FAICO Glaucoma: Syllabus Map and High-Yield Question Areas

There is no published AIOS FAICO Glaucoma topic-weightage table that you should treat as an official syllabus. AIOS currently lists Glaucoma among FAICO fellowship awards, but its live FAICO page does not provide a glaucoma paper blueprint. Prepare for subspecialty depth instead: mechanism and angle anatomy, evidence of glaucomatous damage, target-pressure reasoning, treatment principles, laser and surgical complications, and the ability to explain an image or case in a disciplined order.

That distinction matters. “High yield” in this guide means a domain that repeatedly forces a glaucoma fellow to integrate structure, function and intervention. It does not mean a promised FAICO question, a mark allocation or a substitute for a current AIOS notice. The clinical anchors below are standard guideline/reference concepts for exam education. They are not patient-specific management advice; current local protocols and clinical judgement govern care.

FAICO rule check: AIOS’s live FAICO page was checked on 18 August 2026. It confirms Glaucoma as an award but does not publish a specialty-specific examination blueprint. If a later AIOS notice, call letter or candidate instruction gives a framework, it overrides this revision map.

Build your map around decisions, not chapter headings

A long glaucoma reading list becomes useful only when each topic answers a question under time pressure. Use six decision domains.

This structure is more useful than memorising “POAG, PACG, secondary glaucoma” as three isolated chapters. A glaucoma question often changes only one variable: a narrow angle instead of an open angle, an unreliable field instead of a reliable field, disc haemorrhage with stable pressure, or inflammation after a procedure. Your answer must identify the variable that changes the next principle.

First domain: mechanism, anatomy and gonioscopy

Start every glaucoma case with the angle and outflow pathway. You should be able to distinguish primary open-angle disease from primary angle-closure mechanisms, recognise when the angle finding is incompatible with the label you were about to choose, and explain major secondary mechanisms without reducing them to a list.

For angle closure, revise pupillary block, plateau iris configuration, lens-related crowding and secondary causes. Draw the anatomy from cornea to ciliary body. Then answer: what would indentation gonioscopy contribute? What is the difference between appositional closure and peripheral anterior synechiae? Which part of the history or anterior-segment examination makes a secondary mechanism more likely? A diagram you can redraw is more valuable than a paragraph you merely recognise.

For open-angle presentations, differentiate trabecular dysfunction from conditions that alter the angle appearance or create a secondary outflow obstacle. Pseudoexfoliation, pigment dispersion, steroid response, uveitis, trauma and post-surgical states are high-value comparison topics because their clue, mechanism, natural history and treatment constraint differ. Make four columns: defining clue; angle finding; mechanism; special risk or limitation. Avoid vague cards such as “PXF = high IOP.” They do not train discrimination.

Second domain: prove damage before you describe it

FAICO-level glaucoma preparation needs structural and functional interpretation, not just a list of OCT colours. Use a fixed sequence every time.

1. Check reliability and acquisition. For a visual field, start with fixation/false-positive/false-negative context and the visual plausibility of the plot. For OCT, check signal, segmentation, centration and scan quality. Do not call progression from a poor test.
2. Describe the pattern. Is there localised or diffuse RNFL/GCC loss? Does the field show a glaucomatous pattern, or a defect that needs another explanation?
3. Seek structure–function agreement. Map an inferior RNFL defect to the expected superior field region, for example. Discordance is not an inconvenience; it is the question.
4. Compare with baseline. Distinguish a one-off abnormal result from a repeatable trend. Explain why test variability matters.
5. State the conclusion and the next information needed. Do not jump from a red sector to a procedure name.

The European Glaucoma Society and AAO materials place careful examination, optic nerve assessment, IOP measurement, gonioscopy and perimetry in the core assessment framework. For an exam, translate that into an evidence chain: symptoms and risk factors; IOP context; angle; disc; imaging; field; trend. A question can be answered safely when you can say which link is absent or unreliable.

The image station drill

Take an OCT or field image and give yourself 60 seconds:

“First I would check test quality. The main structural/functional pattern is ____. It does/does not match the disc or corresponding test. Compared with the stated baseline, the evidence for progression is ____. I would next want ____ before making a treatment decision.”

That is a framework, not a scripted answer. It prevents a common viva failure: delivering a long lecture before telling the examiner what the image shows.

Third domain: target pressure and progression reasoning

Target IOP is a clinical planning concept, not a universal number to recite. In an exam, show that you understand why severity, starting IOP, age/life expectancy, rate of documented change, disc/field status, corneal factors, adherence and treatment tolerance can alter the desired reduction. Do not invent a single “correct” target when the stem supplies none.

Practise questions in pairs. First: a newly diagnosed eye with baseline damage and a particular IOP. Second: the same eye with repeatable progression despite a lower IOP. What additional evidence changes? The answer is rarely “add drug X” without context. It is to establish whether progression is real, whether the pressure estimate is meaningful, whether the diagnosis/mechanism is right, and then discuss escalation at a principle level.

Know the pitfalls: diurnal variation, central corneal thickness as one part of interpretation rather than a conversion formula, unreliable fields, OCT artefact, cataract-related field effects, disc haemorrhage, and non-glaucomatous optic neuropathy. These are classic areas where a candidate who knows the definition but not the data can be trapped.

Fourth domain: medicines, lasers and what they change

Do not revise medicines as an alphabetised list. Group each class by main site/mechanism, expected IOP-lowering role, common ocular/systemic adverse-effect consideration, contraindication or caution, and where it fits in a case. The exact choice in real practice depends on the patient and current guideline/local policy; for exam purposes, explain the mechanism and constraint.

For laser, know the indication, tissue target, expected objective, limitations and complication set. Laser peripheral iridotomy is not the same conceptual tool as laser trabeculoplasty, cyclodestructive treatment or iridoplasty. State the mechanism first. A candidate who says “laser for glaucoma” has not answered the question.

NICE, EGS and AAO guidance are useful for grounding the broader care framework, but they do not replace the particular evidence in a stem. Keep your wording conditional: “in this scenario I would consider the principle of…” rather than writing a patient-specific prescription.

Fifth domain: surgery and the complication map

Surgical questions reward ordered thinking. For every procedure, be able to answer five things: what pressure pathway is being altered; which eye/case context makes it reasonable; what early complications are plausible; what late failure mechanism matters; and how you would distinguish that complication from its nearest alternative.

Your map should cover trabeculectomy and bleb-related issues, tube shunts, non-penetrating approaches where relevant to your reading, and the principle and limits of MIGS. Do not flatten them into a “new versus old” comparison. In a viva, an examiner may show a shallow anterior chamber, a high IOP after surgery, a hypotony picture, a red painful eye, a flat bleb or a tube position. Start with the mechanism, then the dangerous differential, then the investigation/management principle. Never offer a memorised intervention without identifying the complication.

Make a complication notebook with these columns: timing; IOP direction; anterior-segment sign; fundus sign; most important differential; first principle of response. Review it weekly. It forces you to compare malignant glaucoma, pupillary block, suprachoroidal haemorrhage/effusion, bleb leak, blebitis/endophthalmitis concern, encapsulation and steroid response as patterns rather than names.

Sixth domain: secondary glaucoma, acute presentations and special contexts

This is where a subspecialty assessment tests whether you can integrate the rest of ophthalmology. Uveitic glaucoma requires you to hold inflammation, steroid effect and angle changes in the same model. Neovascular glaucoma asks you to identify the retinal/ischaemic driver and the anterior-segment consequences. Traumatic, lens-related, aphakic/pseudophakic and paediatric contexts each change the history, examination and risk profile.

Use a consistent four-question approach:

1. What is the mechanism of pressure elevation or nerve damage?
2. What is the angle status and what has changed it?
3. What parallel ocular/systemic problem is driving the case?
4. What immediate danger or surgical limitation must the examiner know you recognise?

This is exam education for doctors, not advice for a real patient. In practice, time-sensitive presentations need supervised, guideline-based clinical assessment.

A weekly FAICO Glaucoma rehearsal loop

Use a loop that creates output, not just reading hours.

When you miss a question, do not merely add its fact to a card. Write what would have separated the correct option from the chosen distractor. “Forgot pseudoexfoliation” is weak. “Saw high IOP but did not use dandruff-like lens material and poor dilation to identify pseudoexfoliation” is actionable.

For supporting resources, use the site’s glaucoma study guide as a lateral topic hub, the FAICO preparation guide for general exam context, and free FAICO sample questions for short retrieval practice. Glaucoma Notes is an optional product preview; it is not an AIOS resource or an official blueprint.

Sources

1. All India Ophthalmological Society: About FAICO — primary source confirming Glaucoma as a FAICO fellowship award and for current general context; checked 18 August 2026.
2. European Glaucoma Society Guidelines, 5th Edition — peer-reviewed professional framework for glaucoma assessment and care principles; accessed for exam-reference context.
3. American Academy of Ophthalmology: Primary Open-Angle Glaucoma Preferred Practice Pattern — professional guidance for assessment and longitudinal management principles.
4. NICE NG81: Glaucoma — guideline context for diagnosis and management pathways; local protocols and current updates prevail.