Neuro-Ophthalmology PGY-1
Medical Expert
Neurology rotation - This rotation should include at least one month on an active neurology ward associated with weekly out patient neurology clinics and a neurology consult service. The PGY-1 candidate should be well read in the symptoms and signs of the major neurological disorders. In order to begin developing some exposure in radiological diagnoses, the resident should follow up relevant neuroradiology results with a staff radiologist.
Neuroanatomy - The learning of visual pathway neuroanatomy should be accomplished via the Houston Basic Science Course. Relevant central and peripheral nervous system anatomy should be learnt through clinical experience on the wards and in the consult service.
Neuro-Ophthalmology PGY-2
Medical Expert
The resident will acquire the knowledge to:
In this year the resident should develop the art of taking a detailed, but selective history. The history should be directed towards the particular patient's eye, complaint, medical, neurological and familial background.
The resident should be able to discern if the etiology of a patient's complaint is on a neuro-ophthalmologic basis or not. The resident should see patients with such problems on ward consult rounds as well as in subspecialty clinics.
The resident will acquire clinical skills:
Neuro-ophthalmologic examination
- Acuity - BEST CORRECTED! (including near vision)
- Pupillary exam (size, shape, reaction to near and light, pharmacology of testing for anisocoria)
- Color vision
- Brightness comparison
- Ocular motility (alignment, movements - saccades & pursuit, forced ductions)
- Ocular adnexa - lids, orbit, face, exophthalmometry
- Gross neurological exam including carotid auscultation
- Corneal eye exam
- Fundoscopy - direct ophthalmoloscopy, 90D lens, 3 mirror lens
- Examining the patient with functional visual loss
- Visual field - technique and interpretation; Goldmann and automated
- Tensilon test
- Electrophysiology - interpretation of ERG and VER
- Neuroradiology - CT/MRI; how to order and interpret orbit and brain views
Neuro-Ophthalmology PGY-3
Medical Expert
The resident will acquire the knowledge to:
The history, exam and appropriate diagnostic test results should be presented to the staff neuro-ophthalmologist during consult rounds.
Presentation skills
The resident should be able to present the history, examination, relevant neuro-radiological data and a review of the literature in reference to a patient to an audience.
The resident will acquire clinical skills:
Consult service
The resident is responsible for examining non-mobile ward patients with neuro-ophthalmologic diagnoses.
Neuro-Ophthalmology clinic
A PGY-3 resident should attend a weekly neuro-ophthalmologic clinic for regular exposure to such patients.
All of the above mentioned examination and diagnostic skills should be familiar to the resident at this point (see PGY-2). Upon completion of the history and exam, the physician should be able to formulate the location of the lesion, a differential diagnosis, and a plan of investigation.
The resident will acquire surgical skills:
Temporal artery biopsy. Management of a central retinal artery occlusion.
Neuro-Ophthalmology PGY-4 and PGY-5
Medical Expert
Continued exposure to Neuro-Ophthalmology patients in both consult rounds and subspecialty clinics is important in order to maintain a familiarity with these diagnoses.
If the PGY-5 candidate is interested, a research project involving electrophysiology or a short term prospective study could be arranged.