International Council of Ophthalmology

Ophthalmic Education:

Principles and Guidelines of a Curriculum for Ophthalmic Education of Medical Students: Chapter VI: Vitreoretinal Diseases

Educational Goal:

Students should understand the normal appearance and function of the retina. They should recognize abnormal anatomy and the signs and symptoms of conditions that are associated with important causes of visual loss, such as macular degeneration, diabetic retinopathy, central retinal artery, and central retinal vein occlusion.

A. Anatomy of vitreous and retina.*

(REF. 22 Fig. G07, K54, K55)

1. Vitreous.**

2. Normal retinal blood vessel walls.*

a. Arterioles.*

b. Venules.*

3. Location of rods and cones in retina relative to vitreous and choroid.**

4. Retinal pigment epithelium.**

5. Macula.*

6. Choroid.**

B. Symptoms suggestive of vitreoretinal disorders.**

1. Flashes.** (REF. 2B Slide 67)

2. Floaters.** (REF. 4 Fig. 1.5)

3. Blurring, distortion, and/or minimalization of central visual acuity.**

4. Abrupt or progressive dimming of vision in one eye.**

5. Abrupt or progressive loss of peripheral visual field in one eye.**

C. Examination of the normal eye with direct ophthalmoscopy.*

(REF. 2G Slide 25, 26) (REF. 22 Fig. I03)

1. Red reflex.* (REF. 2G Slide 23)

2. Optic disc.*

3. Retinal arterioles and venules.* (REF. 4 Fig. 1.18)

4. Posterior retina and choroid.*

D. Abnormal fundus features with direct ophthalmoscopy.*

1. General.*

a. Loss of normal red reflex.* (REF. 2G Slide 7) (REF. 22 Fig. K72)

b. Dark spots in red reflex.*

c. Abnormal color of red reflex.*

2. Fundus features of important systemic diseases.*

a. Diabetes mellitus.*

i. Background diabetic retinopathy.* (REF. 2B Slide 57) (REF. 2A Slides 18-22, 24) (REF. 22 Fig. K14, K15, K40)

ii. Proliferative diabetic retinopathy.* (REF. 2A Slide 26-28, 30) (REF. 22 Fig. K41)

b. Systemic hypertension.*

i. Vasospastic (accelerated) retinopathy.*

ii. Sclerotic (chronic) retinopathy.*
Atherosclerotic carotid occlusive disease.*

iii. Central retinal vein occlusion.*** (REF. 2B Slide 63) ) (REF. 3 Case 21, Central Retinal Vein Occlusion, p. 42) (REF. 22 Fig. K37)

iv. Branch retinal vein occlusion.*** (REF. 2B Slide 64) (REF. 22 Fig. K20)

c. Embolic cardiovascular disease and atherosclerotic carotid occlusive disease.*

i. Central retinal artery occlusion.** (REF. 3 Case 19, Central Retinal Artery Occlusion, p.3) (REF. 2B Slide 61) (REF. 22 Fig. K34, K35, K36)

ii. Branch retinal artery occlusion.** (REF. 2B Slide 62) (REF. 22 Fig. K18, K19)

d. AIDS.** (REF. 2F Slide 82-84) (REF. 22 Fig. K29)

e. Disseminated metastatic cancer.** (REF. 2F Slide 34-36)

3. Fundus features of important ocular diseases.*

a. Retinoblastoma.* (REF. 2G Slide 7) (REF. 22 Fig. H27, H28, H29)

b. Retinal detachment.** (REF. 2B Slide 68, 69) (REF. 22 Fig. K70, K71, K72)

c. Age-related macular degeneration.* (REF. 2B Slide 24-27) (REF. 3 Case 17, Age-Related Macular Degeneration, p. 34) (REF. 22 Fig. K03, K04, K05)

E. When to refer patient to an ophthalmologist.*

1. Abnormal red reflex or fundus.**

2. Visual loss or symptoms consistent with a vitreoretinal disorder.**

Clinical Competencies

Students should:

Understand anatomy and function of retina.*
Understand definition and function of the macula.*
Understand importance of dilated fundus exam.*
Recognize a change in red reflex.*
Recognize normal retinal vasculature.*
Detect diabetic background and proliferative retinopathy.*
Understand definition and importance of retinal detachment.**
Understand importance of retinoblastoma and recognize leukocoria.*

* Basic Level: Necessary in the education of medical students worldwide.

** Standard Level: A higher level of ophthalmic understanding than the basic curriculum of most international medical students.

*** Advanced Level: Advanced cognitive and clinical skills more appropriate for students who seek further training in ophthalmology, which may be covered in an ophthalmology elective in medical school.

(Also see: More on Educational Priorities)

Next: VII. Glaucoma

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