BCSC

Recommended Diabetic Retinopathy Exam Schedule

The Preferred Practice Pattern guidelines for diabetic retinopathy have a really useful table that has helped me figure out the recommended follow-up schedule for patients with diabetic retinopathy. However, that table can sometimes be difficult to conceptualize, so as part of my quest to improve my design skills, I’ve segmented the follow-up periods over the course of a year and used some colors and hierarchy to provide a more visually dynamic presentation.

Daily Study Calendar

Among the many crazy ideas and projects I have bouncing around in my head, I’ve wanted to develop a daily study calendar.

I’ve received a lot of feedback over the years that some of the major challenges to learning ophthalmology include the overwhelming volume and the lack of overall structure in how to study the material comprehensively. Bhullar and Venkateswaran argue this in a 2022 review article (1). While there are many general reading schedules and suggested options available (some here for free!), these still only direct the learner to textbook pages, with little instruction on how and what to study.

So although this is a massive undertaking, I started thinking of how I would design a step-by-step curriculum for a pre-ophthalmology (PGY-1) or first-year ophthalmology (PGY-2) resident. My goals were to:

  • Cover all the major topics in ophthalmology at least once

  • Span around 30-35 weeks (July 1 to OKAP in mid-March is about 37-38 weeks) to allow sufficient time for review

  • Specify learning goals for each day to direct attention to important concepts and topics

  • Allot for an average daily study time of one hour on work days, 3-4 hours on the weekends (including one day off per week for either no study or unstructured study)

  • Incorporate active learning techniques such as generation, elaboration, effortful recall, spaced repetition, and interleaving

The result is a 35-week study calendar that covers the majority of ophthalmology topics 2-3 times. This allows residents who are planning on taking exams in mid-March to start studying at the beginning of July and finish the study calendar with 2-3 weeks remaining for review.

Because learning is an iterative process, the first four weeks are structured as an “introduction to ophthalmology" and covers the afferent visual pathway, eye movements, periocular anatomy and function, and intraocular anatomy and function. These fundamentals are reviewed in subsequent weeks as we dive into most common conditions in ophthalmology (ordered anatomically), and followed by a deeper dive into the “high-yield” topics in each subspecialty.

The challenge with this approach, of course, is that the textbook correlation may be more scattered and voluminous. After all, some sections may reference almost a hundred pages of textbook in a single day, which is not a really feasible prospect.

So, as an attempt to make each day’s reading more accessible (and to the level of detail I was intending), I put together a sample section to see if this would be helpful.

Let me know what you think in the comments below! You can also reach me by email at ophthreview [at] gmail [dot] com, @ophthalmologyreview on Facebook, or @ophthreview on Twitter, Mastodon (@med-mastodon.com), or Instagram.

  1. Paramjit K. Bhullar & Nandini Venkateswaran (2023) Ophthalmology Residency in the United States: The Case for a National Curriculum, Seminars in Ophthalmology, DOI: 10.1080/08820538.2022.2152713

Random Topic Generator

I’m happy to announce that I’ve completed a random topic generator that covers all of the various topics discussed in the AAO’s Basic and Clinical Science Course textbooks (excluding the General Medicine volume). It’s been a while since I’ve coded to this extent so this version is very basic - I’ve included all topics listed in the BCSC (including references such as glossaries and procedure instructions), and I haven’t assigned any priorities to certain topics, which means that there is theoretically an equal chance of getting keratoconus as there is getting molecular genetics testing modalities.

Eventually I’d like to prioritize topics to a certain degree, which may also take into account stage of training (a first-year resident may need to review anatomy a lot more than a recent graduate) as well as type of knowledge (how to perform surgery is probably learned hands-on rather than from a textbook).

I’m working closely with the AAO on projects similar to this, and so eventually this project may be added to one of the resources the Academy offers. Stay tuned for more developments!

Studying After Failing A Test

I’ve been humbled by the many people who have had the courage to contact me over the past few years to ask my advice on preparing for various exams. I don’t claim to be an expert at the various exams, but I do want to help my fellow colleagues succeed in any way possible, and if this website helps more people fare better on their tests and also become better ophthalmologists, that’s great.

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Glaucoma Genetics

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Glaucoma Genetics

There are many inheritable forms of glaucoma, both primary and secondary. While inheritance patterns and genetics are not perfectly mapped out for glaucoma, there are some basic observations that can help us screen for glaucoma among family members:

Last Minute OKAP Review

One of the things I want to do on this site is to provide more finished "products" for you, in addition to the subject/literature reviews, test preparation and study ideas, and book reviews.  These will hopefully include charts, outlines, and other media that will help augment your studies.  I am working on several book-length projects for the site as well, including a mnemonics-style cheat book and a "textbook" of ophthalmology, with the goal of bridging the gap between the traditional high-academic works of the highly reputable textbooks and shorter-length review books.  Since those books are going to take me a considerable time to write and prepare (probably several years at the rate I'm going now), I plan to publish those for sale.  However, I still want to make the bulk of the content free, so the articles won't be hidden behind a paywall.

Ciliary Ganglion

The ciliary ganglion serves as the site of synapse for the parasympathetic nerves innervating the eye.  Because of the many nerves that course through it (not all of them synapse!) and its anatomical location, this structure is of importance in learning the basics of ophthalmology.  According to the Basic and Clinical Science Course, it is located lateral to the ophthalmic artery, situated between optic nerve and lateral rectus muscle, approximately 1 cm (10 mm) anterior to the annulus of Zinn and 1.5-2 cm (15-20 mm) posterior to the globe (1-5).

Phakomatoses: Overview

Phakomatoses are a multidisciplinary category of systemic diseases that is often tested for a multitude of reasons.  Although the incidence of these conditions is fairly low (though chances are you will see at least 1 case of many of these conditions), there are many ocular findings that need to be considered.

I've been debating how to organize this information in a useful manner for review for quite some time.  The subject material is pretty massive, and each condition could easily take several articles (and probably eventually will).  But I wanted to make sure there was a useful review out there on this subject before the written board exam, in case the test covers one of these conditions.

HIV And AIDS

I admit, most of the general medicine categories will be rather broad topics.  Truth be told, the main things you need to know about HIV and AIDS are more geared towards the opportunistic illnesses that arise from the immunodeficient state present in the late stages.  You'll likely see some of those opportunistic conditions pop up in other sections, as we work through each article.

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.

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).

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.

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.