Ultrasound Education: Teaching the Techniques Online Yale Fisher, MD      Ultrasound is a major adjunct to the field of ophthalmology. While it does not replace standard care it significantly improves and adds another dimension to ocular examination. The value of diagnostic ultrasound lies in its reliance upon acoustic impedance tissue differences rather than light reflectivity for imaging. Media opacity, while limiting to light driven instruments, is not a hindrance to ultrasonography.      Over the course of years, I realized ultrasound education for ophthalmic physicians was limited. Technician training was more easily available and quite extensive. Often, graduating residents and young physicians knew how to order an ultrasound for a patient but were not confident to perform or interpret the exam especially when supporting ultrasound facilities were unavailable usually at times outside normal work hours.      For this reason, I developed a website (OphthalmicEdge.org) dedicated to providing basic instructional training in ultrasound for ophthalmologists. The website offers lectures and a real-time video library that provide information on contact B-Scan ultrasound technique and pattern recognition. It is targeted at those who are new to ultrasound, but also offers some insight into more complex cases. The lectures provide instruction on examination technique such as probe position, image interpretation and clinical diagnostic concepts including Real-Time, Gray Scale evaluation and Three-Dimensional Thinking. By far, the most difficult concept to master is 3-D Thinking, interpreting in three dimensions from multiple two dimensional B-scans.      While there are more conventional means offering ultrasound education and training, online material has the great advantage of real-time with interactive capability. Online educational material can be updated or corrected immediately. New material is introduced quickly.      The idea to develop a website offering ultrasound education actually occurred to me 14 years ago, but the resources available were inadequate, in terms of ophthalmic technology, instrumentation and image quality. Furthermore, video capture, storage and online support were limited. Over time, major changes have lead to the launch of OphthalmicEdge.org.      Ellex's ultrasound system, Eye Cubed, provided excellent digital image quality and real time capture for short video segments. Combining a set of lectures and a real-time video library that was internet-available without charge appeared to be the quickest and most effective way of disseminating information. The site is funded by a number of charitable organizations and private contributors.      While I have always believed many ophthalmologists wished to learn ultrasound technique and interpretive skills, availability has always been a problem especially for those with little or no knowledge of the field. To date, response to the website has been extremely positive. Since its launch in January this year the site has had almost 10,000 visits from over 4500 individual users in 1500 cities worldwide. Interestingly, while I had expected the majority of visitors to the website to be ophthalmologists, an online survey to determine who was taking the lecture series revealed there was a 50/50 split between ophthalmologists and ophthalmic technicians.      Future developments for the website are in the pipeline, extending the coverage to other areas of ophthalmic imaging, such as OCT and autofluorescence. The site will also involve non- imaging topics of interest with limited available training such as trauma and the management of intraocular foreign bodies. I am sure future developments in ophthalmology will require additional programs. It is my hope this website will continue to expand eventually providing benefit to specialists in all areas of ophthalmology and maintaining the conceptual ideas and ideals that initiated the Ophthalmicedge.org. -- Dr Fisher's website can be visited at: www.ophthalmicedge.org. Please note that this is an instructional website that provides basic education, and is not to be used as a diagnostic tool.