The FRCOphth Part 1 exam is the first of three fellowships exams completed during ophthalmology training. Despite this, it has one of the lowest pass rates at around 40% (April 2021). The exam consists of two papers, each containing 90 multiple-choice questions. Each paper lasts 2 hours with a 1-hour break in between. Due to the COVID pandemic, it is currently conducted as an online proctored examination. There are various opportunities to sit the exam throughout the year (January, April and October), with a maximum of 6 attempts allowed per candidate.
SCD commonly causes visual problems. It can affect all parts of the eye, as the abnormally shaped blood cells can occlude of any small vessel in the body. The crescent shaped red blood cells affect the oxygen carrying ability of blood. Therefore, SCD affects all major organs such as the spleen, lungs, heart, kidneys, liver and eyes. As a consequence, patients with SCD can suffer from a widespread of serious pathologies such as: chronic anaemia, stroke, chest pain, tissue necrosis, shortness of breath, kidney damage, recurrent infections and painful sickle cell crises.
The optic nerve carries information from the retina to the visual pathways in the brain. Optic neuritis is inflammation of the optic nerve, which can be associated with various aetiologies including demyelinating lesions, autoimmune conditions, infections and other inflammatory processes. This article discusses the clinical presentation of optic neuritis as well as pathogenesis, investigation and management.
Until recently, Terson’s syndrome (TS) was defined as the development of vitreous hemorrhage occurring in tandem with a subarachnoid hemorrhage (SAH). However, the definition has been expanded to include SAH, increased intracranial pressure (ICP), traumatic brain injury, and any form of intracerebral hemorrhage (1). More than 90% of vitreous hemorrhage cases are caused by either direct trauma to the head and orbit or by diabetes; less than 6% are caused by Terson’s (2). TS affects men and women equally and has been reported in infants as young as 7 months of age (3,4). This article will serve as a brief summary on the proposed pathophysiology, diagnosis, clinical implication, and management of TS.
More than 1,000,000 people in Bangladesh suffer from blindness; of that 74.6% are blind due to cataract and 18.7% due to refractive error. Across the country, there is only 32.8% coverage for cataract surgery services, 626 ophthalmologists and 618 mid-level eye care personnel. Hospitals with ophthalmic operating theatres are all based in major cities. The nearest eye care service to Beanibazar/Golapganj Upazila is an hour drive away either in Sylhet city or the Moulvibazar sub-district. There are no primary eye care services in the local region and the population have to rely on alternate medicine or informal healthcare provided by untrained local people. It is common practice to use eye drops for reduced vision over the age of 30.
Gonioscopy is used to visualise the drainage angle of the anterior chamber. It is commonly utilised in the context of glaucoma to grade the anterior chamber angle and to diagnose angle closure. It is a vital skill for all ophthalmologists and good understanding is indispensable in ensuring prompt identification and diagnosis of angle closure.
Pseudoexfoliation Syndrome (PEX) is a systemic disease characterised by the deposition of extracellular fibrillary material in the anterior segment of the eye. It is often identified incidentally on slit lamp examination because patients are typically asymptomatic during initial stages. It is associated with raised intraocular pressure and development of secondary glaucoma. Due to the increased disposition of PEG, patients with PEG should be routinely monitored so that early interventions could be introduced to slow down the progression of glaucomatous changes.
Dome shaped maculopathy (DSM) is a convex anterior protrusion of the macula into the vitreous cavity. DSM is commonly associated with high myopia and posterior staphyloma but can occur in emmetropia. DSM is thought to occur in 12% of highly myopic eyes but the exact population prevalence is currently unknown. The major complication of DSM is serous retinal detachment, likely secondary to subretinal fluid (SRF) accumulation. DSM is an unusual, poorly understood yet relatively common disease that most Ophthalmologists will encounter in their practice.
Central retinal artery occlusion (CRAO) refers to a sudden blockage of the central retinal artery. It is an ophthalmic emergency that can result in profound visual impairment. The Central retinal artery (CRA) is a branch of the ophthalmic artery which is a branch of the internal carotid artery. The CRA is the main blood supply to the inner retinal layers whereas the outer retina is supplied by the choriocapillaris of the choroid which branches off the ciliary artery. CRAO has an incidence of 1 in 100,000 people and is responsible for 1 in 10,000 outpatient ophthalmology appointments. It most commonly affects patients over the age of 60 with men affected more than women. This article will provide a brief outline on the pathophysiology, diagnosis, investigations, and management of CRAO.