Ophthalmology Elective in Hong Kong

Embarking on a two-month ophthalmology elective in Hong Kong was an enriching and eye-opening experience. I had the privilege of undertaking placements at Hong Kong Eye Hospital and Grantham Hospital, where I attended both clinics and theatre sessions. One of the most rewarding aspects of my elective was learning from local experts in the field, and gaining hands-on experience in examining patients with the slit lamp.

Planning the Elective

I started planning for the elective 6 months prior by signing up to the application portal via Chinese University Hong Kong and University of Hong Kong. Upon supplying the relevant information and uploading the required documents on the portal (including travel documents, academic transcripts and vaccination records), I was offered placements at Hong Kong Eye Hospital and Grantham Hospital respectively. Both institutions got in touch with me approximately 1-2 months before the placement with a timetable outlining my day-to-day clinical schedule. I luckily did not have to arrange accommodation as I stayed with my family in Hong Kong during my elective. Some of my peers who were not local to the area were able to book AirBnBs in the Causeway Bay and Wanchai area easily for an affordable price. 

Clinical Exposure to A Variety of Eye Conditions

During my time in the eye casualty department at both hospitals, I had the opportunity to clerk and examine patients with common ophthalmological presentations such as dry eyes, blurry vision and discharge. This was an incredibly valuable experience as it developed my skills and confidence in using the binocular indirect ophthalmoscope and slit lamp in examining anterior and posterior segment pathologies.

While shadowing specialist clinics, I was able to discuss more complex cases with consultants, for example, the management of advanced glaucoma and recurrent retinal detachments. In particular, I observed the administration of intravitreal injections for patients with diabetic retinopathy and age-related macular degeneration (AMD).

Attending theatre sessions was equally fascinating. I witnessed a range of ophthalmological procedures, from oculoplastic surgeries, cataract operations, to intricate vitrectomies performed with 3D visualisation. A particularly memorable operation was a ptosis surgery, where the patient was awake throughout, given a mirror to assess the appearance of their eyelid and given the change to feedback to the operating surgeon for finer adjustments. This allowed me to appreciate the highly personalised patient-centred approach of this procedure, deepening my interest in this specialty.  

Contrasting Healthcare Systems

One of the key learning points from my elective was understanding how the Hong Kong healthcare system differed from the NHS in the UK. Several aspects stood out:

Patient Demographics 

The early-onset and prevalence of myopia in the childhood population was notable, in part due to lifestyle factors such as high academic demands and prolonged exposure to screens from a young age. Interestingly, a significant proportion of adult clinics and theatre cases were dedicated to the management of normal tension glaucoma and primary angle closure glaucoma, to which the East Asian population are known to be genetically predisposed.

Pace of Consultations 

The pace of consultations in Hong Kong was noticeably faster – a typical morning clinic would accommodate up to 50 patients, compared to 10-20 in the UK.  Due to high patient volumes, ophthalmologists had to balance conducting efficient consultations while delivering high-quality care, which was achieved by a relatively more traditional patriarchal approach compared to the UK. Equally, patients in Hong Kong generally expected a more definitive plan from their consultants, as opposed to a shared decision-making approach that is more familiar to us in the UK.

Language Barrier 

Hong Kong is a highly multicultural city, with most of the general population able to understand and speak English well. There were instances where patients, especially amongst the older demographic, who purely spoke Chinese in outpatient clinics. Local doctors and nurses were more than happy to translate in this instance.

Conclusion

My ophthalmology elective in Hong Kong was an invaluable experience that broadened my clinical knowledge and technical skills. The exposure to a different healthcare system allowed me to appreciate the strengths and challenges unique to both Hong Kong and the NHS and reinforced my commitment to pursuing a career in this dynamic specialty.