PGY-2 Goals & Objectives

Medical Knowledge

  • To describe basic examination techniques for strabismus (e.g., ductions and versions, cover and uncover testing, alternate cover testing, prism cover testing).
  • To describe basic visual development and visual assessment of the pediatric ophthalmology patient (e.g., central, steady, maintained fixation; illiterate E, Allen cards, Landolt C rings).
  • To describe basic anatomy and physiology of strabismus (e.g., innervation of extraocular muscles,primary actions, comitant and incomitant deviations, overaction and underaction, restrictive and paretic, saccades and pursuit movements).
  • To describe basic sensory adaptations for binocular vision (e.g., normal and anomalous retinal correspondence, suppression, horopter, Panum’s area, fusion, stereopsis).
  • To describe and recognize pseudostrabismus.
  • To describe basics of binocular sensory testing (e.g., Titmus stereo testing, Randot stereo testing, Worth 4-dot, Bagolini lenses, afterimage testing).
  • To describe different etiologies of amblyopia (e.g., deprivation, ametropic, strabismic,anisometropic, organic).
  • To describe etiologies of esotropia (e.g., congenital, comitant and incomitant, accommodative and non-accommodative, decompensated, sensory, neurogenic, myogenic, neuromuscular junction, restrictive, nystagmus blockage syndrome, spasm of the near, monofixation syndrome, consecutive).
  • To describe etiologies of exotropia (e.g., congenital, comitant and incomitant, decompensated, sensory, neurogenic, myogenic, neuromuscular junction, restrictive, basic, divergence excess, exophoria, convergence insufficiency).
  • To describe various strabismus patterns (e.g., A or V pattern).
  • To describe etiologies, evaluation, and management of vertical strabismus (e.g., neurogenic, myogenic, neuromuscular junction, oblique overaction, dissociated vertical deviation, restrictive).
  • To describe non-surgical treatment of strabismus.
  • To describe different forms of childhood nystagmus.
  • To describe features, classification, and treatment indications for retinopathy of prematurity.
  • To describe etiologies and types of pediatric cataracts.
  • To describe and recognize ocular findings in child abuse (e.g., retinal hemorrhages) and appropriately refer to child protective services or other authorities.
  • To describe common hereditary or congenital ocular motility or lid syndromes (e.g., Duane syndrome, Marcus Gunn jaw winking, Brown syndrome).
  • To describe typical features of retinoblastoma.
  • To describe basic features of dyslexia.
  • To describe basic evaluation of decreased vision in infants and children (e.g., retinopathy of prematurity, hereditary retinal disorders, congenital glaucoma, measles, vitamin A deficiency).
  • To describe identifiable congenital ocular anomalies (e.g., microphthalmia, persistent fetal vasculature).
  • To describe ocular findings in inherited, metabolic disorders
    • Mucopolysaccharidoses (e.g., Hurler syndrome, Scheie syndrome, Hunter syndrome, San Fillipo syndrome, Morquio syndrome, Sly syndrome).
    • Lipidoses (e.g., Tay-Sachs disease, Sandhoff, Niemann-Pick, Krabbe’s, Gaucher’s, Fabry’s, metachromatic leukodystrophy).
    • Aminoacidurias (e.g., homocystinuria, cystinosis, Lowe, Zellweger).
  • To describe ocular findings in chromosomal abnormalities (e.g., Trisomy 21, Trisomy 13, Trisomy 18, Short arm 11 deletion, Long arm 13 deletion, Cri du Chat, Turner).
  • To describe recognizable causes of blindness in infants (e.g., albinism, optic nerve hypoplasia, achromatopsia, Leber’s congenital amaurosis, retinal dystrophy, congenital optic atrophy).
  • To describe etiology, evaluation, and management of congenital infections (e.g., toxoplasmosis, rubella, cytomegalovirus, syphilis, herpes).
  • To describe and recognize the common causes of pediatric uveitis.


Patient Care

  • To perform an extraocular muscle examination based on knowledge of the anatomy and physiology of ocular motility.
  • To assess ocular motility using ductions and versions testing.
  • To perform basic measurement of strabismus (e.g., Hirschberg, Krimsky, cover testing, prism cover testing, simultaneous prism cover test, alternate cover testing, Parks-Bielschowsky three-step test, Maddox rod testing, double Maddox rod testing).
  • To perform assessment of vision in the neonate, infant, and child.
  • To recognize and apply in a clinical setting the following skills in the ocular motility examination (simple, advanced)
    • Stereoacuity testing
    • Accommodative convergence/accommodation ratio (e.g., heterophoria method, gradient method)
    • Tests of binocularity and retinal correspondence
    • Cycloplegic refraction (retinoscopy)
    • Anterior and posterior segment examination
    • Basic and advanced measurement of strabismus
    • Cover test measurement
    • Assessment of vision
      • Teller acuity cards
      • Fixation preference test
      • Standard subjective visual acuity tests
      • Induced tropia test 
  • To perform extraocular muscle surgery including:
    • Recession
    • Resection
    • To assist a primary surgeon performing
    • Muscle weakening (e.g., tenotomy) and strengthening (e.g., tuck) procedures
    • Transposition
    • Use of adjustable sutures