Guidelines and Criteria for Registration as a Specialist in Ophthalmology

Prepared by


Specialty Sub-Committee of Ophthalmology,
National Specialist Register
CONTENTS



Page

1.

Introduction

1

2.

Recognised specialist training

2

3.

List of recognised postgraduate qualifications

2

4.

Requirements for enrolment for specialist training

3

5.

Recognised specialist training programme

3

6.

Recognised specialist training centres

4

7.

Competence in core procedures required of a specialist on
completion of training in ophthalmology

4

8.

Certification of completion in specialist training in
ophthalmology

5

9.

List of Appendices

5


Appendix 1 : Postgraduate training programme structure

6


Appendix 2 : Criteria for recognition of specialist training
centres

23


Appendix 3 : Core procedures required for fulfillment of
training

32

10


11.

Ophthalmology Surgical And Procedural Skills (for fulfillment of
Specialist Registration)

Acknowledgements

39


43
1. Introduction


The National Specialist Register (NSR) has been established to assure quality
care to the public by determining the professional standards expected of
specialists in their respective fields. Specialists are credentialed on fulfilling the
training requirements and have the required competencies stipulated by the
relevant specialty sub-committees.

The Specialty Sub-Committee of Ophthalmology has defined the criteria
for credentialing as an ophthalmologist. To be registered with the NSR,
the candidate must have satisfactorily completed the training programme and
demonstrated clinical competence.

The following requirements need to be fulfilled:


i. Registration with the Malaysian Medical Council and possession of
a current Annual Practicing Certificate

ii. Possession of any postgraduate qualification in ophthalmology
registrable with the NSR

iii. Satisfactorily completed 6 years of recognised training in
ophthalmology of which at least 2 years is after obtaining the
postgraduate qualification



These guidelines deal with the training to be undertaken by trainees enrolled in
a recognised training programme. It is a review of the previous handbook and is
effective from 1
st
January, 2012.













1
2. RECOGNISED SPECIALIST TRAINING


The total duration of training shall be a minimum of 6 years. The trainee must
pursue 4 years of postgraduate training leading to the award of a recognised
qualification, followed by 2 years of supervised training.



3. LIST OF RECOGNISED POST-GRADUATE QUALIFICATIONS


(i) Sarjana Surgeri (Oftalmologi), Universiti Kebangsaan Malaysia
(Master of Surgery (Ophthalmology), Universiti Kebangsaan Malaysia)


(ii) Sarjana Oftalmologi, Universiti Malaya
(Master of Ophthalmology, University of Malaya)


(iii) Sarjana Perubatan (Oftalmologi), Universiti Sains Malaysia
(Master of Medicine (Ophthalmology), Universiti Sains Malaysia)


(iv) Any other equivalent qualification can be considered for recognition
by the Specialty Sub-Committee of Ophthalmology on a case-to-case
basis provided all training requirements and any other requirements as
determined by the specialty sub-committee have been fulfilled.





















2
4. REQUIREMENTS FOR ENROLMENT FOR SPECIALIST TRAINING


A medical doctor who has:

i. at least 2 years of working experience after obtaining a basic medical
degree

AND

ii. full registration with Malaysian Medical Council

AND

iii. possession of a current Annual Practicing Certificate



5. RECOGNISED SPECIALIST TRAINING PROGRAMME


5.1 Postgraduate training leading to the Masters degree or
equivalent

The training shall be based on the Masters programme approved by the Malaysian
Universities Conjoint Committee of Ophthalmology (MUCCO) (Appendix 1).


5.2 Supervised training following postgraduate qualification

5.2.1 The aim of this 2 year period of training is to assist trainees to acquire
both knowledge and competence in the performance of procedures
to be credentialed as an ophthalmologist. It is an additional step
beyond post-graduate qualification where trainees will be assessed
for knowledge, skills and competence.

5.2.2 Supervised Postings
The trainee shall undergo supervised rotational postings of 3-6
months to fulfill their required core procedures and maintain the
logbook. A 6 monthly assessment of supervisors report must be
submitted. (Appendix 1)






3
6. RECOGNISED SPECIALIST TRAINING CENTRES


6.1 The Specialty Sub-Committee of Ophthalmology shall recognise individual
training centres based on specific criteria. (Appendix 2)


6.2 The list of current recognised training centres can be obtained from the
NSR secretariat upon request or its website: www.nsr.org.my. The list may
be updated from time to time.



7. COMPETENCE IN CORE PROCEDURES REQUIRED OF
A SPECIALIST ON COMPLETION OF TRAINING IN
OPHTHALMOLOGY

7.1. Trainees are required to be competent in the core procedures listed
(Appendix 3)


7.2 Trainees are recommended to use the Specialist Training in Ophthalmology
Personal Record and Surgical Logbook that can be obtained from the
Academy of Medicine of Malaysia. This logbook should continue to be used
after the trainee graduates. It is required for registration with the National
Specialist Register.





















4
8. CERTIFICATION OF COMPLETION IN SPECIALIST TRAINING IN
OPHTHALMOLOGY

A certificate shall be awarded after the trainee has satisfactorily completed the
following:

a. Postgraduate training in Ophthalmology (Masters or equivalent)
AND
b. Two (2) years supervised postings following postgraduate training including
review of procedural log book and supervisor reports

AND

c. Successfully attended exit certification conducted by the Specialty Sub-
Committee of Ophthalmology, NSR



9. APPENDICES
Appendix 1: Postgraduate training programme structure
Appendix 2: Criteria for recognition of specialist training centres
Appendix 3: Core procedures required for fulfillment of training




















5
APPENDIX 1

POSTGRADUATE TRAINING PROGRAMME STRUCTURE
(ADAPTED FROM THE MASTERS TRAINING PROGRAMME STRUCTURE
OF THE MALAYSIAN UNIVERSITIES CONJOINT COMMITTEE OF
OPHTHALMOLOGY (MUCCO))

OBJECTIVES
The postgraduate training programme in Ophthalmology aims to produce
graduates who:
1. are able to appropriately assess, diagnose and manage patients with ocular
and systemic related disorders
2. can assess and detect dysfunction of vision and the visual system, and
provide appropriate management for such conditions
3. are able to use current and appropriate technology in the diagnosis and
management of relevant ocular conditions
4. understand their role and are able to participate in the prevention of
blindness programme
5. understand their role as teachers and the importance of continuous
professional development in the advancement of Ophthalmology
6. are able to participate in eye research and development activities
7. can function effectively, ethically and professionally within the profession

LEARNING OUTCOMES
Phase I (Year 1)
At the completion of this phase, trainees possess:
1. good knowledge in basic medical and surgical sciences
2. good knowledge in ocular anatomy, physiology, pathology, basic optics and
ocular diseases
3. basic understanding on the optical principles of ophthalmic instruments and
their applications
4. skills in taking relevant history from patients and performing a complete
ophthalmic examination
5. skills in performing clinical refraction and interpret prescriptions
6. knowledge in basic ophthalmic microsurgery
7. skills in performing minor ophthalmic surgeries under supervision
8. good knowledge in basic research methodology

6
Phase II (Year 2 & 3)

At the completion of this phase, trainees possess:

1. in depth knowledge of ocular diseases and related systemic conditions
2. enhanced skills in eliciting history and performing a comprehensive
examination to arrive at appropriate differential diagnosis
3. the ability to decide on and interpret relevant investigations and manage
most cases with minimum supervision
4. the ability to perform common surgical procedures such as cataract surgery
with supervision
5. knowledge and skills in the assessment of low vision and its management
6. the ability to apply research methods in the conduct of their dissertation
project



Phase III (Year 4)

At the completion of this phase, trainees possess:

1. the ability to manage common and acute ophthalmic conditions
independently
2. the ability to perform common surgical procedures with minimal or no
supervision
3. an evidence-based approach to clinical decision-making and problem-
solving, through an ability to identify, critically analyze and interpret evidence
4. the ability to communicate effectively with patients, their relatives and
professional colleagues
5. knowledge on prevention of blindness programme planning and experience
on related activities
6. knowledge and skills to supervise junior trainees
7. the ability to conduct eye research and research in related sciences
8. good insight and the ability to recognize own limitations and seek appropriate
consultation







7
PROGRAMME STRUCTURE



Year

Phase

Curriculum

Assessment






1






1




Ophthalmology related to basic
medical sciences
Basic ocular sciences
Optics & refraction
Introduction to clinical ophthalmology






Part I

2
3

2

Clinical ophthalmology
Ophthalmology related to
general medicine & neurology






Part II




4




3




Advanced clinical ophthalmology




Part III

The course extends over a minimum period of 4 years and maximum period of
7 years.








8
SYLLABUS
PHASE I
BASIC MEDICAL SCIENCES (in relation to Ophthalmology)
Anatomy
General nervous system
Central nervous system
Detailed anatomy of the eye, orbit and adnexae and the visual pathways
Head and neck anatomy
The respiratory system and cardiovascular systems
Histology
Embryology

Physiology
General physiology (in relation to Ophthalmology)
Cardiovascular system
Respiratory system
Haematological system
Nervous system
Endocrinology
Renal system
Homeostasis
Nutrition

Pathology
General principles of pathology including
Inflammation
Disturbance of growth
Healing and repair
Immunological mechanisms and hypersensitivity reactions
Vascular pathology
Degenerative disorders and aging
Shock & trauma
Neoplasia and the effects of treatment
Common tissue stains


9
Pharmacology
General pharmacological principles
Mode of action of drugs on receptors
Drug toxicity
Absorption, distribution, metabolism and excretion of drugs

Molecular & cell biology
Cell structures and their biochemical functions
Normal cell functions and interactions
Connective tissue and extracellular matrix

Genetics
Principles of genetics
Modes of inheritance
Principle of gene therapy

Microbiology and immunology
Principles of microbial pathogenesis
Principles of sterilisation, disinfection and asepsis
Principles of antimicrobials
Principles of immunology



BASIC OCULAR SCIENCES Anatomy
of visual and ocular system Physiology
of visual and ocular system
Introduction to ocular pathology

Optics & refraction
Physical optics
Geometric optics
Clinical optics
Clinical refraction
Instruments






10
PHASE II SYLLABUS
Clinical history taking and examination
Ocular and systemic


Clinical ophthalmology
External eye diseases & orbit
Diseases of the uvea
Diseases of the lens
Diseases of the retina
Diseases of ocular motility
Glaucoma
Preventive ophthalmology
Investigations for ophthalmic diseases
Therapeutics

Paediatric ophthalmology
The diagnosis and management of common paediatric ophthalmic
conditions


Neuro-ophthalmology
Disorders of the visual pathways
Neuro-ophthalmic disorders of ocular motility


Ophthalmology in relation to medicine
Common neurological conditions affecting the eye
Endocrinology
Principles of resuscitation


Ophthalmic surgery
All surgery related to ophthalmology











11
SCHEDULES (TIMELINE)
PHASE I
Year 1


Jun

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

Mac

Apr

May
Introduction
to eye
Basic
Science

Basic Sciences / Optics

Viva / Revision
Part I
exam

PHASE II

Year 2


Jun

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

Mac

Apr

May

Presentations & Clinical session

1
st
Publication or
Case reports (1-3)
2
nd
Publication or
Case reports (4-7)

Present Research Proposal

Year 3


Jun

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

Mac

Apr

May
Presentations & clinical session /
Medical & Neurology rotation (2 months)

Viva & clinical session

3
rd
Publication or
Case reports (8-10)

Pass up case
reports & log book

Part II
exam

PHASE III

Year 4


Jun

July

Aug

Sept

Oct

Nov

Pass up 1
st
completed draft of
research report
Pass up corrected
copy of research
report
Research
report
presentation
Pass up final
copy of
research report


Dec

Jan

Feb

Mac

Apr

May

Pass up final copy
of publication or
case book

Pass up log book and obtain
supervisors approval to sit
for Part III exams
Part
III
exam

12
ASSESSMENTS



Assessments are carried out throughout the masters program from Year
1 to Year 4. Assessments serve as a guide to the trainee on what should be
achieved at different stages of the training. It also provides the trainee a means
to communicate any problems faced throughout different stages of the training
pertaining to the course.

These continuous assessments will be performed at specific intervals.

1. Supervisors report (at least twice a year)

2. End of rotation assessments (including medical and elective postings)


A log book is an official document which records information about all the
surgical and laser procedures that has been done by the trainee. The log book
should initially be submitted along with the case reports, one month before the
Part II examination and again before the Final Assessment. The initial submission
is for the supervisor to recognize any deficiency in the trainees surgical training
so that it will be rectified during the final year.

Trainees are recommended to use the Specialist Training in Ophthalmology
Personal Record and Surgical Logbook that can be obtained from the Academy
of Medicine of Malaysia. This is to ensure the continuity of the log book after
the trainee graduates and undergoes gazettement and may later undertake the
subspecialty training. It will also facilitate registration with the National Specialist
Registry. The logbook can be purchased from the academy.















13
SUPERVISORS REPORT
Master in Ophthalmology
Phase I Year 1

Name :
System : Open / Close
Hospital :
Supervisor :
Year of Entry :



Goals

Achievements
Comments
(student)
Comments
(supervisor)
Jun
July
Aug
Sept
Assessment

Oct
Nov
Dec
Jan
Assessment

Feb
Mac
Apr
May
Assessment




May



Part 1 Exam


14

Master in Ophthalmology


Phase II Year 1 (Starting after passing May Part I exams)

Name :
System : Open / Close
Hospital :
Supervisor :
Year of Entry :



Goals

Achievements
Comments
(student)
Comments
(supervisor)


Jun
July
Aug
Sept
Assessment

1
st
Publication
or
Case reports
(1-3)

Research
proposal
presentation



Oct
Nov
Dec
Jan
Assessment



Feb
Mac
Apr
May
Assessment



2
nd
Publication
or
Case reports
(4-7)


15

Master in Ophthalmology


Stage II Year 2 (Starting Year 2 in June after passing Part I Exams May)

Name :
System : Open / Close
Hospital :
Supervisor :
Year of Entry :



Goals

Achievements
Comments
(student)
Comments
(supervisor)
Jun
July
Aug
Sept
Assessment

Oct
Nov
Dec
Jan
Assessment


3
rd
Publication
or
Case reports
(8-10)


Feb
Mac
Apr
Assessment
Hand in
3 Publications
or
10 Case report
drafts to dept
by 1
st
February




May



Part II exam



16

Master in Ophthalmology


Phase III (Starting Year 4 in June after Passing Part II Exams in May)

Name :
System : Open / Close
Hospital :
Supervisor :
Year of Entry :



Goals

Achievements
Comments
(student)
Comments
(supervisor)


Jun
July
Aug
Sept
Assessment

Pass up
1
st
completed
copy of thesis
by 1
st
July

Pass up
corrected copy
of dissertation
by 1
st
August



Oct
Nov
Dec
Jan
Assessment

Pass up final
copy of
dissertation by
1
st
Nov

Pass up final
copy of case
book in
January

Feb
Mac
Apr
Assessment

Pass up
log book in
April


May

Final
assessment


17
CLINICAL POSTING ASSESSMENT FORM

Candidate : Supervisor(s) :
Posting/Rotation : Date :



No.

Competency
Level
(1-5)*
Comment by
supervisor

1
Inquiry skills (obtaining data information
from history, physical examination and
Investigations)

2 Problem solving and decision-making skills

3 Technical skills

4 Knowledge

5 Professional characteristics

6 Personal learning and assignments

7 Conduct and communication skills

8 Record keeping

9 Participation in teaching / learning activities

10 Leadership quality

Total for overall clinical competence**

* Level (1: Weak 2: Borderline 3: Satisfactory 4: Good 5: Excellent)
** Overall: Weak: < 15 Borderline: 15-19 Satisfactory: 20-29 Good: 30-39
Excellent: 40-50
*** For detail definition of each assessment, refer to individual university guidebook.

Overall comment / Recommendations by supervisor:



Supervisors signatures: Date:
Comment / Recommendations by Head of Department:

HOD signature: Date:


18
PROFESSIONAL EXAMINATION
PART I examination
Prerequisite
1. Successfully completed Phase I of the training program
2. Satisfactorily completed the log book
3. Obtained a satisfactory supervisor report

Component
A. Theory 50%
B. Clinical 30%
C. Optics and Refraction 20%


Section

Type

Number of Questions

Duration

%
marks
% to
total
marks

A

MCQ I
60 questions (Basic
Ocular Sciences, Optics
and refraction)

2 hrs

100

15


MCQ II
60 questions (Basic
Ocular Sciences, Optics
and refraction)

2 hrs

100

15


Essay
8 short notes questions
(Basic Ocular Sciences)

2 hrs 30 mins

100

20
Total for Theory 200 50

B

OSCE
10 stations
(Basic Ocular Sciences)

50 mins

100

15


Viva
1 session
(Basic Ocular Sciences)

30 min

100

15
Total for Clinical 200 30
C Clinical 1 case (Clinical refraction) 30 mins 100 10


OSCE
4 stations
(Optics & refraction)

20 mins

100

10
Total for Optics & Refraction 200 20
Grand Total 600 100
A candidate shall be deemed to pass the Part I examinations if he has obtained 50% or
more of the marks for each section of the examination and 45% or more of the marks for
each subsection of the examinations. A candidate is only allowed to obtain a borderline
mark (45.00 49.99%) in not more than one subsection under the same
section. A trainee who has failed the Part I examination may be permitted a second
attempt on
2 more occasions at 6 monthly intervals. The Part I examination must be passed not later
than twenty-four months from the date of initial registration as a candidate, failing which
the candidate shall be terminated forthwith from the course without notice.
19
PART II examination

Prerequisite
1. Successfully completed Phase II of the training program
2. Satisfactorily completed the log book
3. Satisfactory supervisor report and continuous assessments
4. Obtained ethical approval for research protocol at least 6 months before the
Part II examination
5. Submitted the first draft of 10 case reports or published/been accepted for
publication in journal according to merit points at least 3 months before the
Part II examination

Component
A. Theory 40%
B. Clinical 40%
C. Viva 20%


Section

Type

Number of Questions

Duration

%
marks
% to
total
marks
A MCQ I 60 questions 2 hrs 100 20


Essay
1 long essay &
4 short notes

1 hr 30 mins

100

10


Essay
1 long essay &
4 short notes

1 hr 30 mins

100

10
Total for Theory 200 40
B


Clinical
1 long case with refraction 1 hr 10 mins 100 15
6 short cases 30 mins 100 15

4 short cases
(Medicine in relation to OPH)
30 mins

100

10
Total for Clinical 300 40
C
Viva
Ophthalmology 30 mins 100 10

Medicine in relation to
Ophthalmology

30 mins

100

10
Total for Optics & Refraction 200 20
Grand Total 700 100

A candidate shall be deemed to pass the Part II examination if he has obtained 50% or
more of the marks for each section of the examination and 45% or more of the marks for
each subsection of the examinations. A candidate is only allowed to obtain a borderline
mark (45.00-49.99%) in not more than one subsection under the same section. A trainee
who failed the first attempt may be permitted a second attempt on 2 more occasions at 6
monthly intervals. A candidate who fails the examination on the third occasion shall not
be permitted to continue the course.
20
PART III examination


Prerequisite

1. At least one year after passing the Part II examination

2. Satisfactorily completed Phase III clinical training

3. Obtained a satisfactory supervisor report and continuous assessments

4. Submitted the research report not later than 6 months before the Final
Examination

5. Submitted case reports or publication (equivalent in merit points) not later
than 3 months before the Final Examination

6. Submitted the log book that has been certified 1 month before the Final
Examination


Assessment of dissertation

1. Research report will be evaluated by the internal, local and external examiners
appointed by the University.

2. Structure

a. Research Report

Oral presentation (20 min)

Viva (20 min)

b. Publication and Log Book (20 min)

3. Candidates should adhere to and make appropriate amendments and
corrections suggested by the examiners. A candidate is deemed to have
failed the examination if the amendments are not satisfactorily made within
the time given. Candidate may be permitted a second attempt on 2 more
occasions at 6 monthly intervals.










21
PUBLICATION AND PRESENTATION REQUIREMENTS



1. Publication

a. Case report / case series / letter to editor

Local journal 2 points

International journal 3 points


b. Original article

Local journal 3 points

International journal 4 points


c. Unpublished case report

1 case 1 point


*Minimum points for Publication is 10 points



2. Presentation

a. Oral presentation
Local 2 points
International 3 points

a. Poster presentation
Local 1 point
International 2 points

*Minimum points for Presentation is 5 points









22
APPENDIX 2



RECOGNISED CENTRES FOR TRAINING IN OPHTHALMOLOGY
SPECIALTY SUB-COMMITTEE OF OPHTHALMOLOGY

Application for departments to be recognised as centres for training in
Ophthalmology (w.e.f. 1
st
January, 2012)


Hospital / Institution:
Address:




Head of Department:
Date of Application:


A. GENERAL CRITERIA



THIS SECTION TO BE FILLED BY
APPLICANT
(FOR OFFICIAL USE)
THIS SECTION
TO BE FILLED BY
ASSESSOR


No.

Criteria
(Required criteria in brackets)

Data
on
Dept.
Meets
Minimum
Criteria
( / )


Notes
1. Total number of Ophthalmologists
registered in NSR
(A minimum of 2 is expected)

2. Total number of Medical Officer posts
filled
(A minimum of 4 including trainees)

3. Total number of beds for
ophthalmology including day care
(A minimum of 6)


23

4. Total number of Ophthalmology Clinic
sessions per week
(Minimum of 3)

5. Total number of operative sessions
per week
(Minimum of 2)

6. Total number of cataract surgeries
per month
(Minimum of 25)

7. Are microbiology services available?
(Yes) specify

8. Are biochemistry services available?
(Yes) specify

9. Are pathology services available?
(Yes) specify

10. Are diagnostic imaging services
available?
(Yes) specify

11. Is an anaesthetist available including
visiting?
(Yes) specify

12. Is there Intensive / Coronary Care
service available?
(Yes) specify

13. Is there a General Medical unit?
(Yes)

14. Is there a trauma / accident and
emergency unit?
(Yes)




24
B. SPECIFIC CRITERIA



No.


Names of Ophthalmologists in
Department

Postgraduate
Qualifications
and Year
Date
Registered
with National
Specialist
Register



1.



i.
ii.
iii.
iv.
v.
vi.
vii.
viii.



25


No.

Criteria
(Required criteria in brackets)

Data on
Dept
Meets
Minimum
Criteria ( / )

Notes
2. Annual workload of inpatients
(use previous year figures)

(should exceed 400)

3. Annual workload of new outpatient
cases (use previous year figures)

(should exceed 1500)

4. Annual workload of follow up cases
(use previous year figures)

(should exceed 6000)

5. Annual workload of major elective
operations done
(use previous year figures)

(should exceed 200)

6. Annual workload of minor operations
done (use previous year figures)

(should exceed 100)

7. Annual workload of emergency
operations done
(use previous year figures)

(should exceed 50)

8. Are surgical audits done in the
Department?
(minimum 3 per year )

9. Equipment

1. Total number of slit lamps

2. Total number of Binocular
Indirect Ophthalmoscope

3. Visual Field Analyser



26


4. A Scan
5. B Scan
6. Fundus Camera
7. Anterior segment camera
8. Other Imaging tools
(OCT/HRT/____________ )
9. Laser
(Type: Argon/YAG/_________ )
10. Indirect laser
11. Phacoemulsification
12. Operating Microscope
13. Vitrectomy machine
14. Others (specify)

10. Optometrist (minimum 1)

11. Technologist

12. Orthoptist

13. Number of Ophthalmology Textbooks

14. Number of Ophthalmic Journals
subscribed by Dept / Library
(state journals)

15. Internet facilities including access to
online journals (state journals)

16. Number of Ophthalmology CME
sessions per week

17. Will trainees be able to do hands on
surgical procedures on patients? (Yes)

18. Will there be an opportunity for
trainees to do a minimum of 20
cataract operations a year? (Yes)

19. Are there facilities for Wet Lab
Sessions? (Yes)

20. Will there be an opportunity for
trainees to participate in community
eye care projects



27
C. ADDITIONAL CRITERIA FOR CENTRES APPLYING FOR
OPHTHALMOLOGY SUBSPECIALTY TRAINING


Criteria Subspecialty
Department
Data

Remarks
1. Number of
practicing
subspecialty
trained
Ophthalmologist
with 2 years
experience
a. VR Surgery

b. Medical Retina

c. Glaucoma

d. Oculoplastics & Orbit

e. Cornea

f. Paediatric Ophthalmology

g. Neuro-Ophthalmology

h. Others (specify)

2. Number of
outpatient
subspecialty
visits per year
a. VR Surgery

b. Medical Retina

c. Glaucoma

d. Oculoplastics & Orbit

e. Cornea

f. Paediatric Ophthalmology

g. Neuro-Ophthalmology

h. Others (specify)

3. Number of
surgeries /
procedures
performed
per year
(for each
subspecialty)
a. VR Surgery

b. Medical Retina

c. Glaucoma

d. Oculoplastics & Orbit

e. Cornea

f. Paediatric Ophthalmology

g. Neuro-Ophthalmology

h. Others (specify)



28

4. Will there be
an opportunity
for candidates
to fulfill the
requirement
and gain
competency in
specified core
procedures?
Please state
YES/NO
a. VR Surgery

b. Medical Retina

c. Glaucoma

d. Oculoplastics & Orbit

e. Cornea

f. Paediatric Ophthalmology

g. Neuro-Ophthalmology

h. Others (specify)


Notes

1. Please enclose together with this application the following:
i. Previous 1 year census
ii. A list of key Ophthalmology textbooks and journals available in the
department/ Hospital
iii. A list of all teaching aids available in the Department (LCD projector, computers,
etc)

2. Period of Recognition
Recognition is given for a period of 3 years on condition that there are no
drastic changes in the minimum requirements during that period.

3. Recognition will be given as:
i. Suitable for General Ophthalmology training up to 6 months
ii. Suitable for General Ophthalmology training up to 6 years
iii. Suitable for Ophthalmology Subspecialty training
iv. Suitable for Specific Area of Training

4. Failure to gain recognition
If a department fails to get recognition, it will be informed in writing of the reasons.
The department may subsequently reapply when the requirements are met.
If criteria are lacking in any of the above, please state reasons why the department
should still be considered for recognition:








29
The Hospital/Institution agrees to pay expenses incurred should the Specialty
Sub-Committee of Ophthalmology decide to make a visit.









Hospital Ophthalmologist Date:
Official stamp:









Hospital Director Date:
Official stamp:









To be filled by representatives of the Specialty Sub-Committee of Ophthalmology:

Comments from visit (if visit is made):















30
RECOGNISED CENTRES FOR TRAINING IN OPHTHALMOLOGY
SPECIALTY SUB-COMMITTEE OF OPHTHALMOLOGY



Certification of the Department for Training in Ophthalmology


The Department of Ophthalmology of _____________________________
Hospital is granted / not granted recognition for training.

Recognition is granted as follows:

Suitable for General Ophthalmology training up to 6 months

Suitable for General Ophthalmology training up to 6 years

Suitable for Ophthalmology Subspecialty training

Suitable for Specific Area of Training in


from to


It is recommended that the total number of trainees in this department should not
exceed in number.

Reasons for not granting recognition:
















Chairman, Date:
Specialty Sub-Committee of Ophthalmology


31
APPENDIX 3



CORE PROCEDURAL SKILLS


A. CLINICAL EXAMINATION SKILLS



No.


CORE PROCEDURES
Minimal Training necessary
for Competence
Observed Assisted Performed
1. Distant Vision including conversion 5

10
2. Near Vision 5

10
3. Visual assessment in children
Preferential looking
OKN
Matching
Objection to Occlusion


5
5
5
5



20
10
20
20
4. Colour - Vision Ishihara 2

Interpret
- 10
Perform
- 5
5. Colour - Vision D 15 2

Interpret
- 10
Perform
- 5
6. Slit Lamp Biomicroscopy including
contact and non contact lens

Optic disc and RNFL assessment
5


5

20


20
7. Intraocular Pressure measurement
and calibration of devices using:
- Applanation Tonometer
- Perkins Tonometer
- Tonopen



5
5
5




20
5
20


32

8. Pachymetry 2

10
9. Gonioscopy 3

30
10. Direct Ophthalmoscopy

20
11. Indirect Ophthalmoscopy with
indentation
5

20
12. Retinal Diagram 5

10
13. Extraocular Muscle Movements 5

20
14. Assessment of Nystagmus 5

5
15. Exophthalmometry 5

10
16. Visual Field Confrontation 5

20
17. Amsler Chart 5

20
18. Dry Eye Assessment 2

10
19. Placido Disc 2

10
20. Cover Test 5

20
21. Prism Cover Test 5

20













33
B. BASIC CLINICAL OPTOMETRY SKILLS



No.


CORE PROCEDURES
Minimal Training necessary for
Competence

Observed

Assisted

Performed
1. Refraction Retinoscopy
+ subjective refraction

Myopia (including high myopia)

Hyperopia

Myopia/Astig

Hyperopia/Astig

Astigmatism only

Pseudophakia

Aphakia
5

20
2. RAF Rule including Interpretation 5

10
3. Use of Focimeter 5

10
4. Use of Autorefractometer 2

10
5. Keratometry 5

30
6. Insertion and removal of Contact
Lenses
5

5
7. Contact lens fitting 5

10
8. Exposure to Low Vision Devices 5 5






34
C. OPHTHALMIC DIAGNOSTIC SKILLS



No.


CORE PROCEDURES
Minimal Training necessary for
Competence

Observed

Assisted

Performed
1. Bjerrum Perimetry 2

Interpret
- 10
Perform
- 5
2. Automated Perimetry 3

Interpret
- 30
Perform
- 5
3. Hess Chart 2

Interpret
- 10
Perform
- 5
4. A Scan and IOL Power Calculation 5

Interpret
- 30
Perform
- 30
5. Ocular Photography
- External
- Ant. Segment
- Optic disc
- Fundus
3 for each

5 for each
6. B Scan basic Interpretation 5

20
7. HRT 3

Interpret
- 20
8. OCT
- Macular
- Optic Disc

5
5

Interpret
- 20
- 20
9. Electrophysiology Tests 2

Interpret
- 5
10. Corneal topography 5

10
11. 100 Hue Colour Vision Test 2

Interpret
- 5
12. Fundus Fluorescein Angiography 5

Interpret
- 20
Perform
- 5


35
D. SURGICAL / PROCEDURAL SKILLS




No.

CORE / SPECIALISED
PROCEDURES
Minimal Training necessary
for Competence

Observed

Assisted

Performed
1. Eye Irrigation 3

10
2. Syringing and Probing
- Adults
- Paeds


5
3



20
3
3. I&C and I&D 3 7 10
3 in
Paeds
4. Lid T&S not involving lid margin 5 7 10
5. Entropion / Ectropion primary repair

2 2
6. STO Cornea / Lids 5

10
7. Tarsorraphy 5 5 5
8. DCR 2 3

9. Brow suspension

2

10. Excision of lid / eyebrow lesions 5 5 5
11. Lateral canthotomy 1

1
12. Removal of corneal / conjunctival
Foreign Body
3

10
13. Conjunctival Graft 3 5 10
14. Excision of pterygium / conjunctival
lesions
5 5 10
15. Harvesting buccal mucosa 3

16. Amniotic membrane transplant 3

17. Corneal Scraping 3

10

36

18. Glueing of corneal perforation 2 1 5
19. Corneal and Scleral T&S 3 5 10
20. Retrieval and processing of donor
eyes
1 1 1
21. Penetrating Keratoplasty 3

22. AC tap / Paracentesis /
Intracameral Injections
3

5
23. Laser Iridotomy 5

20
24. Laser Argon laser peripheral
iridoplasty
5

5
25. Cyclophotocoagulation 5

10
26. Laser suturelysis 3

27. YAG Laser Capsulotomy 5

10
28. Trabeculectomy / phaco
trabeculectomy +/- anti-metabolite
(primary, not repeat)
5 5

29. Glaucoma Drainage Device 3

30. Paediatric Glaucoma Surgeries

3

31. Paediatric Lens aspiration (limited
to children above 6 years of age)

3 3
32. ECCE (including converted phaco
cases)
5 5 20
33. Phacoemulsification 10 40 50
34. ROP Screening

10 50
35. EUA Paediatric

3 10
36. Retinoblastoma management / EUA 3

37. Pan Retinal Photocoagulation 3

50


37

38. Focal / Grid Laser 5

10
39. Laser to retinal breaks / lattice 3

10
40. Indirect Laser Photocoagulation
- Adults
- Premature infants


3
3



10
41. Cryopexy 3 3 3
42. Vitreous tap 3

5
43. RRD Surgery including sclera
buckling (Primary repair)
5

44. Vitreous Surgery 5

45. Insertion and removal of eye
prosthesis
3

5
46. Evisceration /
Enucleation without orbital implant

2
2
1
1
47. Evisceration /
Enucleation with implant

2

48. Exenteration 1

49. Squint surgery
- Adults
- Horizontal Squint in Paeds
patient



5
3

50. Subconjunctival Injection 5

10
51. Orbital Floor Injection 3

3
52. Intravitreal injection 3

5
53. Injection of anti-metabolite
(including preparation and disposal)
3

54. Injection of local anaesthesia
(peribulbar / retrobulbar / subtenon)
5

10



38

OPTHALMOLOGY SURGICAL AND PROCEDURAL SKILLS (for
fulfillment of Specialist Registration)

No CORE / SPECIALISED PROCEDURES
1. Eye Irrigation
2. Syringing and Probing
-Adult
-Paeds
3. I&C and I&D
4. Lid T&S not involving lid margin
5. Entropion / Ectropion primary repair
6. STO Cornea / Lids
7. Tarsorraphy
8. Excision of lid / eyebrow lesions
9. Lateral canthotomy
10.

Removal of corneal / conjunctival
foreign Body
39


11. Conjunctival Graft
12. Excision of pterygium / conjunctival lesions
13. Corneal Scraping
14. Glueing of corneal perforation
15. Corneal and Scleral T&S
16. Retrieval and processing of donor eyes
17. AC tap / Paracentesis / Intracameral Injections
18. Laser Iridotomy
19. Laser - Argon laser peripheral iridoplasty
20. Cyclophotocoagulation
21. Laser suturelysis
22. Laser Capsulotomy
23. Paediatric Lens aspiration (limited to children

above 6 years of age)
40
24. ECCE (including converted phaco cases)
25. Phacoemulsification
26. ROP Screening
27. EUA - Paediatric
28. Pan Retinal Photocoagulation
29. Focal / Grid Laser
30. Laser to retinal breaks / lattice
31. Indirect Laser Photocoagulation
-Adult
-Premature infants
32. Cryopexy
33. Vitreous tap
34. Insertion and removal of eye prosthesis
35. Evisceration /

Enucleation without orbital implant
41
36. Subconjunctival Injection
37. Orbital Floor Injection
38. Intravitreal injection
39. Injection of local anaesthesia
(peribulbar / retrobulbar / subtenon)

















42
ACKNOWLEDGEMENTS:



The Specialty Sub-Committee of Ophthalmology:
Dr. Pall Singh (Chairperson)
Assoc. Prof. Dr. Wan Hazabbah Wan Hitam
Assoc. Prof. Dr. Mimiwati Zahari
Dr. Bethel Indira Livingstone
Dr. Anusiah Selvathurai
Dr. Elias Hussein
Assoc. Prof. Dr. Andrew Tan Khian Khoon
Dato Dr. Y C Lee



The Specialty Training Committee:
Dr. Bethel Indira Livingstone (Chairperson)
Dr. Anusiah Selvathurai
Dr. Pall Singh
Dato Dr. Y C Lee
Dr. Mariam Ismail
Dr. Elias Hussein
Prof. Dr. Ropilah Abdul Rahman
Assoc. Prof. Dr. Mohtar Ibrahim
Assoc. Prof. Dr. Mimiwati Zahari
Assoc. Prof. Dr. Wan Hazabbah Wan Hitam
Assoc. Prof. Dr. Mae-Lynn Catherine Bastion
Assoc. Prof. Dr. Andrew Tan Khian Khoon
Assoc. Prof. Dr. Choo May May
Prof. Dato Dr. Veera Ramani
Dr. Goh Pik Pin
Datin Dr. Rusnah Hussin
Dr. Thayanithi A/P K. Sandragasu







43