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.

As a caveat, my information is based on the 2017-2018 edition of this book.  At the moment I cannot afford to update my BCSC library every year.  While I suspect there will be many changes in the newer edition, hopefully many of the core concepts will remain.

Chapter 1:  The Orbit and Orbital Adnexa

Tip #1:  Don’t freak out.

I am going to warn you, the first section of almost every single BCSC textbook is extremely info-dense and out of all of the chapters of all the BCSC books, this is one of the most dense (though Chapter 1 of Neuro-Ophthalmology ranks a close 2nd).  The main reason why I designate this chapter the hardest is because when I recall my initial experience learning ophthalmology, I remember looking at all the diagrams, measurements, etc., and thinking, “what did I just get myself into?”  But, if you can learn this information really well, understanding eye disease from an anatomical standpoint becomes much easier.

Tip #2:  Don’t just memorize; create mental pictures.

The anatomy of the orbit is extremely complex; it’s crazy to think that many of us only spend 1-2 days in medical school anatomy dissecting this narrow space that we’ve chosen to specialize in.

The BCSC tries to keep the information as succinct as possible; however, describing anatomical relationships in paragraphs doesn’t necessarily help you in the OR when you’re doing a 3-wall orbital decompression (3-WOD) for thyroid eye disease.  Create your own mental pictures and schema to help you retain the detailed information you need to know.  Some people with artistic skills (not me!) will draw out or sculpt out their own models.  Others will use stick drawings, others will find atlases and illustrations made by others and create their own labels.  Whatever method that works for you, try to form an accurate image in your mind as you learn the anatomy.  Believe me when I say that it will help keep you from getting into trouble when you’re in surgery and you accidentally nick a vortex vein and blood is pooling everywhere.

Tip #3:  Yes, the numbers are important.  It helps to find ways to understand why they might be important clinically.

Not only are there the names of all the major bones, blood vessels, nerves, and tissues you need to memorize, but now there are tons of numbers/dimensions that you’ll have to know.  For example, the dimensions of the Spiral of Tillaux will become second nature during residency (hopefully).  But its importance doesn’t really surface until you start doing strabismus surgery, and you take those calipers and measure out 4.5 mm from the limbus to the medial rectus insertion, and you realize, hey, maybe this patient has esotropia because they have an anteriorly inserted medial rectus.  Another example might be measuring dimensions for ptosis surgery – it’s important to know the normal palpebral fissure height so that when you’re measuring Mr. Jones’ droopy eyelid you know how much ptosis he really has.

Tip #4:  Be creative in organizing the information.

If this is the first time you’re reading through the BCSC material, it might be all you can do just to try and keep up with the material.  And that’s fine.  However, I believe that learning this information requires some active learning of some sort, and even as you’re reading through the material for the first time, I’d encourage you to have a highlighter or pen or something so that you’re synthesizing that information.  You may even want to develop your own memory aids (such as mnemonics, mind palace maps, etc.) to help you retain that information.

There are people far smarter than I am (and I know several personally) who have eidetic or near-eidetic memories, who could read through the material quickly and retain all of the information perfectly.  So perhaps my advice is not for everyone.

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