Specialty spotlight – medical ophthalmology

Dr Nima Ghadiri, ST3 in medical ophthalmology at Addenbrooke's Hospital, Cambridge, discusses the beauty and complexity of the eye, how you can see the pathology through the eye, and what medical ophthalmology as a specialty involves.

Introduction to medical ophthalmology

Medical ophthalmology, or ophthalmic medicine, is a small but rapidly growing specialty which focuses on the investigation, diagnosis and management of eye disorders relating to systemic disease. This requires understanding of not only ophthalmic medicine but also expertise with: respiratory medicine, cardiology, neurology, gastrointestinal medicine, rheumatology, endocrinology, haematology and autoimmune medicine (and the list goes on).

Within these specialties there are diseases which can affect the eye in different ways and therefore a physician’s approach and proficiency is crucial to manage both the systemic problem and the eye. Therapeutic options can be very effective, in some cases negating the need for potentially risky surgery. The continued development of new treatments means that the future is exciting.

The specialty is predominantly outpatient-based, although emergencies will need admission. In some centres, medical ophthalmologists have important management and public health roles in overseeing screening services.

Why did I choose medical ophthalmology and why would I recommend it?

Medical ophthalmology requires a detective’s approach which is very rewarding. History-taking is crucial as many clues can be obtained (and a diagnosis often made) before even looking at the eye. Equally great satisfaction can be obtained on examination by diagnosing a systemic disorder from clear ocular pathology in a patient who has been struggling for a while to be diagnosed.

The casemix is absolutely fascinating. Each patient is unique and often a tome can be written about them. The opportunity to follow and get to know the patients over time is also an immense pleasure.

Core attributes required for the specialty include patience, inquisitiveness and a keen eye and ear. Teamwork is essential, as much of the day is spent collaborating with ophthalmic surgeons, physicians of other specialties, nursing staff, photographers, optometrists and orthoptists. Good hand-eye coordination is important both for operating a slit-lamp and for performing procedures.

There are great opportunities in teaching and research and as the specialty is growing. Management and leadership skills are also useful.

Training and working in medical ophthalmology

Medical ophthalmology resources

RCP resources

  • Medical Care: Medical ophthalmology
  • Census of consultant physicians in the UK 2012 – Specialty report: medical ophthalmology
  • Clinical Medicine articles:
    • Williams MA, Chakravarthy U. Evidence underlying the clinical management of diabetic macular oedema. Clin Med 2013;13:353-357.
    • Petros Perros, Colin M Dayan, A Jane Dickinson et al . Management of patients with Graves’ orbitopathy: initial assessment, management outside specialised centres and referral pathways. Clin Med 2015;15:173–8.
  • ebooks and ejournals available online to members [email library@rcplondon.ac.uk for a password] include:
    • American Journal of Ophthalmology (2 months embargo)
    • Journal of Pediatric Ophthalmology and Strabismus
    • BMC Ophthalmology
    • Denniston A, Murray P, Oxford handbook of ophthalmology, 3rd edn. Oxford University Press, 2014.
  • Books available by postal loan from the library include:
    • Gold DH, Lewis RA (eds), Clinical eye atlas , 2nd edn. Oxford University Press, 2010
    • Walsh T (Ed) Visual fields : examination and interpretation, 3rd edn. Oxford University Press, 2011
    • Johnson MC, Policeni BA, Lee AG, Smoker WRK (eds), Neuroimaging in ophthalmology,   2nd edn. Oxford University Press, 2011.

Historical highlights from the library, archive and museum collection

You can read online our biography of Barrie Russell Jones FRCP, the founder of the International Centre for Eye Health. He insisted on the use of the operating microscope by all trainee ophthalmic surgeons, and realised that ophthalmology would only progress by encouraging sub-specialisation. As all trainees spent time working in the professorial unit, while others who were already fully trained returned there to serve as research fellows, a set of bright new microsurgeons emerged from the unit into the ophthalmic world.

The RCP’s collection of rare books holds a wealth of literature related to medical ophthalmology, including Georg Bartish’s Ophthalmodouleia (Augendienst in German), 1583 which was the first German book on ophthalmology. It covers a wide range of eye diseases and defects, methods for curing them and surgical instruments and techniques. The museum has a woodcut portrait of Bartisch which was recently displayed for the first time.

RCP fellow William Briggs (1642–1704) was physician in ordinary to King William III. He published several books on vision and the eye. Isaac Newton supported his theories, and acknowledged his debt to Briggs’ anatomical skill. Briggs’ 1676 Opthalmographia and 1685 Nova visionis theoria can be seen by appointment in the RCP library.

The lending collection includes Milton's blindness by Eleanor Gertrude Brown (New York: Columbia University Press, 1934), in which the author examines the likely causes of the poet’s blindness, autobiographical/poetical references to blindness in his work, and the effects of his blindness.

Also for loan is The world through blunted sight: an inquiry into the influence of defective vision on art and character by Patrick Trevor-Roper (London: Penguin, 1990) the author examines the ways in which defective vision can be related to character, creativity and style with a plethora of images from Albrecht Dürer to J M W Turner to Vincent Van Gogh, to Louis Wain, supporting his thesis.