Ophthalmic Education:

International Curriculum Guidelines on Medical Student Education in Ophthalmology: 1. Fundamentals and Principles of Ophthalmology

On this page:

• i) Ocular Anatomy*
  
  
• ii) Visual Acuity*
  
  
• iii) External Inspection*
  
  
• iv) Pupillary Reaction Testing*
  
  
• v) Ocular Motility Testing*
  
  
• vi) Direct Ophthalmoscopy*
  
  
• vii) Pupillary Dilatation*
  
  
• viii) Intraocular Pressure Measurement*
  
  
• ix) Anterior Chamber Depth Assessment*
  
  
• x) Confrontation Field Testing*
  
  
• xi) Upper Lid Eversion*
  
  
• xii) Fluorescein Staining of the Cornea*
  
  
• xiii) Indications for Referral*
  
  
• Competencies*
  
  
• Educational Priorities

The International Council of Ophthalmology Task Force on Medical Student Education in Ophthalmology

Draft, September 16, 2003

A medical student should recognize external and internal ocular structures of the normal eye and to perform a basic eye examination.

A medical student should know the following:

i) Essentials of ocular anatomy.*
ii) To measure and record visual acuity.*
iii) To assess pupillary reflexes.*
iv) To evaluate ocular motility.*
v) To use the direct ophthalmoscope for assessment of red reflex, the optic nerve and posterior fundus examination.*
vi) To dilate the pupils.*
vii) To perform and evaluate visual fields by confrontation.

i) Ocular Anatomy*

a) Eyelids
b) Sclera
c) Limbus
d) Iris
e) Pupil
f) Conjunctiva
g) Cornea
h) Extraocular muscles
i) Anterior chamber
j) Lens
k) Ciliary body
l) Posterior chamber
m) Vitreous cavity
n) Retina
o) Macula
p) Choroid
q) Optic disc

The student should be able to define each of these structures and provide relevant information regarding function and structure.

ii) Visual Acuity*

Students should understand the purpose of measurement of near visual acuity with and without correction, and test for near visual acuity of the right eye, left eye, and both eyes.

Students should understand the concept of distance visual acuity testing with and without correction and with a pinhole, but not is expected to perform refraction.

iii) External Inspection*

Students should understand the external ocular anatomy and evaluate the position of the lids and inspect the conjunctiva, sclera, cornea and iris with a penlight

iv) Pupillary Reaction Testing*

Students should measure the pupillary size and assess the direct and consensual pupillary reaction.

v) Ocular Motility Testing*

Student should understand the importance of assessing ocular motility in the six primary directions.

vi) Direct Ophthalmoscopy*

Student should understand the use of a direct ophthalmoscope and the importance of testing the patient?s right eye with the ophthalmoscope held in the examiner?s right hand, and left eye with the examiner?s left hand. The student should understand the basic function of an ophthalmoscope including the need to adjust the focus.

vii) Pupillary Dilatation*

Student should understand the need to pharmacologically dilate the pupils in order to facilitate the examination of the fundus. Student should understand the difference between retinal arterioles and retinal venules, the normal appearance of the optic nerve head and macula. Student should understand the normal retinal background is a uniform red-orange color due to pigmentation of the retinal pigment epithelium.

viii) Intraocular Pressure Measurement*

Student should understand the concept, but not actually measure pressure.

ix) Anterior Chamber Depth Assessment*

Student should understand the concept.

x) Confrontation Field Testing*

Student should understand the principle and the technique for determination of confrontation of visual field.

xi) Upper Lid Eversion*

Student should understand how evert the upper lid to examine for foreign bodies.

xii) Fluorescein Staining of the Cornea*

Student should understand fluorescein staining for an epithelial defect of the cornea.

xiii) Indications for Referral*

Student should understand potential causes for reduced visual acuity, abnormal fundus appearance, and potentially other abnormal findings that would result in referral of the patient to an ophthalmologist for evaluation.

Competencies*

Student should:

• Understand basic ocular anatomy.
  
  
• Measure near visual acuity.
  
  
• Test for direct, consensual and afferent pupillary reactions.
  
  
• Understand and master basic direct ophthalmoscopy.
  
  
• Understand normal funduscopic appearance of the optic disc, macula and major vessels.
  
  
• Understand the rationale and interpretation of test the red reflex.
  
  
• Understand the importance of the dilated fundus examination.
  
  
• Understand important causes of reduced vision, abnormal fundus appearance and abnormal findings that would result in referral of a patient to an ophthalmologist for evaluation.

Educational Priorities

In the listing above, essential ophthalmic knowledge and clinical eye care skills are marked with a single asterisk *. This material is basic for all international medical student education.

Information that reflects a greater level of understanding is marked with two asterisks**.

Areas of cognitive and clinical skills that are more appropriate for students who seek further training in ophthalmology are marked with three asterisks***.

While important to ophthalmic care, the Task Force does not regard the cognitive or skill set designated ** or *** as essential to the basic curriculum of most international medical students.

Next: 2. Refraction and Contact Lens

Also see:

• Introduction to the "International Curriculum Guidelines on Medical Student Education in Ophthalmology"
  
  
• Table of Contents for the Curriculum
  
  
• Education of Medical Students in Ophthalmology