Article Archives - Page 15 of 22 - Journal of the Foundations of Ophthalmology

Diagnosis and Management of Vogt-Koyanagi-Harada Disease in a Paediatric Patient: A Case Report

Post published:October 11, 2022
Reading time:18 mins read
Post author:Shi Pei Loo, Kenneth Gilmour, Hashnuhana Soma Chakrabarti
Post category:Article

Posterior uveitis is an uncommon cause of severe visual loss in the paediatric population, usually secondary to macular scarring or secondary glaucoma (1-3). Infectious aetiologies, such as toxoplasma and toxocara, are the most common and are usually associated with classical fundal examination findings (1, 3). Non-infectious causes are less common and can be a diagnostic challenge. We report an atypical presentation of an uncommon disease, particularly so in a paediatric population, with the potential for severe visual impairment if not diagnosed early and managed aggressively.

The Pathophysiological Mechanisms Underlying Corneal Scarring

Post published:October 8, 2022
Reading time:27 mins read
Post author:Alice Ditchfield
Post category:Article

This review aims to elucidate the key mechanisms behind the formation of corneal scars, and to give some consideration to the strength of the evidence behind those mechanisms identified. The review will firstly discuss the process of normal wound healing within the cornea that may precede scarring, and then examine three key factors within this process that have been suggested to contribute to corneal scarring: keratocytes and their activation by growth factors, collagen fibril organisation, and the role of neutrophils. Examination of the literature suggests that keratocyte activation by growth factors to their repair phenotype was found to be the most important factor in the formation of scars, while the disorganised deposition of collagen is a more contentious factor, and neutrophils have only relatively recently been thought to play a role and consequently little supporting evidence currently exists. This knowledge has allowed the development of targeted treatments, and perhaps further progress will be made in the future as our understanding of corneal scarring mechanisms improves.

Why I Chose Ophthalmology & How You Should Decide Which Speciality to Pursue

Post published:September 11, 2022
Reading time:10 mins read
Post author:Muhammad Saad Asghar
Post category:Article

I was never that person who came into medical school knowing exactly what sort of specialist I wanted to be. I began this journey knowing that the feeling I got in knowing exactly what to do during someone’s time of illness, was something I could chase all my life. On first entering medical university, I was overwhelmed by the sheer number of specialties to which one could dedicate their entire life. This concern of mine had to take a backseat though, as the demands of basic sciences studies took over my entire time soon thereafter. At my university, the first 2 years were dedicated to covering Basic Medical Sciences like Anatomy, Physiology, and Pharmacology, among others. Even though these 2 years did give me a good idea about what sort of basic sciences are involved in specialties like Cardiology, Neurology, or Pulmonology, I did not find myself gravitating towards any specialty.

A Case of Bleb Related Endophthalmitis Complicated with Retinal Detachment

Post published:September 11, 2022
Reading time:13 mins read
Post author:Shivam Goyal
Post category:Article

Glaucoma-filtering procedures (e.g., trabeculectomy) is a standard surgical procedure commonly done when maximally tolerated medical therapy or laser trabeculoplasty fails to adequately control intraocular pressure (IOP). The filtering procedure creates a fistula between the anterior chamber and the subconjunctival space, covered with thin sclera and conjunctiva that allows excess aqueous humour to be absorbed into the systemic circulation. Thus, the presence of a filtering bleb poses an enduring risk of a bleb related infection (BRI) over the patient’s lifetime (1). To improve the success of these procedures, it has now become routine to use intraoperative antifibrotic agents (e.g., mitomycin and fluorouracil) as an adjunct to standard trabeculectomy (2). Although these agents have improved the chances of long-term IOP control they have further predisposed to an increased incidence of postoperative complications including late-onset filtering bleb-related infections (1).

Making the most of ‘Clinical Optics’ by Elkington: A Brief Guide for FRCOphth Part 1

Post published:September 11, 2022
Reading time:5 mins read
Post author:Syed Husain
Post category:Article

Having fortunately passed the FRCOphth part 1 in my first attempt, the aim herein is to detail exactly how I used one of the main foundational texts- ‘Clinical Optics’ by Elkington and Frank. Out of 174 multiple choice questions in the April 2022 FRCOphth Part 1 exam, 47 questions were dedicated to Optics; comprising the most number of questions of any topic. Optics generally has formed the majority of questions in previous sittings too, although since its conversion to a pure MCQ exam, there appears to be increasing emphasis in this area.

Retinopathy of Prematurity: An Overview

Post published:September 4, 2022
Reading time:8 mins read
Post author:Imran Karim Janmohamed
Post category:Article

Retinopathy of prematurity (ROP) is an ophthalmic disorder that arises in premature infants, particularly those born before 32 weeks gestation, or who weigh less than 1,500 grams at birth. In many children, it is mild and presents no problems, but can also be severe and lead to blindness. In the 1940s, it was the leading cause of blindness in children in the US and, unfortunately, it still remains a leading cause of blindness in children worldwide.

A Case of Choroidal Naevus in a Child

Post published:August 22, 2022
Reading time:8 mins read
Post author:Shivam Goyal
Post category:Article

Choroidal naevus is the most common benign intra-ocular tumour. It originates from neural crest derived cells. This lesion is of clinical significance due to risk of visual loss especially if located near the foveola and risk of transformation into malignant melanoma. Traditionally choroidal naevus has been assessed using ultrasound and fluorescein angiography. With advent of new imaging modalities like optical coherence tomography (OCT), fundus autofluorescence (FAF) and OCT angiogram (OCTA) they are being more commonly used to assess naevus. Low risk naevus is defined as one that is unlikely to transform into melanoma. Features of low-risk naevi are thickness <2mm, presence of drusen, absence of subretinal fluid, absence of orange pigment, absence of symptoms, tumour margins away from optic disc, and echo dense on ultrasound. It is a common observation that choroidal naevi are rarely seen in younger children. We describe a case of choroidal naevus in a 16-year-old girl referred to our clinic and review of literature to assess its prevalence and outcome in children.

How to make the most of your ophthalmology taster week

Post published:August 21, 2022
Reading time:6 mins read
Post author:Mohammed Talha Bashir
Post category:Article

Medical students have limited exposure to ophthalmology (1) and foundation placements in the specialty are rare. Taster weeks give applicants a chance to broaden their experience and make an informed career decision, and the recruiting bodies for ophthalmic specialist training (OST) in the UK have hence allocated weight in the application for the completion of an ophthalmology taster week (2). However, OST is highly competitive and, while a taster week itself carries 1 point in the application, applicants can use this experience to unlock more opportunities to strengthen their chances of securing a post. The following article explores how those looking to apply for the specialty can get the most out of their taster weeks.

Applying to UK Ophthalmic Specialist Training in the COVID-19 Era

Post published:August 14, 2022
Reading time:11 mins read
Post author:Mohammed Bashir
Post category:Article

Ophthalmic specialist training (OST) is one of the most competitive training programmes in the United Kingdom with only 89 places for over 600 applicants in 2021 (1). The cancellation of face-to-face interviews in response to the Covid-19 pandemic is one of several changes effected by the Royal College of Ophthalmologists and the Severn Deanery which is the lead recruiter for the speciality. Many budding ophthalmologists have struggled to adapt to the changes directly and indirectly imposed by the pandemic and were not successful in securing a training post during this time. The following article aims to outline changes to the OST application experience during the Covid-19 era and offers advice to those hoping to apply in coming cycles.

Never too late: Starting your OST portfolio as a Foundation Doctor

Post published:August 13, 2022
Reading time:10 mins read
Post author:Hui Mei Wong, Kristie Hing Chi Leung
Post category:Article

Advice on preparing the Ophthalmology Speciality Training (OST) portfolio often assumes that the applicant is still in medical school or at a relatively early stage of their career, which can be disheartening for applicants who decide to pursue Ophthalmology later on in their careers (such as during Foundation Years 2 or 3), as this cohort of applicants would have to develop their portfolio within a much shorter timeframe. This article aims to highlight high-yield elements within the OST to maximize points, focusing on applicants who decided to pursue Ophthalmology in their Foundation Years.