Clinical Ophthalmology
Core concepts
Clinical ophthalmology integrates history, examination, and investigation. Master the systematic approach: visual acuity, pupils, motility, slit lamp, tonometry, gonioscopy, and fundoscopy. Know the classic presentations of cataract, age-related macular degeneration, diabetic retinopathy, retinal detachment, and uveitis. Understand grading systems (e.g. diabetic retinopathy severity, cataract nuclear grading) and when to investigate versus observe. Imaging modalities-OCT, fluorescein angiography, ultrasound-each answer specific questions; know their indications and limitations. Management principles include when surgery is indicated, the role of intravitreal injections, and monitoring intervals.
Traps
Examiners test red flags: sudden painless vision loss suggests vascular occlusion or detachment; painful red eye suggests angle closure or keratitis. Distinguish dry from wet AMD by OCT findings. Remember that diabetic macular oedema can occur at any retinopathy stage. Do not confuse pseudoexfoliation with true exfoliation.
Worked example
A 68-year-old presents with sudden painless monocular visual loss and a cherry-red spot. The diagnosis is central retinal artery occlusion. Key points: the cherry-red spot is the preserved fovea against pale ischaemic retina; investigate for embolic source and giant cell arteritis in older patients. Rule of thumb: painless sudden loss = vascular or detachment; painful = inflammation or pressure.