They must be aware of the

possible discomfort and distress and risks to which the patient may be exposed during the test as
well as the cost and resources involved.
Interpretation and an understanding of the performance and underlying basic science of
contemporary tests that are used in ophthalmic practice, including
o Clotting screens
o Blood count
o Blood transfusion
o ESR. CRP and blood viscosity
L. Pathology
All candidates must be able to order and interpret appropriate pathology investigations and
recognise when further action is required. They must understand the limitations of the
investigation and the implications of a positive or negative test result. They must be aware of the
possible discomfort and distress and risks to which the patient may be exposed during the test as
well as the cost and resources involved
are used in ophthalmic practice, including
o Types of biopsy
o Transport of specimens
o The law in relation to human tissue
M. Microbiology
All candidates must be able to order and interpret appropriate microbiology investigations and
recognise when further action is required. They must understand the limitations of the
investigation and the implications of a positive or negative test result. They must be aware of the
possible discomfort and distress and risks to which the patient may be exposed during the test as
well as the cost and resources involved.
contemporary tests that are used in ophthalmic practice, including
o Collection of samples for virology, bacteriology, mycology, parasitology
o Corneal scrapes
o Conjunctival swabs
o Intra-ocular samples
o Sampling for MRSA and other important hospital acquired infections
o Know how to set up and use side laboratory in the eye unit
N. Immunology and allergy testing
All candidates must be able to order and interpret appropriate immunology and allergy
investigations and recognise when further action is required. They must understand the
limitations of the investigation and the implications of a positive or negative test result. They
must be aware of the possible discomfort and distress and risks to which the patient may be
exposed during the test as well as the cost and resources involved
ing basic science of
contemporary tests that are used in ophthalmic practice, including
o Auto-antibodies
o HLA antigens

o Patch/allergy tests
O. Urinalysis
All candidates must be able to order and interpret appropriate urinalysis and recognise when
further referral is required. They must understand the limitations of the investigation and the
implications of a positive or negative test result.
contemporary tests that are used in ophthalmic practice, including
o Proteinuria
o Haematuria
P. Bone scans
All candidates must know when it is appropriate to order bone scans as part of bone protection in
long term steroid use. They must recognise when action is required based upon the report. They
must understand the limitations of the investigation and the implications of a positive or negative
test result. They must be aware of the possible discomfort and distress and risks to which the
patient may be exposed during the test as well as the cost and resources involved..
contemporary tests that are used in ophthalmic practice, including Dexa-scans
8. Patient Management (PM)
This should be consolidated during the trainees clinical ophthalmology postings.
Visual standards
All candidates must know and be able to interpret the visual standards for driving. They must be
able to locate published guidance and advise a patient on occupational visual standards. They
must be able to respond appropriately to requests for information about a patient's vision from
the relevant authority.
individuals country.
Therapeutics
All candidates must understand and apply knowledge of clinical therapeutics relevant to
ophthalmic practice. They must be able to use this knowledge when prescribing for a patient.
They must understand the therapeutics used in general medicine and surgery to a basic standard.
They must be aware of the possible ocular effects of systemic medications and systemic effects
of ocular medications.

-infective drugs
-inflammatory drugs
-elastics
-suppressants and cytotoxic drugs used in ophthalmic practice

-platelet drugs and anti-coagulants

ar medications

Laser
All candidates must understand and apply knowledge of lasers relevant to ophthalmic practice.
They must be able to use this knowledge when recommending laser treatment in the practice of
ophthalmic medicine and surgery. They must be fully versed in local laser safety procedures.

Spectacle lenses
All candidates must be able to identify when a patient may benefit from the use of spectacle
lenses and prisms. They must be able to assess the type and strength of lens or prism and provide
an appropriate prescription. They must be able to advise a patient on the purpose, duration and
optical effects of the prescription. They should be able to liaise with optometrists and orthoptists,
where available.

Contact lenses
All candidates must be able to recommend the use of contact lenses when indicated by the
patient's clinical problem. They must be able to make an appropriate referral and make
appropriate provision for the patient to be reviewed. They must be able to advise on basic contact
lens care and be able to recognise and manage the complications of contact lens use.
es of contact lenses

Diet and nutrition

All candidates must understand how dietary deficiencies and nutritional problems can lead to
ophthalmic disease. They must be able manage the patient appropriately, by prescription of
supplements or referral for expert advice. They must be able to advise a patient on the role of
nutritional supplements in the management of ophthalmic disease

Ocular Manifestations of Systemic diseases

All candidates must be able to recognise when a patient's ocular problem is a manifestation of a
systemic disorder. They must be able to explain this to the patient and make appropriate
arrangements for further management.
related opportunistic infections

abolic disorders relevant to ophthalmology

General Medicine and Neurology

All candidates must understand and apply knowledge of general medicine and surgery relevant
to ophthalmic practice. They must be able to recognise when a patient is seriously ill and make
appropriate arrangements for the patient's care.
Knowledge, to the level of a newly qualified doctor, is expected in the following areas:

-biliary and pancreatic disease

-base balance
espiratory disease

ability to recognize the ill patient

anaphylaxis, hypo/hyperglycaemia, the unconscious
patient and cardiac and respiratory arrest
Psychology
All candidates must understand and apply knowledge of clinical psychology relevant to
ophthalmic practice. They must understand the psychology of vision to a basic standard and how
psychological problems can become manifest with ophthalmic symptoms. They must be able to
recognise when a patient's mental state is disturbed and make appropriate arrangements for the
patient's care.

Sociology
All candidates must understand and apply knowledge of medical sociology relevant to
ophthalmic practice. They must understand how social problems can influence ophthalmic
symptoms. They must be able to refer a patient for appropriate social services support.
ment

Epidemiology/Evidence Based Medicine

All candidates must understand and apply knowledge of clinical epidemiology and evidence
based medicine relevant to ophthalmic practice. They must be able to use this knowledge during
clinical assessment, interpreting investigations and planning clinical management for a patient.

st evidence for practice

Instruments
All candidates must understand and apply knowledge of instrument technology relevant to
ophthalmic practice. They must be aware of the limitations of technology and the risks involved
in their use. They must be able to maintain an understanding of new developments in relevant
technologies

Statistics
All candidates must understand and apply knowledge of statistics relevant to ophthalmic
practice. They must be able to use this knowledge in the interpretation and publication of
research
-parametric hypothesis tests, correlation and
regression, statistical significance)

Genetics
All candidates must understand and apply knowledge of clinical genetics relevant to ophthalmic
practice. They must be able to use this knowledge when advising patients about patterns of
inheritance. They must recognise when it is appropriate to refer a patient for genetic counseling.
They must recognise when it is important to offer a consultation with family members.

Economics
All candidates must understand and apply knowledge of health economics relevant to ophthalmic
practice. They must understand how ophthalmic services are planned and managed within the
health service.

APPENDICES
APPENDIX 1:RECOMMENDED TEXT/READING MATERIALS
BASIC SCIENCES
1. Training centre library books
2. Anatomy
3. Davsons Physiology of the Eye
4. Immunology Roitt
or
Essential Immunology
5. Genetics
6. Elements of Medical Genetics
Churchill Livingstone
7. Pharmacology
8. Pharmacology
Churchill Livingstone,
9. Greers Ocular Pathology by 10. Clinical anatomy of the eye 11. Adlers physiology of the eye-Adlers
SURGICAL OPHTHALMOLOGY
1. Stallards Eye Surgery
2. Ophthalmic Plastic Surgery 3. Elements of Ophthalmology Applied to the
Practice of Tropical Medicine
Lucquiaud, J. Vedy. J.
4. Eye Surgery in Hot Climates- 5. General Surgery at the District Hospital
Sankaran and
Wasunna WHO.
6. General Anaesthesia at the District Hospital
OPTICS AND REFRACTION
1. Clinical Optics
2. Practice of refraction
3. Clinical refraction Series
4. A basic guide to practical refraction for
new residents in Ophthalmology
Okosa
CLINICAL/MEDICAL OPHTHALMOLOGY
1. Principles of Ophthalmology
2. Ophthalmology Principles and Concepts
3. Eye Diseases in Hot Climates
4. Epidemiology of Eye Diseases al

Last JR
Blackwell
Emery and Mueller

-Rang and Dale

- David R. Lucas
- Snell and Lemp

- by Roper-Hall
- by S. A Fox

- by Chovet.,

- Sandforth Smith
- by J. Cook; B

- Elkington
-Duke Elder
American Academy

- Chimdi Chuka-

- Kanski
- Newell F
- Sandforth Smith
- Gordon Johnson et

5. Clinical Ophthalmology(also in CDs)

6. Clinical Ophthalmology Jakobiec
7. Clinical Ophthalmology Peyman
8. American Academy series
-

- Duke Elders
- Albert and

- Goldberg and

- All volumes

Appendix 11: SURGICAL REQUIREMENTS

Surgical Procedures

Nos.

1.
2.

Cataract (with minimal or no supervision)

Capsulotomy (YAG Laser) -

60
10

3.
4.

Trabeculectomy
Lid Lacerations

10
10

5.

Entropion

10

6.
7.

Ectropion (if available)

Tarsorrhaphy -

5
5

8.
9.
10.
11.

Pterygium
Anterior Scleral Suturing/Corneal Suturing Removal of Cornea / subtarsal foreign bodies
Conjunctival flaps
-

10
10
5
5

12.

Paracentesis

10

13.

Evisceration

14.

Enucleation

15.
16.
17.

Orbital abscess-incision and drainage in adults

Chalazion-incision and curettage
Syringing and Probing
-

5
10
5

18.

EUA and Refraction (if possible)

10

19.

Others( specify) eg Strabismus surgery

APPENDIX 111:REFRACTION
Error of refraction
a. Myopia
b. Hypermetropia
c. Presbyopia
d. Astigmatism
e. Pseudophakia/aphakia
f. Children(Cycloplegic refraction) -

Nos
30 cases
20 cases
50 cases
20 cases
50 cases
10 cases

APPENDIX 1V: CONTENTS OF PORTFOLIO

1.
2.
3.
4.
5.
6.
7.
8.

Logbook containing signed Surgeries, Refractions etc

Publishable paper
Certificate of courses attended
Letter of Certification of Rural Posting
Papers presented at departmental clinical meetings Minimum of 5
Cases presented in clinics minimum of 5
Write up of interesting/ challenging cases managed Minimum of 5
Formative assessment papers.

APPENDIX V: ASSESSMENT FORMS

A: Refraction Skills assessment form
INSTRUCTION: TICK in the appropriate box
RESIDENTS NAME: :..............................................................
ASSESSOR:
...............................................................
YEAR OF ENTRY INTO RESIDENCY PROGRAMME... DATE: ......
Level:
l.................................
1-Does not meet expectation; 2 -meets some expectation; 3-meets all expectations
4- Exceeds all expectations.
A. HISTORY-TAKING SKILLS
Introduced Self
Obtained patients personal data
Obtained chief complaint
History of presenting complaint
Past ocular/Medical history

PERFORMANCE
3
4

NA

Family ocular/medical history

Drug/Allergy history
B. EXAMINATION SKILLS
Unaided distant visual acuity
Aided distant visual acuity
Pinhole distant visual acuity
Unaided near visual acuity
Aided near visual acuity
Determination of power of spectacle correction
Ocular motility
Hirschbergs test
Cover/uncover tests
Convergence insufficiency
Examination of the anterior segment
Slitlamp biomicroscopy
Tonometry
Fundoscopy

C. RETINOSCOPY SKILLS
Properly placed trial frame on patients face
Dimmed the room light
Well positioned to examine patient
Instruct patient to fixate at a distance
Gross retinoscopy at working distance
Subjective retinoscopy
Duochrome chart
Jackson cross Cylinder
Astigmatic fan
Presbyopic correction
Assessment of range of vision with correction
IPD (Near, Distance)
Back vertex distance
Segment height
Discussion with pt on type of (presbyopic)
glasses
D. WRITING OF PRESCRIPTION
Clear
Has all relevant measurements
Has instructions for patient
Adequate spectacle specifications
E. CASE PRESENTATION
Clear and concise
Pertinent facts

Accurate prescription
Response to attending questions
Comments: ____________________________________________________________
______________________________________________________________________
______________________________________________________________________
Signed:

.............................

Supervisor

_______________

Resident______________

B: SURGICAL SKILLS ASSESSMENT FORM

TREATMENT OF INTRAOCULAR STRUCTURES
2
3
1.
Careful handling of
Frequently used unnecessary
intraocular tissues but
force or caused damage by
occasionally caused
inappropriate use of instruments
inadvertent damage
TIME, MOTION AND ENERGY
1
2
3
Many unnecessary movements
Efficient time/ motion/energy
Entered and exited eye
but some unnecessary moves
needlessly
EYE POSITION AND MICROSCOPE USE
1
2
Constantly required re-centration
and/or re-focusing of microscope

INSTRUMENT HANDLING AND USE OF NON-DOMINANT HAND

1
2
3
Repeatedly makes tentative,
Competent use of instruments
awkward or inappropriate
but occasionally stiff or
movements with instruments
awkward
KNOWLEDGE OF INSTRUMENTS AND EQUIPMENT
1
2
3
Frequently asked for wrong
Knew names of most
instruments or used
instruments and used
inappropriate instruments.
appropriate tool for task
Unaware of proper equipment
settings
FLOW OF OPERATION
1
2
3
Frequently seemed unsure of
Demonstrated some forward
surgical plan
planning with reasonable
progression the procedure
KNOWLEDGE OF SPECIFIC OR NEW PROCEDURE OR TECHNIQUE

5
Appropriate handling of
intraocular tissues with no
damage to ocular tissue

5
Clear economy of movements
and maximum efficiency by
conserving intraocular motion
and energy

5
Kept the eye centered,
maintained good view with
microscope

5
Fluid moves with instrument
and no awkwardness, conserving
intraocular movement

5
Obviously familiar with the
instruments and equipment

5
Planned course of operation
effortlessly from one move to
next

1
2
3
Require specific instruction at
Knew all important steps of
most steps
the operation
INTER
ACTION WITH ASSISTANTS/SCRUB NURSES
1
2
3
Failed to request or use
Appropriate use of assistance
assistance when needed
most times
HANDLING OF UNEXPECTED INTRAOCULAR EVENTS
1
2
3
Unable to recognize adverse
Professional and competent
events or unable to request
identification of event. Able
proper assistance.
to request appropriate
assistance
OVERALL PERFORMANCE
1
2
3
Unable to perform operation
Competent, could perform
independently
operation with min assistance

RESIDENT

..

SUPERVISOR

..

5
Familiar with all aspects of the
operation

5
Strategically used assistants to
the best advantage at all times

5
Superior independent
management of event

5
Clearly superior, able to perform
operation independently and
with confidence

APPENDIX VI: EXTERNAL POSTINGS

A: ENT Posting
Learning points
1. Understand the anatomy of paranasal sinuses and other structures around the
ocular adnexa
2. Understand the development of the orbit in relation to the sinuses and the nasal
cavity
3. Understand the normal drainage of tears in relation to the nasal cavity
4. Study the aetiopathogenesis of the common diseases of the paranasal sinuses as
they affect the orbit e.g.mucoceles and their management
5. Understand the basis of spread of infections from the nostrils/sinuses to the orbit
6. Understand the common causes of orbital cellulitis
7. Study the common ENT tumors that affect the eye and orbit and the principle of
their management

B: NEUROSURGERY AND NEUROLOGY Postings

Learning points
1. Understand the general outlay of the brain, brainstem and location of the cranial
nerve nuclei
2. Revise the course of the cranial nerves, the sympathetic nervous and
parasympathetic nervous systems
3. Relate the various cranial nerves to one another and clinical signs resulting from
their affectation
4. Revise the anatomy of the visual pathway and the organs in close relation to it
5. Understand the basis for and types of visual field changes in various diseases of
the brain and visual pathway.
6. Understand the general principles of skull x-rays, brain CT Scans and MRI
7. Have an understanding of how to read and interpret skull x-rays, CT Scans and
MRI
8. Revise the diseases of the cranial cavity that affect the eye/vision
9. Correlate the pupillary response with disease conditions affecting the visual
pathway
10. Understand the pathogenesis of the ocular complications of head injury
11. Understand the supranuclear control of eye movements and the manifestations in
pathologic states
12. Understand the aetiology and pathophysiology of headaches
13. Understand the aetiology and management of Ptosis
14. Understand the neurological manifestations and management of suprasellar/sellar
tumours

CURRICULUM FOR THE FELLOWSHIP PROGRAMME

PREAMBLE

The Fellowship will likely commence in October/November 2017.

The fellowship programme of the faculty currently in use will run concurrently with
this new curriculum until it is phased out around 2020/21.
This new fellowship will be purely a subspeciality training programme.
The candidate will specialize in one of the following subspeciality areas:
a. Anterior segment and cornea
b. Glaucoma
c. Paediatric Ophthalmology and strabismus
d. Retina and Vitreous
e. Oculoplastic surgery
f. Neuroophthalmology

A. Entry Requirements for Fellowship Training

i)
Must be registered and in good standing with Medical and Dental
Council
Candidate must possess a membership or equivalent
Candidates can progress directly from membership but One year
experience(postmembership) an advantage
Must produce recommendations from 2 referees
Must pass selection exam/ interview
ii)

Fellowship objectives
Prepare to be a trainer
Prepare to be a specialist: Exposure to subspecialties
o Public health component of each subspecialty
Prepare to be a researcher
o A dissertation
Courses
o Management
o Research methodology
o Communications training methods and skills

B. Expected outcomes of the fellowship programme

1.To produce a subspecialist that can deliver specialist ophthalmic care in response to the
ocular pathology

2. To produce a specialist in a subspeciality area with the requisite amount of knowledge,

skills and attitudes who is capable of independent subspeciality practice
3.He/she should be able to contribute to his subspeciality through publications and is
expected to participate in the training of postmembership trainees under him
C. Duration of Training
i. The duration shall be two (2) years, full-time, for the award of Fellowship of the
College.
D. Course content
This will depend on the area of subspeciality.