Starting your first rotation in ophthalmology is exciting and a little daunting. As the start date approaches, the nerves may start to creep in. What’s expected of me? How much ophthalmology am I supposed to know? How will the on-calls work?
We both asked ourselves these questions before we began our first ophthalmology jobs in the summer of 2025. In this article, we reflect on our early experiences and share some practical tips for new doctors starting in the specialty.
Clinical knowledge
Although our taster weeks highlighted that ophthalmology is an exciting and rewarding career, they only gave a flavour of actual day-to-day work. A foundation programme rotation in ophthalmology is rare, and neither of us had prior ophthalmic experience. We felt underprepared to start our new jobs. However, we quickly discovered that our colleagues starting in ophthalmology felt similarly. Fortunately, many senior trainees and consultants promptly reassured us that little prior ophthalmic knowledge was expected. Most ophthalmologists are enthusiastic teachers and eager to teach interested newcomers.
One of our consultants encouraged us to keep a list of “new things” we encountered daily. We try to spend 15 minutes after work reading about one topic or watching a short video. Over time, this approach builds a surprisingly strong foundation. Here are some resources we found invaluable (and wish we had known prior to starting):
- Eyeguru.org [1]: Excellent for breaking down core topics. Use before, or soon after starting.
- Kanski’s Clinical Ophthalmology [2]: A classic – well-illustrated and concise. It’s often available in hospital libraries.
- Practical Emergency Ophthalmology Handbook [3]: Summarises common ophthalmic presentations and provides an algorithmic approach for their assessment.
- Slit Lamp Studios [4]: Short, video explanations of slit lamp signs.
- Eyes For Ears [5]: Easy to listen to during commutes, and the hosts are entertaining. The ‘Buddy Call’ episodes are particularly useful for managing common on-call scenarios.
Senior support and managing the on-calls
Most units offer an induction period during which you’ll be closely supervised before you begin seeing patients independently. In our experience, this involved 4–6 weeks of shadowing. After this, seniors are usually accessible nearby and can advise about patients that you have seen. On-call arrangements vary between hospitals. You may initially be ‘buddied’ with a senior trainee who can support you during your first few on-calls. After this, whilst working independently, there will always be a senior available to contact for advice.
There are only a small number of time-critical ophthalmic emergencies, and we recommend reviewing these prior to starting on-calls. These include: endophthalmitis, acute angle closure glaucoma, giant cell arteritis, retrobulbar haemorrhage, orbital cellulitis, central retinal artery occlusion, penetrating ocular trauma, burns, keratitis, and retinal detachment. Recognise the red flags and examination findings for these conditions and escalate promptly.
Clinical skills
Using a slit lamp is a core skill, and we found it difficult at first (especially the fundus exam!). We attended a slit lamp training course, which gave us confidence performing a systematic examination. Some deaneries have access to a slit lamp virtual reality simulator, which is useful for learning basic and advanced skills (like gonioscopy). There is no substitute for practice, and we benefited from spending time with other resident eye doctors to examine each other. Finally, during the shadowing period, we found it beneficial to assess patients independently, then present our findings to the supervising consultant and receive targeted feedback.
Surgery
We recommend practising suturing, as you may get the opportunity to participate in simple cases like blepharoplasty. Many will have done the college’s ‘Introduction to Ophthalmic Surgery’ course, and refreshing the contents of the course handbook will be useful to review instrument handling, needle types, different types of sutures and knots.
For cataract surgery, Cataract Coach is excellent and is watched by junior and senior ophthalmologists worldwide [6]. Whilst US-based, the PGY2 and PGY3 playlists are directly relevant to new UK ophthalmology doctors.
The RCOphth requires all new eye doctors to complete the ‘Introduction to Phacoemulsification’ course before undertaking any live intraocular surgery, ideally within the first two months of starting training. However, a prerequisite to attending the course is completing EyeSi courseware A & B training. If you can finish these EyeSi modules prior to starting your new ophthalmology job, this will save you a lot of stress when you start. Be mindful that transferring EyeSi training records between different units may not be possible.
Keeping a portfolio
It is important to meet with your supervisors early on and map out a personal development plan for progression. Both trainees and clinical fellows should review the RCOphth’s ophthalmic specialist training webpage, which contains resources and excellent videos of the recent changes to ophthalmic training [7]. Reviewing this early will prepare you for starting your job and setting expectations for your progress. Keep a record of any cases you observe and assist with. Trainees can use eyelogbook.co.uk [8], and an alternative is e-logbook.org [9]. Aim to write a short reflection on what you have learnt once a week, as regular entries into your portfolio will make the end-of-year supervisor meetings easier.
Non-clinical tips
Some eye units have special programmes for reviewing investigations such as OCT, fundus images and visual fields. These require their own logins, and you may not be given access automatically. In hindsight, we think it would have been better to spend an afternoon sorting access out within the first week, rather than be attending different training sessions one month later!
Most deaneries are quite large for ophthalmology training, and you may decide to commute to work. Bear in mind, what may seem like a commutable distance on Google Maps may turn out to be a tiring journey when you start. Ensure your plan for commuting to work is sustainable.
Final thoughts
Working in ophthalmology is exciting! If you’re feeling nervous, know that you aren’t the only one. Whilst there is a steep learning curve, nobody expects you to know everything on day one. Approach each week as an opportunity to learn and contribute to your patients’ health. Soon enough, you’ll look back and realise how far you’ve come.
References
1. https://eyeguru.org/
2. https://www.uk.elsevierhealth.com/
kanskis-clinical-ophthalmology
-9780443110993.html
3. https://www.routledge.com/Practical-Emergency
-Ophthalmology-Handbook-An-Algorithm-Based
-Approach-to-Ophthalmic-Emergencies/Shirodkar
-Williams/p/book/9780367110277
4. https://www.youtube.com/c/SlitLampStudios
5. https://eyesforears.net/
6. https://cataractcoach.com/
7. https://www.rcophth.ac.uk/training/
ophthalmic-specialist-training/
8. https://www.eyelogbook.co.uk/login.html
9. https://e-logbook.org/
Declaration of competing interests: None declared.
