As a foundation year doctor, I didn’t expect ophthalmology to feature much in acute medicine or surgery. Yet it kept appearing at the periphery – and when it did, it was often complex and unexpectedly urgent.
A confused older patient with a ‘red eye’ on the frailty unit turned out to have acute angle-closure glaucoma. A man admitted with a headache was later found to have visual field defects and raised intracranial pressure. Another patient admitted after a fall hadn’t seen an optometrist in years and couldn’t navigate the ward safely without assistance.
Like many clinicians in training – not only doctors but also nurses – I’d had very little exposure to ophthalmology. The Royal College of Nursing has even lobbied for greater inclusion of eye health in nurse curricula, recognising how often it is overlooked. These early glimpses on the wards taught me something unexpected: ophthalmology isn’t a remote, hyper-specialised island. It weaves into the everyday work of acute medicine and surgery, and the skills it teaches carry far beyond the eye clinic.
For me, it meant learning to act quickly in time-critical situations, like recognising when a red eye was more than conjunctivitis. It also meant communicating clearly with patients who couldn’t always see the person speaking, adjusting my style to build trust. And at times it meant breaking news gently – explaining that sight loss might be irreversible – which felt just as weighty as any conversation in oncology or cardiology. Those skills, though learned through ophthalmic cases, are ones I still carry into every ward I work on.
A specialty full of surprises
I didn’t rotate through ophthalmology as a foundation doctor, and like many of my peers, I hadn’t seriously considered it as a career. But the more I encountered eye problems on the ward, the more I realised how much I didn’t know – and how much I wanted to.
The first surprise was just how time-critical some presentations are. Sight is unforgiving: in conditions like temporal arteritis, wet age-related macular degeneration, or retinal detachment, the window for intervention can be measured in days, sometimes hours. Recognising the problem isn’t just helpful; it can be sight-saving.
The second surprise was the emotional weight of the specialty. Losing vision isn’t just about the loss of a sense – it is the loss of independence, identity, and confidence. I began to notice how patients spoke differently when they mentioned their eyesight. Some underplayed it. Others broke down. Sight loss is intimate and deeply felt, and supporting patients through it requires more than technical knowledge – it demands patience and empathy.
What I wish I’d known sooner
If I could go back and give myself, or any new doctor, a primer on ophthalmology, it would include three simple truths:
1. Not every red eye is benign
Pain, reduced vision, photophobia, or vomiting should ring alarm bells. Acute angle-closure glaucoma, scleritis, and keratitis can all masquerade as “just a red eye,” but the consequences of delay are serious.
2. Visual symptoms are always time critical
Sudden loss of vision, field defects, or visual obscurations need urgent attention. In medical settings, visual changes can be dismissed or missed, particularly in older patients or those with delirium. But ophthalmic emergencies are common and frequently present outside of eye clinics.
A red eye with pain, photophobia, or vomiting may point to acute angle-closure glaucoma; a tender globe with deep pain might be scleritis; a hazy cornea could be keratitis. In all these cases, a delay in recognising the signs can be sight-threatening. As a foundation doctor, I learned that the skill isn’t just in naming conditions but in recognising when the story doesn’t fit “just conjunctivitis” and escalating quickly.
3. Vision loss magnifies vulnerability
On the ward, I saw how easily vision loss is overlooked, especially in patients with cognitive impairment, communication barriers or complex comorbidities. I learned to ask, “Can you see your food?” or “Do you usually wear glasses?” These small questions often made a big difference to how patients managed on the ward.
But vision loss isn’t only about vulnerability; it can also be a place where ophthalmology helps people regain independence and a sense of dignity. Cataract surgery, for example, doesn’t just improve visual acuity. On the wards I saw how it transformed lives for patients with conditions like dementia, learning disabilities, or mental illness – where sight loss had only made things harder. Being able to read a clock, recognise a face, or navigate a meal tray could mean the difference between dependence and autonomy.
These encounters reminded me that ophthalmology is about more than just numbers on a Snellen chart. What mattered most to patients was not only how far down the chart they could read, but whether they could see well enough to live their daily lives. A patient might technically ‘see’ 6/9, but if glare from early cataracts stopped them going out at night, their independence was still limited. Similarly, a small improvement in contrast sensitivity or reduction in distortion could make reading, cooking or travelling alone possible again.
For me, the lesson was that even small ophthalmic interventions can bring big changes – not only in eyesight, but in confidence, mental health, and how connected patients feel to the world around them.
The hidden challenge of ophthalmology
Ophthalmology is often perceived as a precise, technical specialty. But I also found it to be one of the most interpersonally demanding specialties.
Consultations are frequently brief but emotionally loaded. Many patients attend alone, face life-changing diagnoses, or struggle to understand a condition invisible to others. In some cases, the hardest task is helping someone come to terms with a loss that cannot be reversed.
You are also communicating across barriers: reduced vision, hearing loss, mobility problems, and fear. As a junior doctor, these moments pushed me to slow down, explain carefully, and sometimes simply sit with the silence.
What stood out to me in ophthalmology was the intensity of its consultations. They were often brief, but rarely simple. I remember having to explain sight loss that could not be reversed, talk a patient through a procedure they could not see, or work around barriers when hearing loss or confusion got in the way. Each of these moments carried more weight than their length might suggest.
Those experiences taught me that ophthalmology isn’t only about making the right diagnosis – it’s about communicating it in a way that patients can grasp and cope with. They also showed me how to stay calm in situations where patients might not understand the urgency, or where the news itself could change the course of their lives.
For anyone considering ophthalmology
If you haven’t rotated through ophthalmology and are still deciding your future specialty, don’t overlook it. Ophthalmology combines immediate impact with long-term continuity, diagnostic precision with delicate communication. It is also one of the most rapidly evolving fields – with advances in imaging, artificial intelligence, and minimally invasive treatments. But at its heart, it remains a specialty centred on listening carefully and seeing clearly, in every sense of the word.
Whether or not you choose ophthalmology, the lessons it teaches about urgency, empathy and the power of sight will stay with you.
Declaration of competing interests: None declared.
