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F2 Ophthalmology should you do it

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U.S. Navy Hospital Corpsman 1st Class Kaleb Sherwood points to a letter on an eye chart for a patient during a pre-op clinic at the National Referral Hospital in Honiara, Solomon Islands, during Pacific Partnership 2024-1 Nov. 20, 2023. Pacific Partnership, now in its 19th iteration, is the largest multinational humanitarian assistance and disaster relief preparedness mission conducted in the Indo-Pacific and works to enhance regional interoperability and disaster response capabilities, increase security stability in the region, and foster new and enduring friendships. (U.S. Army photo by Cpl. Nathanuel C. Mansfield)

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Established in 2024 with more than 800+ page views and counting, we aim to provide valuable resources to anyone visiting!

A linear accelerator (LINAC) is set up to deliver stereotactic radiosurgery.

Dr James Ng is an aspiring Ophthalmologist with prior experience working in the Eye Casualty unit as a Foundation Doctor

Dr James Ng

Dr Johann Panthakey is a current Ophthalmology ST1 trainee in the KSS deanery. He was also previously working as an optometrist with an abundance of experience in eye health

Dr Johann Panthakey

Dr Naomi Melamed is a current Ophthalmology ST2 trainee at the KSS deanery who performed exceptionally well for her ophthalmology application

Dr Naomi Melamed

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Read about pathophysiology, signs and symptoms, important investigations and prognosis

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F2 Ophthalmology, should you do it?

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Age Related Macular Degeneration

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How to prepare for MSRA?

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<h3>By: James Ng</h3>10/12/2024Hi, I am an eye doctor but I'm not there yet! Perspective of an F2 doctor working in a busy eye department.As someone who has always been interested in a career in Ophthalmology, I was extremely pleased to land a job as an F2 in Ophthalmology as part of my foundation training.At the start, I found the experience incredibly exciting as I had the opportunity to use the slit lamp and other specialised equipment in the eye department to diagnose various ophthalmic conditions. It was fascinating to witness the quick turnaround in patient and high level of satisfaction among patients. This aspect of ophthalmology, seeing rapid improvement in patients' conditions, attracted me more to the specialty.In addition, I was also able to participate in theatres observing multiple procedures from different sub-specialties and directly learn from the consultant performing these intricate procedures.There were moments when I felt the work was beyond my current depth of knowledge, but I found this both challenging and intriguing. Having supportive seniors available for discussions, significantly enhanced my learning experience. Their guidance helped me improve my history taking and ophthalmic examination skills, boosting my confidence and competence in clinical practice.Additionally, working in this environment has allowed me to participate in projects and audits, which has been valuable in strengthening my portfolio and gaining further experience in this field.Overall, it has been a wonderful experience and a privilege to work in such a conducive environment with ample senior support. The combination of hands on learning, mentorship and meaningful patient care has been trily rewarding. This is definitely something that I would recommend to other aspiring ophthalmologists if they are able to choose their foundation jobs!Author: James Ng

F2 Ophthalmology should you do it? 

By: James Ng 15/11/2024Herpes zoster&nbsp;ophthalmicus&nbsp;(HZO) is a potentially sight-threatening condition caused by reactivation of the varicella-zoster virus (VZV) within the ophthalmic division of the trigeminal nerve&nbsp;(V1). VZV is a herpesvirus&nbsp;commonly known&nbsp;for&nbsp;causing&nbsp;chickenpox during primary infection. This virus could&nbsp;remain latent in sensory nerve ganglia for decades&nbsp;and cause reactivation known as shingles.&nbsp;HZO&nbsp;accounts&nbsp;for&nbsp;approximately 10–20% of all herpes zoster cases and&nbsp;carries&nbsp;a significant risk of ocular morbidity if not&nbsp;managed appropriately.&nbsp;&nbsp;Risk factors for HZO include older age, immunocompromised&nbsp;states&nbsp;e.g.&nbsp;HIV infection, malignancy, chemotherapy, organ transplantation, long-term corticosteroid use,&nbsp;and&nbsp;diabetes&nbsp;mellitus.&nbsp;Briefly on the&nbsp;sensory distribution of the&nbsp;ophthalmic division of the trigeminal nerve, it&nbsp;supplies sensation to the forehead, scalp, upper eyelid, cornea, conjunctiva, iris, and ciliary body.&nbsp;A positive Hutchinson’s&nbsp;sign – when vesicles are present on the tip of the nose&nbsp;indicates&nbsp;nasociliary&nbsp;nerve involvement,&nbsp;is 76-89% predictive for the likelihood of developing HZO and therefore risk of ocular complications&nbsp;– this is an important sign for you to be aware of in both your clinical practice and exams!&nbsp;&nbsp;&nbsp;The clinical course of HZO often begins with a prodromal phase characterized by fever, malaise, headache, and neuropathic pain or tingling in the periorbital region. These symptoms may precede the rash by several days, which can&nbsp;ultimately&nbsp;delay&nbsp;diagnosis.&nbsp;Ocular involvement/symptoms&nbsp;may&nbsp;present together&nbsp;with the rash or develop days to weeks later.&nbsp;Herpes zoster could affect multiple parts of the eyes including the eyelid, conjunctiva, cornea, uvea, and the retina itself.&nbsp;On the cornea, it can present as punctate epithelial keratitis,&nbsp;pseudodendrites&nbsp;(not to be confused with dendritic ulcer in herpes simplex) and stromal keratitis.&nbsp;Uvea and retina complications include anterior uveitis and acute retinal necrosis, therefore complete ocular examination&nbsp;is essential&nbsp;– this will normally include slit lamp examination, intraocular pressure&nbsp;check&nbsp;and fundus examination.&nbsp;&nbsp;The diagnosis of herpes zoster&nbsp;ophthalmicus&nbsp;is primarily clinical, based on the characteristic unilateral dermatomal rash and associated ocular findings. Laboratory confirmation is&nbsp;generally&nbsp;not&nbsp;required&nbsp;but may be useful in atypical presentations.&nbsp;&nbsp;Antiviral agents such as acyclovir, valacyclovir, and famciclovir&nbsp;are normally used as first line management to&nbsp;reduce viral replication, shorten disease duration, decrease the severity of symptoms, and significantly reduce the risk of ocular complications and postherpetic neuralgia.&nbsp;There is a role of using steroid to help reduce&nbsp;inflammation&nbsp;but its use must be thoroughly discussed with an ophthalmologist.&nbsp;&nbsp;With prompt treatment, many patients recover with minimal long-term sequelae,&nbsp;whereas&nbsp;delayed management significantly increases the risk of permanent visual impairment. Prevention plays a crucial role in reducing disease burden&nbsp;and this could be achieved by getting the shingles vaccine if you meet the criteria.&nbsp;&nbsp;In summary, herpes zoster&nbsp;ophthalmicus&nbsp;is a serious manifestation of varicella-zoster virus reactivation with the potential for significant ocular morbidity and vision loss. Early recognition of prodromal symptoms, identification of warning signs such as Hutchinson’s sign, prompt antiviral therapy, and close ophthalmologic follow-up are essential to improving outcomes. Continued emphasis on vaccination and early intervention&nbsp;remains&nbsp;vital in preserving vision and reducing the long-term impact of this disease.&nbsp;&nbsp;Author: James Ng

Herpes zoster ophthalmicus

<h3>Author: James Ng</h3>25/12/2024Age-related macular degeneration (AMD) is a common eye condition and a leading cause of vision loss in people over the age of 50.&nbsp;As reflected in its name, it is a disease that&nbsp;affects the macula, the central part of the retina responsible for sharp, detailed vision needed for activities such as reading, driving, and recognizing faces. While AMD does not cause complete blindness, it can&nbsp;cause&nbsp;signficant&nbsp;impact&nbsp;on&nbsp;patient’s&nbsp;quality of life.&nbsp;As the main area affected is the macula – which&nbsp;is responsible for&nbsp;central vision, the peripheral vision usually&nbsp;remains&nbsp;intact.&nbsp;There are two main types of AMD:&nbsp;<ul><li>Dry AMD:&nbsp;The most&nbsp;common form, caused by the thinning of macular tissue and the buildup of tiny deposits called drusen. Vision loss is usually gradual.&nbsp;</li><li>Wet AMD:&nbsp;A less common but more severe form,&nbsp;associated with&nbsp;abnormal blood vessels growing under the retina.&nbsp;If left untreated, these vessels can leak fluid or blood, leading to rapid vision loss.&nbsp;</li></ul>The exact cause of AMD is not fully understood, but several risk factors increase the likelihood of developing the condition:&nbsp;<ul><li>Aging&nbsp;</li><li>Family history of AMD&nbsp;</li><li>Smoking&nbsp;</li><li>High blood pressure and cardiovascular disease&nbsp;</li><li>Obesity and poor diet&nbsp;</li><li>Prolonged exposure to ultraviolet (UV) light&nbsp;</li></ul>Symptoms may develop slowly, especially in dry AMD. Common signs include:&nbsp;<ul><li>Blurred or fuzzy central vision&nbsp;</li><li>Difficulty reading or recognizing faces&nbsp;</li><li>Straight lines appearing wavy or distorted&nbsp;</li><li>Dark or empty areas in the center of vision&nbsp;</li><li>Need for brighter light when doing close work&nbsp;</li></ul>AMD is diagnosed through a comprehensive eye examination&nbsp;via Ophthalmologist, if&nbsp;there is any suspicion of&nbsp;AMD&nbsp;they must be referred to ophthalmology within 2 weeks.&nbsp;Important tests may include&nbsp;optical coherence tomography (OCT), fluorescein angiography, and use of an Amsler grid to detect visual distortions.&nbsp;There is currently no cure for&nbsp;dry&nbsp;AMD,&nbsp;but&nbsp;&nbsp;lifestyle&nbsp;changes&nbsp;(stopping smoking, good blood pressure control)&nbsp;and specific vitamin supplements (AREDS formulations) may reduce the risk of progression.&nbsp;On the other hand, wet AMD is commonly treated with anti-VEGF injections, which help stop abnormal blood vessel growth and leakage.&nbsp;Early treatment&nbsp;is crucial to prevent severe vision loss.&nbsp;Age-related macular degeneration is a serious eye condition that affects central vision and daily activities. Early detection, healthy lifestyle choices, and&nbsp;timely&nbsp;treatment can help&nbsp;maintain&nbsp;vision and independence for those living with AMD.&nbsp;Author: James Ng

Author: Naomi Melamed29/10/2024The Multi-Specialty Recruitment Assessment (MSRA) is a crucial exam for doctors applying for specialty training in the UK. It assesses clinical knowledge, decision-making, and the application of guidelines across a wide range of medical specialties. Effective preparation requires planning, consistency, and smart use of resources.&nbsp;Understand the Exam Format&nbsp;Before starting revision, become familiar with the MSRA structure. The exam consists of multiple-choice questions based on clinical scenarios, focusing on diagnosis, investigation, and management. Questions are largely&nbsp;guideline-driven, so understanding current UK guidelines is essential.&nbsp;The exact details of the format can also be found on the official website.Create a Realistic Study Plan&nbsp;Start preparing early and develop a structured study timetable. Break the syllabus into manageable sections and&nbsp;allocate&nbsp;time for each specialty. Aim for regular, shorter study sessions rather than infrequent long ones to improve retention and avoid burnout.&nbsp;Use High-Yield Resources&nbsp;Question banks are the cornerstone of MSRA preparation.&nbsp;Practising&nbsp;large volumes of questions helps reinforce knowledge,&nbsp;identify&nbsp;weak areas, and improve exam technique. Supplement this with concise revision notes, national guidelines (such as NICE and SIGN), and trusted online resources.&nbsp;Focus on Weak Areas&nbsp;Use mock exams and question bank analytics to track performance.&nbsp;Prioritise&nbsp;topics where you consistently score&nbsp;lower, and&nbsp;revise them thoroughly. Revisiting incorrect questions and understanding why an answer was wrong is more valuable than simply doing more questions.&nbsp;Practice&nbsp;Exam Technique&nbsp;Time management is key&nbsp;in&nbsp;the MSRA.&nbsp;Practice&nbsp;answering questions under timed conditions and learn to&nbsp;recognise&nbsp;common question patterns. Avoid overthinking—often the simplest, guideline-based answer is correct.&nbsp;Revise Little and Often&nbsp;Regular revision helps&nbsp;consolidate&nbsp;knowledge. Use active recall methods such as flashcards and spaced repetition to reinforce key facts and guidelines.&nbsp;Look After Yourself&nbsp;Finally,&nbsp;maintain&nbsp;a healthy balance. Adequate sleep, regular exercise, and short breaks can significantly improve concentration and performance.&nbsp;Conclusion&nbsp;Success in the MSRA depends on consistent preparation, focused practice, and a clear understanding of clinical guidelines. With a structured approach and the right mindset, you can&nbsp;maximise&nbsp;your chances of achieving a strong score.&nbsp;Author: Naomi Melamed

How to prepare for the MSRA

By: Johann Panthakey15/12/2024Cataracts are one of the most common eye conditions affecting vision, especially as people grow older. They occur when the normally clear lens of the eye becomes cloudy, leading to blurred or dim vision. Cataracts are a leading cause of visual impairment worldwide, but the good news is that they are highly treatable with modern medical care.&nbsp;What Is a Cataract?&nbsp;The&nbsp;eye’s&nbsp;lens works much like a camera lens, focusing light onto the retina to produce clear images. A cataract forms when proteins in the lens begin to clump together, causing cloudiness that interferes with light passing through. Cataracts can develop in one or both eyes, but they do not spread from one eye to the other.&nbsp;Causes and Risk Factors&nbsp;Aging is the most common cause of cataracts, and most people develop some degree of lens clouding after the age of 60. However, cataracts can also occur due to:&nbsp;<ul><li>Prolonged exposure to ultraviolet (UV) sunlight&nbsp;</li><li>Diabetes&nbsp;</li><li>Smoking and excessive alcohol consumption&nbsp;</li><li>Eye injuries or&nbsp;previous&nbsp;eye surgery&nbsp;</li><li>Long-term use of steroid medications&nbsp;</li><li>Genetic factors or congenital conditions&nbsp;</li></ul>Symptoms of Cataracts&nbsp;Cataracts usually develop slowly, and early symptoms may be mild. Common signs include:&nbsp;<ul><li>Blurry or cloudy vision&nbsp;</li><li>Increased sensitivity to light and glare&nbsp;</li><li>Difficulty seeing at night&nbsp;</li><li>Fading or yellowing of colors&nbsp;</li><li>Double vision in one eye&nbsp;</li><li>Frequent changes in eyeglass or contact lens prescriptions&nbsp;</li></ul>As cataracts progress, daily activities such as reading, driving, or recognizing faces may become difficult.&nbsp;Diagnosis&nbsp;Cataracts are diagnosed through a comprehensive eye examination by an eye care professional. Tests may include a visual acuity test, slit-lamp examination, and retinal exam to assess the health of the eye and the severity of lens clouding.&nbsp;Treatment Options&nbsp;In the&nbsp;early stages, cataract symptoms may be managed with stronger lighting, anti-glare sunglasses, or updated eyeglasses. However, surgery is the only definitive treatment. Cataract surgery is a safe and common procedure in which the cloudy lens is removed and replaced with a clear artificial lens (intraocular lens). Most patients experience significant improvement in vision after surgery.&nbsp;Prevention and Eye Care&nbsp;While cataracts cannot always be prevented, the risk can be reduced by wearing UV-protective sunglasses,&nbsp;maintaining&nbsp;good blood sugar control, avoiding smoking, eating a healthy diet rich in antioxidants, and having regular eye exams.&nbsp;Conclusion&nbsp;Cataracts are a common but treatable cause of vision loss. Early detection and&nbsp;timely&nbsp;treatment can restore&nbsp;clear vision&nbsp;and&nbsp;greatly improve&nbsp;quality of life. Regular eye check-ups are key to&nbsp;maintaining&nbsp;long-term eye health.&nbsp;Author: Johann Panthakey

Cataracts 

By: Johann Panthakey15/12/2024Keratoconus is a non-inflammatory eye condition that affects the shape and clarity of the cornea—the clear, dome-shaped front surface of the eye. In keratoconus, the cornea gradually thins and bulges outward into a cone-like shape, leading to distorted vision. The condition often begins in adolescence or early adulthood and can progress over time.&nbsp;What Is Keratoconus?&nbsp;The cornea plays a crucial role in focusing light onto the retina for&nbsp;clear vision. In keratoconus, structural weakness in the corneal tissue causes it to lose its normal round shape. As the cornea becomes irregular, light entering the eye is scattered rather than focused properly, resulting in blurred or distorted vision. Keratoconus usually affects both eyes, though one eye may be more severely affected than the other.&nbsp;Causes and Risk Factors&nbsp;The exact cause of keratoconus is not fully understood, but it is believed to result from a combination of genetic, environmental, and biochemical factors. Known risk factors include:&nbsp;<ul><li>A family history of keratoconus&nbsp;</li><li>Frequent or vigorous eye rubbing&nbsp;</li><li>Allergic eye conditions such as hay fever&nbsp;</li><li>Connective tissue disorders (such as Marfan syndrome)&nbsp;</li><li>Poorly fitted contact lenses&nbsp;</li></ul>Symptoms of Keratoconus&nbsp;Symptoms typically develop gradually and may worsen as the condition progresses. Common signs include:&nbsp;<ul><li>Blurred or distorted vision&nbsp;</li><li>Increased sensitivity to light and glare&nbsp;</li><li>Frequent changes in eyeglass prescriptions&nbsp;</li><li>Ghosting or multiple images&nbsp;</li><li>Difficulty seeing clearly at night&nbsp;</li><li>Eye strain or headaches&nbsp;</li></ul>In advanced stages, vision may become significantly impaired and difficult to correct with regular glasses.&nbsp;Diagnosis&nbsp;Keratoconus is diagnosed through a detailed eye examination. Advanced imaging tests such as corneal topography and tomography are used to map the shape and thickness of the cornea, allowing early detection and monitoring of disease progression.&nbsp;Treatment Options&nbsp;Treatment depends on the severity and progression of the condition. In&nbsp;early stages, glasses or soft contact lenses may improve vision. As keratoconus advances, rigid gas permeable (RGP), hybrid, or scleral contact lenses are often&nbsp;required&nbsp;to provide clearer vision.&nbsp; To slow or stop progression, corneal collagen cross-linking (CXL) may be recommended. In severe cases where vision cannot be corrected with lenses, corneal transplant surgery may be necessary.&nbsp;Managing and Preventing Progression&nbsp;Although keratoconus cannot be prevented, progression may be reduced by avoiding eye rubbing, managing allergies, and attending regular eye check-ups—especially for individuals at higher risk.&nbsp;Conclusion&nbsp;Keratoconus is a progressive eye condition that can significantly affect vision if left untreated. Early diagnosis and&nbsp;appropriate management&nbsp;can preserve vision and improve quality of life. Regular eye examinations and&nbsp;timely&nbsp;intervention are essential for long-term eye health.&nbsp;Author: Johann Panthakey

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Team

Dr James Ng

Dr Johann Panthakey

Dr Naomi Melamed

List of our Articles

Herpes Zoster Ophthalmicus

F2 Ophthalmology, should you do it?

Age Related Macular Degeneration

How to prepare for MSRA?

Cataracts

Keratoconus

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