Curriculum standards
Knowledge guides
LG21: Disorders of vision and other senses
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations – hearing
- Dysphagia
- Ear:
- malformation
- pain
- Fever
- Headache
- Hearing loss
- Hyperacusis
- Loss of balance
- Nausea
- Rash
- Tinnitus
- Vertigo
- Vomiting
Presentations – smell and taste
- Change or loss in taste
- Drooling
- Headache
- Loss of smell
- Parosmia
- Seizure
Presentations – vision
- Decreased visual acuity
- Double vision
- Drooping of eyelids
- Dysmorphism
- Falls
- Fever
- Hallucinations
- Headache / Periorbital pain
- Microcephaly
- Microphthalmia
- Migraine
- Motor delay
- Night blindness
- Nystagmus
- Opsoclonus
- Pain on eye movement
- Papilloedema
- Photophobia
- Poor depth perception
- Poor fixation
- Seizures
- Speech delay
- Vertigo
- Visual hallucinations / auras
- Visual loss
Conditions – hearing
- Acoustic neuroma and other brainstem tumours
- Congenital deafness
- Medication-related
- Post-infection / Post-meningitis
Conditions – smell / taste
- Bell’s palsy
- Neurodegenerative conditions
- Orbitofrontal tumours
Conditions – vision
- Achromatopsia
- Acute demyelinating encephalomyelitis
- Cataracts
- Cerebral / Cortical visual impairment
- Epilepsy
- Functional neurological disorder
- Idiopathic intracranial hypertension (pseudotumor cerebri)
- Infections
- Leber congenital amaurosis
- Leber hereditary optic neuropathy
- Medication-related
- Migraine
- Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)
- Multiple sclerosis (MS)
- Neuromuscular conditions
- Neuromyelitis optica
- Ocular motor nerve palsies
- Oncological conditions, such as:
- optic pathway gliomas
- Optic nerve hypoplasia
- Optic neuritis
- Raised intracranial pressure secondary to intracranial space-occupying lesion or cerebral venous thrombosis
- Retinal dystrophies
- Retinopathy of prematurity
- Septo-optic dysplasia
- Stargardt disease
- Trauma affecting vision
- Vascular event resulting in sudden vision loss
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Congenital myasthenic syndromes
- Other iatrogenic / hypertensive / toxic / traumatic occurances
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Causes of visual disturbance and eye movement abnormalities
- Methods of assessing automated and confrontation perimetry, pupillary function, visual acuity, and visual fields, including non-organic presentations
- Neuroanatomy and neurophysiology of the auditory, oculomotor, olfactory, pupillary, vestibular, and visual systems
- Neurodevelopmental features and examination findings of normal preterm and term infants
Cerebrospinal fluid (CSF) procedures and investigations
- Fundoscopy – normal versus abnormal
- Lumbar puncture (LP) and interpretations results of investigations, such as:
- basic CSF analysis:
- cell count
- cytology
- immunological tests
- lactate
- microbiological tests
- protein level
- glucose level
- xanthochromia
- opening pressure
- special tests:
- amino acids
- neurotransmitters
- oligoclonal bands
- basic CSF analysis:
Clinical neurophysiology investigations
- EEG:
- sleep-deprived EEG
- standard EEG
- video EEG
- Electromyography (EMG):
- needle EMG
- single-fibre EMG
- Electroretinogram
- Evoked potentials:
- brainstem
- visual
- Nerve conduction studies
- Repetitive nerve stimulation
Neurogenetic investigations
- Genetic testing, including, but not limited to:
- chromosomal testing, such as:
- karyotype
- microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
- chromosomal testing, such as:
- Referral to a neurogeneticist
Neuroimaging investigations
- CT, including:
- CT angiography
- Functional imaging:
- functional MRI (fMRI)
- PET
- single photon emission computed tomography (SPECT)
- Magnetic resonance:
- angiography (MRA)
- spectroscopy (MRS)
- venogram (MRV)
- MRI
Neuroimmunology investigations
- Autoantibody measurement:
- anti-acetylcholine receptor antibodies
- anti-aquaporin 4 antibodies
- anti-myelin oligodendrocyte glycoprotein (MOG) antibodies
- paraneoplastic antibodies
Neuropathology investigations
- Biopsy:
- brain
- muscle
Neuropsychological investigations
- Autoimmune work up
- Mini-Mental State Examination
- Referral to a neuropsychologist
- Routine bloods including inflammatory markers
- Overlap with other medical specialties, such as ophthalmology and otolaryngology / ear, nose, and throat (ENT) specialties
- Prognosis and implications of these disorders