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2 Specialties Medical ophthalmologyTable 1 Typical job plan of a medical ophthalmologistActivitySessionsDirect patient care 7.5Outpatient clinics – which may include: ocular inflammation clinic, neuro-ophthalmology clinic, diabetic eye diseaseclinic, medical retina clinic, AMD clinicProcedures (injection or laser)Retinal screeningAdministrationInpatient (ward rounds, referrals, MDT meetings)This may include: inpatient and day-case workNeuroradiology meetingElectrophysiology meetingOcular imaging meeting(NB: for units with a large tertiary referral cohort, there may be additional inpatient or day-case work and fewerclinics.)Supporting professional activities (SPAs)Work to maintain and improve the quality of healthcare 2.5ophthalmic physician per 263,000 population. 14 Thenumber of ophthalmic physicians needs to be balancedwith the workforce plans for ophthalmology and thecurrent plan is to expand the workforce to around100 consultant ophthalmic physicians to providespecialist medical services to ophthalmic patients.The JRCPTB is working with the Royal College ofOphthalmologists to support the specialty to expandthe number of medical ophthalmology trainingprogrammes to 16 and to provide opportunities foracademic training.9 Consultant work programme/specimenjob planThe range of activities a medical ophthalmologist wouldconduct in a typical week is reflected in Table 1. Like allspecialties, the workload can be heavy at times, withsome busy clinics, but the working times are usuallyquite predictable.10 Key points for commissioners1 Medical ophthalmology is a diverse specialty andthe needs of an individual service will depend onthe specialist interest of the ophthalmic physicianand the requirements of the local population.2 Ophthalmic physicians provide secondary andtertiary level care to patients with complexproblems, including those with ocularinflammation, neuro-ophthalmic disease, diabeticeye disease, inherited eye diseases and degenerativeconditions.3 Specialist clinics for ocular inflammation andneuro-ophthalmology require direct consultantinvolvement. With the high-demand services likeAMD and diabetic retinopathy, there is often amore supervisory role.4 Procedures performed by ophthalmic physiciansinclude retinal laser and intravitreal injections.5 Recent pharmacological developments and anageing population mean that the workload for anophthalmic physician has increased substantiallyand is likely to continue to increase.6 Medical ophthalmology is predominantlyoutpatient based but day-case and inpatientfacilities are required for a minority ofpatients.7 All ophthalmic physicians require a comprehensiveocular imaging service and access to optometrists.Those working in neuro-ophthalmology requireC○ Royal College of Physicians 2013 165
Consultant physicians working with patientsorthoptic support, electrophysiology andneuroimaging services.8 Ophthalmic physicians need to be able to interactwith the wider team in order to act as an effectivelink between medical and ophthalmic care. Thismay involve joint ward rounds and clinics,multidisciplinary radiology meetings and ocularimaging meetings.9 Education of doctors in training, trainee doctorsand other members of the team, includingoptometrists and nurses, is an important part ofthe role of the consultant ophthalmic physician.10 Integrating research into clinical care is a priorityfor medical ophthalmology as the evidence base islacking, particularly in the management of ocularinflammation and neuro-ophthalmic conditions.References1 Dick AD, Forrester JV. The ophthalmic physician: anindulgence or a necessity? Br J Ophthalmol1996;80:782–3.2 Department of Health. Supporting people with long-termconditions. London: DH, 2005. www.dh.gov.uk/prod consum dh/groups/dh digitalassets/@dh/@en/documents/digitalasset/dh 4122574.pdf [Accessed 15December 2010]3 Royal National Institute of Blind People. Losing patients.Why are blind and partially sighted patients still givenhealth information in print they cannot read? Campaignsreport 28. www.rnib.org.uk [Accessed 15 December2010]4 Royal National Institute of Blind People. Employmentcampaign briefing autumn 2009. www.rnib.org.uk[Accessed 15 December 2010]5 Rothova A, Suttorp-Schulten MS. The possible impact ofuveitis in blindness: a literature survey. Br J Ophthalmol1996;80:844-8.6 Royal College of Ophthalmologists. Commissioningcontemporary AMD services: a guide for commissionersand clinicians. Version 3. London: RCOphth, July 2007.www.rcophth.ac.uk. [Accessed 15 December 2010]7 Royal College of Physicians and Royal College of GeneralPractitioners. Making the best use of doctor’s skills– a balanced partnership. London: RCP, RCGP, April 2006.http://old.rcplondon.ac.uk/news/statements/jointRCPGP.pdf [Accessed 21 June 2011]8 Joint Royal Colleges of Physicians Training Board.Medical ophthalmology specialty training curriculum2010. www.jrcptb.org.uk/specialties/ST3-SpR/Pages/Medical-Ophthalmology.aspx [Accessed 15 December2010]9 Royal College of Ophthalmologists. Clinical guidelines.www.rcophth.ac.uk/page.asp?section=451&sectionTitle=Clinical+Guidelines [Accessed 15 December 2010]10 NHS Quality Improvement Scotland. Diabeticretinopathy screening. Clinical standards – March 2004.www.ndrs.scot.nhs.uk/Links/Docs/drstandards2004.pdf[Accessed 15 December 2010]11 Department of Health. General ophthalmic servicesreview. London: DH, January 2007. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH 063984 [Accessed 15 December2010]12 Scottish Executive. Review of community eyecare servicesin Scotland: final report. Edinburgh: Scottish Executive,December 2006. www.scotland.gov.uk/Publications/2006/12/13102441/0 [Accessed 15December 2010]13 Greiner K, McCormack K, Grant A, Forrester JV. Therelative contribution of medical and surgical referrals tothe workload in general ophthalmic practice. Br JOphthalmol 2003;87:933–5.14 Centre for Workforce Intelligence. Medical specialtyworkforce factsheet: medical ophthalmology. CFWI: August2010. www.cfwi.org.uk [Accessed 15 December 2010]Note to readers: This chapter has been reproduced from the book’s 5th edition (2011) as the author felt it did not need updating for the 2013 revision.166 C○ Royal College of Physicians 2013
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