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Ophthalmology
RCGP and the RCOphth
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To gain a good working knowledge of the anatomy, physiology and pathology of the eye, adnexae and visual pathways. | ||||||||||||||||||
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To be able to take a directed ophthalmological history. | ||||||||||||||||||
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To be able to undertake an ophthalmological examination assessing both structure and function, including:
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To be able to recognise and manage common and important eye problems (see below). | ||||||||||||||||||
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To know the indications for referral to an ophthalmologist and the elements of a good referral letter. | ||||||||||||||||||
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To understand the principles of team-working with the optometrist and ophthalmologist, including areas such as the measurement of intra-ocular pressures and more formal methods of visual field assessment. | ||||||||||||||||||
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To be aware of the roles of other health professionals and the overlap with other relevant specialities. | ||||||||||||||||||
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To be able to recognise his/her limitations. | ||||||||||||||||||
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To be able to employ appropriate consultation skills to elicit the history (including understanding the patient's perspective) and inform, explain or clarify the diagnosis and treatment options for patients presenting with common eye conditions. | ||||||||||||||||||
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To understand the principles of critically evaluating one's own work. |
For each patient or topic the following aspects should be considered:
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Awareness of patterns of presentation/symptoms and typical signs/examination findings, use of appropriate investigations and of systemic conditions that may be linked. Ability to assess the progress of the illness against that expected. |
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Understanding of therapeutic options available, including common drug therapies used, and knowledge of guidelines or consensus management framework. |
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Awareness of legal issues, ethical issues and the influence of social and cultural factors. |
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Prevention, individual- and population-based. |
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Practice and NHS management issues. |
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superficial ocular trauma, including assessment of foreign bodies, abrasions and minor lid lacerations |
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severe blunt injury, including hyphaema |
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severe orbital injury, including blow-out fracture |
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penetrating ocular injury and tissue prolapse |
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retained intra-ocular foreign body |
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sudden painless loss of vision |
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severe intra-ocular infection |
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acute angle closure glaucoma |
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blepharitis |
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stye and chalazion |
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entropion and ectropion |
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basal cell carcinoma |
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naso-lacrimal obstruction and dacryocystitis |
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conjunctivitis (infective and allergic) |
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dry eye syndrome |
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episcleritis and scleritis |
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corneal ulcers and keratitis |
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iritis and uveitis |
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cataract |
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myopia, hypermetropia, astigmatism |
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principles of refractive surgery |
| acute angle closure glaucoma |
| primary open angle glaucoma |
| secondary glaucomas |
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flashes and floaters |
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vitreous detachment |
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vitreous haemorrhage |
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retinal detachment |
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diabetic retinopathies |
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retinal vascular occlusions |
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amaurosis fugax/transient ischaemic (TIA) |
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macular diseases |
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hypertensive retinopathy |
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attacks |
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swollen optic disc: recognition and differential diagnosis |
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atrophic optic disc: recognition and differential diagnosis |
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pathological cupping of the optic disc |
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migraine |
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visual pathway TIA |
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diplopia |
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non-paralytic and paralytic strabismus |
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assessment of neurological disorder, including hemianopia, nystagmus and other ophthalmological manifestations of pituitary and cerebral tumours |
| removal of a superficial foreign body |
| incision and curettage of chalazion |
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Number of cases presenting* per 1000 population per year |
Percentage of all ophthalmology cases presenting |
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Infective conjunctivitis |
13.5 |
33.8% |
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Allergic conjunctivitis |
4.4 |
11.0% |
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Corneal abrasion |
3.2 |
8.0% |
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Dry eyes |
3.1 |
7.8% |
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Corneal foreign body |
2.7 |
6.8% |
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Subtarsal foreign body |
2 |
5.0% |
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Chalazion |
2.1 |
5.2% |
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Cataract |
1.9 |
4.8% |
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Blepharitis |
1.8 |
4.5% |
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Subconjunctival haemorrhage |
1.2 |
3.0% |
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Refractive problems |
1.1 |
2.8% |
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Allergic blepharitis |
0.7 |
1.8% |
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Macular degeneration |
0.7 |
1.7% |
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Anterior uveitis |
0.6 |
1.5% |
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Closed angle glaucoma |
0.5 |
1.3% |
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Open angle glaucoma |
0.4 |
1.0% |
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Total |
39.9 |
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*Number of cases of new or recurrent (i.e. new episodes of) disease. |
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The educational aims are divided into five categories:
Health and Diseases
Human Development
Human Behaviour
Medicine and Society
The Practice
*: Expertise may need 6-month post
At the conclusion of his/her vocational training the doctor should be confident in the management of:-
Clinical Method
Examination of eye.
Direct ophthalmoscopy
*Use of Slit Lamp.
Indirect ophthalmoscopy
Use of mydriatics and other diagnostic agents
Emergencies
Penetrating and blunt trauma. Chemical and UV Radiation Injury.
Acute glaucoma.
Retinal detachment.
Acute vascular disorders of the retina.
Herpes simplex keratitis. Herpes zoster ophthalmicus.
Facial nerve palsy
Optic neuritis, papilloedema, ischaemic optic neuropathy (arteritic and non-arteritic forms).
Common Eye Disorders
Blepharitis. Conjunctivitis
Dacryocystitis and disorders of tear ducts
Uveitis
Cataract, aphakia, pseudoaphakia
Age-related macular degeneration
Chronic glaucoma
Effect of hypertension
Effect of diabetes
Neuro-Ophthalmology
Paralytic squints
The eye in cerebrovascular disease
Nystagmus
Transient loss of vision.
Refractive Problems
Myopia, Hypermetropia. Astigmatism. Presbyopia
Assessment of acuity
Problems associated with contact lenses
Role of surgery in treatment of refractive error.
Treatment
The pharmacology and use of oral and topical agents in ophthalmology. The effect of drugs on the eye.
Incision of meibomian cysts
Dilation of tear ducts
Removal of conjunctival and corneal foreign bodies
Normal development of eye and visual apparatus
*Congenital abnormalities of eye and eyelids
*Normal development of binocular vision and acuity
Detection of visual problems in new-born and infants
*Detection of squints
Vision screening in pre-school children
Genetic advice and counselling
Relationship between eye disorders and other disabilities
Prevention of injuries to eyes at home and work
Patient education on detection of visual problems
Value of regular optician checks. Exemption from charges.
Hysteria and its ‘diagnosis’.
Vision problems and driving.
Career guidance to those who are colour blind.
Definition of blindness and partial sightedness. Registration., Value of registration. Methods of registration. Specialist social workers.
Social support for visually handicapped adults:
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RNIB. Talking book services |
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Social Services |
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Local services |
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Care of family. Financial support |
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Low vision aids. |
Social support of visually handicapped child:
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Statementing. Education Act |
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Schooling. Peripatetic teachers |
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Career guidance. |
Equipment needed in General Practice. *Minor surgical procedures.
Role of GP, Optometrist, Orthoptist, Eye Clinic, Community Eye Clinics, School Health Service.
Organisation of screening for:-
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Vision disorders in children |
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Diabetic retinopathy |
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Glaucoma |
Learning experience in the subject
| History and examination of eye. |
| Direct and indirect ophthalmoscopy, use of slit lamp. |
| Diagnosis and management |
| Penetrating and blunt trauma. Hyphaema |
| Acute glaucoma |
| Retinal detachment, acute vascular disorders of the retina |
| Herpes simplex keratitis, herpes zoster ophthalmicus |
| Optic neuritis. Papilloedema |
| Temporal arteritis |
| Conjunctivitis. Allergy |
| Episcleritis, sub-conjunctival haemorrhage |
| Keratitis, uveitis |
| Cataract, aphakia |
| Disorders of lids, meibomian cysts, ectropion, blepharitis |
| Squint , refractive disorders, contact lenses |
| Chronic glaucoma |
| Retinopathy, Diabetic Hypertensive |
| Age related macular degeneration |
Source: D Rapley Surviving GP Training (Download Word version)
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