STUDY GUIDE IN OPHTHALMOLOGY - KGMC
1 STUDY GUIDE IN OPHTHALMOLOGYFor 3rd and 4th Professional MBBS StudentsKhyber Girls Medical CollegeProf. Dr. Tariq Farooq BabarHead Department of OphthalmologyMTI/ Khyber Girls Medical CollegeHayatabad Medical Complex, Peshawar
2PREFACEThis “Study guide” is another token of my dedication to this profession.However, I would not have come this far had it not been for the endless supportof my family, my wife, in particular for supplying me with adequate tea( andsnacks) at all the right times and putting up with my work ethic in just four days.I was also supported by Dr. Yousaf Jamal Mahsood, Assistant Professor Glaucoma,during writing of this guide book. Syed Sajjad Hussain and Mr. Yasir Nawaz ourcomputer Operators fully helped me in typing this manuscript. They never raisedtheir eyebrows in its corrections and collecting materials from different sources.For proof reading I acknowledge the services of our Peadiatric Ophthalmologist,Prof. Dr. Muhammad Naeem Khan.I hope my students of 3rd and 4th Professional MBBS will make the most of thisguide.Best of luckRegardsPROF. DR. TARIQ FAROOQ BABARHead Department of OphthalmologyMTI/KGMC/ HMC, Peshawar
3S. No.ContentsPage1.2.Welcome address by Head of DepartmentPM&DC Clinical Ophthalmology Syllabus for 3rd and 4thProfessional MBBS students Course contact Level Assessment of level of competence3.Division of PM&DC syllabus into 3rd and 4th Professional MBBS4.Time table for 3rd year students Hospital ward duty rota / Clinical schedule for year 2019-20 Tutorial schedule5.Time table for 4th year Students Hospital ward duty rota / Clinical schedule for 2019-20Tutorial scheduleLecture / practical time tableTheme- Based lecture scheduleContact sessions/plans of lectures of 1st 10 lecturesTwo SEQ’s and two MCQs
4WELCOME ADDRESSByHead of Ophthalmology Department Ophthalmology Department orientation Student’s Log Book
5WELCOME ADDRESSOn behalf of my Faculty I welcome you in Ophthalmology Department, KhyberGirls Medical College. Our Ophthalmic Unit is considered to be one of the best inPakistan and is declared Centre of Excellence with state of art instruments andequipments and a highly equipped Diagnostic Centre with facilities of Argon Laser,Nd: Yag laser, Visual field, Optical Coherence Tomography, B-Scan, FundusFluorescein Angiography, Contact lens Clinic, Low Vision Clinic and RehabilitationCentre. The Operation Theatre has facilities for phaco emulsification, Par planaVitrectomy, Glaucoma procedures like trabeculectomy and valves implant andOculoplastics and Orbitotomy.The Ophthalmology Department of KGMC has three groups/UnitsGroup AProf. Dr. Tariq FarooqBabarDr. Mushtaq AhmedDr. NazullahGroup BProf. Dr. Sanaullah JanGroups CProf. Dr. M. Naeem KhanDr. Umer KhanDr. Yousaf JamalMahsoodDr. Afzal QadirDr. Tariq MarwatDr. M. Zia-ud-Din KhailiDr. Samina KarimSub-Specialty-wise, we have the following:Vitreo-RetinaProf. Dr. Sanaullah JanDr. Tariq MarwatPaediatric OphthalmologyProf. Dr. M. Naeem KhanDr. Afzal QadirGlaucomaDr. Yousaf Jamal MahsoodDiagnostic OphthalmologyDr. Samina Karim3rd year KGMC students stays in Eye Department will be for two weeks while 4thyear students will be visiting Eye for four weeks and will have Eye lectures inKGMC in addition. Our Group C/Unit will look after 3rd year MBBS and Group A &B / Unit will take care of 4th year with two weeks stay in each Unit.
6We have separate teaching programs for 3rd & 4th year, which will be evidentwhen you visit our Department. On the first day Group/Unit Incharge willintroduce you to his faculty and Eye Department, OPD and OT.The 3rd year students will escort with the Incharge of Group C and will follow theirgroup duty schedule. Similarly 4th year MBBS students will accompany their GroupA or B Incharge and will pursue their schedule given in this study guide.For 3rd year the Hospital timings are10:00 AM to 12:00 PMMonday to ThursdayFor 4th year the Schedule Hospital timings are10:00 AM to 01:00 PM05:00 PM to 07:00 PMMonday to SaturdayExcept FridayThe details of the contact hours for 3rd and 4th year MBBS students are givenbelow:a. Contact hours for 3rd Year MBBS Students for OphthalmologyDurationTimingNumber of Subject Hours2 weeksMorning8 hrs per week OphthalmologyFor 2 wksClinical/Hospital work8x2 16 hrs10am – 12:00 pm(Mon – Thurs)4 days a weekContact hours for 3rd YearHours peryear16 hours16 hoursb. Contact hours for 4th year MBBS Students for OphthalmologyDurationTiming32 weeksMorning2 hrs per weekOphthalmology8:00am – 9:00amFor 32 wksLectures in KGMCTwo days a week2x32 64 hrs class roomMorning15hrs per week Ophthalmology10am – 1:00 pmFor 4 wks 60hrs clinical/hospital(Mon – Thurs,work4 weeks(2 weeks perward)Saturday)5 days a weekNumber of Subject HoursHours per year64 hours60 hours
74 weeks(2 weeks perward)Evening5mm – 7:00 pm(Mon – Thurs,Saturday5 days a week10hrs per week OphthalmologyFor 4 wks 40hrs Evening bedside teaching inwardContact hours for 4th YearTotal Contact hours for 3rd & 4th Year MBBS Students:40 hours164 hours180 hoursThe student are advised to study the logbook in detail in which their progress ismonitored daily in form of history taking, skills performed and minimumprocedural skills required to be successfully carried out by each student duringtheir stay in the Eye Department
8A copy of student’s log book is enclosedDepartment of OphthalmologyKhyber Girls Medical CollegeHayatabad Medical Complex,PeshawarPHOTOGRAPHStudent’s log book
9Department of Ophthalmology “ ” UnitStudent NameFather’s NameRoll /Class No. in 3rd year 4th Batch No/Dates of rotationIntroductionAs part of structured learning program, this log book will identify the objectives for eachperiod / rotation of learning. The main purpose of the logbook is to help you monitoryour own competence, to recognize gaps and address them. Its second purpose is todescribe the minimum competence level expected of you at the end of every rotation.StructureThe skills to be achieved are laid out in two sections.The first section is related to history taking, and procedure skills and the second sectionconsists of operative skills.
10Level of competenceThe level of competence ranges from observation (1) to independent practice(5).The following list specifies what is meant by each level.Level 1ObservesLevel 2Level 3AssistsLevel 4IndirectsupervisionIndependentLevel 5Director supervisionObserves the clinical activity performed by a colleague/ seniorAssists a colleague / Senior perform the clinical activityPerforms the entire activity under direct supervision ofa seniorPerforms the entire activity with indirect supervisionof a senior colleaguePerforms the entire activity without need forsupervisionTeacher / trainer will tick off competence level as you achieve them and sign them withdate.Section 1History taking skillsCompetenciesHistorya). History takingb). Visual acuityo Distanceo Nearc). Pupil reactiond). Clinical examinationo Lido Conjunctivao Iriso Anterior chamberooooExpected level of competence CertificationTo be tick when achievedTeacher to sign & date1 2345SignDatePupilLensLacrimal sacOcular mediaGood pointsSuggestion for improvement:-Teacher SignatureDate
11CompetenciesSkills performedExpected level of competenceTo be tick when achieved12345CertificationTeacher to sign & dateSignDateTorchSlit lamp examinationDirect ophthalmoscopyIndirect ophthalmoscopyTrial lens boxRetinoscopy with plane mirrorPerimetryEye movementsCover testConfrontation visual fieldBiometryB-ScanFundus cameraDigital tonometryCorneal stainingLacrimal sac regurgitation testUpper lid eversionSection 2Procedural skillsCompetenciesProcedural SkillsRemoval of suturesRemoval of foreign body(lid, conjunctiva, cornea)Irrigation of lacrimal passages(syringing)Lacrimal probingPunctal dilationExpected level of competence CertificationTo be tick when achievedTeacher to sign & date1 2345SignDate
12CompetenciesProcedural SkillsCertificationTeacher to sign & date12CertificationTeacher to sign & dateSignDatePterygiumIncision and curettage formeibomian cystCataract surgeryGlaucoma surgerySquint surgeryRetinal detachmentDacryocysto rhinostomyEnucleationEviscerationThis logbook is going to be updated in line with PM&DC syllabus in a couple of weeks by theCollege’s DME Department and is freely available from them. You need to sign this logbook byyour Group/Unit Incharge on completion of your rotation.Although PM&DC has not recommended any specific book for Ophthalmology, we recommendthe following books of Ophthalmology for the students of KGMC.Basic BooksS. No Book Name1Clinical OphthalmologyText and Atlas2Parson’s Diseases of the Eye3Comprehensive OphthalmologyAuthorShafi M. JatoiEdition6th EditionRamanjit SihotaRadhika TandonA.K Khurana22nd editionReference books1Kanski’s Clinical Ophthalmology2Oxford handbook of Ophthalmology3For Clinical methods visitBrad BowlingChua Website5th edition8th Edition3rd Editionwww.mrcophth.comThe marks allotted for your Ophthalmology paper in the 4th Professional MBBS exam are asunder:Theory -----------------------90 marksInternal Evaluation-------10 marksOral & Practical -----------90 MarksInternal evaluation-------10 marks(TOACS)Total200 marksAt the end of your rotation if you feel any deficiency in our program please do not hesitate byinforming us on the e-mail: tariqbabar5@gmail.com
13PM&DC Clinical Ophthalmology Syllabus for 3rdyear and 4th year MBBS Course content Level Assessment of Level of competence
14PM&DC Clinical Ophthalmology Syllabus for 3rd year and 4th year MBBSPM& DC has setup minimum standards for Health care. In Medicine andDentistry. It has laid down syllabus for MBBS students in Pakistan which they aresupposed to follow.Regarding Ophthalmology the syllabus consist of the following course content:COURSE CONTENTBasics Anatomy and the functions of the Eyeball/Adenexa and Orbit.Orbit: Orbital Cellulitis, Proptosis.Lids: Blepharitis, Stye, Chalazion, Trichiasis, Entropion, Ectropion, Ptosis, andCommon Tumours.Conjunctiva: Infective and Allergic Conjunctivitis, Pterygium.Cornea: Keratits, Corneal Ulcers, risk factors, complications and its management.Sclera: Episcleritis and Scleritis.Pupil: Pupillary reflexes and their common abnormalities.Lacrimal Apparatus: Composition and function of Tear film, Dry Eye, Excessivewatering (Epiphora), Dacryocystitis (Acute & chronic).Therapeutics: Drugs used in common ophthalmic conditions.Vitamin A Ocular manifestations of vitamin A Deficiency and its management.Uveal Tract: Uveitis, and its differential Diagnosis from other causes of the RedEye.Lens: Classification of cataract,Congenital Cataract (lamellar, Signs and Symptoms and Management), Rubellasyndrome, Acquired Cataract (Senile, Traumatic, Drug induced), Cataract due tosystemic diseases (Clinical Picture and Management including VisualRehabilitation).Glaucoma: Physiology of Aqueous humour formation and its circulation.Measurement of IOP, Definition and Classification of Glaucoma, Primary Openangle and closed angle Glaucoma, Secondary Glaucoma due to hyper-matureCataract and Uveitis. Principles of Medical and Surgical Management ofGlaucoma.Vitreo-Retina: Posterior Vitreous/Haemorrhage, detachment, Pri-mary RetinalDetachment (Common Presentation and Principles of Management),Diabetic Retinopathy, Hypertensive Retinopathy,Retinitis Pigmentonsa, Retinoblastoma.Optic Nerve: Papilloedema, Optic Neuritis (Papillitis and Retrobulbar Neuritis),Optic Atrophy.Visual Pathway: Introduction to Visual Field defects in the lesions of Chiasma andvisual Pathway.
15Injuries: Extraocular Foreign Bodies, Closed globe injuries, Open globe injurieswith or without retained Intra ocular foreign bodies, Burns and Chemical Injuries,Sympathetic Ophthalmitis.Squint and Amblyopia: Definition, Classification and Principle of Management.Errors of Refraction: Introduction to Optical System of Normal Eye, Emetropia,Myopia, Hypermetropia, Astigmatism, Presbyopia, Aphakia, Pseudophakia,Anisometro-pia, and Amblyopia.Systemics Disease: Diabetes, Thyroid Diseases, vitamin deficienciesCommon cauuses of Definition and standards of vision/Blindness.Aim & objectives / ExpectationThe PM& DC expect that the student should be well versed with the basics ofocular history taking, examination, preparation of patients for eye surgery andcommon eye procedures.
16The details are as under:LEVEL(a) History Taking1. Defects in Vision2. Pain in and around the Eye3. Discharging Eye4. Abnormal appearance of the Eye and Orbit5. Colour vision6. Diplopia(b) ExaminationVisual Acuity, for distance and nearUse of a pinholeExamination of Adnexa and anterior segmentof the eye.Eversion of the upper Eye LidLacrimal regurgitation testDetection of the Deviated EyeOcular MovementPupillary Reflexes (Afferant Pupillary defects)Measurement of Intra-ocular pressure.- Palpation Assessment- Schiotz TonometerDistant Direct Ophthalmoscopy for Identificationof defects in the Ocular MediaDirect Ophthalmoscopy with emphasis on discand its abnormalities Swollen disc, cup discand pale disc/retinal lesion.Confrontation test for field of vision 1(c) Familiarization with Retinoscopy, IndirectOphthalmoscopy, Slit Lamp and its Uses, VisualFields and Use of Laser in Ophthalmology 1(d) Procedure 4- Irrigation of Eye- Instillation of Eye drops- Staining for Corneal Ulcer- Removal of Superficial Foreign Bodies- Rational use of Topical Anaesthesia(e) Preparation for operation and post Operative Management(f) Understand Medical Ethics and maintain the Confidentiality of the Patient
17Standard / competenceAssessment of Level of CompetenceTo Diagnose, treat and prevent certain common eye conditions e.g.BlepharitisStye and r Trauma (Corneal Foreign Body/Abrasion)Ocular AllergiesII. To diagnose certain eye diseases, initiate first aid treatment and refer them intime e.g.Corneal UlcerUveitisAcute Congestive GlaucomaOpen or closed globe injuriesRed EyeIII. To enable them to diagnose other eye conditions and refer them to secondaryor tertiary eye care centres for further management(Medical/Surgical) e.g.CataractSquint and AmblyopiaRefractive ErrorsTumours (white Pupil)Serious Ocular TraumaPainful or painless loss of visionIV. To understand the importance of prevention in Ocular DiseasesDeficiency Diseases resulting in ocular ProblemsEarly Detection of GlaucomaDiabetic RetinopathyBy the end of the training student should be a caring and compassionate, generalpurpose, doctor who is competent to deal with the common health problemsrelated to Eye diseases.V. Understand the relationship between Eye and Systemic DiseasesVI. To visit community for Eye Health Care problems including Eye Camps
18GENERAL OBJECTIVESTo equip them with essential knowledge, skill and attitude In order to enablethem:1. Identify Ophthalmic diseases including emergencies, provide primary Eye care,refer to appropriate centre and provide follow-up to the patients.2. Perform essential minor surgical procedures.3. Communicate effectively with the patient, the family and the communityregarding Eye diseases and its related issues.4. Understand medical ethics and its application pertaining to Ophthalmology andmaintain the confidentiality of the patient.5. To understand the prevalence and prevention of the common Public HealthProblem related to Ophthalmology in the community.6. Understand the principles of medical research including fundamentals ofInformation Technology.Details of Clinical & Practical competenceLevel of Learning:Level – 1Level – 2Level – 3Level – 4Observer statusAssistant statusPerform under supervisionPerform independently
19Division of PM& DC Ophthalmology Syllabuscontent into 3rd and 4th Year MBBS
20Division of PM& DC Ophthalmology Syllabuscontent into 3rd and 4th Year MBBSFor convenience, I have divided the level of competence skills between 3rd and 4thyear MBBS intoa.b.c.d.History takingExaminationProcedures andOphthalmic instruments identificationDivision of PMDC syllabus content into 3rd & 4th years MBBS3rd YearHistory Taking Defects in visionPain in and around eyeDischarge from eyesRed eyesPainless loss of visionPainful loss of visionAbnormal appearance of the eye& orbit Colour vision disturbance Diplopia4th YearExaminationExamination of adnexa and anteriorsegment of eyeEversion of upper eye lidLacrimal regurgitation test.Detection of deviated eyeOcular movements.Pupillary reflexesDistant direct ophthalmoscopy (fordefects in ocular media)Direct ophthalmoscopyDisc and its abnormalitiesRetinal lesions detection
213rd year4th YearExaminationFamiliarization withVisual Acuity- Distance- NearUse of a pinholeMeasurement of Intraocular pressure- Palpation assessment- Schiotz tonometerConfrontation test for field of visionRetinoscopyIndirect OphthalmoscopySlit lamp and its usesVisual fieldsUse of laser in OphthalmologyMiscellaneousWet lab once / Two weeksVideos of important topics andExamination methods once/Twoweeks
22Time table for 3rd year Students Hospital Ward duties rota / Clinical Schedule for year 2019-20 Tutorial schedule
23On arrival of 3rd year MBBS students into Eye Department, they are guided by their Group CIncharge about their Department and duties. For this year, the schedule is divided into thefollowing headings:a. 3RD YEAR MBBS HOSPITAL WARD DUTIES/CLINICAL TIMETABLE FOR THESession 2017-2018 & Academic Year 2019-20Clinical wards duties started w.e.f. 31/12/2019Winter Vacation EHGJIMNABCDEFGHIJKLNMBADCFEHGJILK22nd December to29thDecember11/03/2020to26/03/2020Spring Vacation Break29thMarch – 05th 1/05/2020to26/05/202027/05/2020to11/06/2020Summer VacationBreakth16stJune –31 AugustthNote: Pre-Prof. Exam. will be taken w.e.f. 12 June to 22ndJune, 2020
24b.TUTORIAL (THURSDAY) 3rd yearDatest1 Oct, 2019th8 Oct, 2019Class Batch3rd year3rd yearth3rd yearnd3rd year29 Oct, 2019th3rd year5th Nov. 20193rd year15 Oct, 201922 Oct, 2019th3rd yearth3rd yearth3rd year12 Nov, 201919 Nov.201926 Nov. 2019rd3 Dec. 2019h3rd year 10 Dec.20193rd year17th Jan. 20193rd yearth3rd yearst3rd year24 Dec. 201931 Dec. 2019th7 Jan. 2020th14 Jan., 20203rd year3rd yearTutorial TopicsConsultantHistory taking counseling / Prof. Dr. M Naeem KhanconsentDr. M. Tariq KhanDr. Zia-ud-Din KhalilA/S examProf. Dr. M Naeem KhanDr. M. Tariq KhanDr. Zia-ud-Din KhalilSlit lamp / tonometryProf. Dr. M Naeem KhanDr. M. Tariq KhanDr. Zia-ud-Din KhalilPupil examProf. Dr. M Naeem KhanDr. M. Tariq KhanDr. Zia-ud-Din KhalilVisual field examProf. Dr. M Naeem KhanDr. M. Tariq KhanDr. Zia-ud-Din KhalilVisual acuity testingProf. Dr. M Naeem KhanDr. M. Tariq KhanDr. Zia-ud-Din KhalilEOMProf. Dr. M Naeem KhanDr. M. Tariq KhanDr. Zia-ud-Din KhalilCover / uncover testsProf. Dr. M Naeem KhanDr. M. Tariq KhanDr. Zia-ud-Din KhalilBiometry / B-ScansProf. Dr. M Naeem KhanDr. M. Tariq KhanDr. Zia-ud-Din KhalilFFAProf. Dr. M Naeem KhanDr. M. Tariq KhanDr. Zia-ud-Din KhalilRefraction / direct & indirect Prof. Dr. M Naeem KhanophthalmoscopesDr. M. Tariq KhanDr. Zia-ud-Din KhalilVisual acuity testingProf. Dr. M Naeem KhanDr. M. Tariq KhanDr. Zia-ud-Din KhalilEOMProf. Dr. M Naeem KhanDr. M. Tariq KhanDr. Zia-ud-Din KhalilHistory taking counseling / Prof. Dr. M Naeem KhanconsentDr. M. Tariq KhanDr. Zia-ud-Din KhalilA/S examProf. Dr. M Naeem KhanDr. M. Tariq KhanDr. Zia-ud-Din KhalilSlit lamp / ton
3 Comprehensive Ophthalmology A.K Khurana 5th edition Reference books 1 Kanski’s linical Ophthalmology Brad Bowling 8th Edition 2 Oxford handbook of Ophthalmology 3rd Edition 3 For Clinical methods visit Chua Website www.mrcophth.com The marks allotted for your Ophthalmology paper in the 4th Professional MBBS exam are as under:
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