Stargardt disease is an autosomal recessive condition characterised by a mutation in the adenosine binding cassette transporter 4 (ABCA 4) gene, which is pivotal in the normal physiological metabolism of vitamin A. This loss of function of the ABCA 4 gene results in damage to the retinal cells from vitamin A dimers which are not metabolised normally and causes a build-up of lipofuscin within the retinal pigment epithelium (RPE) of the retina. Stargardt disease is one of the most common causes of macular dystrophy in young adults, the prevalence of Stargardt disease within the western world is approximated to be 1-10 per 100,000.

The nature of the medical field is such that large volumes of information need to be committed to memory and contextualised and recalled in many different settings such as simulated OSCEs, in a Viva and in clinical scenarios too. Whether it is in medical school examinations, or whether you are preparing for the FRCOphth exams, utilising effective studying techniques can benefit everyone in terms of encoding key concepts to long term memory and allowing for greater retention over time.

Curriculum 2024 is the new curriculum for Ophthalmology trainees commencing August 2024, with the new e-Portfolio pilot launching August 2023. This article aims to highlight key changes regarding the new curriculum and how this may impact ophthalmology trainees.  All information has been acquired from the Royal College of Ophthalmology website and presentations at the Royal College of Ophthalmology Congress in May 2023.

Thyroid eye disease (TED) is an autoimmune inflammatory disorder of the orbit related to autoimmune thyroid disease. It results in several disabling ocular sequelae, significant ocular morbidity and can be sight-threatening in severe cases. In over 90% of cases, TED is most often associated with Graves’ disease, with an overall prevalence of 40% in Graves’ disease patients (2). Risk factors for the development of TED include cigarette smoking, being female, increased age, thyroid dysregulation amongst others. TED is evaluated based on two main criteria; clinical activity most commonly categorised through the use of the Clinical Activity Score and severity scoring through the use of the EUropean Group on Graves’ Orbitopathy (EUGOGO) guidelines.

In our bodies, there are several tissues that can limit their inflammatory reactions. These tissues are, the eye, brain, testes, placenta, and foetus (3, 4). However, the question is, why does IP exist in these tissues specifically? Taking the eye as an example, its function relies on the clarity of the visual axis and constituent tissues such as the corneal endothelium and some elements of the retina, which are amitotic and unable to regenerate. Thus, collateral damage from inflammatory responses would lead to severe consequences.

Leber hereditary optic neuropathy (LHON) is one of the most common ophthalmological mitochondrial disorders, characterised by optic neuropathies resulting in bilateral central vision loss. A point mutation in mitochondrial DNA, most common being G3460, G11778A and T14484C, results in disruption of the retinal ganglionic cells due to dysregulation of the respiratory chain. The worldwide prevalence since it was first described in 1858 is approximately 1 in 50,000. As it is a mitochondrial disorder, it mainly effects young males in their second or third decade of life with males being 5 times more likely to be afflicted.

Keratoconus is a progressive, non-inflammatory eye disorder leading to corneal thinning and irregular astigmatism. The cornea is the window of the eye, which acts as a covering of its anterior chamber and refracts approximately 60% of the light entering the eye. Keratoconus is marked by thinning and projection of the cornea; which can progress to lead to high myopia and asymmetrical astigmatism.  This condition has an incidence of one in two thousand, is most common in early adolescence and is believed to be caused by a combination of genetics, as well as environmental influence such as allergens.

Central Serous Chorioretinopathy, also known as CSC, is thought to occur due to choroidal hyperpermeability which leads to sub-RPE and subretinal fluid (SRF) accumulation. It is the fourth most common retinopathy after age-related macular degeneration, diabetic retinopathy and branch retinal vein occlusion.