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- Resident Master Classes for Ophthalmology by Dr Sourabh Sharma
DAMS brings Live app based structured course for Ophthalmology residents for the first time.
The course involves live interactions of important topics to make you proficient in theory and practical knowledge.
The aim is to demonstrate an easy approach towards residency and other foreign degree exams like FICO, FRCS. Kanski based academic teaching, live demonstration of ideal way to do basic investigations, perform clinical examination for practical exam purposes with recent updates will be the key takeaways from this course.
The course is designed to make one confident in clinical examination skills, interpretation of various examination techniques and investigations and not per se rote theory learning. The recordings of the live lectures will also be available for those who miss the live session.
Module 1:
Introduction, Investigations and Techniques, Clinical
Embryology- 2 sessions
VISION sense
• Basics and charts
• Colour Vision
• Contrast sensitivity
Know your devices
• Slit lamp basics
• llumination techniques
• Ophthalmoscopies and optics
• Auxillary lenses
Basic investigations
• Tonometers
• Gonioscopy: Direct and Indirect
• Perimetry: How to read chart
• Retinal Angiography (Pre-recorded)
Basic and clinical Embryology
• Clinical applications
Module 2: Optics and Refraction- 2 sessions
1. Properties of light
• Basics
• Clinical implications
2. Visual functions
• Stereopsis- Clinical tests and concepts
3. Optics of Ametropia
• Refractive error
• Accommodation
4. Presbyopia
• Presbyopic correction
• Types of Bifocals
5. Clinical Refraction
• Objective and Subjective refraction
6. Optical Prescriptions
• Spectacles and contact lenses
7. Instruments
• Retinoscope
• Purkinje image based devices (Pachymetry, Keratometry, Specular)
8. Lasers in Ophthalmology (Pre-recorded)
9. Basics of Refractive Surgery
Module 3: Lens and Clinical applications- 2 sessions
Lens Anatomy and Physiology
• Gross and microscopic anatomy
• Embryology
• Metabolism of lens
• Biochemical structure
Cataracts
• Etiology
• Pathophysiology of senile cataract
• Stages of senile cataract
• LOCS clinical demonstration
Congenital cataracts
• Approach and management
Cataract surgeries
• Pre-operative considerations
• Anaestheia and viscoelastics
• STEP by STEP surgeries
• Instrumentation
• SICS, ECCE, Phacoemulsification
• Know your Phaco machine
• Phacodynamics
Intraocular Lenses
• Types and materials
• Biometry
• All formulaes
Complications of cataract surgeries: Clinical scenarios
Ectopia Lentis
Module 4: The Glaucomas- 2 sessions
Aqueous dynamics
• Aqueous production and outflow
• Aqueous composition
• Goldman equation
• Intraocular pressure basis and variations
Evaluation of optic nerve head
• Normal optic nerve head
• Changes in glaucoma
• Role of Optical coherence tomography Perimetry
• Visual field changes in glaucoma
• Hodapp, Parrish and Anderson’s criteria
• Progressive analysis
Open angle spectrum glaucomas
• Definitions of POAG, OHT, NTG
• Approach to an open angle glaucoma patient
• Management protocol
• Related studies and trials
Angle closure spectrum glaucomas
• Mechanism of closed angles
• Definitions of PACS, PAC, PACG
• Approach to a closed angle glaucoma patient
• Management protocol
• Related studies and trials
• Acute angle closure scenario
Medical and Surgical Management of glaucoma
• All classes of drugs and recent surgical advances
• MIGS (Minimally invasive glaucoma surgeries)
SECONDARY glaucomas: Clinical scenarios
Module 5: Retina and Vitreous part 1- 2 sessions
Basic Anatomy and Histology
• Retinal layers and neurotransmitters
• Rods and Cones structure
• Visual cycle
Retinal Detachment
• Peripheral lesions leading to RD
• Posterior Vitreous detachment
• Identification of retinal breaks
• Types of retinal detachment
• Proliferative Vitreoretinopathy
• Pars plana Vitrectomy, Pneumatic retinopexy, Scleral buckling
• Complications of Surgeries
Vascular supply and blood retinal barriers
• Clinical implications
• Cystoid macular edema
• Central serous retinopathy
Age Related macular degeneration
• Approach, types, management
• AREDS trial
• Retinal Angiomatous proliferation
Polypoidal choroidal vasculopathy
Module 5: Retina and Vitreous part 2- 2 sessions
Acquired Macular disorders
• Macular function tests
• Vitreomacular traction: Macular hole
• Degenerative myopia
• Angiod streak
• Other macular disorders
Retinal Vascular disorders
• Diabetic retinopathy
• Hypertension and Retinal venous occlusive diseases
• Retinal arterial occlusive diseases
Other important conditions: Sickle cell, ROP
Hereditary fundus dystrophies
• Electrodiagnostic tests (ERG,VER, EOG, Dark adaptation)
• Approach to night blindness
• Rod-Cone and Cone-Rod dystrophies
• Choroidal dystrophies
• Macular dystrophies
Albinism
Module 6: Orbit- 2 sessions
Basic anatomy
• Bones and fissures
• Orbital fascia
• Surgical spaces of orbit
• Clinical applications and syndromes
Approach to proptosis
• Exam case study
• Clinical test methods
• Related investigations
Thyroid eye disease
• Risk factors and pathogenesis with new treatment modality approach
• Clinical features and classifications
• Current Management protocols
Idiopathic orbital inflammatory Disease
• Pseudotumour/Myositis/Dacryoadenitis
• Current Diagnostic criterion
• Imaging and histochemistry
• Current management protocol
Orbital cellulitis
• Classification
• Rhino-orbital mucormycosis
• Management
Orbital tumours
• Neural tumours
• Vascular tumours
• Cystic lesions
• Lacrimal gland lesions
Surgical procedures
• Enucleation
• Exenteration
• Eviseration
Anophthalmic socket
Module 7: Eyelids and adnexa- 2 sessions
Basic anatomy of eyelids
• Structural and clinical aspect
• Epicanthal folds
• Congenital anamolies
Eyelid embryology
• Clinical implications
Eyelid layers
• Lamella of eyelids with clinical relevance
• Each layer linked to clinical points
• Blinking mechanism
• Tarsorapphy types, procedure
• Structural support and ligaments
• Orbital septum and fat pads
Eyelid margin
• Strucural anatomy
• Clinical relevance
Eyelash disorders
Ptosis (pre-recorded)
• Levator palpebral superioris anatomy
• Classification of Ptosis
• Exam case study clinical evaluation
• Clinical test methods
• Management options
• Surgical instruments used in Ptosis Surgery
• Complications of Ptosis Surgery
• Short notes: Myasthenia/Marcus Gunn/BPES
Blepharitis
• Types
• Clinical spectrum
• Management with new modalities
Ectropion and Entropion
• Types, Staging and features
• Simplified treatment options
Eyelid tumours
• Evaluation of eyelid mass
• Differentiate benign and malignant lesions
• Common tumours
• Reconstruction of eyelid
Module 8: Cornea Part 1- 2 sessions
Anatomy and Physiology of Cornea
• Structural and clinical aspect of each layer
• Confocal microscopy
• Nervous supply
• Applied physiological aspects
Signs in Corneal disease and Corneal Colour Coding
Approach to a patient of Corneal ulcer
Infectious keratitis
• Fungal keratitis
• Acanthamoeba keratitis
• Herpes Simplex Viral keratitis
• Herpes zoster Ophthalmicus
• Bacterial keratitis
Interstitial keratitis
Persistent epithelial defect
Neurotrophic keratitis
Peripheral ulcerative keratitis
Corneal ectasias
• Corneal topography
• Keratoconus
• Pellucid and Terrien’s degeneration
• Corneal collagen cross linking
• Management options
Module 8: Cornea and Sclera Part 2- 2 sessions
Corneal dystrophies
• IC3D and anatomical classification
• Clinical spectrum and important signs
Corneal degenerations
• Arcus senilis
• Vogt limbal girdle
• Crocodile shagreen
• BAND shaped keratopathy
• Spheroidal and Salzmann degeneration
• Lipid keratopathy
Wilson disease
Corneal depositions
Vortex keratopathy
Eye banking
Penetrating keratoplasty
• Indications
• Surgical steps
• Complications
• Corneal graft rejection
Lamellar keratoplasty
• Indications
• Anterior and posterior lamellar procedures
• Big bubble types
Keratoprosthesis
• Types: Boston
• Osteo-odonto (Kpro)
Sclera and staphyloma
Module 9: Uveitis
Overview and classification of uveitis
• Anatomical classification
• Clinical terms- Standaraization uveitis Nomenclature
• Granulomatous and Non-granulmatous
Clinical features of anterior uveitis
• Examination of cells in anterior chamber
• Standaraization uveitis Nomenclature grading of cells and flare
• Blood-acqueous barrier and implication
• Type of keratic precipitates
Other clinical signs and complications
Approach to anterior uveitis
-HLAB27
-Fuch’s heterochromic
-Viral uveitis
Intermediate uveitis
• Disease entity, signs and complications
• Vitreous haze grading
• Modified Kaplan approach
Approach to anterior uveitis
• Infectious vs Non-infectious
• Choroiditis vs Retinitis
• Masquerade uveitis
• White dot syndrome overview
Parasitic Posterior uveitis
• Ocular Toxoplasmosis
• Ocular Toxocariasis
• Diffuse unilateral subretinal neuro-retinitis
• Ocular cysticercoisis
Viral retinitis
• Acute retinal necrosis
• Progressive outer retinal necrosis
Cytomegaloviral retinitis
Pan-uveitis
• Sympathetic Ophthalmia
• Vogt-Kayangi-Harada syndrome
Module 10: Neuro-Ophthalmology and Squint- 4 sessions
Visual pathway and defects
• Optic nerve anatomy and blood supply
• Lesion of optic nerve and defects
• Optic chiasma- anatomy, blood supply and clinical visual field defects
• Retrochiasma- anatomy, blood supply and lesions
• Light/Puplillary pathway
• Basic anatomy and clinical testing
• Afferent pupillary defects
• Light-Near dissociation
• Parinaud syndrome
• Argyll-Roberston pupil
• Adie’s pupil
Near/Accommodation pathway
Sympathetic pathway and implications
• Basic pathway
• Horner syndrome
• Pharmacological action of drugs in Horner
Anisocoria
• Approach to a miotic pupil
• Approach to a dilated pupil
Ocular motor nerves
• 3 rd , 4 th , 6 th nerve pathway
• Syndromes associated
• Nuclear control of eye movements
Optic nerve function tests
• Clinical features of optic neuropathy
• Visual evoked response
Optic disc swelling
• True vs pseudo-edema
• Optic nerve hyploplasia
• Optic disc drusen
• Myelinated nerve fibres
Optic neuritis
• Demyelinating conditions
• IO
• BAND shaped keratopathy
• Spheroidal and Salzmann degeneration
• Lipid keratopathy
Approach to disc edema: Clinical aspects
Optic atrophy
Papilledema
• CSF pathway
• Pathophysiology flowchart
• Stages and Frisen grading
• Management
Extraocular muscles and actions
• Clinical Anatomy of extraocular muscles
• Ductions, Versions and Vergences
• Herring and Sherrigton law
Definitions in Strabismus
• Tropia and Phoria
• Kappa angle and its implications
Basics of Binocular Vision
• Horopter
Pannum’s area
Types and adaptations to strabismus
• Incomitant vs Comitant squint
• Muscle sequlae in paralytic squint
• Motor and Sensory adaptations
Examination of strabismus patient
Tests for MOTOR status in strabismus
• Hirshberg reflex test
• Cover-uncover (Prism bar cover)
• Modified Krimsky
Tests for SENSORY status in strabismus
• Tests for Binocular vision, Correspondence, Suppression
• Worth 4 dot test, Bagolini glasses, Base out prism, Synaptophore
Tests for ocular movements
• Grading of underacting and overacting muscles
Comitant Esotropia
• Essential infantile
• Accommodative esotropias
• Other types and management
Comitant Exotropia
• Intermittent exotropia
• Other types and management
A and V pattern squints
• Basics
• Different school of thoughts and theories
Amblyopia and clinical management
• Types and Mangement
Approach to Incomitant squint
• Subjective tests for angle of deviation
• Maddox rod and wing
Diplopia charting
Hess/Lees charts
Forced duction test
Ocular motor nerve palsies
• 6th nerve palsy
• 3 rd nerve palsy
• 4 th nerve palsy
Park 3 step test
Congenital cranial dysinnervation disorders
• Duanne’s retraction
• Mobius
• Strabismus fixus
Brown syndrome
Supranuclear control of eye movements and Clinical significance
• Horizontal and Vertical gaze center
• PPRF lesion
• Internuclear ophthalmoplegia
• One and half syndrome
Nystagmus and Practical aspects
• Basics
• Types and documentation
Video : 5:00:00 mins
Video : 16:05 mins
Video : Session 24_Congenital Cranial dysinnervation disorders mins