® P R A C T I C I N G O P H T H A L M O L O G I S T S C U R R I C U L U M 2 0 1 4 - 2 0 1 6 Core Ophthalmic Knowledge *** Core Ophthalmic Knowledge 2 © AAO 2014-2016 Practicing Ophthalmologists Curriculum Disclaimer and Limitation of Liability As a service to its members and American Board of Ophthalmology (ABO) diplomates, the American Academy of Ophthalmology has developed the Practicing Ophthalmologists Curriculum (POC) as a tool for members to prepare for the Maintenance of Certification (MOC) -related examinations. The Academy provides this material for educational purposes only. The POC should not be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the best results. The physician must make the ultimate judgment about the propriety of the care of a particular patient in light of all the circumstances presented by that patient. The Academy specifically disclaims any and all liability for injury or other damages of any kind, from negligence or otherwise, for any and all claims that may arise out of the use of any information contained herein. References to certain drugs, instruments, and other products in the POC are made for illustrative purposes only and are not intended to constitute an endorsement of such. Such material may include information on applications that are not considered community standard, that reflect indications not included in approved FDA labeling, or that are approved for use only in restricted research settings. The FDA has stated that it is the responsibility of the physician to determine the FDA status of each drug or device he or she wishes to use, and to use them with appropriate patient consent in compliance with applicable law. The Practicing Ophthalmologists Curriculum is intended to be the basis for MOC examinations in 2014, 2015 and 2016. However, the Academy specifically disclaims any and all liability for any damages of any kind, for any and all claims that may arise out of the use of any information contained herein for the purposes of preparing for the examinations for MOC. THE AMERICAN ACADEMY OF OPHTHALMOLOGY DOES NOT WARRANT OR GUARANTEE THAT USE OF THESE MATERIALS WILL LEAD TO ANY PARTICULAR RESULT FOR INDIVIDUALS TAKING THE MOC EXAMINATIONS. THE AMERICAN ACADEMY OF OPHTHALMOLOGY DISCLAIMS ALL DAMAGES, DIRECT, INDIRECT OR CONSEQUENTIAL RELATED TO THE POC. Any questions or concerns related to the relevance and validity of questions on the MOC examinations should be directed to the American Board of Ophthalmology. COPYRIGHT © 2014 AMERICAN ACADEMY OF OPHTHALMOLOGY ALL RIGHTS RESERVED Core Ophthalmic Knowledge 3 © AAO 2014-2016 Practicing Ophthalmologists Curriculum Authors and Financial Disclosures The Practicing Ophthalmologists Curriculum was developed by a group of dedicated ophthalmologists reflecting a diversity of background, training, practice type and geographic distribution. Jeffrey A. Nerad, M.D., American Academy of Ophthalmology Secretary for Knowledge Base Development, serves as the overall project director for the acquisition and review of the topic outlines. Practicing Ophthalmologists Curriculum Panel Jeffrey A. Nerad, M.D., Chair Ramana S. Moorthy, M.D. Anthony J. Aldave, M.D. Christie L. Morse, M.D. Jason Bacharach, M.D. Timothy W. Olsen, M.D. James T. Banta, M.D. Rajesh K. Rajpal, M.D. Christopher L. Blanton, M.D. Russell W. Read, M.D. Michael H. Goldstein, M.D. Stuart R. Seiff, M.D. Richard J. Grostern, M.D. Brian D. Sippy, M.D. Jeffrey D. Henderer, M.D. Mitchell B. Strominger, M.D. Leon W. Herndon, M.D. Roger E. Turbin Erich P. Horn, M.D. Matthew Dean Kay, M.D. Louise A. Mawn, M.D. Financial Disclosures The Academy’s Board of Trustees has determined that a financial relationship should not restrict expert scientific clinical or non-clinical presentation or publication, provided appropriate disclosure of such relationship is made. All contributors to Academy educational activities must disclose significant financial relationships (defined below) to the Academy annually. Contributors who have disclosed financial relationships: Anthony J. Aldave, M.D. Consultant/Advisor: Allergan, Bausch Lomb Grant Support: National Eye Institute Lecture Fees: Alcon Laboratories, Inc., Allergan, Jason Bacharach, M.D. Consultant/Advisor: Allergan, Sucampo Lecture Fees: Allergan, Lumenis, Inc., Merck & Co., Inc. Christopher L. Blanton, M.D. Consultant/Advisor: Abbott Medical Optics, Allergan Lecture Fees: Abbott Medical Optics, Allergan Grant Support: Abbott Medical Optics Leon W. Herndon, M.D. Consultant/Advisor: Alcon Laboratories, Inc., Sight Sciences Lecture Fees: Alcon Laboratories, Inc. Louise A. Mawn, M.D. Grant Support: Research to Prevent Blindness Core Ophthalmic Knowledge 4 © AAO 2014-2016 Christie L. Morse, M.D. Grant Support: AAPOS EVP Timothy W. Olsen, M.D. Grant Support: Abraham J. and Phyllis Katz Foundation, National Eye Institute, Research to Prevent Blindness, The Fraser Parker Foundation, The R. Howard Dobbs Jr. Foundation Patent/Royalty: A Tissue Support Structure, Scleral Depressor Rajesh K. Rajpal, M.D. Consultant/Advisor: Abbott Medical Optics, Alcon Laboratories, Inc., Allergan, Inc., Avedro, Bausch Lomb Equity Owner: Avedro Lecture Fees: Alcon Laboratories, Inc., Allergan, Inc., Avedro, Bausch Lomb Grant Support: Allergan, Inc., Avedro Russell W. Read, M.D. Consultant/Advisor: Allergan, Eleven Biotherapeutics, Santen, Inc. Grant Support: Eyegate Pharmaceuticals, Inc., EyeSight Foundation of Alabama, International Retinal Research Foundation, Matthews Family Foundation, Research to Prevent Blindness Brian D. Sippy, M.D. Grant Support: Regeneron, Inc. Contributors who state they have no significant financial relationships to disclose: James T. Banta, M.D. Richard J. Grostern, M.D. Jeffrey D. Henderer, M.D. Erich P. Horn, M.D. Matthew Dean Kay, M.D. Ramana S. Moorthy, M.D. Jeffrey A. Nerad, M.D. Stuart R. Seiff, M.D. Mitchell B. Strominger, M.D. Roger E. Turbin, M.D. Background on Maintenance of Certification (MOC) Developed according to standards established by the American Board of Medical Specialties (ABMS), the umbrella organization of 24 medical specialty boards, Maintenance of Certification (MOC) is designed as a series of requirements for practicing ophthalmologists to complete over a 10-year period. MOC is currently open to all Board Certified ophthalmologists on a voluntary basis; time-limited certificate holders (ophthalmologists who were Board Certified after July 1, 1992) are required to participate in this process. All medical specialties participate in a similar process. The roles of the American Board of Ophthalmology (ABO) and the American Academy of Ophthalmology relative to MOC follow their respective missions. The mission of the American Board of Ophthalmology is to serve the public by improving the quality of ophthalmic practice through a process of certification and maintenance of certification that fosters excellence and encourages continual learning. The mission of the American Academy of Ophthalmology is to advance the lifelong learning and professional interests of ophthalmologists to ensure that the public can obtain the best possible eye care. Core Ophthalmic Knowledge 5 © AAO 2014-2016 The role of the ABO in the MOC process is to evaluate and to certify. The role of the Academy in this process is to provide resources and to educate. Background on the Practicing Ophthalmologists Curriculum (POC) At the request of the ABO, the Academy developed the Practicing Ophthalmologists Curriculum (POC), a knowledge base that identifies and defines areas of knowledge important to the delivery of quality eye care as a basis for the content of examinations for the MOC process. The content in the POC is comprised of the information deemed as the most relevant clinical information for a practicing ophthalmologist. The ABO has agreed that their Periodic Ophthalmic Review Test (PORT) and closed-book Demonstration of Ophthalmic Cognitive Knowledge (DOCK) examinations will be based on the POC. The ABO is solely responsible for creating the PORT and DOCK exams and for certifying MOC candidates. The Academy has developed study tools based on the POC to assist doctors preparing to meet these MOC requirements. Organization of the POC The Practicing Ophthalmologists Curriculum comprises 10 practice emphasis areas (PEA), plus Core Ophthalmic Knowledge. The ABO has designated the following as practice emphasis areas: • Comprehensive Ophthalmology • Cataract/Anterior Segment • Cornea/External Disease • Glaucoma • Neuro-Ophthalmology and Orbit • Oculoplastics and Orbit • Pediatric Ophthalmology/Strabismus • Refractive Management/Intervention • Retina/Vitreous • Uveitis In addition to two practice emphasis areas of choice, every diplomate sitting for the DOCK examination will be tested on Core Ophthalmic Knowledge. Core Ophthalmic Knowledge is defined as the fundamental knowledge every practicing ophthalmologist must have whatever their area of practice. Each PEA is categorized into topics presented in an outline format for easier reading and understanding of the relevant information points by the reader. These outlines are based on a standard clinical diagnosis and treatment approach found in the Academy’s Preferred Practice Patterns. For each topic, there are Additional Resources that may contain journal citations and reference to textbooks. These resources are supplemental to the topic outline, and should not be necessary for MOC exam preparation purposes. Creation of the POC The POC was developed by panels of practicing ophthalmologists in each of the ten practice emphasis areas. The panels reflect a diversity of background, training, practice type and geographic distribution, with more than 90 percent of the panel members being time-limited certificate holders. Core Ophthalmic Knowledge 6 © AAO 2014-2016 The panels ranked clinical topics (diseases and procedures) in terms of clinical relevance to the subspecialist or comprehensive ophthalmologist. The panelists created outlines for the topics deemed Most Relevant, based on what an ophthalmologist in a specific practice emphasis area needs to know to provide competent, quality eye care (i.e., directly related to patient care). These outlines were reviewed by subspecialty societies and the American Board of Ophthalmology. Revision Process The POC is intended to be revised every three years. The POC panels will consider new evidence in the peer-reviewed literature, as well as input from the subspecialty societies, the American Board of Ophthalmology and the Academy’s Self-Assessment Committee, in revising and updating the POC. Prior to a scheduled review the POC may be changed only under the following circumstances: • A Level I (highest level of scientific evidence) randomized controlled trial indicates a major new therapeutic strategy • The FDA issues a drug/device warning • Industry issues a warning *** Core Ophthalmic Knowledge 7 © AAO 2014-2016 Core Ophthalmic Knowledge Cataract/Anterior Segment Types of Cataracts 1. Adult cataract ................................................................................................................................. 17 2. Traumatic dislocation and subluxation .......................................................................................... 20 Anesthesia/Infection Prophylaxis/Viscosurgical Devices 3. Anesthesia for cataract eye surgery .............................................................................................. 22 Surgery 4. Cataract surgery in the adult ......................................................................................................... 25 Cornea/External Disease Anatomy and Basic Concepts 5. Anatomy of the cornea .................................................................................................................. 29 6. Universal precautions for minimizing transmission of bloodborne pathogens and surface infectious agents ................................................................................................................................................. 30 Diagnostic Tests 7. Anterior segment examination ...................................................................................................... 32 8. Tear film evaluation ....................................................................................................................... 34 9. Corneal topography ....................................................................................................................... 35 Ocular Surface Disorders 10. Aqueous tear deficiency, Sjögren syndrome and Mucin deficiency ............................................ 37 11. Hordeolum and chalazion ............................................................................................................ 41 12. Exposure keratopathy .................................................................................................................. 43 13. Recurrent corneal erosion ........................................................................................................... 46 Infectious Diseases 14. Acute conjunctivitis ...................................................................................................................... 48 Core Ophthalmic Knowledge 8 © AAO 2014-2016 15. Chronic conjunctivitis ................................................................................................................... 50 16. Herpes simplex virus keratitis ...................................................................................................... 52 17. Varicella-zoster virus keratitis ...................................................................................................... 54 18. Adenoviral conjunctivitis and keratoconjunctivitis ...................................................................... 57 19. Blepharitis .................................................................................................................................... 61 20. Bacterial conjunctivitis ................................................................................................................. 63 21. Bacterial keratitis ......................................................................................................................... 67 Immune-Mediated Disorders 22. Allergic conjunctivitis ................................................................................................................... 69 23. Episcleritis .................................................................................................................................... 71 Corneal Dystrophies 24. Fuchs corneal dystrophy .............................................................................................................. 73 25. Keratoconus ................................................................................................................................. 75 Degenerative Disorders 26. Pterygium ..................................................................................................................................... 77 Toxic and Traumatic Injuries 27. Chemical (alkali or acid) injury of the conjunctiva and cornea .................................................... 79 28. Toxic medication injury of the cornea (medicamentosa) ............................................................ 81 29. Subconjunctival hemorrhage ....................................................................................................... 82 30. Conjunctival foreign body ............................................................................................................ 84 31. Corneal foreign body ................................................................................................................... 87 32. Traumatic corneal abrasion ......................................................................................................... 88 33. Corneal laceration ........................................................................................................................ 90 34. Corneal perforation...................................................................................................................... 92 Glaucoma Core Ophthalmic Knowledge 9 © AAO 2014-2016 Diagnostic Tests 35. Intraocular pressure ..................................................................................................................... 94 36. Gonioscopy................................................................................................................................... 97 37. Examination of the optic nerve .................................................................................................... 99 38. Standard automated static perimetry ......................................................................................... 102 39. Corneal pachymetry ..................................................................................................................... 104 Open-Angle Glaucomas 40. Primary open-angle glaucoma ..................................................................................................... 105 41. Normal tension glaucoma ............................................................................................................ 109 42. Primary open-angle glaucoma suspect ........................................................................................ 111 43. Secondary open-angle glaucomas ............................................................................................... 113 44. Hyphema ...................................................................................................................................... 119 45. Corticosteroid-induced glaucoma ................................................................................................ 121 Angle-Closure Glaucomas 46. Acute angle-closure glaucoma ..................................................................................................... 123 47. Neovascular glaucoma ................................................................................................................. 125 Medical Management of Glaucoma 48. Glaucoma medications ................................................................................................................ 127 Neuro-ophthalmology and Orbit Diagnostic Tests and Pupils 49. Visual field testing ........................................................................................................................ 137 50. Examination of the pupil .............................................................................................................. 140 51. Horner syndrome ......................................................................................................................... 142 52. Neuroimaging ............................................................................................................................... 144 Core Ophthalmic Knowledge 10 © AAO 2014-2016