I had the privilege of undertaking two glaucoma fellowships in the UK – first at the St Paul’s Eye Unit in Liverpool (2022–23), followed by a second year at Moorfields Eye Hospital in London (2023–24).
Many of my seniors had gone down the well-trodden path from Australia to the UK for further subspecialty experience after ophthalmology registrar training, and spoke of the rigorous training, breadth of exposure and enjoyable experiences outside of work gained from an overseas fellowship. This was enough to spark my interest and begin planning for the fellowship well in advance.
I spoke to a number of seniors who had been to Moorfields Eye Hospital and other major eye units in Manchester, Birmingham, Cambridge and Bristol. The St Paul’s Eye Unit came up as an option through a mutual colleague with one of the consultants in Liverpool. I applied for a couple of positions through the NHS trac website, sat for the subsequent interviews over video-conferencing, and was ultimately offered the Liverpool glaucoma fellowship. This was followed by several months of administrative hoops to jump through to obtain sponsorship by the Royal College of Ophthalmologists and a skilled worker visa.
Settling into Liverpool
The glaucoma service in Liverpool is run by a mix of younger consultants (Neeru Vallabh, Hussam Muntasser) who had recently completed their training and more senior consultants (Anshoo Choudhary, Mark Batterbury), making for a nice balance of perspectives. The department had a collaborative and friendly environment, which made it a pleasure to work there. A couple of months into my fellowship, the entire hospital relocated to a brand-new building, something the staff had been anticipating for over a decade. It felt like a privilege to be part of the move and a part of the unit’s history!
Clinically, Liverpool provided a wide spectrum of surgical training in glaucoma. I performed trabeculectomies, Preserflo microshunts, Paul glaucoma implants, Hydrus and iStent procedures, cataract surgeries, and gained substantial experience with non-penetrating deep sclerectomy – a technique rarely performed in the UK or worldwide. Outside the theatre, I helped to run the weekly glaucoma journal club and became involved in glaucoma research.
Night out in Liverpool’s party district!
Life outside work was equally rewarding. With no on-call commitments, weekends were free to explore the country and beyond. My wife Ranee and I lived in the city centre, and we spent our weekends exploring different bars and restaurants and always looked forward to the occasional Sunday roast! We got to watch Liverpool FC play at Anfield on the opening day of the season and visited the Beatles museum and Sefton Park. We also explored other areas of Britain, such as the Lake District, Snowdonia National Park, and nearby cities like Chester and York.
Moving on to Moorfields
After Liverpool, I began my second clinical and research fellowship at Moorfields Eye Hospital in London. As the largest specialist eye hospital in the UK, I was immediately struck by the sheer breadth and complexity of cases. Many of the patients I operated on had undergone previous filtration surgeries that had failed, making the cases technically demanding but also fantastic learning opportunities.
I was able to further refine my surgical skills under the guidance of consultants with meticulous surgical technique. The glaucoma department at Moorfields is truly international, with a large and diverse cohort of consultants and fellows from across the globe. A unique aspect of my time at Moorfields was the chance to spend part of my week in the David Crabb lab, where I undertook visual field research with brilliant and accomplished lab colleagues. This experience broadened my perspective on glaucoma beyond the clinic and theatre and gave me valuable exposure to the research methodologies.
Dinner with other Moorfields glaucoma fellows at the European Glaucoma Society meeting in Dublin, Ireland.
Life in London was, of course, very different to Liverpool. Accommodation was substantially more expensive, so my wife and I had to budget more carefully, but the city offered endless opportunities in return. London’s theatres, museums and food markets provided plenty to explore, while its excellent connections to Europe meant we were able to take short trips to Spain, Italy and Germany during weekends away.
Clinical differences between the UK and Australia
Having trained in Australia before coming to the UK, I was struck by how similar the hospital environments felt. Both are based within government-funded public health systems, so the structure of clinics, theatres and patient flow was familiar.
One difference lies in the duration of training. UK ophthalmology training is typically longer than in Australia, and as a result, UK trainees often gain substantial subspecialty experience before they commence their fellowships. The exposure, case mix and sheer volume of patients in the NHS also provides ample opportunity to refine clinical and surgical skills, which I am deeply grateful for.
Another difference is the structure of the eye units themselves. In Australia, eye departments often have a larger number of consultants who each spend relatively less time in the public hospital setting, as a substantial part of their week is spent in private practice. By contrast, UK eye units – particularly outside London – tend to have fewer consultants, who are more consistently present in the hospital. This means fellows often get more day-to-day continuity and supervision with their consultants, which can be an advantage when developing surgical independence.
Training environments in the UK
One standout feature of the UK system is the integration of highly skilled optometrists into glaucoma care. At both St Paul’s and Moorfields, optometrists are central to service delivery, performing not only routine assessments but also laser procedures and interventions like bleb needling. Their involvement allows services to meet the high patient demand while ensuring that consultants and fellows can focus on surgery and complex cases.
Another memorable aspect was the diversity of the workforce. Particularly at Moorfields, I worked alongside colleagues from every continent. The multicultural environment created an enriching professional and personal experience – swapping clinical insights and also sharing food, traditions and stories from around the world.
Advice for future international fellows
For anyone considering a fellowship in the UK, I would strongly recommend visiting the departments in advance if possible. Getting a feel for the environment and culture is invaluable in deciding where you will thrive. Speaking to past fellows is also important, as they can provide candid insights into both the strengths and challenges of a particular centre.
Practical preparation is also key. Accommodation in both Liverpool and London can be competitive, so planning well ahead is essential to avoid stress in the early weeks. Finally, I’d advise future fellows to make the most of life outside work. The UK is a fantastic base to explore Europe, and both Liverpool and London offer their own unique lifestyle opportunities – whether that’s football at Anfield, hiking in the Lake District, or catching a theatre show at the West End.
Closing reflections
Looking back on my two years in the UK, I feel incredibly grateful. Liverpool gave me a warm introduction to the NHS and a strong foundation in glaucoma surgery, while Moorfields exposed me to the full scale and diversity of the renowned eye unit. Together, they provided an ideal balance of supportive learning, surgical independence, academic opportunity and cultural adventure.
Since returning home, I have established a monthly journal club modelled after my experience in Liverpool. The knowledge and surgical skills picked up in the UK are also now an integral part of my practice. For me, the fellowships were not just about developing as a glaucoma surgeon, but also about growing as a person – adapting to new systems, building friendships across cultures, and experiencing life in two very different UK cities. It is an experience I would wholeheartedly recommend to any international trainee considering a move abroad.
Declaration of competing interests: None declared.
