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blindness, total achromatopsia, and in-complete achromatopsia.

Dr. Sloan was married to William M. Rowland, an ophthalmologist in private practice in Baltimore. Her legacy to us is her work and the many outstanding for-mer Wilmer residents whose understand-ing of basic psychophysical testing she established and fostered through the demonstration of its clinical applicability. We will all certainly remember that viva-cious, dynamic member of the Wilmer staff, affectionately called "Sloanie," who in her persistent and dedicated way was an example of the scientist who integrates basic and clinical research in order to enhance the understanding of disease mechanisms and to alleviate visual handi-caps.

IRENE H. MAUMENEE

R E F E R E N C E

1. Walsh, F. B., and Sloan, L. L : Idiopathic flat detachment of the retina. Am. J. Ophthalmol. 19:195, 1936.

CORRESPONDENCE

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Ocular Pathology and the American Board of Ophthalmology

Editor:

The recent editorial, "Ocular patholo-gy and the American Board of Ophthal-mology" (Am. J . Ophthalmol. 93:367, 1982) raised several issues about the orga-nization and content of the oral examina-tion that deserve further explanation. The Board tries to maintain the highest standards of examination in order to iden-tify those individuals deserving of certifi-cation. In revising the content of the oral examination, the Board never intended to deemphasize ocular pathology or medical ophthalmology. Further, the proposed changes for 1983 do not simply replace a combined examination on medical oph-thalmology and ocular pathology with an examination on the lens and glaucoma. On the contrary, the revisions are the outgrowth of prolonged deliberations re-sulting in part from our concern that each year more candidates were failing the oral examination in ophthalmic pathology. It seemed that the whole field of medical ophthalmology was not being adequately examined.

The Board believes that the oral exami-nation should determine the candidate's basic fund of knowledge, problem-solving ability, and clinical judgment by techniques unique to the encounter be-tween the examiner and the candidate, rather than by repeating the simple recall and recognition methods of the written qualifying test. Therefore, it seemed logi-cal to develop new test subjects based on the type of clinical problem rather than on a basic area such as histopathology or a general method of management such as surgery. The reorganized examination should in no way disregard basic science or medical ophthalmology but, if properly constructed and administered, should test for knowledge in anatomy, physiology, histopathology, pathophysiology, princi-ples of examination, clinical science,

798 AMERICAN JOURNAL OF OPHTHALMOLOGY JUNE, 1982

medical therapeutics, and surgery within each subject.

In reviewing the evolution and content of the oral examination, it was apparent that three test subjects—optics and re-fraction, motility, and neuro-ophthal-mology—already contained this mixture of basic science, clinical science, and clinical application. The four other sub-jects had been plagued with ambiguity, repetition of material, and artificial re-striction of discussion. Why, for exam-ple, should the candidate's knowledge of the diagnosis and therapy of bacterial keratitis, the pathophysiology of corneal suppuration, and the indications for and techniques of therapeutic penetrating ker-atoplasty be assessed in three separate examinations? Similarly, a determination of the candidate's fund of information and problem-solving ability in regard to cho-roidal melanoma logically should include clinical diagnosis, laboratory methodolo-gy, and the rationale for surgery as well as the pathophysiology and histopathologic features of various tumor types, all ideal-ly included in one examination. Further, although the oral examination permitted a departure from the test material, the visual props used for medical ophthalmol-ogy testing emphasized only the ophthal-moscopic features of ocular and systemic disease. As the editorial stated, ophthal-moscopy is only one method of recogniz-ing systemic diseases affecting the eye. Additionally, the four disparate examina-tions had not adequately dealt with the basic and clinical aspects of two topics of major significance to the ophthalmolo-gist, cataract and glaucoma.

Because of these considerations, the Board attempted to develop three new test subjects that would encompass the remaining clinical and anatomic areas of ophthalmology. The Board had consid-ered for several years the possibility of decreasing the number of subjects in the oral examination from seven to six in order to reduce the examination time for the candidates and examiners and to

eliminate by approximately one-third the number of associate examiners required. Expanding the examination on external disease and creating new examinations covering the lens and glaucoma and the retina, vitreous, and choroid seemed log-ical. Further, these changes would re-quire candidates to demonstrate a knowl-edge of ophthalmic pathology in at least four of the six oral examinations. To as-sume that this reorganization deempha-sizes ophthalmic pathology and medical ophthalmology also implies that we in-tend to minimize ocular surgery. These conclusions are simply not correct.

Throughout these deliberations, the Board considered the possible adverse impact on the training of residents and preparation for the written qualifying test and oral examination. We reviewed the possibility of revitalizing a practical ex-amination in ophthalmic pathology either as a component of the written qualifying test or as a separate examination proce-dure. Several specialty boards use some type of practical examination in conjunc-tion with or supplementary to their writ-ten and oral examinations. The Board concluded that the logistics and expense of an examination using microscopes or even projection apparatus were prohibi-tive. With the help of J . Donald M. Gass and Melvin M. Rubin, we have designed new visual material and multiple-choice questions in ophthalmic pathology that will be included in the 1983 written qual-ifying test. These questions may be grad-ed separately and scores for the written qualifying test may be determined by individual subtests.

The extent of these deliberations and the efforts required for this reorganiza-tion should attest to the Board's desire to maintain the high standards of the oral examination. We did not intend to mini-mize any area, certainly not ophthalmic pathology or medical ophthalmology. We believe that these revisions will enable us to assess better the candidate's ability as an ophthalmologist and as a physician.

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Retaining the old system in which sub-jects were divided by basic discipline (such as histopathology), single method of management (such as surgery), or artifi-cial link to systemic disease (such as med-ical ophthalmology) seemed illogical and outmoded.

DAN B. JONES, M.D.

Chairman, Oral Examination Committee

American Board of Ophthalmology

Ocular Pathology and the American Board of Ophthalmology

Editor:

We read with considerable interest the editorial, "Ocular pathology and the American Board of Ophthalmology" (Am. J . Ophthalmol. 93:367, 1982), on the de-cision of the Board to discontinue the separate oral examination in ophthalmic pathology and David Paton's response (Am. J . Ophthalmol. 93:656, 1982).

We have made several inquiries in order to determine as precisely as possi-ble the intents and probable effects of the Board's decision, and the matter was taken up during the business session of the Verhoeff Society meeting in Washing-ton, D.C., on April 24 and 25, 1982. We are both entirely satisfied that the objec-tives of the American Board of Ophthal-mology are highly meritorious and sound. The Board has long been aware of the overall low performance of Board candi-dates in ophthalmic pathology, and it is their purpose to strengthen the incen-tives for candidates to prepare more thor-oughly in this area.

To this end, the Board has decided to increase the number of questions on the written examination that are devoted to ophthalmic pathology, as well as to show more high-quality photomicrographs of pathologic conditions that will serve as the basis for questions. The Board is planning to analyze the candidates' per-formance on the questions earmarked for ophthalmic pathology, and should per-

formance continue to lag, further steps may be taken to encourage candidates to prepare themselves better. Rather than being at single jeopardy for not passing the oral examinations because of a failure to perform satisfactorily in one examina-tion on ophthalmic pathology, the disper-sion of ophthalmic pathology questions throughout all of the remaining sections of the oral examination places the poorly prepared candidate at multiple jeopardy. We have no doubt that the American Board means business in strengthening the ophthalmic pathology preparation of candidates. The Board's underscoring of the importance of ophthalmic pathology nicely dovetails with the recommenda-tion of the Accreditation Council for Graduate Medical Education, which now requires 50 hours of intramural education in ophthalmic pathology during the course of residency training in order for a program to be accredited.

It is heartening for us to realize that ophthalmic pathology is so widely per-ceived as the centerpiece of clinically valid learning on ocular disease. In an era when there are so many new techniques available for the treatment of ocular dis-ease, only the practitioner who is well-rounded, with a clear understanding of the entities being treated, can select the appropriate therapeutic option for the patient.

Never before have residents been con-fronted with the abundance of teaching aids that are now available for learning ophthalmic pathology. A new edition of Yanoff and Fine's1 textbook of ophthalmic pathology has just appeared, as has a brand-new two-volume pathophysiologic text edited by Klintworth and Garner.2 A revision of Hogan and Zimmerman's text-book on ophthalmic pathology is being completed by its new chief editor, Wil-liam Spencer3; it will comprise three vol-umes and may become the American Henke-Lubarsch. The American Acade-my of Ophthalmology has reinstituted a separate section devoted to ophthalmic