6 Tips For Learning Ophthalmology

Here we are, at the end of September, and for those in residency and fellowship, hopefully you're starting to get used to the lifestyle of the trainee.  By now, the routine of waking up at all hours of the day and night, working on minimal sleep, cramming in study time, etc. should be second nature.

It was around this point during my first year of ophthalmology residency that I began to question the effectiveness of my learning/studying strategies.  It seemed like my peers always had a better grasp on the obscure facts, picking up on subtle clinical findings, or be able to answer questions in lecture while I sat there clueless.

Orbital Roof

The orbital roof separates the orbit from the anterior cranial fossa, which houses the frontal lobes of the brain.  There are several structures and features regarding the orbital roof that we need to remember.  While this article will try to list most of the important features of the orbital roof, it is by no means comprehensive.

Orbital Bones

There are 7 bones that comprise the orbit.  It is our job as ophthalmologists to be able to readily identify these bones and know pretty much every bump, notch, hole, and contour of these bones and what structures pass through, travel along, and attach to these bones.

Whitnall's Tubercle

The lateral orbital tubercle, or Whitnall's tubercle, is found on the zygomatic bone.  According to the Basic and Clinical Science Course, it is typically around 11 mm inferior to the frontozygomatic suture (the junction between the frontal bone and zygomatic bone) (1), and sits 4-5 mm posterior to the lateral orbital rim around the midline (2).

4 Tips For Beginning Residency

Happy early July!  For those who just started residency, congratulations!  Hopefully the first few days of residency have been a smooth transition.

Perhaps some (or many) of you are just getting started with ophthalmology residency.  This week may have been full of firsts, such as your first full refraction, your first dilated fundus exam, your first call, your first consult, etc.  There will probably be many other firsts to come - your first cataract surgery, your first post-cataract 20/20 patient, your first posterior capsular tear, your first vitrectomy, your first open globe, etc.  Okay, not all of these things are going to be super exciting.  But it's the beginning of one of the most rewarding and exciting specialties in medicine.

Classification Of Nonproliferative Diabetic Retinopathy

The modified Airlie House classification has been used to classify nonproliferative diabetic retinopathy (NPDR) since the Diabetic Retinopathy Study (DRS) and Early Treatment Diabetic Retinopathy Study (ETDRS). (1-3)  Since this classification determines management of nonproliferative diabetic retinopathy, it is extremely important to know these criteria.  This classification has been further refined by Wilkinson et al for international use and was adopted as part of the AAO's Preferred Practice Pattern for Diabetic Retinopathy. (4,5)

Article Review: Top Resources For OKAP And Board Review

Dr. James G. Chelnis contributed an article to the American Academy of Ophthalmology listing 9 very useful resources for OKAP and board exam review.  His article can be found here (this may be member-only content).

I don't have any critiques of the resources he lists; from what I can tell, there is no specific order to his recommendations.  If you used all 9 resources, I suspect you would do very well.

Out of that list, I personally used the following resources when I studied for the OKAP and board exams:

Reading the BCSC: Fundamentals and Principles of Ophthalmology, Chapter 1

The BCSC Section 2, Fundamentals and Principles of Ophthalmology, provides an extremely detailed overview of the anatomy and physiology of the eye.  Organizationally, it lays out the “fundamentals” of learning about the eye so that by the end of reading this book, you should be able to understand the anatomical structure of the eye, eye genetics, embryology, growth, and development, physiology of the eye, and medications that are used to treat eye conditions.

For this reason, this book is typically suggested as the first book to read for first-year ophthalmology residents.  Please see the articles Reading The BCSC and OKAPs Reading Schedule to learn how to pace yourself through learning the material.

The 8 Causes of Tunnel Visual Fields

There are relatively few causes for tunnel visual fields (or “gun barrel” visual fields), which is a relatively common finding in neuro-ophthalmology.  There are 8 major categories of tunnel visual fields, which can be determined systematically through careful history and examination.  This differential diagnosis is adopted from Duane’s Clinical Ophthalmology.

Another Approach To OKAP Study

When I started looking on Google for helpful guides for OKAP or board exam study, a thread on studentdoctor.net was listed towards the top.

In the thread, the original poster presented a very thorough and detailed plan of attack for studying ophthalmology in his (I apologize, I'm assuming that the user is a "he" due to the username) first year of residency (PGY-2), including a specific reading schedule, reviews of textbooks and question banks, with links to different articles for additional reading.  In some ways, it sounds eerily like what I'm trying to put together on this site.

Corneal Dystrophies Presenting as Recurrent Erosions

Corneal dystrophies are clinically fairly rare (with notable exceptions) but have pretty easily identifiable appearances.  Because we have learned quite a bit about the genetics, inheritance, etc. about many of the dystrophies, this seemed to be a pretty popular topic on tests – though it seemed like in the past few years the number of questions on corneal dystrophies decreased quite a bit.  I don’t know the minds of the test-writers, so who knows if it was a random thing, or if there was more emphasis on clinically significant questions.

Causes of Leukocoria: CREAM PIGMENT

There are TONS of causes of leukocoria (white pupil).  But this can be a very important differential, as it can be the presenting sign of some sight-threatening and life-threatening conditions (most obviously retinoblastoma).  Because of its clinical importance, it is essential to be able to not only recognize what it is, but to also have a decent differential diagnosis so that you don’t miss out on any key causes when conducting a history and physical.