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Residency training

The Residency Training Program in Ophthalmology





Currently, there are 3 well structured joint Residency Training Programs in Ophthalmology (RTP) that are supervised by the Saudi Commission for Health Specialties and located in Riyadh, Jeddah and Dammam.  All the programs will provide an opportunity for residents to learn in depth the fundamental basic sciences as applied to clinical ophthalmology.  These include anatomy, physiology, microbiology, pharmacology, pathology, and optics & refraction that will be given during the rotation in the first year of training.  The program provides an intensive clinical experience during rotations in subspecialties such as anterior segment/cornea and external disease, retina, oculoplastic and pediatric ophthalmology.

The program will also enforce gaining experience in preoperative, operative, and postoperative care of patients for all common ocular surgical procedures.


Admission requirements

To be accepted in the training programs, the candidate has to fulfill the following requirements:


1.      MBBS from a recognized university

2.     Successful completion of one year internship rotation before the commencement of the program

3.     To provide 3 recommendation letters from consultants, preferably ophthalmologists

4.  To provide a sponsorship letter indicating eligibility of the candidate to join the program for four years in a full time basis.

5.     To pass the admission exam and the interview committee and comply with the specific regulations of

each residency training program.

6.     To pass the licensing exam of the Saudi Commission for Health Specialties

7.     Signature of an obligation to abide by all the rules and regulations of the training program and the Saudi Commission for Health Specialties

8.     Registration as a trainee at the Saudi Commission for Health Specialties

9.     Registration as a trainee in the post graduate of the associated university, if it is required.


Training Requirements;

1.      Training is a full time commitment. Residents shall be enrolled in a continuous full time training the whole period of the program.

2.     Training is to be conducted in an institution accredited for training by the Scientific Board of Ophthalmology.

3.     Training shall be comprehensive including inpatient, ambulatory and emergency room care.

4.     Trainee shall be involved in direct patient care with gradual progression of responsibility.

5.     Trainee shall abide by the training regulations and obligations set by the Scientific Board of Ophthalmology.


Structure and content of Training Program;

This four years structured training program in Ophthalmology is divided into two stages.

A Junior Residency

B. Senior Residency


A.     Junior Residency (24 months, R1 & R2)

This includes rotations/seminars, lectures with technical and surgical procedures, etc, and can be summarized as follows:



N. B. Important Notice:

The following scheme of monthly rotations per each year of training is currently applied in the Residency Training Program of Riyadh Center.  The other training centers can follow the same pattern or adjust the rotations, by using the comprehensive ophthalmology training method, so as to reach the total recommended rotations in each subspecialties by the end of four years of training.


First Year (R1)

4 months, General Ophthalmology, Anterior Segment & Cornea/External Eye Disease & Systemic Diseases

2 months, Basic Science Course (including Optics & Refraction & Ocular Pathology)

2 months, ER

1 month, Retina

1 month Oculoplastic

1 month Anesthesia/Pathology

1 month vacation


During this year, the resident is expected to attend educational activities which include didactic lectures for 36 hours, conferences and subspecialty seminars for 24 hours.


a.)  Emergency Room Skills

1.      Work-up of “red eye” patient, differential diagnosis and management.

2.     Work-up of blunt trauma patient, differential diagnosis and management.

3.     Evaluate and repair of lid lacerations.

4.     Preoperative work-up and participation in management of patients with ruptured globe

5.     Obtain cultures and initiate therapy of conjunctivitis and keratitis.

6.     Identify common emergency room fundus pathology.

7.     Recognize causes and differential diagnosis of painful eye with or without sudden loss of vision.


b.)  Basic Clinical Skill

1.      Refraction and prescribing spectacles including reading correction

2.     Retinoscopy refraction

3.     Biometry and Intraocular lens calculations

4.     Pupil exam and interpretation (including pharmacologic studies)

5.     Motility examination and interpretation

6.     Visual field testing, selection and interpretation

7.     External and slit lamp techniques and interpretation

8.     Tonometry methods, selection and interpretation

9.     Funduscopy of different methods

10.    Fundus biomicroscopy

11.     Gonioscopy

12.    Tear secretion tests and interpretation

13.    Lacrimal system dye tests and interpretation

14.    Examination of children and infants



c.)   Surgical Skills (including postoperative management)

1.      Minor lid laceration repair

2.     Chalazia, incision and curret

3.     Enucleation

4.     Conjunctival biopsy

5.     Lateral canthotomy

6.     Retrobulbar block

7.     tarsorrhaphy

8.     Cyclocryotherapy

9.     lacrimal probing

10.    Microsurgical training








Second Year (R2)

2 months Anterior Segment

2 months Glaucoma

2 months Pediatrics

1 month Retina

1 month Optics & Refraction

1 month Oculoplastic

1 month Neuro-ophthalmology

1 month ER

1 month Vacation


The second year resident has to attend weekly grand rounds and conferences (96 hours), didactic lectures (36 hours), and weekly specialty seminars (36 hours).  Residents are encouraged to participate in clinical or laboratory research studies.


By the end of the second year, a resident is able to diagnose and manage ocular emergencies, identify common eye disorders and perform simple lid procedures and extracapsular cataract extraction under close supervision by senior staff.  The second year resident is on first call for the service that he or she is rotating in.



B.   Senior Residency (24 months, R3 & R4)

This includes clinical rotations/seminars, lectures, technical and surgical procedures, etc.


Third Year (R3)

Residents will have rotations in the following services:

3 months, Anterior Segment

2 months, Retina

2 months, Oculoplastic

2 months, ER

1 month Neuro-ophthalmology

1 month, Systemic Diseases

1 month Vacation




By the end of the third year, the resident is able to identify most ocular disorders and manage all ocular emergencies.  Residents should be able to perform simple lid procedures, extracapsular cataract extraction by ECCE and phaco emulsification, in addition to anterior vitrectomy.


A third year resident is given extensive clinical responsibilities, runs one of the clinical services, under the attending physician’s supervision and is on second call for ocular emergencies.  They should assist in teaching first year residents in the management of ocular disorders and minor ocular injuries in the emergency room.  He/she assists in developing their skills in performing minor and major surgical procedures.


The third year resident acquires proficiency in various diagnostic procedures including flourescein angiography, ultrasonography, ERG & EOG (if available).  The residents will have to attend and give seminars in eye pathology, flourescein angiography, orbital disorders, ultrasonography, neuro-ophthalmology and cornea.


Educational activities include didactic lectures of 36 hours, specialty seminars of 36 hours, conferences of 96 hours & clinical responsibilities with a minimum of 1730 hours.






Fourth Year (R4)

During this year, the resident will acquire proficiency in rotating in the following services;

3 months, Pediatrics

2 months, Anterior Segment

2 months, Retina

2 months, Glaucoma

2 months ER

1 month Vacation


By the end of this year, the resident shall have the following capabilities and skills:

Can diagnose and manage common ocular disorders, can diagnose and manage all ocular emergencies, be able to do most of the common surgical ophthalmic procedures.

Residents should participate in the preparation and presentation of cases in conferences.


Educational activities include didactic lectures of 36 hours, specialty seminars of 36 hours, conferences of 96 hours & clinical responsibilities with a minimum of 1730 hours.






















Approved Minimum Surgical & Laser Requirements


The following minimum requirements should be fulfilled by the end of 4 years of training, before a resident is allowed to sit for the final exam:

1.      Trainee should complete successfully 4 years of training at a capacity of a resident.

2.     Trainee should attend annually 110 hours of didactic lectures and academic activities organized by the program.

3.     Trainee should perform clinical refraction and write down prescriptions, for a minimum of 100 patients under direct supervision.

4.     Trainee should accomplish within the 4 years of training, the performance of the operative and laser requirement as specified below:


In-training Evaluation & Annual Performance

1.      End of rotation evaluation:

        At the end of each training rotation, the supervising consultant/team shall provide the training committee with a written evaluation of resident’s performance during that rotation.

2.     End of the Year Exam

3.     For the Calculation Formula of the Annual Overall Performance refer to the Booklet of Regulations for Promotion Exam



N. B. Important Notice:

It is feasible to add another evaluation parameter for any level of training, e.g, Thesis, Clinical OSCE, etc. by adjusting the percentage of either the Monthly Evaluation or the End of the Year Exam in the calculation formula.



1.      Annual promotion (e.g. R1 to R2) depends on annual overall evaluation.

2.     Promotion to senior residency depends on annual overall evaluations, and passing first board examination.


Vacations, holidays and On-call Duty

1.      Residents are entitled for four weeks vacation annually and a maximum of 10 days for one of the Eid holidays.

2.     Emergency leave:  Death or incapacitating illness in a close member of the family entitles the Resident for 2 to 5 working days of uncompensated leave per year of training, based on the judgment of the Director of the Residency Training Program.

3.     Sick and maternity leave shall be compensated for during or at the end of training.

4.     On call duty shall be an average of one every three to four nights (minimum of 7 calls per month, 24 hours per call).  Residents are expected to perform regular duty the day after call and ensure continuity of care for their patients.  In case of a heavy on call duty in the night before, the resident should contact his/her attending in the next day to take permission for a half day off.


Board Examinations

a.)  First Board Examinations

1.      This examination is held at least once per year in one or more of the training centers.

2.     It is a written examination, and includes applied basic sciences and clinical ophthalmology.

3.     Candidates are allowed to sit the examination after successful completion of the minimum of nine months of the first year level and obtaining a pass mark in the annual overall performance.

4.     Passing the first board examination is a pre-requisite for promotion to senior residency.

5.     Candidates are allowed a total of three attempts.  Those failing the third attempt will be dismissed from the program, or else they must obtain an approval for a fourth attempt.

b.)  Final Board Examination;

1.      This examination is given to candidates after successful completion of training, as evidenced by a NOTICE approved by the Director of the Residency Training Program.

2.     It is held at least once per year in one or more of the training centers.

3.     The final examination consists of two parts;


a.)    Written part; designated to evaluate knowledge and clinical judgment.  Only successful candidates in this part are allowed to sit the clinical/oral part.

b.)    Clinical/oral part; designated to test clinical skills/abilities judgment in the field of ophthalmology.  Candidates are allowed a maximum of five attempts to pass the examination within a period of five years after completion of the training.










Candidates passing the final board examination are awarded the certificate of the Saudi Board of Ophthalmology.



Objectives of Training

General objectives

1.)     To produce highly qualified ophthalmologists who possess:

a.     the professional knowledge and are devoted to a life long commitment to continuous

                medical education

b.     the art to exercise sound clinical judgment

c.      the ability to communicate with patient

d.     the top level of ethical standard


2.)    To encourage the teaching skills

3.)    To develop the research skills

4.)    Upon successful completion of four years training in the program residents will become eligible to sit for the final Saudi Board Exam, or the equivalent exams.


Specific objectives;

Residents who completed four years of training in the program should be able to perform the following:

1.)     Complete Ophthalmological History and Examination

2.)    Diagnosis, prevention and management of eye disorders, including systemic disorders.

3.)    Identify most ocular abnormalities.

4.)    Manage all medical and surgical ocular emergencies.

5.)    Refraction and prescription of corrective lenses.

6.)    Acquire good skills in various diagnostic procedures and ocular surgery.

7.)    Communicate well with patients, relatives and colleagues.

8.)    Keep orderly and informative medical records.

9.)    Educate and update himself/herself and others in his/her field.

10.)  Advise colleagues from other specialties in problems related to ophthalmology.

11.)   Possess high moral and ethical standards.


Final knowledge and skill that should have been gained after four years training should include the



A.   Anterior Segment/Cornea and External diseases

1.  Diagnosis and management of conjunctivitis.

2. Diagnosis and management of microbial keratitis.

3. Diagnosis and management of blepharitis.

4. Diagnosis and management of episcleritis and scleritis.

5. Diagnosis and management of uveitis entities.

6. Basic knowledge of corneal dystrophies.

7. Specular microscopy of corneal endothelium

8. Considerations, indications and post operative management of PKP.

9. Considerations, indications and postoperative management for cataract extraction.

10.    Considerations, indications and postoperative management of keratorefractive surgery.

11. Know types and indications of ophthalmic medications and their side effects.

12.    Surgical skills – able to do ECCE + IOL implantation with or without anterior vitrectomy and

            phaco emulsification.

13.    Trabeculectomy with or without cataract extraction.

14.    To know indications of PKP and asses in PKP/LKP and does part of it and able to recognize and

            manage common complications.

15.    To be able to do ICCE and know its indications.

16.    To perform Keratectomy, corneal/scleral laceration repair, and corneal biopsy.




Continuation… Final Knowledge & Skills…)


17.    Remove superficial conjunctival tumors.

18.    Remove pterygium with or without conjunctival or amniotic membrane grafting.

19.    Be able to manage all complications of above surgical procedures.

20.   Manage all ocular emergencies medically and surgically.


B.   Glaucoma

1.  Be able to diagnose all types of glaucoma; developmental, open-angle, narrow-angle, secondary

glaucomas, etc.

2. Be able to manage acute and chronic types of glaucoma medically and surgically (e.g.

trabeculectomy, combined procedures, cyclocryotheraphy).

3. Be able to interpret gonioscopy, optic nerve head examination and different visual field changes.

4. Be familiar with possible medical and surgical complication of glaucoma and the sequelae of


5. Be able to do laser PI, trabeculoplasty and iridoplasty and cyclophotocoagulation.


C.   Retina

1.  Able to do a complete fundus examination and to recognize normal variation.

2. Identify and detect common posterior segment pathology.

3. Able to diagnose, manage and know indications of surgical intervention in diabetic retinopathy.

4. Interpret fundus flourescein angiography, OCT & electrophysiology testing.

5. Do cryopexy, panretinal photocoagulation, focal macular laser therapy, laser treatment for holes,

vascular retinopathies or other indications.

6. Recognize retinal degeneration and dystrophies and know the necessary investigations and their

indications and interpretation.

7. Evaluation and differential diagnosis of pigmented fundus lesion.


D.   Pediatric Ophthalmology

1.  Be able to do full ophthalmologic examination including refraction and orthoptic work-up and

recognize variation in normal examination.

2. Approach to examination of infant.

3. Diagnosis and management of common pediatric ophthalmology problems.

4. Diagnose the cause of leukocoria.

5. Recognize common pediatric tumors.

6. Diagnose strabismus and be able to do simple strabismus surgery.


E.    Oculoplastic

1.  Know the indications and complications of entropion/ectropion repair, tarsorrhaphy, evisceration,

enucleation, lid laceration repair, lacrimal probing.

2. Be able to do tarsorrhaphy, lid laceration and lacrimal probing.


F.    Neuro-ophthalmology

1.                                  Visual field interpretation and clinical correlation

2.                                 Pupillary exam and interpretation

3.                                 Optic nerve head (disc), normal variation and the differential diagnosis of disc pathology.

4.                                 Basic radiologic studies, indications and interpretation

5.                                 Basic knowledge of nystagmus











(Continuation… Final Knowledge & Skills…)


G.   Ocular Pathology

1.  Be able to do and interpret Gram, Giemsa, GMS staining for ocular specimens.

2. To recognize the histopathological appearance of common ocular disease especially ocular

dystrophies and ocular neoplasms.


H.   Anesthesia

1.  Be able to perform local anesthesia for ophthalmic procedures, in particular, retrobulbar and

peribulbar methods.

2. To be certified with the Basic Cardiopulmonary Resuscitation (CPR) during this rotation.

3. To be able to know the indications, contraindications and complications of general anesthesia.