The Complete Guide To Becoming An Ophthalmology Doctor
The Role Of An Ophthalmologist
Ophthalmologists are doctors who diagnose, treat and prevent diseases of the eye and visual system. This includes acute and chronic eye conditions. Their role involves both the duties of a physician and a surgeon.
It is important to recognise that ophthalmologists are not the same as medical ophthalmologists who focus on the medical assessment, investigation, diagnosis and treatment of patients with eye disorders.
What patients do ophthalmologists see and what conditions do they diagnose/treat?
Ophthalmology is a specialty which includes both medicine and surgery. Ophthalmologists see patients of all ages. A wide range of ophthalmological conditions are seen in the UK, especially in the ageing population. Most patients are generally well and conditions are not usually life-threatening. Some common conditions ophthalmologists treat and manage include:[1]
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Corneal pathology
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Cataracts
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Glaucoma
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Retinal problems, such as retinal detachment or oedema
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Macular degeneration
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Intraocular inflammation
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Squints
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Eye injuries, major and minor
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Infectious eye disease
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Neurological problems related to the eye
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Diabetic retinopathy
Mix of medical, surgical, imaging, interventional work
Most ophthalmologist job roles are ‘surgical ophthalmologists.’ Medical work involves seeing patients in outpatient clinics and often many are follow-up appointments from an existing condition. Surgery is performed with the help of an operating microscope with or without lasers. Some types of surgery include:[1]
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Cataract surgery: performed through keyhole surgery, it is the commonest surgery undertaken in the NHS and in the world.
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Squint and glaucoma surgery
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Retinal surgery
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Corneal transplantation
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Orbital surgery
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Nasolacrimal surgery
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Oculoplastic surgery
Generally, most time during the working week is spent seeing patients in outpatient clinics. In the elderly population, many will have age-related macular degeneration and cataracts, etc. However, diabetes is the main cause of visual impairment in those aged under 65 years.
Diabetes is one example of how diseases of the eye may be part of underlying systemic disease. This means that working in a multidisciplinary team with doctors from other specialties is required. This may include endocrinologists, neurosurgeons, ENT and maxillofacial surgeons, neurologists, plastic surgeons, etc.
Ophthalmologists also work with ophthalmic nurses and allied health professionals including orthoptists, optometrists, electrophysiologists, visual function technicians, ophthalmic photographers, and ocular prosthetists.[2]
Proportion of men/women
Data from NHS Hospital and Community Health Service (HCHS) workforce statistics shows that in 2020, there were 1,359 consultant ophthalmologists and 70% were male.[3]
Desired skills, aptitudes, traits
Ophthalmology is a unique specialty as the eye is a transparent, delicate structure, meaning that excellent hand eye coordination and manual dexterity is required. A good ophthalmologist should have the fine level of detail required of a microsurgeon, as well as the diagnostic and therapeutic abilities of a physician.
The future of ophthalmology
In recent years there have been massive improvements in technology to aid microsurgical procedures in ophthalmology. The discovery of novel treatments for degenerative retinal diseases have been promising in patients who would previously have a poor prognosis. Further, community or primary care ophthalmologists are likely to carry out more routine procedures, allowing patients with more complex problems to be treated in hospitals using more specialised and advanced technology.
The Life Of An Ophthalmologist
Typical week
A typical week for a consultant ophthalmologist involves 3-4 outpatient sessions and 2-3 theatre sessions. Outpatient sessions may include general and specialty clinics, and treatment clinics using laser injections. Theatres sessions would include performing operations such as cataract surgery in the specialist eye theatre. Most acute clinics are managed by staff doctors and trainees, although senior advice is available when required.
On call commitments and working hours
Ophthalmology is generally a nine to five specialty. Compared to other medical specialties, out of hours work is much less and shift work is unlikely. For eye emergencies some consultant ophthalmologists may be required to be on-call but working at night is unusual. The ‘hospital at night’ team can manage most routine ward work outside of normal working hours. Most consultants are on an on-call rota; rotas may range from 1:5 to 1:10 depending on the size of the unit. Smaller units would require more frequent on calls.
Under the EU Working Time Directive, a typical working week is limited to 48 hours. Consultants can work part-time, and trainees who are unable to work full-time for personal reasons may be able to train on a less than full-time basis.[1]
An example of on-call duty is shown below:
On call on weekdays - 5pm until start of next normal working day (9am)
On-call on weekend - 9am Saturday until Sunday morning (9am), 1pm Sunday until Monday morning (9am)
The Route To Becoming An Ophthalmologist
Entry requirements and training pathway
After completion of a two-year UKFPO-affiliated foundation programme, doctors can apply directly to a ST1 ophthalmology training post. Ophthalmic specialist training is a ‘run-through’ programme lasting a minimum of 7 years (ST1-7).
The programme is run by the Royal College of Ophthalmologists Training Committee and approved by the General Medical Council. On completion of 7 years of training, eligible doctors will be awarded a Certificate of Completion of Training (CCT) or Certificate of Eligibility for Specialist Registration (Combined Programme).[4]
Some of the content covered in the specialist training programme is shown below:
ST1-2: Core training
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General clinical skills of ophthalmology
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Basic knowledge of conditions in ophthalmology
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Master common surgical procedures
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Assist more complex operations
ST3-7: Specialised training
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More time spent in specialist clinics
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More time spent in theatre and laser clinics
Examinations required to pass to progress through training include:
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Fellowship of the Royal College of Ophthalmologists (FRCOphth) part 1, to be passed before entering ST3. This consists of a 3 hour MCQ paper and a 2 hour Constructed Response Questions paper.
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Refraction Certificate, to be passed by the end of ST3. This is a practical OSCE examination.
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Fellowship of the Royal College of Ophthalmologists (FRCOphth) part 2, to be passed by the end of ST7. This includes 180 single best answer MCQs, a structured viva and a clinical OSCE examination.
Competition
Ophthalmology is a fairly competitive specialty. In 2019, competition ratio for ST1 training post was 3.24.[5] Further, there are around 1,359 ophthalmic consultant posts in the UK with many applicants of high quality.[2]
Tips for success
For those interested in ophthalmology, it is important to begin a portfolio early on in order to demonstrate commitment and interest to the specialty. During medical school this may include student selected components or electives relating to ophthalmology.
The Duke Elder Undergraduate Prize Examination is run by the RCOphth annually. Additional qualifications (e.g. intercalated degrees, BSc, etc.), academic and research achievements, audit and research skills are all highly desirable.
Subspecialties
Ophthalmologists are able to pursue their interests in a number of sub-specialty areas, and this can include both surgical or non-surgical subspecialties. Some specialist interests include:[1,2]
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Cataract and refractive surgery
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Corneal and external diseases
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Glaucoma
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Medical ophthalmology (separate training programme at ST3)
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Medical retina
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Ocular oncology
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Paediatric ophthalmology
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Primary care
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Vitreoretinal surgery
Opportunities for research or an academic career
There are increasing numbers of academic ophthalmologists in the NHS. Those wishing to pursue an academic career usually undertake a higher degree during training or through fellowships and carry out research.
A clinical academic training pathway through the National Institute for Health Research (NIHR) is available, which includes Academic Clinical Fellowships (ACF) and Clinical Lectureships (CL). Often these lead to a PhD.
Earnings
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
There is also potential to enhance NHS earnings through private practice, shown below in table 3.
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|
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Year |
2017 |
2018 |
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Revenue |
132,000 |
139,000 |
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Expenses |
57,000 |
61,000 |
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Profit |
75,000 |
78,000 |
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Table 3. Ophthalmology earnings in private practice.[6] |
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For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
Resources
Societies and institutions
Journals
Textbooks
- Kanski's Clinical Ophthalmology – known as ‘the Kumar and Clark’ of eyes.
Hospitals
Related Job Sources With BMJ Careers
- GP Jobs
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- NHS Jobs in England
- NHS Jobs in Northern Ireland
- NHS Jobs in Scotland
- NHS Jobs in Wales
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References
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NHS. Ophthalmology. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/ophthalmology [last accessed 3rd June 2020].
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Royal College of Ophthalmologists. So you want to be an ophthalmologist? Available from: https://www.rcophth.ac.uk/wp-content/uploads/2014/07/RCOphth-Ophthalmology-Career-Feb2017.pdf [last accessed 3rd June 2020].
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NHS Digital. Analysis of the representation of women across the hospital and community health services workforce. 2018. Available from: https://digital.nhs.uk/data-and-information/find-data-and-publications/supplementary-information/2018-supplementary-information-files/analysis-of-the-representation-of-women-across-the-hospital-and-community-health-services-workforce [last accessed 3rd June 2020].
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GMC. Ophthalmology curriculum. Available from: https://www.gmc-uk.org/education/standards-guidance-and-curricula/curricula/ophthalmology-curriculum [last accessed 3rd June 2020].
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NHS. Specialty Recruitment Competition Ratios 2019. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Competition%20Ratios%202019_1.pdf [last accessed 3rd June 2020].
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