To describe the indications, evaluation and management, and intra- and post-operative complications of cataract surgery and other anterior segment procedures.
To formulate the differential diagnoses of cataract and evaluate the normal and abnormal lens.
To describe the less common causes of lens abnormalities (e.g., spherophakia, lenticonus, ectopia lentis).
To describe the pre-operative evaluation of the cataract patient, including:
The systemic diseases of interest or relevance to cataract surgery.
The relationship of external and corneal diseases of relevance to cataracts and cataract surgery (e.g., lid abnormalities, dry eye).
The relationships of glaucoma and capsular opacities related to cataract surgery
To describe glare analysis testing for cataract surgery.
To describe the use of A and B scan ultrasonography in cataract surgery.
To describe the instruments and techniques of cataract extraction, including extracapsular surgery and phacoemulsification (e.g., trouble-shooting the phacoemulsification machine, altering the machine parameters).
To describe the types, indications and techniques for anesthesia for cataract surgery (e.g., topical, local, general).
To describe indications, techniques, and complications of surgical procedures, including
Extracapsular surgery
Intracapsular surgery
Phacoemulsification
Paracentesis
To describe the indications for, principles of, and techniques of YAG laser capsulotomy.
To describe history and techniques of basic IOL implantation.
To correlate the level of visual acuity with the lens opacities.
To describe the common complications of cataract and anterior segment surgery (e.g., intraocular pressure elevation, hyphema, endophthalmitis, cystoid macular edema, retinal detachment, intraocular lens dislocation, lens-induced glaucoma and uveitis).
Patient Care
To perform the complete pre-operative ophthalmologic examination of cataract patients.
To perform optimum refraction of the post-cataract surgery patient.
To develop and exercise clinical and ethical decision-making in cataract patients.
To develop good patient communication techniques regarding cataract surgery.
To perform routine and advanced cataract surgery and intraocular lens (IOL) placement.
To manage basic and advanced clinical and surgical cataract problems.
To effectively diagnose and manage intraoperative and post-operative complications of cataract surgery.
To perform local injections of corticosteroids, antibiotics, and anesthesia.
To implement the basic preparatory procedures for cataract surgery (e.g, obtaining informed consent, identification of instruments, sterile technique, gloving and gowning, prep and drape, other pre-operative preparation).
To perform extracapsular surgery in a practice setting (e.g, animal or practice lab) and then in the operating room under supervision, including mastery of the following skills:
IOL implantation (e.g., anterior and posterior, special IOLs)
To perform paracentesis of the anterior chamber.
To use the operating microscope for basic cataract surgery.
In addition to performing the appropriate steps in cataract surgery, to assist in cataract surgery and perform more advanced steps in patient preparation and anesthesia.
To describe the more advanced applications of viscoelastics in surgery (e.g., control of iris prolapse, elevation of dropped nucleus, viscodissection).
To recognize and refer or treat common post-operative complications of cataract surgery (e.g., endophthalmitis, elevated intraocular pressure, cystoid macular edema, wound leak, uveitis).
To perform basic post-operative evaluation of the cataract patient.
PGY-4 Level goals (in addition to PGY-3 level goals)
Medical Knowledge
To define the more complex indications for cataract surgery (e.g. better view of posterior segment), describe the performance of and describe the complications of more advanced anterior segment surgery (e.g., pseudoexfoliation, small pupils, mature cataract, hard nucleus, black cataract, posttraumatic, zonular dehiscence), including more advanced procedures (e.g., secondary IOLs and indications for specialized IOLs, capsular tension rings, iris hooks, use of capsular staining).
To describe the indications for, techniques of, and complications of cataract extraction in the context of the subspecialty disciplines of glaucoma (e.g., combined cataract and glaucoma procedures, glaucoma in cataractous eyes, cataract surgery in patients with prior glaucoma surgery), retina (e.g., cataract surgery in patients with scleral buckles or prior vitrectomy), cornea (e.g., cataract extraction in patients with corneal opacities), ophthalmic plastic surgery (e.g., ptosis following cataract surgery), and refractive surgery (e.g., cataract surgery in eyes that have undergone refractive surgery).
To independently evaluate complications of cataract and IOL implant surgery (e.g., posterior capsular tears, choroidal effusions).
To describe the instruments and techniques of cataract extraction including extracapsular surgery and phacoemulsification (e.g., trouble-shooting the phacoemulsification machine, altering the machine parameters).
To understand indications for and technique of intracapsular surgery (e.g., rare cases may require this procedure or patients may have had the procedure performed previously).
To describe indications for and instrumentation and techniques used to implant foldable and nonfoldable IOLs.
To describe the evaluation and management of common and uncommon causes of post-operative endophthalmitis.
To perform repositioning, removal or exchange of IOLs.
To assist in the teaching and supervision of basic and standard level learners (i.e., first and second year residents).
To describe the government and hospital regulations that apply to cataract surgery.
Patient Care
To describe the indications for, mechanics of, and performance of A scan ultrasonography and calculation of IOL power.
To perform phacoemulsification in a practice setting (e.g, animal or practice lab) and then in the operating room, including mastery of the following skills:
Wound construction
Anterior capsulotomy/capsulorrhexis
Viscoelastics
Intracapsular, extracapsular and phacoemulsification-techniques (e.g., sculpting, divide & conquer, phaco-chop, stop and chop)
Instrumentation and techniques of irrigation and aspiration
IOL implantation (e.g., anterior and posterior, special IOLs)
IOL repositioning, removal or exchange
To perform implantation of foldable and non-foldable IOLs.
To perform intraoperative and postoperative management of any event that may occur during or as a result of cataract surgery, including:
