University of Iowa Health Care

Ophthalmology and Visual Sciences

Iowa Glaucoma Curriculum

About

The Iowa Glaucoma Curriculum

This site was created to serve as an introduction to glaucoma for residents and perhaps as a review for practitioners. It began in the early 1990s when I recognized that – left to my own devices – I tended to talk to the residents and fellows about the topics that interested me (gonioscopy, genetics, normal tension glaucoma, pigmentary glaucoma) and I never talked about aqueous humor dynamics or cholinergic agonists. I therefore created a checklist that includes tasks (like sitting in on a visual field and having one performed on themselves) and 50 didactic topics that hopefully cover all of glaucoma in digestible pieces. At the end each day’s clinics the residents convince one of our glaucoma faculty (Dr. Fingert, Sears, Boese, or myself) that they know the important features of, for example, aniridia. As this has gone along I have collected a large number of clinical photos and video clips to reinforce what we discuss. This curriculum melds the 50 topics with my image and video collection.

I am a visual learner. It helps me if I can see lots of photographs of the disease being discussed. So, this curriculum has >900 figures (mostly clinical photographs and visual fields) and > 90 brief movies. Because there is no limit on the number of images, I am able to show the very subtle case of ICE syndrome and not just the most amazing example I have ever seen. While there are a lot of pictures and movies, there are very few big tables. I don’t see much value in memorizing, for example, every syndrome that has been associated with primary congenital glaucoma. It is easy to search PubMed or to consult a comprehensive glaucoma textbook to determine whether the association that you are seeing has been described before.

I have attempted to use only my own photographs and movies. I have acknowledged the source when material has been contributed by colleagues. If you have a better example of any figure or are a skilled artist, I would welcome any better examples. Submitted materials cannot have been previously published and copyrighted. Many short video clips are from my website gonioscopy.org.

This is an introduction. At the end of every section I remind you to delve into more detailed textbooks and the literature as interesting patients come along – there is much more to learn. But, hopefully you will recognize that subtle ICE patient and then dive deeply into the literature.

The fifty chapters provide an introduction to glaucoma. For many chapters there is supplementary material for those who want to delve deeper. For example, Chapter 34 discusses “General Principles of Glaucoma Management.” A table on existing glaucoma medications from The Medical Letter on Drugs and Therapeutics is provided as a supplement. There are a large number of clinical examples from gonioscopy.org ( http://gonioscopy.org ) and EyeRounds ( http://www.eyerounds.org ).

Lastly, I call this the Iowa Glaucoma Curriculum. If you are a resident or fellow your faculty may have a different approach to diagnosing and treating glaucoma. But, if you suffer through these twelve hours or so, you will hopefully be off to a strong start.

Please let me know how I can make this better.

Wallace L. M. Alward, M.D.
Frederick C. Blodi Chair in Ophthalmology
Professor and Vice-Chair
Director, Glaucoma Service
Department of Ophthalmology and Visual Sciences
University of Iowa Carver College of Medicine