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:
