FEBOD GLAUCOMA APPLICATION FORM 2016
1.
Do you have the title of specialist in ophthalmology in your country?
Yes
No
2.
After the graduation from your ophthalmology program, did you complete a oneyear glaucoma-fellowship / training?
Yes
No
3.
Did you accomplish this glaucoma-fellowship / training in one of the EU or UEMS
associated countries?
Yes
No
a)
Which country?
Austria
Belgium
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Italy
Latvia
Lithuania
Luxenbourg
Malta
Netherlands
Norway
Poland
Portugal
Romania
Republic of Ireland
Slovenia
Slovakia
Spain
Sweden
Switzerland
United Kingdom
If no, please specify which country:
4.
Is the institution where you attended the glaucoma fellowship / training an academic
center?
Yes
No
5.
Did the institution where you attended the fellowship / training offer a structured
training program?
Yes
No
6.
Did the institution where you attended the fellowship / training provide in addition
to basic ophthalmological equipment an area with current diagnostic equipment?*
OCT
Yes
No
HRT
Yes
No
Gdx
Yes
No
AVF (Humphrey or Octopus)
Yes
No
AS OCT
Yes
No
UBM
Yes
No
* Note: In-depth clinical/practical knowledge of at least one of these instruments (OCT,
HRT, GDx) is considered necessary for the glaucoma subspecialty examination.
7.
Did the institution where you attended the fellowship / training have adequate
surgical facilities (operating microscope etc)?
Yes
No
8.
Did the institution where you attended the fellowship/training provide access to a
medical library and facilities for electronic retrieval of medical literature and
information from medical databases?
Yes
No
9.
Did the main member of faculty/person responsible for your training (not
necessarily head of department) have appropriate qualifications (acknowledged
expertise in glaucoma)?
Yes
No
10.
Does the main member of faculty / responsible of your training have a minimum of
5 years devoted mainly to the care of glaucoma patients?
Yes
No
11.
Does the main member of faculty / responsible of your training have national and
international activities in teaching/research in the area of glaucoma?
Yes
No
12.
Did the main member of faculty / responsible of your training give active
supervision during the training?
Yes
No
13.
Did the main member of faculty / responsible of your training establish a document
of accomplishment of all requirements (theoretical, clinical, surgical, research,
reading, behavioral)
Yes
No
14.
Did the main trainer / member of faculty / responsible of the training give periodical
evaluations / progress reports?
Yes
No
LOG-BOOK
15.
Are these following items part of the training that you have accomplished?
List of pre-requisite knowledge from residency training
Embryology and anatomy of the eye
Embryology and anatomy of the anterior
chamber angle
Embryology and anatomy of the retina
optic disc and nerve fiber layer
Anatomy of the cornea
Physiology of aqueous humor
Anatomy of the zonule, the lens of the
hyaloid and vitreous
Anatomy of the ciliary body
Yes
No
Yes
No
Yes
Yes
Yes
No
No
No
Yes
Yes
No
No
Theoretical knowledge
- Epidemiology
- Pathophysiology
- Diagnostics
- Treatment (medical, surgical, laser procedures)
- Complications
- Follow-up
- Critical evaluation of literature (Evidence-Based
Medicine), including health economics
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Yes
No
Classification of the Glaucoma and list of pathologies
- Ocular hypertension/Primary open angle suspect
Yes
No
- Primary open-angle glaucoma (POAG)
Yes
No
- Primary juvenile glaucoma (JG)
Yes
No
- Primary congenital glaucoma
Yes
No
- Secondary open-angle glaucoma (pigmentary,
pseudoexfoliative, lens induced, corticoid induced,
hemorrhage induced, uveitic, increased episcleral
venous pressure)
Yes
No
- Primary angle closure (patient at risk, primary angle
closure suspects, primary angle closure, angle closure
glaucoma)
Yes
No
- Iris plateau configuration and syndrome/glaucoma
Yes
No
- Secondary angle closure/glaucoma (neovascular,
lens/IOL induced, uveitic, traumatic)
Yes
No
- Malignant glaucoma
Yes
No
- Developmental glaucomas with associated anomalies
Yes
No
- Axenfeld-Rieger syndrome, Aniridia, Peter’s Anomaly
Yes
No
- ICE syndromes (Chandler Syndrome, Essential /
Progressive Iris Atrophy, Iris Nevus / Cogan-Reese
Syndrome)
Yes
No
16.
CLINICAL KNOWLEDGE
Do you have extended knowledge of the following clinical diagnostic procedures and
interpretation (beyond residence level of knowledge?)
IOP Measurements
Goldmann applanation tonometry
Dynamic contour tonometry (Pascal)
Air-puff
Ocular Response Analyser
Tono-pen
Rebound tonometry
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Pachymetry
Yes
No
Gonioscopy
Indirect gonioscopy (Goldmann 3-2-1 mirror lenses)
Direct gonioscopy (Koeppe lense etc)
Dynamic gonioscopy (Zeiss, Posner, Sussmann lens)
Yes
Yes
Yes
Yes
No
No
No
No
Tests of visual function
Standard automated perimetry (SAP)
Goldmann perimetry
FDT
Yes
Yes
Yes
No
No
No
Extensive knowledge of analyzing Humphrey and
Octopus visual field results
Yes
No
Clinical examination of the optic nerve head and retinal nerve fiber layer (RNFL)
structure
Evaluation of disc and RNFL photography
Yes
No
Evaluation with:
HRT
Yes
No
OCT
Yes
No
GDX
Yes
No
Anterior segment imaging
Anterior segment OCT
UBM
Yes
Yes
No
No
Electrophysiology
Yes
No
Extensive and detailed knowledge in Medical treatment of glaucoma
All available classes and their:
Modality and form of administration
Mechanism of action
Indications
Limitations
Quality of life
Side effects
Cost containment
Neuroprotection
New modalities of administration
New molecules in the pipeline
17.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
Please state your surgical experience by indicating if “none” or give an
“approximate number” of procedures performed by you as first surgeon
Laser procedures
Trabeculoplasty (Argon and SLT)
Yag iridotomy
Peripheral iridoplasty
YAG capsulotomy
Suture lysis
Cataract surgery
Complex cataract surgery
Trabeculectomy
Use of antimetabolites and anti-VEGF
Aqueous shunts (non-valved and valved)
Non-penetrating procedures
MIGS
Combined procedures
Cyclodestructive procedures
None
None
None
None
None
None
None
None
None
None
None
None
None
None
or
or
or
or
or
or
or
or
or
or
or
or
or
or
Approx Number
Approx Number
Approx Number
Approx Number
Approx Number
Approx Number
Approx Number
Approx Number
Approx Number
Approx Number
Approx Number
Approx Number
Approx Number
Approx Number
New devices/surgical methods
None
or
Approx Number
or
or
or
Approx Number
Approx Number
Approx Number
or
Approx Number
or
Approx Number
Management of complications of glaucoma surgery
Needling of failing/encysted filtering blebs
None
Repair of leaking blebs
None
Management/reformation of shallow AC
None
Management of hypotony and choroid
detachment
None
Goniotomy/trabeculotomy for primary
congenital glaucoma
None
Re-operation following failure of
glaucoma surgery
None
or
Approx Number
Childhood glaucoma
Examination under anesthesia for
congenital glaucoma
Goniotomy
Trabeculotomy
Trabeculectomy
None
None
None
None
or
or
or
or
Approx Number
Approx Number
Approx Number
Approx Number
18.
Did the training provide knowledge on how to organize, run and continuously
improve a successful and sustainable (cost-effective) care service for glaucoma
patients?
Yes
No
19.
CLINICAL EXPOSURE
a)
Did you have sufficient exposure during the training period to gain
experience and be able to run independently a glaucoma clinic, medical and
surgical management?
Yes
No
b)
Have you been trained to evaluate literature critically?
Yes
No
c)
Did you participate during the training in basic and/or clinical research?
Yes
No
d)
Did you participate during the training in local, regional, national, or
international professional and scientific meetings?
Yes
No
e)
Did you participate at national or international meetings with active
presentations at meetings?
Yes
No
f)
Did you have the opportunity to publish in peer-reviewed journals?
Yes
No
20.
Have you read the following text books?
EGS Guidelines 4th Edition 2014
www.eugs.org
Relevant national evidence-based guidelines
Shields Textbook of Glaucoma 6th Edition
R. Rand Allingham, Karim F Damji, Sharon F Freedman.
Lippincott Williams & Wilkins 2011
Glaucoma, A color Manual of Diagnosis and Treatment
Jack Kanski, J McAlliester, John F. Salmon.
Butterworth-Heinemann 1996
The Glaucoma Book; a practical, evidence based
approach to patient care.
Paul N. Schacknow, John R Samplers.
Springer science and business media LLC 2010
The Glaucomas
Robert Ritch, M. Bruce Shields, Theodore Krupin.
Motsby 1996
Glaucoma, 2nd ed,
Tarek Shaarawy, Marc Sherwood, Roger Hitchings,
Jonathan Crowston
2014. Saunders Ltd
Evidence Based Medicine
Straus SE, Glasziou P, Richardson WS, Haynes RB,
How to Practice and Teach it.
Churchill Livingstone Elsevier, 2011
Glaucoma
American Academy of Ophthalmology
www.aao.org/pdf/Glaucoma
21.
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Are you familiar with the following randomized controlled clinical trials for
glaucoma?
Yes
No
Study
CNTGS
EMGT
OHTS
EGPS
CIGITS
AGIS
UKGTS
EAGLE
Other relevant randomized
controlled trials
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
Yes
No
22.
Are you familiar with the listed literature and clinical research evaluations?
- Suggested literature/textbooks Table 2
Yes
No
- Articles from important Randomized Controlled
Clinical Trials in the field of glaucoma Table 3
Yes
No
- Critical evaluation of ophthalmic literature
(Evidence Based Ophthalmology)
Yes
No
- Systematic reviews last 5 years including such as
Cochrane reviews, Health Technology Assessments
Yes
No
- Evidence based guidelines (National, International, EGS)
Yes
No
PLEASE RETURN THIS FORM TO LAURA.MULLINS@EBO-ONLINE.ORG BY
MONDAY 29 FEBRUARY 2016
WITHOUT THIS COMPLETED FORM, YOUR APPLICATION FOR THE FEBOS
GLAUCOMA EXAM WILL NOT BE CONSIDERED.