Herein, we present a case report of a young male with worsening headaches and visual disturbance who was found to have papilloedema. Through exclusion, there is a high index of suspicion that this was related to N2O abuse. Therefore, we hope clinicians will adopt a low threshold for taking a detailed drug history and investigation for raised intracranial pressure (ICP) in this patient population, including ophthalmological assessment.

During the course of one’s medical career, there will be plenty of opportunity to be involved in formal and informal teaching. Attending a Teach-the-Teachers course is a useful way to learn and practice the principles of teaching adults. Moreover, it is a good way to collect a point for the  ophthalmology specialty training (OST) application. There are a number of companies which run this course, the most prominent of which are Oxford Medical and ISC Medical. Here I detail my experience of attending the Oxford Medical course.

Principally, corneal dystrophies are a set of conditions that impact corneal transparency and distorts corneal structure. They are commonly bilateral, progressive, and differs from corneal degeneration as they are often inherited through autosomal dominant or recessive modes as well as x-linked modes.  Several genes have been implicated in corneal dystrophies and will be elaborated on in the description of dystrophies in this article. Management of corneal dystrophies depend on severity of symptoms and require specialist input. Mildly symptomatic dystrophies do not warrant management. However, in those with progressive disease and/or poor vision, surgical options may be of use. Techniques commonly involved in the management of dystrophies include deep lamellar endothelial keratoplasty, penetrating keratoplasty, or the area of disease is ablated using a photo-therapeutic keratectomy.

Known as the ‘Great Imitator’, ocular syphilis often mimics a variety of ocular inflammatory conditions, and as such can pose a challenge to diagnosis. It is classically associated with secondary syphilis, however may present in all stages of disease. Presentations include scleritis, interstitial keratitis, iritis, chorioretinitis, papillitis, retinal vasculitis, exudative retinal detachment and optic and cranial neuropathies. Non-treponemal tests (VDRL, RPR) are used for screening and to monitor response to treatment, while treponemal tests (FTA-ABS, TPPA) are used for confirmation of diagnosis and remain positive for life.

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.