Ophthalmologists are medically trained doctors with specialist skills in the diagnosis, treatment and prevention of diseases of the eye and visual system. They treat patients of all ages, from babies to the elderly.

Common conditions dealt with include cataracts, glaucoma, diabetes and degenerative conditions resulting from ageing. They work in outpatient clinics, the operating theatre, laser eye surgery clinics and community clinics. There is also a limited amount of work based on wards.

There are a small number of medical ophthalmologists who are trained in general medicine, as well as ophthalmology. They are concerned with managing eye disorders that are specifically related to whole-body disease, such as diabetes, meaning they need to treat the patient and not just their eye condition.

Responsibilities

Tasks are varied but may involve:

  • assessing and examining patients in order to make a diagnosis;
  • management of ophthalmic conditions, taking into account both medical and psychological aspects of patient care;
  • managing busy general outpatient clinics, emergency eye clinics and specialist clinics;
  • ward rounds, but this is limited as most ophthalmic patients have day surgery and do not stay in hospital overnight;
  • working as part of a multi-disciplinary team that includes optometrists, orthoptists, nurses and with specialists such as neurologists, ENT (ear, nose and throat) surgeons and paediatricians;
  • operating equipment such as ophthalmoscopes, slit lamps and lenses;
  • carrying out surgical procedures using an operating microscope, small incision (keyhole) surgery, laser surgery, etc.;
  • communicating and empathising with patients and family members;
  • educating patients to understand their medical condition;
  • handling legal documentation for the certification of patients as blind or partially sighted;
  • supporting health promotion and disease prevention activities.

Medical ophthalmologists are also involved in:

  • using therapeutic procedures, such as laser therapy and intraocular, periocular and botox injections;
  • carrying out biopsies of tissues, including the eye;
  • managing diabetes retinal screening programmes.

For those in consultant posts, duties also include:

  • teaching and training junior doctors and other healthcare professionals and leading members of the ophthalmology team; research;
  • management of resources, practice development or leading on specific aspects of care.

Salary

  • Junior doctors in Foundation Year 1 (F1) earn a basic starting salary of £22,636. In Foundation Year 2 (F2) this increases to £28,076.
  • A doctor in specialist training starts on a basic salary of £30,002.
  • Bonuses are paid for work outside the hours of 7am to 7pm, Monday to Friday or if more than 40 hours are worked per week. The amount varies according to the situation but it is typically 20% to 50% of the basic salary.
  • Once qualified as a specialty doctor, basic salaries range from £37,176 to £69, 325.
  • Consultants earn a basic salary of between £75,249 and £101,451 depending on length of service and payment of additional performance-related awards.

Income data from Health Careers. Figures are intended as a guide only.

Working hours

You may be required to work extra hours, especially as a junior and be on an on-call rota. Out-of-hours work is generally not as onerous as in other specialties and night work is unusual.

There are opportunities for part-time work and job sharing. Staff, associate specialist and specialty (SAS) doctors often work in outpatient departments on a sessional basis or part time, combining ophthalmology with general practice. Consultants in community eye care may also work in GP practices.

What to expect

  • Ophthalmologists work in operating theatres, outpatient clinics and community care settings. You may work for extensive periods in rooms with low-level lighting.
  • Ophthalmology is a popular specialty with those who wish to work part time. Many consultant positions are job shares.
  • Jobs are available throughout the UK and competition for consultant posts is high.
  • The skills of an ophthalmologist are transportable to other countries and so there are extensive opportunities for travel and work abroad.
  • Many consultants travel extensively to attend international meetings, see international patients or operate in other countries.

Qualifications

To become an ophthalmologist, you must complete:

  • a degree in medicine, recognised by the General Medical Council (GMC);
  • a two-year foundation programme of general training;
  • specialist training in ophthalmology.

Entry with an HND or foundation degree only is not possible.

You can complete an undergraduate degree in medicine and will typically need good A-levels in chemistry and biology, plus another science subject such as mathematics or physics. If you have an arts A-level it may be accepted as the third qualification. Undergraduate medicine courses last five years.

It is also possible to study medicine at graduate level after you have already completed another degree. These courses are usually four years long and typically require you to have a science-related degree at a 2:1 or higher. Some medical schools will accept an arts degree, so check with individual institutions. A list of medical schools which offer the graduate route can be found at British Medical Association (BMA): Applying To Medical School.

The medical school may require you to complete a foundation year if they believe you do not already have sufficient science qualifications. This will then lead into the full programme of study for a medical degree.

It is also possible to apply for the undergraduate route even if you already have a degree, particularly if it is in a non-related subject.

After completing the two-year foundation programme, the specialist training in ophthalmology usually takes seven years to complete. For more information on how to apply for this see NHS Specialty Training.

If you are an undergraduate at medical school considering a career in ophthalmology, it is advisable to choose ophthalmology as a student selected component/special study module and consider an elective placement in ophthalmology in the UK or abroad. Visit your local eye hospital/department and speak to ophthalmic staff.

A limited number of prizes and awards are made to undergraduates to help fund electives in ophthalmology. Check with your medical school for individual medical school awards or see the Royal College of Ophthalmologists for details of its awards.

Support and information is available from the Ophthalmologists in Training Group (OTG).

Skills

You will need to show evidence of the following:

  • good stereoscopic vision and professional health requirements in line with the GMC;
  • practical hand skills and good hand-eye coordination;
  • communication skills, including empathy and sensitivity;
  • problem-solving skills and high-level decision making;
  • the ability to work as part of a multidisciplinary team;
  • leadership skills (for consultants);
  • the ability to work under pressure;
  • good organisational and planning skills.

Employers

The majority of ophthalmologists are employed by NHS trusts. Some work for private hospital companies and there are increasing numbers of ophthalmologists working as laser eye surgeons in the private sector.

Some consultants also work for the Royal Colleges (e.g. the Royal College of Ophthalmologists), the National Institute for Health and Clinical Excellence (NICE) and other government bodies.

Surgical ophthalmologists are particularly in demand overseas, where there is high demand for primary care and medical ophthalmologists. Some experienced practitioners offer their skills to work in the third world.

Ophthalmologists may become medical representatives for pharmaceutical companies or companies dealing with ophthalmic instruments.

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Professional development

Once you have completed the two-year foundation programme, you need to apply for ophthalmologist specialist training (OST), which takes seven years to complete. The different stages are known as ST1 to ST7.

The first two years of specialist training (ST1 and ST2) involve gaining the general clinical skills of an ophthalmologist and basic knowledge of conditions covered by the specialty. This may include working in general and specialist clinics, casualty work and theatre sessions.

Part 1 of the Fellowship in Ophthalmology (FRCOphth) from the Royal College of Ophthalmologists is taken by the end of ST2. You then progress onto ST3, where you become proficient in assessing patients for glasses and gain the Refraction Certificate.

Years ST4 to ST7 cover more advanced training, including using laser technology.

Part 2 of the FRCOphth needs to have been taken by the end of ST7. Assessment of both parts involves:

  • exams;
  • case-based discussions;
  • observation of procedural skills;
  • objective assessment of surgical and technical skills.

When the full seven years are successfully completed, you are awarded the Certificate of Completed Training (CCT) and can then join the specialty register and begin applying for consultant posts.

For all ophthalmologists, regular commitment to continuing professional development (CPD) is required for the development of skills and knowledge. Amongst other providers, skills training courses are provided by:

More information on the OST is available from the Royal College of Ophthalmologists. They also have an Ophthalmologists in Training Group (OTG), which represents the interests of ophthalmic trainees.

Career prospects

When you have been awarded the Certificate of Completed Training (CCT), you can start applying for consultant posts. These are management positions that involve leadership and the coordination of junior doctors' training. Some positions require management of resources, practice development or leading on specific aspects of care.

Consultants initially spend one or two years training in a specific area to gain a sub-specialism. For surgical ophthalmology consultants, specialist areas can include:

  • cataract and refractive surgery;
  • glaucoma treatment;
  • paediatric ophthalmology;
  • medical retina ophthalmology;
  • neuro-ophthalmology.

Consultant medical ophthalmologists tend to develop a sub-specialism in one of four main areas:

  • diabetes;
  • neuro-ophthalmology;
  • ocular inflammatory disease;
  • medical retinal disease.

Posts are also available as staff, associate specialist and specialty (SAS) doctors, where more time may be spent as service providers in outpatient clinics. These tend not to be career development positions and are likely to carry fewer management responsibilities.

It is possible to combine clinical practice with research and you may eventually be appointed to a lectureship or chair in ophthalmology.