In this article, Resident Doctor Chi Kit Yan sits down with Consultant Glaucoma Specialist Salman Sadiq and explores the daily life of a glaucoma specialist, the pros and cons of the role, how trainees can prepare for this subspecialty, and what the future holds for glaucoma care.
Chi: Why should you choose glaucoma as a subspecialty?
Salman: Glaucoma is the leading cause of irreversible blindness worldwide [1]. As populations age, the prevalence of glaucoma is only expected to increase, making it a vital area of focus in ophthalmology. Subspecialisation within ophthalmology, particularly in glaucoma, offers clinicians the opportunity to impact patients’ lives profoundly by preserving their vision and independence. For junior doctors and ophthalmology trainees considering their career path, understanding what a glaucoma specialist does is key to making an informed decision.
What does a typical week look like for a glaucoma specialist?
The weekly timetable is both diverse and demanding, encompassing clinical outpatient care, surgical and laser procedures, as well as non-clinical academic and administrative responsibilities. The job plan is never boring, as it includes a variety of tasks. Below is a typical template for a consultant role in glaucoma. This template may vary depending on factors such as your work pattern, hospital demand, staffing levels, and commitments to teaching and research. However, there is usually a good mix in a 10-programmed activity consultant job, typically consisting of 7.0–8.0 direct clinical care sessions, which may include clinics, laser treatments, and theatre work. Additionally, there are 2.0–3.0 sessions dedicated to supporting your professional development needs (SPA), administrative tasks, teaching and academic work.
Typical working week of a glaucoma consultant.
Clinical duties
Nearly half of your time is dedicated to outpatient clinics, where you diagnose and monitor patients with glaucoma. These clinics are especially busy in larger units, requiring efficient teamwork to handle the high patient load. Advanced imaging technology, particularly optical coherence tomography (OCT), has transformed glaucoma care over the past decade. This technology enables earlier detection of glaucoma and its progression, helping to prevent vision loss before it significantly impacts the patient’s visual field, which is evaluated through automated perimetry. Most units have trained glaucoma practitioners, including specialist nurses and optometrists, who help manage high patient volumes efficiently.
Virtual glaucoma clinics are becoming increasingly popular. In these clinics, nurses measure visual acuity and intraocular pressure while imaging technicians perform necessary imaging and visual field tests. As a specialist, you later review the results and decide whether to continue monitoring, maintain treatment or escalate care. These virtual reviews are highly beneficial, freeing up clinic space for face-to-face appointments with patients who have advanced or progressive glaucoma, while low-risk and stable patients can be safely managed remotely.
Finally, specialists also perform laser procedures, including selective laser trabeculostomy (SLT) and peripheral iridotomies – quick yet effective treatments that can greatly improve a patient’s quality of life. With the 2022 National Institute for Clinical Excellence (NICE) guidelines recommending SLT as a first-line treatment for open-angle glaucoma, laser clinics are becoming increasingly essential in glaucoma management.
Surgical duties
Glaucoma remains a surgery-heavy specialty, offering plenty of operating opportunities to satisfy your surgical appetite. Over the last decade, the advent of minimally invasive glaucoma surgery (MIGS) has transformed glaucoma management, making it both more diverse and enjoyable.
A wide range of MIGS are now available, including trabecular bypass microstents, canaloplasties, suprachoroidal shunts, excimer laser trabeculoplasty, subconjunctival microshunts, and micropulse cyclophotocoagulation. Minimally invasive glaucoma surgery is effective and offer quick recovery; however, traditional surgeries such as trabeculectomy and glaucoma drainage devices (tubes) remain essential for managing patients especially with advanced disease.
With so many surgical options, a glaucoma specialist’s role is both challenging and rewarding. You must carefully assess each patient’s needs and choose the right intervention at the right time to achieve the best long-term outcomes, considering disease severity, patient factors, and overall prognosis.
Unlike our colleagues in vitreoretinal or cornea, who often handle urgent or emergency cases, glaucoma surgery is rarely an emergency. This means most of your surgical lists are planned elective procedures, allowing for a more structured and predictable schedule – a definite perk of the specialty.
Non-clinical responsibilities
There is a significant administrative workload, particularly in managing patient queries. Since glaucoma is a lifelong condition, once a patient is diagnosed, they remain under your care indefinitely. As a result, your clinic list only grows over time.
To address this increasing demand, efforts are underway to establish community-based, optometry-led surveillance clinics to monitor low-risk patients, similar to diabetic eye screening programmes. However, until these services are fully implemented, you are expected to handle a high volume of patient queries, which are sometimes not adequately accounted for in your job plan.
If you’re interested, you can find time to teach, mentor, and engage in research. With ongoing advancements in imaging, therapies, lasers, and MIGS, you can contribute to clinical trials, innovation, and service development, shaping the future of glaucoma care while expanding your expertise.
What are the pros and cons for trainees considering it?
It’s important to weigh the pros and cons of a specialty before committing to it. For glaucoma, consider the following:
A summary of pros and cons of glaucoma as a subspecialty.
What can be done in preparation before entering the subspecialty?
The Royal College of Ophthalmologists (RCOphth) launched a new ophthalmic specialist training (OST) curriculum in 2024, requiring trainees to select their subspecialty much earlier than before. To maximise your career prospects and development, I strongly recommend making this decision as soon as possible. The earlier you identify your area of special interest, the more opportunities you’ll have to refine your skills and build a strong foundation for your future. Here are some useful steps to consider as a trainee if you wish to pursue a career in glaucoma:
Foundational knowledge
It is essential to build a solid understanding of the anatomy and pathophysiology of glaucoma. Familiarity with imaging modalities such as OCT and visual field analysis is also critical. While there are several online resources and textbooks available, I would recommend attending the European Glaucoma Society residents’ course. This two-day course is held annually and covers in-depth discussions on diagnosis and therapy, available technologies and surgical techniques for glaucoma, led by leading European glaucoma specialists.
Practical skills
Microsurgical skills are essential for becoming an ophthalmologist, regardless of subspecialty. However, for glaucoma specialists in particular, proficiency in fine suturing is crucial. Practising suturing under a microscope in dry lab simulations can significantly enhance your skills. As the saying goes, practice makes perfect. This will prepare you effectively before you enter level four training in glaucoma during your OST. To support this learning, various courses are available, including the RCOphth Glaucoma Simulated Surgery Skills course. Likewise, there are a few laser simulation courses, including one offered by Moorfields Eye Hospital that can be helpful.
Networking
Attend glaucoma-focused national and international conferences, such as the annual UK & Eire Glaucoma Society (UKEGS) conference in the UK and the European Glaucoma Society (EGS) conference in Europe, to stay updated on the latest advancements in the field. These events offer valuable workshops and insights from leading experts. Additionally, networking with mentors and specialists can provide invaluable career guidance and open doors to new opportunities.
Building your portfolio
There are ample opportunities to engage in research projects, audits or case presentations focused on glaucoma. Publishing papers or posters or presenting at conferences can help demonstrate your commitment to the field.
What does the future of glaucoma look like?
The landscape of glaucoma care is rapidly evolving, offering exciting opportunities and challenges for future specialists:
Workload
The workload of glaucoma specialists is expected to increase significantly, as the number of people with glaucoma in the UK is projected to reach nearly one million by 2035 [2]. This represents a 40% rise from the current estimated prevalence. A positive development is that healthcare systems are adapting to meet the increased demand by establishing referral refinement pathways and involving allied health professionals – such as optometrists and nurse practitioners – in taking on larger roles in the management of glaucoma. This trend may shift the focus of glaucoma specialists toward managing more complex cases and performing surgeries. Furthermore, advancements in imaging and AI are revolutionising diagnostics, which will aid in more efficient screening for glaucoma and better risk stratification.
Technological advancements
Minimally invasive glaucoma surgery procedures are becoming increasingly popular due to their safety and efficacy. We anticipate the emergence of more exciting devices in the near future. After over two decades, we have seen promising developments in the medical treatment of glaucoma, including medications such as netarsudil, nicotinamide, and drug-eluting implants. Home monitoring tools, including home tonometry and AI-assisted perimetry are expected to make glaucoma care more patient-friendly. While a cure for glaucoma seems a distant goal, I remain optimistic about the rapid progress being made in stem cell therapy in other fields. This advancement gives me hope that we may eventually develop stem cell therapies that target the regeneration of damaged optic nerve fibres, potentially restoring vision.
Global perspectives
Disparities in glaucoma care remain a significant challenge. The number of people with glaucoma worldwide is expected to increase to 111.8 million by 2040, disproportionately affecting those residing in Asia and Africa [3]. As a glaucoma specialist, you can make a global impact by contributing to initiatives aimed at improving access to diagnostics and treatment in underserved regions. Virtual training platforms can play a crucial role in bridging this gap by providing specialised education to ophthalmologists in these areas. A notable example is the British Pakistani Ophthalmic Society’s Advanced Virtual Adult Glaucoma Fellowship, launched in 2021 [4]. This programme has been instrumental in delivering high-quality remote training to glaucoma specialists in Pakistan, ultimately improving patient care on a larger scale. Such initiatives are vital in strengthening glaucoma management in underserved communities worldwide.
Do you have some final thoughts for trainees?
To me, there is no challenge more rewarding than combating the leading cause of irreversible blindness: glaucoma. As a glaucoma specialist, you’re not just treating an individual; you’re safeguarding the vision of an entire community affected by this widespread public health issue, thereby enhancing overall health and wellbeing.
This subspecialty offers an extraordinary fusion of individualised, problem-based clinical care, surgical precision, and opportunities for innovation, making it an appealing choice for many ophthalmology trainees. I take great pride in having chosen this field at a time when we have more to offer our patients than ever before. However, the challenge persists as the number of glaucoma patients continues to rise. We must stay ahead of this growing burden from leading to widespread vision loss through innovation, early detection, and proactive care.
For those considering this path, the journey begins with building strong fundamentals in general ophthalmology, gaining hands-on experience, and, most importantly, finding the right mentor at the right time. If you are passionate about patient care at a community level, problem-solving, surgical resilience, and lifelong learning, a career in glaucoma may be the perfect fit for you.
References
1. GBD 2019 Blindness and Vision Impairment Collaborators, Vision Loss Expert Group of the Global Burden of Disease Study, et al. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to Vision 2020: the right to sight. Lancet Glob Health 2021;9:e144–60.
2. https://www.rcophth.ac.uk/wp-content/uploads/
2021/12/RCOphth-The-Way-Forward-Glaucoma-300117.pdf
[Link last accessed September 2025]
3. Tham YC, Li X, Wong TY, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 2014;121(11):2081–90.
4. https://bpos.org.uk/?page_id=329
