“Herr Doktor, I can’t see but I am driving”

This 56-year-old lady was quite puzzling. With her own glasses and the pinhole she merely managed to see the 1.3 and 1.0 logMAR lines with her right and left eye, respectively (I am currently working in Germany again, so goodbye...

How I overcame the hurdle that is the FRCOphth Part 1

The FRCOphth Part 1 is one of the most difficult exams in ophthalmology training, with an exam pass rate of 39.6% over the last 12 months (compared to 60.8% for FRCOphth Part 2 oral [60.8%] and written [68.7%]). Stack the...

Light in darkness – manual small incision cataract surgery in India

Cataract has been documented to be the most significant cause of bilateral blindness in India, where vision <20/200 in the better eye on presentation is defined as blindness [1,2]. Estimation of blindness in India by the World Health Organization (WHO)...

A closed angle seldom comes alone

Case report An 89-year-old lady with dementia was referred to me out of hours by her GP with a few days history of an angry looking left eye for suspected elevated intraocular pressure (IOP). I discovered that this lady first...

Simulation in ophthalmology: a pedagogic viewpoint

The advent of simulation technology has enhanced modern medical training. The first utilisation of simulation was in 1929 where Edward Link used this concept to develop a mechanical flight simulator [1]. Industries such as aviation, nuclear power and the military...

A log in the eye

"My friend wanted to show how far he could throw that log. So, he helicoptered it over his head, faster and faster and when he let go, it hit my eye at full speed,” a young lady of 19 years...

An arm and a leg

“It cost me an arm and a leg.” – Mr B told me. An arm and a leg to be seen by the famous Russian eye surgeon who said that everybody can be spectacle-free. He took Mr B’s money (roughly...

Take this waltz

My last weekend on-call was the busiest I can remember for a very long time. We were just completely swamped with patients. The weather was not too good that Saturday and it felt like every second inhabitant of our ocean...

The ‘art’ of refraction – designing a refraction course

Learning how to refract requires theoretical knowledge, practice and determination. Refraction is a notoriously challenging skill to acquire and the competing demands on junior ophthalmologists can often be restrictive of the development of this core skill. To consolidate theory learnt...

A tale of two membranes

It was the best of times, it was the worst of times... It was the season of Light, it was the season of Darkness... I am fortunate to work on a vitreoretinal firm at the moment and only a few...

Principles of contact lens fitting in keratoconus

Keratoconus is an ectatic condition of the cornea characterised by progressive conical distortion with irregular astigmatism, myopia and apical protrusion. Most cases progress slowly resulting in varying degrees of myopic astigmatism. Management of keratoconus includes spectacles, soft contact lenses, a...

Preventing refractive surprises by real time biometry during cataract surgery

A few months ago a retired lady presented for second eye cataract surgery. I noted on the pre-op ward round that the outcome of her first eye’s surgery looked like a refractive surprise as her spherical equivalent in that eye...