A foundation job in ophthalmology is more common than you might expect. Looking through the 2027-29 programme listings across the deaneries, most offer at least a handful of FY1 or FY2 ophthalmology rotations. Whether you ranked it first or the preference-informed allocation algorithm had other ideas [1], it is worth having an idea of what to expect before starting.
I did an ophthalmology rotation as an FY2, and this is a practical guide to what the job involved, what I learned along the way and, looking back, what I wish I had known before starting. Hopefully it will be useful to anyone heading into an ophthalmology post, whether or not they are considering a career in the specialty.
Frequently asked questions
What does a foundation doctor do in ophthalmology?
It varies by unit. Most posts are outpatient-based, with time in the emergency eye clinic, subspecialty clinics and theatre, where you may assist in squint or oculoplastic surgery. Some include eye casualty on-calls, ward reviews or triaging referrals, and some are paired with general ED shifts.
Does a foundation job in ophthalmology count for ST1 points?
Yes. Evidence of a foundation year attachment in ophthalmology can be used in place of a taster week for 1 point. It does not count towards the separate point for attending clinics and theatre sessions, which must happen outside the rotation [5].
Is an ophthalmology rotation useful if I don't want to be an ophthalmologist?
Yes. You will learn to examine eyes properly, use a slit lamp, recognise sight-threatening emergencies and prescribe eye drops correctly, all of which carry over to ED, general practice and the wards.
How should I prepare before starting?
Arrange IT access to the eye department's systems early, watch introductory videos such as OphthoBook or EyeGuru Essentials, and get a pocket reference such as the Wills Eye Manual. Speaking to the previous foundation doctor in the post is the best way to find out what your week will look like.
What the job involves
Foundation posts in ophthalmology can look quite different depending on the unit, so the experience will not be the same for everyone.
In my post, I was effectively supernumerary within ophthalmology but also worked general ED out-of-hours weekend shifts. Most of my time was spent in clinics, particularly paediatrics and the emergency eye clinic (EEC). I often had my own room where I could see patients with supervision available and complete the documentation. I was also regularly scheduled to assist in squint lists.
Other foundation doctors have described quite different placement structures. One post involved admitting day-case surgery patients, following them through theatre and managing any post-operative complications, alongside helping with basic examinations in clinic [2]. Another followed a similar pattern to the ST1 rota, with eye casualty and on-call shifts, departmental teaching and regular oculoplastic lists [3]. A third was weekday-only, with no on-calls or weekends, and their role included ward-based patient reviews, assisting in oculoplastic and squint surgery, supervised eye casualty, teaching medical students, and triaging referrals [4].
During my rotation, my week included:
- Clinics: EEC, paediatrics, minor ops, medical retina, the one-stop injection clinic, oculoplastics, laser, and general clinics.
- Theatre: mainly assisting in squint lists, with some oculoplastics and the opportunity to observe cataract surgery.
If possible, speak to doctors who have done the rotation before you, as they can give you a better idea of what to expect in your particular unit. The rest of this guide focuses on more general advice that should be useful whatever your post looks like.
Preparing for the job and making the most of it
Sort out IT access early
Eye departments often use separate systems for clinical records (such as mediSIGHT) and for viewing OCT scans and other investigation results. These usually require separate logins, so contact IT before starting, as access can take a while to arrange and is vital to have in place.
It is also important to find out where to access clinic schedules and theatre lists, as these may be on different systems. Get familiar with the clinic codes so you know where you need to be and how to view the workflow, and have a look at theatre lists in advance so you know what cases to expect.
Depending on your hospital, you may also need access to software such as Concentric for electronic consent. This can be useful for preparing consent forms for your senior doctors and, once trained and if local policy allows, consenting patients yourself for procedures such as skin lesion biopsies.
Brush up on the basics
If you have the time and energy before starting, EyeGuru Essentials and Tim Root's OphthoBook videos are worth a look. They are a useful way to familiarise yourself with common eye conditions and the equipment you are likely to come across.
Bring a pocket reference to clinic
A small textbook or reference guide is useful for looking things up quickly between patients. I bought an older edition of the Wills Eye Manual second-hand on eBay, which is compact enough to carry around.
Get hands-on
Try to get as much practical experience as possible, for example in:
- Goldmann tonometry, the standard way to measure IOP
- the iCare tonometer, which is quick to learn
- everting eyelids, which is harder than it sounds
- the indirect ophthalmoscope
- gonioscopy and three-mirror lenses, which take a lot of practice
- doing corneal scrapes
- removing corneal and conjunctival foreign bodies
- conjunctival suturing, if the opportunity arises
Some of these, such as gonioscopy, take far more practice than a single rotation allows, so do not expect to be proficient, but have a go when the opportunity arises.
Get to know the theatre team
In other foundation jobs you may rarely be in theatre, but here it is important to get to know the theatre staff. They can be very helpful, show you where things are kept, and may know what is available in the department for practising skills such as suturing.
Give the slit lamp time
The slit lamp has a steep learning curve, and even after four months I did not feel I was even near reaching a plateau. There are lots of different techniques and lenses to get used to, and it takes time to become comfortable using them.
YouTube can be a useful resource for learning specific examination techniques and for finding reference videos of clinical signs. However, I found it less helpful for learning how to operate a slit lamp itself. Although slit lamps work on the same basic principles, there are many different models, and practical details such as the position of switches, dials and controls vary considerably between them. Hands-on familiarisation with the specific slit lamp you will be using is therefore essential.
I would recommend taking a photo of the slit lamp you will be using at the start of your rotation and labelling the different controls, or recording a short video of someone showing you how to use it. This gives you something specific to refer back to, rather than trying to follow a video of a different model.
Medical retina clinics are a good place to start practising examination of the posterior segment, as patients are already dilated.
EyeSi simulation
Not every hospital has an EyeSi simulator, and mine did not. I booked sessions at the Royal College of Ophthalmologists in London instead. Some companies, such as Alcon, may also be able to arrange for you to use a simulator at one of their offices if you speak to their reps, whom you may meet in theatre.
If you are thinking about ophthalmology specialty training, this time counts. Under the current ST1 self-assessment, ophthalmology simulation training, including EyeSi, scores 1 point for each activity of at least four hours or a whole-day course, up to a maximum of 2 points [5]. Keep a record of the dates and hours and collate the evidence as you go.
Outpatient skills
Because most of the work is likely to be in outpatients, you will need to learn how to write (and possibly dictate) outpatient letters, arrange outpatient prescriptions and write FP10s, as well as how to organise your workflow in a busy clinic.
Prescribing
Always clarify anything you are unsure about. Check with your senior whether the patient needs preservative-free (PF) drops, as this has to be specified on the prescription, and always be clear whether a medication is for one eye or both.
Learn the shorthand and how to document
Examination findings are usually recorded for each eye separately, with the right eye first. For example, "IOP 15|16 mmHg" means 15 mmHg in the right eye and 16 mmHg in the left, and "VA 0.10|0.20" means logMAR acuity of 0.10 on the right and 0.20 on the left. Diagrams are drawn as if you are facing the patient, so the right eye appears on the left of the page. Some other abbreviations worth knowing:
| Term | Meaning |
|---|---|
| OD / OS / OU | Right eye / left eye / both eyes (from Latin); mostly seen on printouts such as visual fields, while notes often use RE / LE / BE |
| G. / Oc. | Guttae (drops) / oculentum (ointment), e.g. G. chloramphenicol 0.5% QDS RE |
| PF | Preservative-free |
| BCVA / PH | Best corrected visual acuity / pinhole acuity |
| CF / HM / PL / NPL | Counting fingers / hand movements / perception of light / no perception of light |
| Phakic / pseudophakic / aphakic | Natural lens / lens implant (e.g. PCIOL) / no lens |
| ET / XT / HT | Esotropia / exotropia / hypertropia |
Don't be disheartened
Moving to ophthalmology from other medical or surgical jobs can be challenging, and it is normal to feel overwhelmed at first. The knowledge required is specialist and quite different from other jobs, and most foundation doctors arrive having done only a few days of ophthalmology placement at medical school, so the examination techniques, equipment, and terminology are all new. Working mainly in outpatients is also very different from ward-based jobs, although it may feel more familiar if you have already done a GP placement, for example. It can be harder still if the post is new or the team has not had many foundation doctors before. Be upfront about your level, ask for things to be explained from the basics, and remember that it does get easier.
If you are interested in ophthalmology
The rotation is a good opportunity to build skills and experience for applications:
- FRCOphth Part 1: one topic the exam covers is orthoptic tests, such as Hess charts, Maddox rod and wing, fusion and suppression tests (e.g. Worth four dot, Bagolini glasses) and stereopsis tests (e.g. TNO, Frisby, Lang). These are much easier to understand once you have seen them done, so sitting in with the orthoptists is very helpful. If you plan to sit Part 1 during or after the rotation, the Eye Academy FRCOphth Part 1 question bank covers these topics.
- Interviews: EEC is good preparation for interview clinical scenarios.
- Theatre: observe, and you may be able to assist, mainly in open procedures such as squints or oculoplastics cases.
It is also a good opportunity to get to know the registrars and consultants. Once they know who you are and that you are keen, it is much easier to ask about projects, such as case reports, audits and other research opportunities.
You may also have some free time to think more creatively about portfolio points, for example writing an e-book or creating an e-learning resource, such as a guide to examining eyes for non-ophthalmologists at your hospital. Under the current self-assessment these score 0.5 points each in the Education and Teaching domain, up to 2 points, and you need specific evidence of their impact, such as usage figures or feedback [5].
How a foundation rotation counts for ST1 points
The scoring rules are easy to misread, so it is worth being precise. Under the current self-assessment guidance for ophthalmology ST1 [5]:
- Taster week: worth 1 point, and evidence of a foundation year attachment in ophthalmology can be presented instead. The rotation replaces the taster week; it does not earn a second point on top of one.
- Clinics and theatre sessions: a separate point requires a minimum of 10 sessions outside a formal taster week or foundation post, spaced out over more than three months, with dates and supervisor-signed evidence. Sessions during the rotation itself therefore do not count, so you would need to attend on zero days, in your own time or during other placements.
- Simulation: EyeSi and other simulation training, as above, up to 2 points.
Scoring changes between recruitment rounds, so check the current NHS England guidance before you apply. For a full breakdown of every domain, see Eye Academy's ophthalmology ST1 portfolio guide and taster week letter template to get your foundation attachment evidence signed off in the format markers look for.
If you are not interested in ophthalmology
The rotation can still be useful even if you are not considering a career in ophthalmology. Focus on the common presentations you are likely to come across in ED and elsewhere, and on getting comfortable with the eye examination, including visual acuity, pupil assessment and fundoscopy. These are useful skills to take into any future non-ophthalmology job. You will also become more familiar with recognising sight-threatening conditions, knowing which patients need urgent referral, and when visual symptoms might point towards a wider systemic problem. The rota may also be a little lighter, leaving more time for your portfolio and life outside work.
You will also take useful medication knowledge back to the wards. Eye drops are easily overlooked when clerking patients or prescribing their regular medications. Having spent time in ophthalmology, you will hopefully have a better understanding of why they matter. Remember to include them when clerking and make sure they are prescribed correctly, including which eye they are for and whether they need to be preservative-free.
Core conditions to learn in EEC
Many eye conditions overlap with ED and general medicine, so they are especially worth learning to examine and assess. The Royal College of Emergency Medicine curriculum lists red eye, painful eye, sudden visual loss, diplopia and eye trauma among the ophthalmic presentations emergency clinicians should be able to manage [6], which gives a useful way to group them:
- Red or painful eye: acute angle-closure glaucoma, microbial keratitis (especially in contact lens wearers), anterior uveitis, scleritis, herpes zoster ophthalmicus, preseptal and orbital cellulitis, and allergic eye disease
- Sudden vision loss or visual disturbance: giant cell arteritis (GCA), optic neuritis, retinal vascular occlusions (CRAO and CRVO), field loss from stroke, retinal tears and detachment, vitreous haemorrhage, papilloedema and raised intracranial pressure, and new diplopia or cranial nerve palsies
- Trauma: chemical injury, penetrating eye injury, retrobulbar haemorrhage, hyphaema and orbital floor fracture
This made a noticeable difference on my ED weekend shifts. I felt confident using the slit lamp in ED, and knew what else to look for beyond a corneal abrasion when using fluorescein. Understanding the local referral pathways also helped, for example redirecting some patients from ED to the Community Urgent Eyecare Service (CUES). If you want hands-on practice with emergency procedures such as lateral canthotomy, I have reviewed the Moorfields A&E Clinical Skills course separately.
Suggested resources
These are the resources I found most useful, grouped by when they are likely to help.
Getting started
- Tim Root's videos (OphthoBook): clear introductions to the basics
- EyeGuru Essentials: short guides to high-yield conditions and techniques such as the slit lamp, indirect ophthalmoscopy and OCT interpretation, ideally worked through before day one
- Oxford Handbook of Ophthalmology: pocket-sized overview
Quick reference in clinic and EEC
- The Wills Eye Manual: practical diagnosis and management of common and emergency presentations
- EyeWiki: free online reference for looking things up
- OcuLearning: a free iPhone and iPad app I only found towards the end of my placement. It has simulators for the slit lamp, gonioscopy and fundoscopy, interactive eye models for visualising neuro-ophthalmology lesions, and management algorithms
In-depth reading (if interested in ophthalmology)
- Kanski's Clinical Ophthalmology: detailed reference, useful for FRCOphth revision
- Wills Eye Library: free surgical videos, operative reports and lectures by subspecialty, helpful for preparing before theatre sessions
Final thoughts
Whatever your career plans, an ophthalmology rotation is a chance to become comfortable with eye problems that many doctors find daunting. Sort out your IT access early, get hands-on with as much as you can, and use the time in the way that suits where you want to go next.
References
- UK Foundation Programme. UKFP 2027 key changes. foundationprogramme.nhs.uk
- Ong WH. Foundation job in ophthalmology. Journal of the Foundations of Ophthalmology. 2023. doi:10.48089/jfo7688132
- Dodd A. Foundation post in ophthalmology. Eye News. February 2023. eyenews.uk.com
- Aziz R. Making the most of your foundation year rotation in ophthalmology. Eye News. June 2025. eyenews.uk.com
- NHS England. Ophthalmology ST1: self assessment and supporting evidence. Last reviewed 16 October 2026. medical.hee.nhs.uk
- Royal College of Emergency Medicine. Emergency Medicine Training Curriculum 2021. Version 1.5, updated 6 August 2025. London: RCEM. rcem.ac.uk (PDF)