As time progresses, surgery trainees graduate from seeing patients in the ophthalmology clinic, diagnosing and providing them with medical treatments such as eye drops (for example Xalatan drops for glaucoma or steroid eye drops for inflammatory eye conditions such as uveitis), through straightforward surgical procedures such as laser capsulotomy or iridotomy eventually ascending the heights of proper eye surgery – cataract surgery, retina surgery, squint and paediatric eye surgery, demanding eye laser procedures such as the treatment of diabetic retinopathy and the like. At the end of this gruelling process (which incidentally is sometimes voluntarily interrupted by time out for more research to gain a degree such as a PHD and which always finishes with the acquisition of sub-speciality eye surgical skills during a Fellowship) the ophthalmology graduate takes the final component of the eye surgery examination – the Fellowship of the Royal College of Ophthalmology, attains the prized FRCOphth diploma and is entered onto the General Medical Council (GMC) Register as a specialist in ophthalmology.
All that is now required is for the (probably exhausted and certainly much older and wiser!) ophthalmology graduate to acquire a position as a Consultant Ophthalmologist at an NHS unit somewhere in the United Kingdom. Jobs at the Consultant level are competitive, unfortunately because manpower planning in the NHS being what it is, there are often more potential consultant ophthalmologists than places. The process of choosing a Consultant Ophthlamologist is quite complicated, representatives of the NHS, the Royal College of Ophthalmology, the local eye department, and senior management at the hospital itself meeting to discuss the relative merits of applicants for each eye surgical position. Usually Consultant Ophthalmology jobs are advertised with a view to choosing somebody with appropriate surgical skills – so rather than the adverts in the British Medical Journal (BMJ) reading ‘Consultant Ophthalmologist required’, the blurb will announce a requirement for a ‘consultant ophthalmologist specialising in cornea surgery’ or a ‘fully trained eye surgeon with the FRCOphth Diploma whose surgical skills include cataract and refractive surgery’. Numerous CVs may land on the desk of the senior eye surgeons chosen to appoint their new colleague and frequently many of the applicants are perfectly well qualified to do the job. The judges may look for particular aspects of the eye surgeon’s training that will make them suitable for the particular eye surgery position advertised – for example a candidate may have done two Fellowships, one in cataract and refractive surgery and another in cornea surgery (as Eyesite’s consultant surgeon Dr Simon Levy did) making him (or of course her) especially attractive on that occasion.
Once in post, most ophthalmologists stay for decades! Don’t worry – constant upgrading of medical and surgical eye skills s required by law (and also by common sense) and consultants move with the times – Eyesite’s surgeon Simon Levy began his career performing large – incision cataract surgery in which up to one third of the eye wall was incised to allow the cataract to be manually extracted from the eye. He would not dream of doing the procedure like this these days! As you may have read elsewhere on Eyesite.org, ultra-small incision technology (only 2.2mm wide and usually no sutures!) has transformed cataract surgery.
When you choose an eye surgeon, begin at the beginning. If you have any significant problem with your vision or if you are looking for the comfort of vision correction so that you no longer need glasses, attempt a little self-diagnosis. If you have no idea what the eye problem is the next steps are to seek help from either your General Practitioner (GP) or probably more appropriately your optometrist (optician). Either may be able to help you themselves (GPs will prescribe eye antibiotics, optometrists will give you glasses or contact lenses and may also treat some eye disorders such as blepharitis) but when they know that they cannot help you, a referral to a professional ophthalmologist who has the ability to diagnose and treat your eye condition correctly will be organised. If you think you have something significantly and acutely wrong with your eyes, seek help as soon as possible as this may prevent complications and may avoid the need to have eye surgery. Your optician or GP will guide you to an ophthalmologist with the correct skills, but you are entitled to join in the process of choosing, of course. A good place to start is the consultant ophthalmologist’s website or if they do not have one of their own, visit the website of the hospital in which they work and you will usually find a CV and information on what type of ophthalmology he does.
Without wishing to scare the reader, you should be aware of the importance of any eye operation. Few parts of your body are as important or as precious as your eyes, even if you do have two of them! Try to choose an ophthalmologist who specialises in what you need to have done – removal of cataract is best performed by a high volume cataract surgeon whose website describes specialist knowledge of lens implants, Lasik or Lasek laser eye surgery should be done a clinician who specialises in refractive surgery (check out which eye laser he uses as well – they are not of the same quality!), fixing an eyelid problem whether it is cosmetic such as blepharoplasty or something serious such as an eyelid reconstruction necessitated by a tumour is best done by a consultant oculoplastic specialist. By the way in the UK unlike America and many countries in Europe, eye doctors do not generally perform refraction (glasses or contact lenses prescribing), general eye care or screening for glaucoma. In this country opticians generally undertake these roles.
If you are looking for further information about eye care or require an eye doctor skilled in cataract, refractive or cornea surgery – contact the friendly team at Eyesite.org today by telephoning 020 8951 1951.
