As a teaching fellow in ophthalmology, I have delivered various aspects of the curriculum, including examination skills. Direct Ophthalmoscopy (DO) is currently taught within the ophthalmology placement, and it is a skill that the GMC require medical students to develop competency in. However, perhaps due to the minimal time and exposure within ophthalmology, in what is usually a two-week placement, the students’ confidence in their ability to perform this or indeed identify abnormalities is variable. There is also evidence to show that postgraduate doctors are not confident in this skill. The Royal College of Ophthalmologists (RCO) encourage undergraduates and junior doctors to conduct slit lamp examination (SLE). SLE is not currently taught within the ophthalmology undergraduate curriculum across most schools. This article will discuss the possibility of developing the way we teach medical students to carry out ophthalmology examinations, and if students see value & are interested in this advancement.

We present a case with a sustained 2-year effect post one FA implant.  A 72-year-old male patient presented with a left hemi-retinal vein occlusion with macular oedema in January 2013. Initial treatment was intravitreal dexamethasone implants. Although he showed an excellent response, it became short lived with further retreatment, with the effect lasting for 8-10 weeks on average before oedema returned. This necessitated additional treatment with numerous anti-VEGF injections in addition to treating angiographically ischemic areas with retinal laser. At 17 months follow up, after off label use of FA, we demonstrated an improvement in both visual acuity and central subfield thickness for the patient Retinal vein occlusion is a common pathology that can be treated by various means. The off label fluocinolone acetonide (FA) implant demonstrated a sustained response over 2 years in this case. Further prospective studies of its use are needed to confirm its role in clinical practice.

Posner-Schlossman syndrome, also known as glaucomatocyclitic crisis, is a rare condition characterised by recurrent transient elevations in intraocular pressure (IOP) concomitant with anterior chamber inflammation. It principally affects young to middle-aged adults, chiefly males, within the age range of 20 to 50 years. While the exact aetiology remains equivocal, several factors have been implicated, including possible viral triggers, autoimmune processes and genetic predilection.

The Ophthalmology Specialty Training pathway continues to be one of the most competitive in the UK, with approximately 9 applicants for each available position. The application process undergoes annual modifications, and the 2023/2024 cycle has introduced some significant changes compared to previous years.

Ocular sarcoidosis typically presents either to the uveitis or neuro-ophthalmic service, depending on the compartment affected. Here we present a case of a 70-year-old woman who developed profound right eye visual loss to hand movements over two weeks with unilateral disc swelling and optic neuropathy. OCT demonstrated the dynamics of vertically migrating intraretinal hyperreflective foci, subretinal fluid, choroidal thickening and vitreous haze. Intracranial and orbital imaging, blood tests, lumbar puncture and whole-body PET MRI excluded neoplastic, infiltrative, inflammatory, infectious and known auto-immune causes. Treatment with corticosteroids led to rapid improvement of symptoms and the final visual outcome was good: pinhole acuity 0.3 with 10/17 Ishihara plates correctly identified, though a central scotoma remained. A literature review suggests that intraretinal sarcoidosis may be a novel, OCT-supported manifestation of this systemic disease. OCT permits dynamic monitoring of the inflammatory response on a cellular level between three adjacent compartments. These findings highlight the importance of multidisciplinary management of sarcoidosis, with OCT as a central part of the standard work-up.

In my experience, ophthalmological issues are often underestimated, in many situations considered comparably less important than other ongoing medical issues. Despite this, newly qualified foundation doctors must be able to recognise some of the most serious, most urgent and most common ophthalmological problems, at a minimum.

Pigment dispersion syndrome (PDS) and its potential sequel, pigmentary glaucoma, are characterized by the anomalous dispersion of pigment granules within the ocular structures. This overview discusses the clinical manifestation of these conditions and the management options including medical, laser and surgical treatment.

Best disease or Best vitelliform macular dystrophy (BVMD) is a rare autosomal dominant condition due to a BEST1 gene mutation with highly variable expression. It typically presents in childhood; however, most patients retain reading vision beyond the fifth decade. It is characterised by egg-yolk-like vitelliform lesions in the macula. The condition is named after Dr Friedrich Best who described the detailed pedigree of the disease in 1905. This overview will summarise the aetiology, pathophysiology, diagnosis and management of Best disease.

Cataract describes clouding of the lens which leads to scattering of light. Lens abnormality accounts for up to 20% of paediatric blindness globally and congenital cataract affects around 2 per 10,000 births. The term congenital cataract is often used synonymously with infantile cataract, despite the former more strictly referring to cataract present at birth as opposed to present within the first year of life.

As a junior doctor, knowing how to make appropriate referrals to specialists is essential for ensuring optimal patient care. What can often seem like a daunting task can be made much simpler once broken down into pertinent information that should be communicated.