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Aristotle University of Thessaloniki
Medical School – Sensory organs Faculty
2nd Department of Ophthalmology
Medical Director: Professor Stavros A. Dimitrakos
Undergraduate Training in Ophthalmology
Coordinator: Ass. Professor Ioannis Tsinopoulos
Syllabus
Αcademic year 2015-2016
1
1. Basic principles followed in Pre-graduate training
1.
2.
3.
4.
5.
6.
Undergraduate training in Ophthalmology at the Second Department of Ophthalmology,
since its initiation in 2004, is carried out by radical methods and undergoes a constant
process of trial implementation and evaluation. During the current academic year it was
modeled according to the following parameters - requirements of modern international
and Greek teaching:
ECTS (European Credit Transfer System), as decided by the Medical School of Aristotle
University of Thessaloniki (14 March 2011) in implementation of Law 1466/2007
(Articles 1, 2, 3)
Proposed Diploma Supplement (Supplement Diploma MEDICINE) (GG (1091/10 August
2006 No D5 / 72535 / B3) of the Department of European Educational Programmes
AUTH (annexed) *
Evaluation of Committee for Undergraduate Students that joined the Undergraduate
Programme 2011 -2012, as approved by the General Assembly of the Medical School (GA
38, June 14, 2011)
ECTS guide and Learning Outcomes and Competences for undergraduate Medical
Education in Europe (Tuning Educational Structures in Europe: Lifelong Learning
Programme - Users Guide 06.02.2009)
Evaluation of student questionnaires to assess the course of Ophthalmology and
transformations over the last nine years
Estimation of nine-year teaching and recommendations for a more modern and
sophisticated form of teaching by the faculty members of the Second Department of
Ophthalmology, AUTH.
2. Training in Ophthalmology corresponding to 3 ECTS credits
In accordance to the decision of the General Assembly of Medical School, Ophthalmology
should be mastered by our students in a 'workload' of 78 hours (3ECTS x 26 hours)
'Workload' is defined as the total number of hours to be worked by the student to
achieve the desired and predetermined learning outcome.
The knowledge, skills and competencies to be acquired by students are already
predetermined. The skills of the DS of Medicine (see. Annex), while the competencies to
be held by the student at the end of training in ophthalmology are available on the
website in the Second Department of Ophthalmology, AUTH.
http://www.med.auth.gr/depts/bophthalmo/ and https://elearning.auth.gr
3. Training methods
The modern form of teaching and consolidation of learning outcomes requires mainly
teaching in small groups and training in corresponding practice skills. Thus, the form of
teaching in the Second Department of Ophthalmology, as decided by its faculty members,
has the following format and partition of the students’ “workload”:




Consolidation of theoretical skills in small groups (10-12 people)
Practice transmission of practical skills in small groups (10 -12 people)
Emergency care (triage, first aids) (5-6 people)
Preparing the tutorial and exam
2
Students’ Workload
hours
Introduction - sightseeing in the 2nd Department of Ophthalmology AUTH
Tutorial theoretical skills
Preparation - repetition theoretical skills
Transmission of practical skills
Emergencies in Ophthalmology
Consideration of practical skills
General repetition of theoretical skills in the group
Multiple choice written exam
3
11x2=22
11x2=22
10x1=10
2x4=8
3
9
1
Total workload
78 hours
The weekly schedule is as follows:
Every Monday, Wednesday, Thursday, and Friday for 3 weeks you will attend:
108 students will be grouped in 4 groups of 27 and each group will be trained for 3 weeks Every
Monday, Wednesday, Thursday, and Friday as follows:
Group C
English
9/11 – 27/11
Group D
English
30/11 – 18/12
The programme for 2015-2016 academic year is carried out as follows:
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3
4
5
6
7
8
9
10
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12
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Date
Monday
Wednesday
Thursday
Friday
Monday
Wednesday
Thursday
Friday
Monday
Wednesday
Thursday
Friday
Theoretical
Practical
Introductory lesson – welcoming in the department
Skills 1- 8 & 9-19
Skills 3-5 & 6-12
Skills 1-2 & 15-21
Skills 20-27 & 28-33
Skills 34-47 & 48-53
Skills 22-26 & 13-14
Skills 26-28 & 29
Skills 54-59 & 60-64
Skills 65-75 & 76-90
Skill
29 & 30 + 1-5
Exams in practical skills
Written exams
Each group of students is trained by the same trainer throughout the sessions. Students are
expected to prepare for each session, i.e. study for the same amount of time that its session lasts,
which is 2 hours. For each week the student should prepare the specified theoretical skills that
are to be discussed on the upcoming session. During the session the trainer can a) evaluate the
students’ preparation and b) discuss and clarify any questions on the topic.
On-call sessions (8 hour duration) are to be attended by the students in 16 groups of 4 students
on dates the Department is on-call (the programme will be announced in the beginning of
October). Students are then exposed to current management of everyday emergency eye
problems.
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4. Studying material
Students are given the following:
a) Diagnostic and Therapeutic Approaches in Ophthalmology (Dimitrakos, Economides
and faculty member of the 1st and 2nd Departments of Ophthalmology, AUTH) with
electronic referrals and 50 multiple choice questions. University Studio Press, 2014, [in
greek] Eudoxus
b) You can access all theoretical skills - Powerpoint presentations at
http://www.med.auth.gr/depts/bophthalmo/
https://elearning.auth.gr/course/view.php?id=3813
http://eclass.auth.gr/courses/OCRS393/index.php
5. Examinations
Each student will be examined on the theoretical and practical skills by their trainer on the
last day of the 3week course (Friday). The student will be asked to demonstrate his/her
theoretical knowledge and practical dexterity on these topics, and will be given a mark (0-3)
by the trainer. This mark will account for 30% of the final mark.
Each student is expected to additionally study for 14 hours in order to prepare for the
written exam which will be held on the third week of the exam period, on Friday, from 14:00
to 15:00 at the auditorium of Papageorgiou Hospital.
The written exam will include
a) 28 multiple choice questions (with only one correct answer). Correct answers are
credited +0.25 marks, the first 8 incorrect answers are credited 0 marks, and the
subsequent incorrect answers are debited 0.25 marks each.
b) 3 questions requiring a short answer (about a paragraph each) which will be
marked with 0-1 marks each
The mark of the written exam will account for 70% of the final mark.
The final marks will be announced shortly after the written exam, in both the decimal from
and the ECTS form.
It is essential that the students who wish to participate in the written exam declare so at the
Department’s secretary office, where they should hand in their registered attendencies.
6. Evaluation
At the end of their practical training, the students are asked to hand in an anonymous
evaluation of their training, which will especially regard:
a) an evaluation of whether 78 hours of training were sufficient to achieve the training
goals initially set
b) if 3 ECTS credits appear in balance with the rest of the students’ training in other
subjects
7. Examination grading
Grading is assigned in numeric range (0-10) as well as in European Credit Transfer
System (ECTS) grading scale (A, B, C, D & F). ECTS grading represents the correlation
between the individual’s own performance and the overall exam performance. It is usually
described by Gaussian distribution curves.
An example of normal distribution is shown below:
Distribution (%)
ECTS grade
10%
A
25%
B
30%
C
25%
D
10%
E
F (failed to pass exams)
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8. Undergraduate teaching scheme
Aiming at essential education of medical students in Ophthalmology, the 2nd
Department of Ophthalmology is responsible for the teaching of 125 medical students in 10 th
semester. Teaching is provided and supported by 5 academics, 2 University Fellows and 3
military ophthalmologists, the latter derived from 424 Military Hospital.
The students are assigned to our department randomly. Randomization is based on
drawing of lots arranged by student’s representatives. Following initial randomization, the
students are distributed into 10 groups of 12 subjects according to their registration
numbers (second order randomization). Interchanges between different groups after
randomization are not possible. The distribution in this way is necessary because it ensures
the proper evaluation of both the instructor, and the students (minimizing error - random
distribution).
As posted online, there is an option of teaching and being examined in English
language provided for two teaching groups so far.
The list of students is to be delivered by the representatives to the Directorate of 2nd
Department of Ophthalmology at the beginning of the semester.
The list of the distribution of students in groups will be posted shortly after the
publication of the names and before the start of the first course. There will be a web posting.
9. Sites of teaching and practicing
Welcome reception takes place in the foyer of Papageorgiou Hospital auditorium on the
first Monday of the respective week at 9. and 30 November 2015
2nd department of Ophthalmology is located on the 3rd floor of southwest wing of
Papageorgiou General Hospital.
Outpatient clinics are located at the outpatient department of Papageorgiou Hospital, on
the ground floor.
Group
3
4
Tutor
Nikolaos Chalvatzis
Asimina Mataftsi
Site
Resident
Y-A(English) Outpatient clinics
Y-B(English) Outpatient clinics
Sotiris Basiakos
Artemis Matsou
Exercise in Ophthalmology emergencies (Papageorgiou Hospital Emergency Department)
and investigative procedures (clinical labs)
Date of on-call duty Time appointed
15.00-23.00
Clinical labs
Subgroup
November 2
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6
8
10
9
18
10
26
11
30
12
December 4
13
8
14
12
15
16
16
20 Compensation in case
of illness
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10. Tutors
Academics
Asimina Mataftsi
Nikolaos Chalvatzis
Assistant Professor, Coordinator of teaching
Assistant Professor
*Supplement Diploma MEDICINE
The skills to be developed by the medical student's attendance at the Aristotle
University of Thessaloniki are defined as follows:
“…in applied level training is aimed at learning outcomes and competencies, which give
the ability to offer services in the areas of Health, Education and Environment.
Specifically, the learning outcomes and competencies intended to be:”
 Clinical examination
 Patient assessment, request of laboratory tests, differential diagnosis and
management
 Emergency care
 Prescription of medicines
 Simple practical skills in ophthalmology
 Efficient communication with patients and colleagues
 Knowledge of essential medico-legal issues
 Ability to appraise social and psychological factors associated with the disease
 Application of evidence-based medical knowledge.
 Efficient use of computer technology in every-day practice.
 Familiarity with medical methodology and research in Ophthalmology
 Basic knowledge of epidemiology and health care policies.
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Theoretical skills
The student should be able to:
1.
Describe the epidemiological aspects of conjunctivitis neonatorum and epidemic
keratoconjunctivitis. Suggest the proper management for each one of them
2.
Explain the rationale about the use of antibiotics in bacterial conjunctivitis and
name at least two of the commonest antibiotics used in adults and children respectively.
3.
List the criteria for differential diagnosis between conjunctivitis, scleritis,
keratitis, iritis and acute angle-closure glaucoma
4.
Distinguish the conjunctival tumors from other benign conditions (i.e. pterygium,
pinguecula)
5.
Describe the physiological functions of the cornea with regards to its anatomical
architecture and consider it as part of the optical system of the eye and vital structure of
the anterior segment
6.
Understand the pivotal role that the normal tear film plays in the corneal
physiology and refraction and describe how the dry eye syndrome affects the cornea
(skill 26)
7.
Know of the neuroparalytic keratitis as well as the lagophthalmos-induced
keratitis
8.
Describe the clinical features of megalocornea and buphthalmos and the criteria
that differentiate these two entities
9.
Distinguish corneal infiltrates from ulcers, epithelial defects and corneal scars and
suggest appropriate treatments for all these entities
10.
Describe the symptoms and clinical signs of ultraviolent keratitis as well as its
pathophysiology, complications and management
11.
Mention the common clinical manifestations of Herpes Simplex Virus (HSV)
keratitis (dentritiform, stromal, disciform) and the usual complications. Suggest a proper
management and point out frequent mistakes that may lead to mistreatments
12.
Recognize arcus senilis as a totally benign condition
13.
List the contact lens-related complications
14.
Describe the pathophysiological and clinical features of chemical and thermal
burns. Describe the primary emergency care in such cases.
15.
Recognize lacerations of the lid margins and the upper lacrimal duct and suggest
a proper management
16.
Recognise the mechanisms involved in a blunt or penetrating ocular injury (with
or without the presence of an intraocular foreign body) and seek relevant information
from the patient’s history. Describe the methods of tracking and investigating
intraocular foreign bodies. Recognise the possible complications related to a residual
metallic foreign body in the eye
17.
Recognize the anterior chamber haemorrhage (hyphema) and the distorted pupil
as signs of a recent blunt ocular trauma and refers to the late possible complications of
this condition.
18.
Describe causes, types, symptoms and progression stages of cataract. Describe
complications related to mature cataracts and their management
19.
List indications for the surgical management of cataract. Recognise the
importance of early management of infantile cataract in avoiding amblyopia. Describe
the current cataract operation technique and its complications
20.
Understand the factors and mechanisms that determine the size of the pupil
21.
Describe the afferent and efferent nerve fibres controlling the pupil size
depending on imminent light
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22.
Understand why, in a IIIrd nerve paresis, pupillary dysfunction is an early
manifestation
23.
Describes the differences between the afferent and efferent papillary defects in
relation to the pupillary reflex pathways (p. 894-898)
24.
Describe the direct and indirect pupillary reaction to light as a result of the
pupillary reflex pathway.
25.
Recognize anisocoria as a result of either sympathetic or parasympathetic route
dysfunction.
26.
Describe the symptoms, causes and lesion locations of Cl. Bernarnd-Horner
syndrome
Describe the pharmakodynamics of myotic and mydriatic drugs. Name at least one from
each category. Understand the possible complications that may derive from mydriasis in
an eye with narrow angle
27.
Name common causes that may lead to an irregular pupil, such as anterior and
posterior synechiae, iris trauma, previous surgery etc., and describe the form of
irregularity
28.
Understand how the aqueous humor is produced and circulates in the eye and
explains the roles of the ciliary body, the pupil, Schlemm’s channel and episcleral veins
in this process
29.
Describe the early, characteristic functional defects as well as the morphological
changes of the nerve fibre layer following a longstanding rise of the intraocular pressure.
Describe the course of functional decline in primary open angle glaucoma.
30.
Name the symptoms, signs and management of acute angle-closure glaucoma
31.
Name the clinical and paraclinical tools for early detection, diagnosis and
monitoring of glaucoma
32.
Describe the clinical appearance of congenital glaucoma and buphthalmos. How
does the photophobia relate to it?
33.
List commonest causes of secondary glaucomas
34.
Distinguish the ischaemic swollen disk from true papilloedema (p. 807-809) and
make the differential diagnosis based on the functional defects
35.
List common causes of a swollen disk: intracranial hypertension, optic nerve
inflammation and ischaemic diseases
36.
Diagnose optic disk atrophy and set it apart from normal or glaucomatous
cupping. Describe retinal, optic nerve, chiasmatic, optic and pre-geniculate body
disorders as possible causes of optic disk atrophy
37.
Make the differential diagnosis between glaucomatous and ischaemic optic nerve
defects based upon the changes in visual acuity and visual fields and the time of their
appearance
38.
Distinguish intraocular from extraocular disorders that may affect the visual
pathway based on the type of visual field defects (altitudinal-vertical defects or
scotomas etc.)
39.
Track down lesions/defects across the visual pathway by studying the visual field
defects
40.
List common causes of endoptical phenomena (floaters). In which cases must
they be taken into serious consideration?
41.
Describe 3 causes of sudden vitreous opacification and distinguish them from
posterior pole disorders
42.
Explain the differences in visual perception (image resolution) of the macular
area compared to that of the peripheral retina based upon their unique anatomical
features
8
43.
Acknowledge the vascular changes encountered in the retina during the course of
arteriosclerosis, systemic hypertension, vein thrombosis and diabetes
44.
Acknowledge the vascular changes encountered in the retina during the course of
arteriosclerosis, systemic hypertension, vein thrombosis and diabetes
45.
Distinguish the (central or branch) retinal arterial obstruction from vein
thrombosis based upon their clinical appearance
46.
Describe the clinical findings in diabetic retinopathy and mention the types and
stages of the disease as well as the prevention measures, follow-up plan and the
appropriate time for laser treatment
47.
Know about age related macular degeneration (ARMD): epidemiology,
pathogenesis, early symptoms and modern treatments
48.
Describe causes, types, early and late symptoms of retinal detachment in relation
to the progress of the disease. How does it end up if untreated?
49.
Recognise, a retinal detachment that involves the macula based on ophthalmic
history and fundoscopy, and distinguish it from retinal vascular disorders
50.
Describe retinoblastoma epidemiology, clinical findings, systemic complications,
treatment and family plan counselling
51.
Recognize the symptoms and clinical manifestation of acute iritis and makes the
differential diagnosis from conjunctivitis and acute angle-closure glaucoma
52.
List the commonest systemic diseases that may cause autoimmune uveitis
53.
Recognize the complications related to iridocyclitis and suggest measures to
prevent them
54.
Describe epidemiologic features, signs and prevention measures of ocular
toxoplasmosis
55.
Describe the symptoms, signs and management of choroidal melanoma
56.
Know that premature babies kept in incubation units under high-pressure O2
conditions may be at high risk for development of retinopathy of prematurity
57.
Acknowledge the ways in which multiple sclerosis (MS) may affect the vision and
the eye
58.
Consider the likelihood to encounter ocular haemangiomas or even secondary
glaucoma in patients who present with facial haemangiomas
59.
Know the deriving pathway of ophthalmic herpes zoster infection and its ocular
manifestations
60.
Recognize Sjogren syndrome as causative of dry eye syndrome
61.
Know that several collagen autoimmune diseases may affect the scleral and
episcleral tissue
62.
Understand that Adamandiades-Bechet syndrome is a systemic vasculitis and
describe its possible ocular manifestations
63.
Describe signs and symptoms of intraocular metastatic tumors, and intraocular
lymphomas
64.
Describe the ocular complications related to chronic quinine, amiodarone and
ethambutol administration, systemic corticosteroids
65.
Define the visual acuity as the resolving power of the eye and understand the
mechanism of resolution based on the stimulation / non-stimulation of adjacent
photoreceptor cells.
66.
Define the visual acuity as the resolving power of the eye, whereby normal acuity
corresponds to the state at which 2 separate points of light subtend an angle of 1
minute of arc on the retina and can therefore be recognised as separate. Relate other
levels of visual acuity to this state.
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67.
Recognise the difference between visual acuity and vision. Relate the visual
acuity to a level of function. Recognise the difference of measuring visual acuity in a
decimal or logarithmic scale
68.
Estimate what the visual acuity level is from elements of the history.
69.
Recognise what the full visual field represents.
70.
Define refraction as a function of the refractive power of the eye in relation to its
axial length
71.
Define emmetropia, hypermetropia, astigmatism, and describe the principles of
their management.
72.
Understand the mechanism of accommodation and its results in near vision.
73.
Describe how the hyperopic eye can see clearly at distance and at what cost.
Explain the symptoms of eye strain secondary to hyperopia.
74.
Know that parasympatheticolytic agents (atropine, tropicamide) cause loss of
accommodation
75.
Define presbyopia as the result of loss of lenticular elasticity secondary to
advancing age, describe the symptoms of presbyopia, and the range of ages at which it
appears. Relates presbyopia to eyestrain secondary to hyperopia.
76.
Recognise the concept of retinal correspondence and describe the states of
binocular vision (simultaneous perception, fusion, stereopsis)
77.
Describe pseudostrabismus and accommodative strabismus
78.
Differentiate paralytic from concomitant strabismus and describe the clinical
signs and symptoms, e.g. diplopia and dependence of the angle of squint on the gaze
position
79.
Describe the etiology of amblyopia and recognise the importance of early
diagnosis and intervention
80.
Recognise ocular surface pain characteristics, from dry eye symptoms to the
sharp pain in corneal epithelial erosions, and describe its management
81.
Distinguish ocular surface pain characteristics from deep pain and localise the
potential insults leading to it (conjunctival, corneal, scleral or uveal disease).
82.
Describe refractive error (hyperopia) or latent squint as possible causes of a
headache that increases with ocular strain (near work) during the course of the day
83.
Recognise other forms of headache, such as migraine, temporal migraine, cluster
headache, and describe possible ocular symptoms
Describe that in visual disturbances a) that are accompanied by headache in advanced
age, one must suspect temporal arteritis, b) that are accompanied by nausea and
vomiting, one must suspect acute glaucoma (in the differential diagnosis of acute
cholelithiasis/cholecystitis
84.
Recognise retrobulbar neuritis as a possible cause of visual loss accompanied by
retrobulbar pain especially when this pain is increased with eye movements
85.
Recognise retrobulbar neuritis as a possible cause of visual loss accompanied by
retrobulbar pain especially when this pain is increased with eye movements
86.
Recognise presbyopia as the commonest cause of visual acuity reduction for near
(after a certain age)
87.
Recognise the possible causes of recent visual acuity loss both in distance and
near
88.
Name the vascular retinal diseases and optic nerve diseases that may cause
sudden visual filed loss of the hemi-field or totality of the field
10
89.
Distinguish the acute onset of visual loss form gradual visual field loss (in the
form of a curtain that falls or a wall that rises)
90.
Suspect a peripheral retinal tear and possible accompanying retinal detachment
in the presence of photopsiae and/or floaters
91.
Recognise diseases of the posterior pole of the eye as causes of metamorphopsia
and selective loss of the central visual field
92.
Name causes of binocular diplopia (which is relieved when one eye is covered),
especially paralytic strabismus
93.
Name possible causes of red eye accompanied by visual disturbance and pain:
diseases of the cornea, iris, ciliary body, but not of the conjunctiva or sclera.
94.
Describe the role of lids in mechanical protection and lubrification of the cornea
95.
Describe the elements of lid anatomy (conjunctiva, tarsus, levator muscle, skin,
lacrimal glands etc.)
96.
Name the two cranial nerves that are responsible for lid movements
97.
Recognise lagophthalmos, upper lid ptosis, entropion and ectropion, and list their
commonest causes
98.
Describe possible corneal complications and their management
99.
Recognise the element of emergency in managing upper lid ptosis in children
100. Recognise the localisation of ophthalmic zoster features and the location of
residence of the virus
101. Recognise the features of stye and describe its management
102. Recognise the features of chalazion and describe its management
103. Recognise exophthalmos. List most frequent causes: inflammation in the orbit,
venous stasis in the cavernous sinus, thyroid eye disease, orbital tumors.
104. List diagnostic features of inflammatory globe proptosis versus a noninflammatory globe proptosis, and describe first measures to be taken in managing this
condition
105. List characteristic features of thyroid eye disease
106. Distinguish preseptal from orbital cellulitis
107. List the tear film layers, describe what they consist of and what their function is
108. Recognise congenital nasolacrimal duct obstruction: features and management
109. Describe dacryocystitis and its relation to stenosis or obstruction of the
nasolacrimal duct, and describe its management
110. List symptoms of acute and of chronic conjunctivitis, how this condition presents
and how symptoms differ depending on cause
111. Describe the relationship between chronic conjunctivitis and chronic blepharitis
and dacryocystitis
112. List common causes of conjunctivitis: bacteria, chlamydia, viruses, physical or
chemical irritations, allergy, refractive error, and local or systematic autoimmune
diseases
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