Glaucoma is the second leading cause of graft failure after graft rejection. Sustained elevations in intraocular pressure (IOP) can lead to corneal endothelial decompensation, graft failure and vision loss. Causes of glaucoma post-keratoplasty include steroid response, pupillary block, retained viscoelastic material, distortion of the trabecular meshwork or Schlemm’s canal, haemorrhage, lens protein leakage, secondary angle-closure from peripheral anterior synechiae, and pre-existing glaucoma. Close monitoring, coupled with prompt diagnosis and appropriate treatment of post-keratoplasty glaucoma are vital to the preservation of optic nerve function and a successful graft outcome.

The eyes can be somewhat of a challenge for many of the non-specialist doctors. It certainly was for me and that’s the reason I attended The Edinburgh Focus course. The course was founded by Dr. Vikas Chadha, Dr. Vijay Hegde, Dr. Shyamanga Borough, Dr. James Cameron and has been operating since January 2007. It was designed at the time to teach the basic practical skills which are essential for doctors starting their first job in ophthalmology. Alternatively, teaching those who want to learn the basic ophthalmological examinations skills to improve their day-to-day practice.

I spent my time with the Ophthalmology department at the Karapitiya Teaching Hospital and I was able to appreciate how structural decisions ensured that the highest level of care was provided to the greatest number of patients but in ways very different to that in the UK. While it is saddening to learn about the current situation in Sri Lanka, it has served as a personal reminder to reflect on my experience as an elective student. Indeed, looking back, it might be the case that the things that initially startled me during my time there might actually serve as lessons as to what we can do to improve our own healthcare system overburdened by extensive waiting times.

Demonstration of publication and leading a successful closed-loop audit are both fundamental skills required of the modern ophthalmology trainee seeking to further their career. Both can seem like mammoth tasks with most publications failing to see the light of day and most audits failing to make a difference. However, it is possible to publish an audit or quality improvement project (QIP) allowing you to achieve both in one fell swoop. The path to achieve this objective can be treacherous which is why I have written the following top tips from bitter experience!

Refractive error, the second leading cause of blindness across the globe is an umbrella term comprising of conditions where rays of light entering the eye are unable to focus on the retina. Examples of such errors include hyperopia (far-sightedness), myopia (near-sightedness), astigmatism, and presbyopia (age related visual changes). Myopia is particularly common, affecting 23% of the world’s population. These values are set to soar with 49.8% of the global population expected to be myopic by 2050, 9.8% of whom will have high degrees of myopia.

Ophthalmology is one of the most competitive specialties out there. It is no wonder that in 2021 there was a study carried out called Predictors of Ophthalmology Career Success (POCS) study. The study was the first quantitative assessment of the factors that determine success in OST (Ophthalmology Specialty Training) recruitment and ophthalmology postgraduate examinations in the UK. This only buttresses the fact that it is a sought out specialty by many. In 2021, there were 89 posts for 605 applicants. This put the competition ratio at 6.80. This ratio only went up in 2022 and it appears it will maintain this trend in the years to come.

Lower lid blepharoplasty is becoming an increasing popular cosmetic surgery to create a more youthful effect around the eyes. As the normal ageing process takes place this can affect the periorbital region giving the appearance of puffy eyes with dark circles. The transconjunctival approach allows this problem to be rectified without making any external skin incision, allowing for a scar free approach. This has led it to it becoming an increasingly sought-after surgery.

Alongside establishing a thorough history, the slit lamp examination forms the foundation of an ophthalmology consultation. Prior to ophthalmology placements, medical students and junior doctors have minimal exposure to the slit lamp microscope despite its value in visualising the eye and identifying ocular pathology. Understanding the structure and function of the slit lamp microscope is fundamental to carrying out an effective examination.

UK medical schools are no longer required to include ophthalmology rotations in clinical attachments. The current state of ophthalmic education has sadly seen little improvement over the last few decades with studies 25 years ago also reflecting an inadequate system, resulting in general practitioners with poor confidence in looking after patients presenting to them. Scantling-Birch and colleagues go as far as to say that we have a current crisis in ophthalmic education, where we may be seeing non-ophthalmologists in medico-legally indefensible positions, unable to complete a basic examination. Declining exposure to ophthalmology and the issues relating to its undergraduate education are not limited to the UK; Mottow-Lippa discusses the similar decline in the United States and stresses that efforts from the profession are needed if we want to preserve doctors who are competent in basic ophthalmic examination.