International Council of Ophthalmology




Residency Curriculum


   Contact Lenses



Basic Level Goals: Year 1

 

A.  Cognitive Skills
1.   List advantages and disadvantages of contact lens (CL) wear.**
2.   List indications and contraindications for CL wear.**
3.   List medical indications for CL wear.**
4.   Describe a systematic and comprehensive ophthalmic examination oriented for CL fitting, including complex and challenging cases.**
5.   Describe the various CL indications and options for each contact lens type (eg, soft CL [SCL], rigid gas permeable [RGP] CL, toric CL, multifocal CL, scleral CL).**
6.   Describe how to decide which CL categories (eg, SCL, RGP CL, hybrid CL, and subgroups within each category (eg, sphere, toric, bifocal, frequent planned replacement) are best suited for a particular patient.**
7.   Describe how to convey the basic CL parameters for SCL and RGP CL:**
a.   Base curve**
b.   Diameter refractive power**
c.   Lens materials**
i.      Center thickness**
ii.     Peripheral curvature**
8.   Explain the concept and clinical relevance of oxygen permeability (Dk) and oxygen transmissibility (Dk/center thickness).**
9.   Describe various materials used in the manufacture of CL.
10. Explain the optics of SCL and RGP CL:**
a.   Base curve changes**
b.   Lacrimal lens**
c.   Vertex distance**
d.   Optic zone.**
11. Recognize the importance of obtaining central keratometry in CL fitting of patients without complex needs, and explain the conversion between radians and diopters.**
12. Identify different methods of obtaining central keratometry readings (eg, manual keratometry, computerized corneal topography).
13. Explain the importance of using diagnostic staining agents (eg, fluorescein, lissamine green, rose bengal) to assess corneal and conjunctival staining patterns.**
14. Describe basic tests to assess the tear film properties (eg, Schirmer test, tear break-up time, phenol red thread tear test, meibomian gland assessment).**
15. Describe conversion of a spectacle prescription (Rx) to a CL Rx, including method of converting from plus to minus cylinder and vertex distance calculations.**
16. Describe basic steps for SCL fitting.**
17. Identify the main characteristics to be present in a CL prescription (eye designation, brand identification, base curve, diameter, and refractive power).**
18. Describe CL care guidelines to be given to the patient related to insertion, removal, and disinfection of CL.**
19. Describe risk factors for CL-related complications (eg, overnight wear, nonpreserved saline solution usage).**
20. Describe treatment of CL-related complications (eg, tight lens syndrome, overwear syndrome, giant papillary conjunctivitis, infectious keratitis).**
B.  Technical/Surgical Skills
1.   Perform a basic CL history.**
2.   Perform all the steps of a basic clinical examination oriented for CL fitting (ie, refraction, keratometry, visual acuity assessment).**
3.   Perform a routine comprehensive slit-lamp examination of the anterior segment as applied to CL fitting.**
4.   Perform tear film assessment required for CL patients.**
5.   Perform the techniques of retinoscopy, refraction, and over-refraction in the routine CL patient.**
6.   Perform central keratometry.**
7.   Discuss with the patient the most appropriate choice for their particular clinical case.**
8.   Perform initial SCL fitting, evaluation of fit (loose CL versus tight CL), and over-refraction.**
9.   Insert and remove a trial SCL.**
10. Instruct patients regarding safe CL insertion and removal, CL wearing schedule, lens care regimens, CL disinfection care, indications, contraindications, and possible complications.**
11. Work effectively within a medical care team.**
 
                                                                                   Standard Level Goals: Year 2
 
A.  Cognitive Skills
1.   Explain applied anatomy and physiology (eg, corneal metabolism and temperature, oxygen consumption, stromal acidosis, tear osmolarity, tissue fragility, cell apoptosis, corneal sensitivity, closed eyelid-related ocular surface repercussions).**
2.   Recognize signs and symptoms of CL intolerance and overwear.**
3.   Explain the importance of assessing tear film and ocular surface condition with more complex auxiliary tests in certain CL fitting situations (eg, tear film osmolarity and biochemical composition, impression cytology).
4.   Identify CL fitting situations requiring corneal topography (eg, computerized/Placido rings).**
5.   Explain the rationale underlying different topography profiles and how these relate to the manifest refraction.**
6.   Summarize and analyze topography maps.
7.   Explain physical properties of CL materials:
a.   International Organization for Standardization (ISO) classification
8.   Explain advantages and disadvantages of SCL materials.**
9.   Explain advantages and disadvantages of RGP CL materials.**
10. Explain RGP/SCL geometry relation with corneal geometry (ie, lacrimal meniscus, refraction, and ocular surface implications).**
11. Explain main principles to fit RGP CL (eg, first trial CL choice, fluorescein patterns, alignment, movement, wearing and replacement schedule, fitting motivation, and follow up).**
12. Explain main principles to fit toric SCL:**
a.   Stabilization**
i.      LARS rule (ie, Left Add, Right Subtract)
ii.     Movement
iii.    Rotation
iv.    Possible refitting needs
13. Appraise clinical situations best suited for RGP CL fitting versus toric SCL fitting.**
14. Explain when CL refitting is indicated and perform refitting when needed.**
15. Recognize signs and symptoms of a tight, optimal, and loose CL fitting.**
16. Explain advantages and disadvantages of different wearing schedules (eg, conventional, frequent planned replacement, flexible, daily).**
17. Describe ocular impact and physiological needs regarding different CL wearing schedules.
18. Identify and describe CL requirements for materials needed for extended/flexible CL wearing.**
19. Explain patient and CL selection and fitting techniques as applied to fit presbyopia.**
20. Explain how to keep a CL fitting trial set (ie, CL, equipment, and disinfection care).**
21. Describe and evaluate different CL care systems.
22. Explain the clinical importance of CL environment (ie, CL patient surrounding, ocular surface, and storage case).**
B. Technical Skills
1.   Perform a CL history in patients requiring more complex CL fitting (eg, subclinical ectatic corneal disorders such as keratoconus and pellucid marginal degeneration, regular moderate astigmatism, presbyopia, ocular surface disease, and post-refractive surgery).**
2.   Perform a clinical examination, including retinoscopy and refraction techniques to verify and inspect CL in patients requiring more complex CL fitting (eg, subclinical ectatic corneal disorders such as keratoconus and pellucid marginal degeneration, regular moderate astigmatism, presbyopia, ocular surface disease, and post-refractive surgery).**
3.   Indicate more complex additional auxiliary tests (eg, computer-based corneal topography, tear film osmolarity, impression cytology) in patients requiring more complex CL fitting (eg, subclinical ectatic corneal disorders such as keratoconus, pellucid marginal degeneration, regular moderate astigmatism, presbyopia, ocular surface disease, and post-refractive surgery).
4.   Perform RGP CL fitting (spherical).**
5.   Perform SCL toric fitting.**
6.   Perform presbyopia CL fitting.**
7.   Perform appropriate CL selection and material or parameters modification in CL refit.**
8.   Perform CL verification for visual acuity, fitting, and comfort in patients requiring more complex CL fitting.**
9.   Educate patients regarding CL-related complications.**
10. Diagnose, manage, and treat CL-related complications.**
11. Perform the skills needed for long-term management and follow up of CL patients.**
 
                                                                              Advanced Level Goals: Year 3

A.  Cognitive Skills
1.   Describe the various options for SCL, RPG CL, and hybrid CL fitting in advanced ectatic corneal disorders such as keratoconus and pellucid marginal degeneration, including post-intracorneal ring segment implantation cases.**
2.   Describe the various options for SCL and RPG CL fitting in postkeratoplasty cases.**
3.   Describe the various options for SCL and RPG CL fitting in complex post-refractive surgery, including corneal ectasia.**
4.   Describe CL fitting in special clinical situations such as severe dry eye, glaucoma, diabetes, allergy, pregnancy, strabismus, sports practice, adverse environmental and occupational conditions.**
5.   Describe indications, fitting techniques, and long-term management of CL wear for children and adolescents.**
6.   Describe CL options and most complex fitting techniques for medical CL indications such as aphakia, albinism, recurrent corneal erosions, neurotrophic keratitis, corneal scarring, aniridia, and prosthetic cosmesis.**
7.   Identify indications for scleral CL fitting.**
8.   Explain reverse geometry RGP CL for post-graft or post-refractive surgery cases.**
9.   Synthesize the concept underlying orthokeratology.
10. List the indications for therapeutic CL.**
11. Describe material selection, physiological implications, mechanisms of action, and adjuvant topical treatment associated with therapeutic CL.**
12. Describe the various possibilities of fitting with soft and hard therapeutic CL.
13. Explain the importance of appreciating visual acuity, fit, and comfort in therapeutic CL.**
14 Describe the differences among CL material choices especially suited for more complex cases and its clinical correlation.**
15. Explain the influence of both systemic and topical medication on CL fitting and tolerance.**
16. Describe the methods of modifying a CL to improve comfort, vision, or physiological response.**
17. Evaluate CL-induced complications, and describe treatment strategies for their management, in particular acanthamoeba and fungi infections.**
18. Appraise clinical situations requiring additional complementary examinations in CL fitting and follow up (eg, endothelial, confocal biomicroscopy, aberrometry).
19. Describe indications and methods for fitting front surface toric, back surface toric, and bitoric RGP CL.
B. Technical Skills
1.   Perform an advanced CL history and examination.**
2.   Obtain a full ocular history and conduct necessary tests to perform a complex CL fitting examination (eg, postkeratoplasty, multiple surgeries, post-refractive surgery, corneal ectasia, advanced corneal ectatic disorders such as keratoconus and pellucid marginal degeneration, and active corneal and ocular surface disease).**
3.   Perform CL fitting and management in babies, children, and adolescents.**
4.   Perform scleral CL fitting.
5.   Perform refraction, retinoscopy, and over-refraction in complex cases.**
6.   Use advanced CL designs including reverse geometry.**
7.   Indicate the auxiliary CL instruments in patients with complex needs (eg, computerized topography, fluorescein patterns, diagnostic lenses).**
8.   Interpret and interpret topography in complex CL fittings.**
9.   Perform and analyze aberrometry and endothelial/confocal biomicroscopy.
10. Indicate CL modification and refitting in complex cases, when needed.**
11. Select the appropriate CL in complex clinical cases (eg, postkeratoplasty, multiple surgeries, post-refractive surgery, corneal ectasia, advanced ectatic corneal disorders such as keratoconus, pellucid marginal degeneration, and active corneal and ocular surface disease).**
12. Perform therapeutic CL fitting and follow up.**
13. Diagnose and treat CL-induced complications, both infectious and noninfectious
      (eg, sterile infiltrates, corneal neovascularization, corneal permanent staining, giant papillary conjunctivitis).**
14. Develop an educational skill set to effectively educate rotating students and residents about CL topics.**







© 2006, 2012 by The International Council of Ophthalmology

 

All rights reserved. First edition 2006

Second edition 2012.