Definition of a Comprehensive Eye Care Optometrist
The Comprehensive Eye Care optometrist is a practitioner with ongoing responsibility for the total visual, ocular and related care of a population of patients. Comprehensive Eye Care optometry is a focus of practice activity that emphasizes the development and maintenance of a high level of knowledge and clinical ability over the entire area of eye/vision care and associated areas of eye-related health care.
Purpose of the Diplomate Program of the Comprehensive Eye Care Section
The purpose of the Diplomate Program of the Comprehensive Eye Care Section Program is to recognize that continually increasing competence is needed to practice as a Comprehensive Eye Care Optometrist. The Diplomate Program of the Comprehensive Eye Care Section Program is a distinction achieved by doctors of optometry who strive through their Comprehensive Eye Care practice activities and through this Diplomate Program to attain a level of excellence in patient management beyond the regular American Academy of Optometry Fellowship program.
Characteristics of a Comprehensive Eye Care Optometrist
The components of the process for achieving Diplomate status are designed in an effort to identify and measure characteristics of a Comprehensive Eye Care Optometrist. Thus, a Diplomate of the Comprehensive Eye Care Section:
- Is a seasoned practitioner with clinical experience well beyond regular Fellowship status
- Is committed to assuming greater responsibility for total patient care, over the entire area of eye/vision care and associated areas of eye-related health care
- Is committed to practicing to the full extent of his/her training and state licensure, incorporating state-of-the-art techniques and patient care philosophies into his/her practice
- Is committed to and highly skilled in providing ongoing care for patients of all ages
- Is committed to and provides patient education that is highly effective due to the experience, communication skill and sensitivity of the practitioner
- Is a caring practitioner who recognizes the individuality of each patient
- Actively participates in co-managed patient care by delivering the complete aspects of the care at the highest possible level
- Assumes a high level of responsibility in coordinating necessary visual, ocular and related care of the patient with other professionals
- Demonstrates aggressive acquisition of new knowledge through available avenues
- Actively contributes to the advancement and success of the profession of optometry
Requirements for Diplomate of the Comprehensive Eye Care Section Status
Diplomate of the Comprehensive Eye Care Section Status will be granted only following successful completion of Parts I through VI. No "grandfathering" of Academy Fellows into active Diplomate of the Comprehensive Eye Care Section Status will occur.
PART I REQUIREMENTS FOR REGULAR DIPLOMATE STATUS
A prospective applicant for the Diplomate Program must be a Fellow in good standing of the American Academy of Optometry.
PART II APPLICANT STATUS
2. Curriculum Vitae
A current Curriculum Vitae shall accompany the completed application form. The Curriculum Vitae should be as complete as possible and should include information on educational background, professional experience, publications, speaking activities, optometry organizations, honors, and certifications
3. Application Fee
A $100 application fee should accompany the completed application.
The materials described in #1 through #2 will be reviewed for completeness, and additional information will be requested as needed. Favorable review of these materials by the Diplomate Program Committee will result in the assignment of Candidacy Status to the applicant. The Candidate has five years from the time of granting of Candidacy Status to complete Parts III through VI. It is anticipated that the entire Comprehensive Eye Care Section Diplomate process will take 2-3 years to complete. If the five-year period lapses without successful attainment of Diplomate of the Comprehensive Eye Care Section Status, the application process, including payment of the current application fee, must be re-initiated.
PART III CANDIDATE STATUS AND CASE REPORTS
Each Candidate will complete seven (7) written case reports selected from the case category/topic listing that follows. Each case report must represent a patient directly examined and managed by the Candidate and must be separate and different from any of the cases that were previously submitted for the Fellowship process. The quality and depth of each completed case report should clearly be appropriate to the level of Diplomate of the Comprehensive Eye Care Section Status and should be well above the complexity of cases prepared for Academy Fellowship.
Note: Completion of case reports in two case topics (indicated by Roman numerals) is required within each category (A, B, and C). The Candidate may select the topic of the final (7th) case report from any unutilized topic from any category. No duplications of topic are allowed. However, due to the breadth of the categories, some cases could be placed in more than one topic. The Diplomate Committee will provide guidance to the Candidate. Communication is encouraged.
Category A: Clinical Optometry (minimum of 2 topics, e.g. Topic I & IV)
Topic I. General Optometry
Examples: Geriatric case, Special population case (mental, physical, cognitive, or developmental disabilities), Unusual refractive case
Topic II. Contact Lens
Examples: Significant ametropia, Trauma, Post-operative, Therapeutic case
Topic III. Functional Vision
Examples: Sports vision case, Diagnosis and management of binocular/accommodative disorder, Vision training/visual perception case, Amblyopia case, Pediatrics case
Topic IV. Vision Rehabilitation/Neuro-Optometric Rehabilitation
Examples: TBI, HHA, Low vision case
Topic V. Public Health
Examples: Environmental vision/occupational case, Health promotion/disease prevention-related case, Management of a disease or condition from a group or population-based perspective
Category B: Ocular Disease/Surgery (minimum of 2 topics, e.g. III & V)
Topic I. Diagnosis & Management of Glaucoma
Topic II. Peri-Operative Management of Ocular Surgery
Examples: Diagnosis & peri-operative management of cataract, strabismus, lid anomalies (excluding refractive surgery)
Topic III. Management of Refractive Surgery Complication
Examples: Corneal ectasia, DLK
Topic IV. Diagnosis & Management of Ocular Disease-Anterior Segment
Examples: Keratitis, Recurrent corneal erosion, Trauma, Anterior uveitis, Disorders of the lids, lacrimal system, conjunctiva, cornea, and iris
Topic V. Diagnosis & Management of Ocular Disease-Posterior Segment
Examples: AMD, ICSC, Disorders of the vitreous, retina, choroid, sclera, and optic nerve
Category C: Related Systemic Disease (minimum of 2 topics, e.g. I & III)
Topic I. Neuro-Optometry-Diagnosis & management of related neurological disease
Examples: CN palsy, tumor, migraine, Horner’s syndrome, cerebrovascular disease, pseudotumor cerebri
Topic II. Oral Pharmaceuticals-Diagnosis and treatment of disease by candidate with prescription oral medication, Diagnosis and management of an adverse reaction to a systemic medication, or Clinical ocular toxicology case
Topic III. Principles of Diagnosis -Diagnosis & management of patient utilizing laboratory testing, imaging, visual fields (excluding glaucoma), OCT, corneal topography, VEP, new diagnostic technologies
Topic IV. Systemic/Ocular Disease –Diagnosis & management of ocular-related systemic disease (cardiovascular, dermatological, endocrine, infectious, rheumatologic/inflammatory disorders, etc.)
Examples: Vascular diseases both systemic and ocular, HTN, retinal emboli, rosacea, DM, thyroid dysfunction, HIV/AIDS, HZV, GCA, Sjogren’s syndrome, etc.
CASE REPORT INSTRUCTIONS FOR DIPLOMATE CANDIDATES
I. Title Page
Full title, each author's name, highest academic degree and affiliation and department and institution where case study was performed
Include a structured abstract (200 words or less) with the following four headings:
B. Case Report
Number the pages of the report consecutively. The report should be double-spaced. Restrict abbreviations to those that are widely used and understood (i.e. avoid abbreviations that have meaning only within the context of the specific manuscript). Introduce each abbreviation in parentheses after the first appearance of the expanded term. Abbreviations of standard measure used with number quantities (mm, Hg, cm, and ml) are used without initial expansion. Each major section does not need to start on a new page. Each Case report should be concise, yet complete based upon the complexity of the case.
Number references consecutively in the order of their citation in the text and identify by superscript numbers. Do not insert references as footnotes. Candidates are responsible for making sure that each reference is correctly cited and listed. It is strongly recommended that candidates use a reference management system such as Endnote. References must be in the form currently used in the OVS Journal. A file containing the journal’s format for references is available on the Journal home page (http://ovs.edmgr.com/) Click on “Instructions for Authors.”
Data that can be stated in the text in one or two sentences should not be presented in table format. Each table should have a brief, self-contained title understandable without reference to the text. Assign a short heading to each column in the table.
VI. Legends for Figures and Illustrations
Figure Legends should be double-spaced and numbered consecutively.
Any correspondence with other practitioners that assists or corroborates the candidate’s diagnosis or treatment plans must be included and/or attached to the case report.
VIII. Previously Published Articles
Published articles in refereed journals may be substituted for up to five of the written case reports. The case report must have been published in one of the approved journals listed on the Academy’s list of journals approved for Fellowship case reports (Explanation of the Point System for Clinical Candidates). The candidate must select the topic category for which he/she is submitting the publication. The candidate must be the primary author, have a maximum of two authors, and it must have been published within 5 years of the date it is submitted. Four of the published case reports must be a clinical case report and the candidate must have participated in the clinical care of the patient(s). One of the published papers may be a research paper, but submission of a research paper does not relieve the candidate of submitting two case reports from each of the three major categories of case reports. Published papers are still subject to review by the committee; they are not automatically accepted.
All completed case reports must be uploaded to the web portal for review.
Diplomate examinations take place during the Annual Meeting of the American Academy of Optometry. Candidates are eligible for the Written Examination (part IV) upon acceptance of two Case Reports. Candidates are eligible for the Practical Examination (Part V) upon acceptance of four Case Reports. All 7 Case Reports must be accepted for the Candidate to complete the Interview (Part VI). Three referees will review each case report; additional information or revisions may be requested. The Candidate is encouraged to wait for approval of the first two Case Reports before proceeding with the remaining 5 to ensure that his/her efforts are directed appropriately.
PART IV: WRITTEN EXAMINATION
Following successful completion of two case reports as described above, the Candidate is eligible to take the Written Examination during the Annual Meeting. The primary purpose of the Examination is to assess the Candidate's skills in clinical diagnosis, pathophysiology, data analysis, and patient management/co-management. Additionally, some aspects of the written examination may test candidates' knowledge of basic science relevant to clinical care such as optics, anatomy, physiology, pathology and pharmacology. The Written Examination is constructed to determine if the candidate practices Comprehensive Eye Care Optometry beyond the entry level and at a level of excellence consistent with Diplomate status.
Practitioners are expected to understand and to coordinate, in the best interest of their patients, management plans that may be technically beyond their current scope of direct care as allowed by state law. In addition to the patient scenario questions, multiple-choice questions pertaining to state-of-the-art information for the Comprehensive Eye Care practitioner will be included.
The written examination consists of two sections. The first section of the written examination is a 3-hour multiple choice examination that consists of 220 questions spread over 10 sections as follows:
- Posterior segment - 25 questions
- Systemic disease and the eye - 35 questions
- Refraction, ophthalmic materials, general optometry - 20 questions
- Pediatrics/binocular vision - 20 questions
- Neuro-ophthalmic disease - 20 questions
- Low vision - 20 questions
- Lens and refractive surgery - 20 questions
- Glaucoma - 20 questions
- Anterior segment - 20 questions
- Contact lenses - 20 questions
The second section of the written examination is the Clinical Correlations examination. This is a one hour short answer examination with a photographic identification module (12 pathological slides) that assesses how well a candidate can analyze and solve a clinical problem. This is NOT a multiple-choice examination format, as candidates must provide a written response to the questions on each of the slides. The general structure of each item format will be as follows:
I. Patient scenario: including demographic data, history, initial data results
II. Examination questions: pertaining to pathophysiology, additional test findings, differential diagnoses, treatment and management/co-management
III. Comment: the Candidate may comment on the nature of his/her responses to the exam questions
Candidates must achieve at least 70% on every individual section of the test to pass. If the candidate fails to achieve 70% on an individual section, then the candidate will only have to repeat that one (or more) section(s) at the next meeting.
Concerning the textbook sources for the questions, more than 70% of the questions in the written examination are referenceable to Ophthalmology (Yanoff, M, Duker, J., 4th Ed. St. Louis, MO., Mosby 2014). There will be no questions drawn from part 1 and 8 of Yanoff's Ophthalmology textbook.
Less than 30% of the questions in the written examination are drawn from the following textbooks:
- Clinical Manual of Contact Lenses (Bennett ES, Henry VA (Eds). Philadelphia: Lippincott Williams & Wilkins; 2014)
- Contact lens Complications (Efron, N. London: Elsevier Saunders; 2012)
- Clinical Management of Binocular Vision: Heterophoric, Accommodative, and Eye Movement Disorders (Mitchell Scheiman and Bruce Wick, 2014)
- Essentials of Low Vision Practice (Brilliant, R.L., Boston, MA, Butterworth - Heinemann 1999)
The AOA Optometric Clinical Practice Guidelines are a useful resource for the contact lens and pediatric sections, however more than 95% of the questions are referenceable to the above textbooks.
PART V: PRACTICAL EXAMINATION
Following successful completion of four case reports the candidate is eligible to take the practical examination. The practical examination will be given during the Annual Meeting of the Academy, and is normally given at a local optometric office or clinic. The practical examination is designed to assess the Candidate's skill levels in procedures integral to Comprehensive Eye Care Optometry. The Candidate will be asked to examine patients, and often to arrive at a diagnosis and/or formulate a treatment plan or plans for the patient. The Candidate may be asked questions regarding the patient or related conditions or situations involving some aspect of that patient. An examining proctor designated by the Diplomate Committee will sit in with the Candidate to observe, and to discuss or question as noted above. The practical examination will be divided into stations, with the Candidate rotating through the stations, from patient to patient. The Practical Examination may not be offered at every Annual Meeting, depending on demand.
PART VI: ORAL EXAMINATION
Following successful completion of all seven case reports, 3-5 members designated by the Diplomate Oral Examination Committee will interview the Candidate. The examination is a two-step process. The first step is to review interesting aspects of the case reports and ask questions of the candidate regarding current standards of care related to their case report, clinical skills, diagnoses and treatment modalities.
The second portion of the interview process comes after all the other steps have been completed. Usually, this is done during the same Annual Meeting at which the practical examination was completed. This "exit" interview provides the candidate and the Diplomate Committee members a chance to briefly review the entire process. This interview is meant to be more informative rather than an examination. The committee will discuss with the Candidate his/her strong and weak points on all parts of the Diplomate process, including the practical examination.
The Candidate will be notified as to whether Diplomate Status has been achieved either during the exit interview, or shortly thereafter. New Diplomates will be formally recognized and introduced at the Annual Banquet. Diplomate Status will begin immediately.
Inactive Diplomate Status
Inactive Status applies to the Diplomate who is, for good reason, in a state of hiatus from his/her full time clinical activity. Reactivation of Regular Status will occur when full time practice resumes, subject to fulfillment of all other requirements. A written request for Inactive Status must be made to the Diplomate Program Chair.
Emeritus Diplomate Status
Emeritus Status applies to the earned Regular Diplomate who permanently retires from patient care activities and is otherwise entitled to Regular Status. To be eligible for Emeritus Diplomate Status, a Diplomate must first be eligible for and become an Emeritus Fellow in the Academy. A written request for Emeritus Diplomate Status must be made to the Diplomate Program Chair.