Direct ophthalmoscopy is a core clinical skill expected of UK medical graduates, yet many students lack confidence due to limited undergraduate ophthalmology exposure. This quality improvement project evaluated whether a structured teaching programme could improve final year medical students’ confidence and perceived competence in direct ophthalmoscopy.

Most local pathways triage eye presentations from the Emergency Department (ED), directly to Eye Casualty. However, a smaller number are managed, at least initially, by the ED team. This can include patients with polytrauma or that are systemically unwell. Some smaller departments do not even have on-site out-of-hours Ophthalmic services. A proportion of these presentations are true emergencies, where any delay to recognition or management could cost a patient their sight.

Retinopathy of prematurity (ROP) screening has a staffing problem that predates any conversation about artificial intelligence. A 2006 survey of paediatric ophthalmologists and retinal specialists found that only about half were willing to manage ROP at all, and roughly one in five of those already doing it were considering stopping, citing falling reimbursement and the weight of medicolegal exposure. Two decades on, the pressure has not eased. Reviews of the U.S. workforce describe a shortage that is "serious and growing" even as improved neonatal survival pushes more extremely preterm infants into the screening pipeline. By one 2022 estimate, four U.S. states and 90% of counties had no paediatric ophthalmologist at all.

Few medical specialities have experienced such profound transformation over the past three decades as ophthalmology. Diseases that once carried a prognosis of inevitable blindness can now often be stabilised for many years through advances in diagnostics, pharmacotherapy and surgery. Anti-VEGF therapy has revolutionised the management of neovascular age-related macular degeneration (AMD), reducing rates of legal blindness that were once considered unavoidable.