Description of specialty

Medical ophthalmology involves the medical assessment, investigation, diagnosis and management of a range of disorders affecting vision. Ophthalmic physicians undergo training in both ophthalmology and internal medicine. A study from 2003 indicated that over half (55%) of patients referred to an eye clinic require predominantly medical management rather than surgery. Medical ophthalmology was recognised as a specialty in 1995 by the Royal College of Ophthalmologists (RCOphth) and the Royal College of Physicians (RCP) in recognition of the demand for specific medical skills and ophthalmic expertise in the UK. The terms medical ophthalmologist and ophthalmic physician are synonymous. The RCP website has more information on the specialty.

Nearly two million people in the UK are living with sight loss. This number is set to almost double by 2050. Ophthalmology has the second highest number of outpatient appointments of any specialty in the UK and this number is increasing. These figures are from a review of eye health data (opens PDF, 1.85MB) published by RNIB in 2014.

Medical ophthalmic conditions are typically chronic diseases, although patients can present acutely with sight loss. Hereditary retinal diseases, followed by macular degeneration and diabetic retinopathy, are the most common causes of registration as blind or partially sighted in England and Wales.

The objectives of medical ophthalmic subspecialties are to:

  • prevent sight loss
  • treat sight loss
  • prevent and treat other causes of visual disability, such as double vision.

Key subspecialty disease groups

  • Ocular inflammation – includes ocular, corneal and orbital inflammatory disease
  • Medical retina – includes retinovascular diseases (eg age-related macular degeneration) and inherited degenerative retinal diseases
  • Neuro-ophthalmology – includes optic neuropathies and eye movement disorders
  • Public health – diabetic retinopathy screening, screening for uveitis in juvenile idiopathic arthritis.

Medical ophthalmology is primarily an outpatient-based specialty. Care is delivered by a multidisciplinary team typically centred around an ophthalmology outpatient department in a secondary or tertiary setting. This team includes:

  • doctors
  • nurses
  • clinical nurse specialists
  • optometrists
  • eye clinic liaison officers (to provide information and emotional support to patients with visual loss)
  • allied health professionals (including orthoptists)
  • infusion services for biologic therapies.

The following procedures are undertaken within medical ophthalmology:

  • intravitreal injection services
  • laser procedures
  • botulinum toxin injection service
  • ophthalmic investigations: colour photography, fundus fluorescein angiography, ocular coherence tomography, B-mode ultrasound, Humphrey visual field analysis, electrophysiology
  • imaging services: imaging is a key component of work within ophthalmology services and guidance is available from RCOphth (opens PDF, 57.5KB).