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.
The Edinburgh “Foundation Course in Ophthalmology” (FOCUS) is a two-day clinical skills course that has been running annually since 2007 – returning after a two-year hiatus due to Covid-19 restrictions.
It was started by Edinburgh ophthalmology trainees with the aim of equipping incoming ST1 doctors with the skills and knowledge necessary to transition smoothly into training. Nowadays, the course attracts not just prospective trainees, but medical students, and other healthcare professionals allied with ophthalmology.
Retinitis Pigmentosa (RP) is a genetic disease that encompasses a spectrum of hereditary conditions caused by shared physiological processes that lead to retinal degeneration (1). In RP, genes that encode proteins responsible for photoreceptor and retinal pigment epithelium function get mutated. More than 100 genetic mutations have been implicated in RP, causing a loss of rod and cone photoreceptors in the retina through apoptosis (1). Initially, rod photoreceptors are predominantly affected, followed later by degeneration of cones (rod-cone dystrophy) (2).
Bacterial endophthalmitis describes inflammation of the vitreous secondary to bacterial colonisation. It is an ophthalmic emergency requiring prompt treatment to increase the chance of preserving sight and saving the eye. It is categorised as exogenous or endogenous in origin. Endogenous bacterial endophthalmitis is rare, resulting from the haematogenous spread of bacteria from systemic infection. Exogenous bacterial endophthalmitis, however, results from the introduction of bacteria from the ocular surface or an external source into the eye. This can occur post-operatively, following a penetrating ocular trauma, or after an intra-ocular procedure such as intravitreal injections.
Haemolacria is defined as having blood in the tears. It is an extremely rare phenomenon and is both concerning for physicians and, as you can imagine, the patients and their families. It was first noted in the literature in the 6th century and then 1000 years later in the 16th century. Since then there have been very few cases that have been reported in the literature. Due to the limited literature and number of cases of haemolacria there is no known pattern or prevalence of the condition within any given demographic. There have, however, been a number of different causes and associations of haemolacria which will be mentioned below.
Artificial intelligence (AI) is a discipline within computer science which aims to develop tools capable of undertaking tasks that usually require human intellect. Coined by the Computer Scientist John McCarthy in 1956, AI has been likened to the industrial revolution. It has played a pivotal role in the growth of many key industries, ranging from the financial sector to manufacturing. Seamlessly integrated into our daily lives; it is used to recommend products when shopping online, suggest films based on our preferences when binge-watching Amazon Prime and recognise speech when calling an automated call centre.
Cataract surgery is the most commonly performed procedure within the National Health Service (1). In most cases, the intended post-operative visual outcome is emmetropia, which is significantly influenced by the intraocular lens (IOL) power calculated and selected by the surgeon (2). The capsular bag is the preferred position for IOL implantation due to its stability and proximity to the position of the native lens (3). The most common intraoperative complication of cataract surgery is posterior capsular (PC) rupture (1). This is one instance in which placement of the IOL in the ciliary sulcus, rather than the capsular bag, may be necessary, in addition to other situations such as cases of zonular laxity (3). The Royal College of Ophthalmologists state in their cataract guidance that back-up lenses should be available in theatre in case non-capsular bag fixation is required (4).
Ophthalmology is a rewarding and exciting career that attracts many applicants each year. The recruitment process is overseen by Severn deanery and applications open at the beginning of November each year on Oriel. Applicants are ranked by their cumulative score of portfolio points, MSRA scores and interview scores. Severn deanery has published the portfolio scoring for the recruitment this year and there have been substantial changes overall. This article will go through the changes for each section and provide useful tips to score points.
Isotretinoin is a retinoid and derivative of vitamin A used to treat severe recalcitrant acne vulgaris. By affecting the cell cycle, cell differentiation, survival, and apoptosis it reduces sebum production, prevents the blockage of pores, and growth of acne-causing bacteria. Additionally, isotretinoin may interact with FoxO1, which may explain a substantial number of isotretinoin's unexplained actions.