DR DAVID SAUNDERS • March 28, 2019
David graduated from the University of Cambridge on 2011 and went on to become an Ophthalmology registrar in the Southampton Region. He has leveraged his clinical experience to now work in consulting as an Associate for McKinsey.
WHAT IS AN OPHTHALMOLOGIST?
An Ophthalmologist is a medical doctor that deals with diagnosing and treating various types of eye disorders. In short, an Ophthalmologist is an 'eye doctor'. They identify eye problems, perform medical eye surgery, diagnose and treat eye diseases and prescribe medications to patients. It is a really tricky speciality as the eye is so delicate. Ophthalmology has both medical and surgical branches, with the training taking seven years. The eye surgeries require fine precision, hence the long training. As part of your preparation for your medical school interview, it is important to consider the different specialities one can go into.
OPTOMETRIST VS OPHTHALMOLOGIST
It is important to recognise that an ophthalmologist is a highly specialised role, very different from an optometrist. Optometrists must complete four years of training in optometry school but are not medical doctors.
WHAT DOES A TYPICAL DAY LOOK LIKE FOR AN OPHTHALMOLOGIST?
1. THE WARD
The day starts with the ward round. The patients are brought to us, and there are never more than four of them. These patients will have complex and serious eye conditions which need intense treatment and input. They could have problems with their contact lenses, their vision could be deteriorating, and sometimes people do just come in for routine eye exams.
Another example of a patient we might see on a ward round are patients who have really high intraocular pressures who need a combination of eye drops, IV medications, laser treatments and surgical eye care. There is always something to learn from managing these patients, and there is really good ophthalmology consultant input to make sure they are managed appropriately. Vision care both in the hospital and thereafter is so important.
2. THE CLINIC
Following the ward round, I head down to the clinic, where the majority of the ophthalmology patients are seen. I check the list of patients that are booked to see me and go through all their notes, requesting the tests that I would like them to have before I see them so I can quickly sort their diagnosis and treatment plan. Clinics are split into subspecialty and are usually very full-on.
Glaucoma is a condition where the intraocular pressure inside the eye is too high which can damage the optic nerve and affect sight. In the glaucoma clinic, the patients often have visual field testing. This helps assess whether if their vision problems have got any worse and whether they need an increase in their treatment.
Another specialised clinic is the macular clinic, for patients with macular degeneration, which is age-related, and causes blurring of the centre of someone’s vision, and can lead to partial blindness. Patients in the macular clinic will need an OCT (optical coherence tomography), a scan which has really improved the macular service. It uses infrared light to produce a really detailed picture of the macula and you can see if there is any fluid present, which can be affecting the vision in these patients.
The first patient has had their tests and is ready to be seen. I take their history and then manoeuvre them into the slit lamp. It enables us to get a really good magnified view of the patient’s eyes. We can look at the anterior segment of the eye (the front), including the cornea, the anterior chamber, the iris and the lens.
I may be looking for signs of infection in the cornea, tiny white blood cells floating in the anterior chamber, fine new blood vessels on the iris or evidence of a cataract (opacification of the lens of the eye). The slit lamp also lets us look at the back of the eye using a special optical lens. The patient has had dilating drops put in, so their pupil is nice and big, and you can easily see all around the retina and the optic disc. I am checking the optic disc, looking for any signs of glaucoma or disc swelling; looking at the macula to see if there is any evidence of macular degeneration; and checking the peripheral retina to make sure there aren’t any retinal tears or detachments. There are loads of other tests that we regularly carry out in the clinic, depending on the patient’s condition. The most common is checking the patient’s intraocular pressure.
Each patient will have a focused examination and I will collect all the information I need to decide how best to manage the patient and write prescriptions accordingly. Depending on the findings, I can assess if the patient is doing well on their current treatment, or if they need more treatment. This can take the form of eye drops, laser therapy, injections, contact lenses or surgery. The clinic is fast-paced and good fun and I get to make the majority of clinical decisions myself.
After the clinic, it’s time for lunch and to prepare for the afternoon. There is plenty of variety in the ophthalmologist’s workload. The afternoon could be spent doing laser treatments for patients with diabetic retinopathy or glaucoma. Another option is doing injections. There are a lot of injections in ophthalmology for the treatment of age-related macular degeneration. Sometimes, you may even get to go to the operating theatre!
Cataract surgery is almost always done under local anaesthetic, which itself adds certain challenges, including keeping the patient calm and making sure they keep their eye still. The patient’s eye is cleaned and a sterile drape is used to cover the face.
The operation starts with a 2.4mm incision in the cornea, which has a thickness of about 800µm in the periphery. I make a completely circular incision in the anterior lens capsule, which is only a few micrometres thick. This lets me get at the cataract. I use a phacoemulsification machine to chew up and suck out the cataract using ultrasound energy. This is the scariest bit because the posterior lens capsule is behind the cataract and if I make a hole in it, the cataract can fall to the back of the eye and the patient will need another emergency operation.
This time I manage to get all the cataract out successfully. Next, I inject a new lens through the same incision. It comes folded so it can fit through the incision and it unfolds when it’s in the eye to sit nicely in the right position. Theatre finishes without a glitch. If I am on call then I would have to head to the Eye Casualty to see any remaining patients there, as well as going to see any ward referrals that I had got during the day. I am on call overnight but can spend that at home unless I get called in, which doesn’t happen very often.
We hope you found this information useful in helping you get a sneak peek into a career in ophthalmology. If you have any questions or need advice don’t hesitate to email us at hello@theMSAG.com.