Ahmed Ellabban

Introduction

Ophthalmology occupies an unusual position within UK undergraduate medical education. Eye conditions account for a substantial proportion of presentations in primary care and emergency settings, yet formal exposure at medical school is often brief, sometimes optional, and frequently dominated by lectures. Like many students, my early encounters with ophthalmology were limited to a handful of lectures and the occasional slit-lamp demonstration, which often felt more intimidating than enlightening. Formal ophthalmology exposure is not only short but also highly variable: many students receive only brief standalone attachments or integrated teaching alongside other specialties. In a national survey of UK medical schools, nearly two-thirds offered just one to two weeks of dedicated ophthalmology teaching, while almost a third integrated ophthalmology with other subjects rather than providing it as a distinct block (1). These factors lead many students in their final year to seek elective placements in ophthalmology, often overseas—a path I also chose to follow by organising my elective in Kyoto, Japan.

In this article, I reflect on my elective experience, describe the clinical and educational environment, and consider what it may offer to UK medical students interested in ophthalmology placements abroad.

Why I chose an Ophthalmology Elective at KUH

Kyoto University Hospital (KUH), founded in 1899, is one of Japan’s oldest and most prestigious tertiary teaching hospitals, serving the Kansai region with over 1,100 beds and more than 30 specialised departments (2,3). As a major referral centre, it manages large annual caseloads across inpatient, outpatient, and surgical services. Within this framework, the ophthalmology department provides comprehensive care for conditions including cataracts, glaucoma, retinal detachment, diabetic retinopathy, and age‑related macular degeneration. It operates multiple specialist outpatient clinics supported by advanced imaging modalities. Surgical activity is integrated within the hospital’s theatre complex, with vitreoretinal and glaucoma procedures forming a substantial portion of operative cases (4).

A key factor that drew me to Kyoto University was the practical and immersive ophthalmology curriculum. Students gain hands-on experience interpreting fundus images and OCT scans, and uniquely at the undergraduate level, have access to a wet lab to practise basic cataract surgery (5). This combination of structured clinical exposure, advanced diagnostic training, and surgical practice is rarely available in UK undergraduate programmes.

My decision to pursue an elective in Kyoto was therefore motivated by both academic and personal factors. I was drawn to Japan’s reputation for technological precision, evidenced by the widespread use of Japanese ophthalmic equipment internationally — particularly in the UK, with systems such as Topcon OCT and fundus cameras, NIDEK diagnostic platforms, and Takagi slit-lamp microscopes. The strong surgical focus and practical nature of ophthalmology training offered an appealing contrast to my UK experience. I chose Kyoto as a city for its calmer pace, which I hoped would support a well needed break after finals as well as reflective learning. The university-affiliated teaching hospital I attended serves a large, predominantly elderly population, providing exposure to a wide spectrum of ophthalmic conditions.

Elective structure

Organising the elective required careful planning and took approximately three months. I coordinated primarily via email with a contact I knew at Kyoto University, navigating the university’s extensive requirements for visiting trainees. These included repeated blood tests to confirm vaccination status and a medical review to ensure I was healthy and carried no transmissible diseases. A chest X-ray was also requested; however, I was able to negotiate that this was not routinely indicated in the UK without clinical justification. After my GP confirmed my health status as normal, the hospital accepted this alternative. I kept receipts for the associated costs, which were subsequently reimbursed through the NHS bursary. In total, I arranged a three-week elective and stayed in hospital accommodation located a ten-minute walk from the department, which allowed easy access to clinics and theatres throughout the placement.

My days typically began at 10 a.m., and on my first day I was introduced to the ophthalmology team. Many of the residents spoke English and acted as informal translators, and for convenience I was paired with two English-speaking residents for the duration of my placement. After an initial tour of the department, I met with the team again to structure my timetable to my needs, agreeing on three full clinic days and one theatre session each week.

During the first few days, I observed the age-related macular degeneration (AMD) clinic, with residents translating for me as needed. The clinic itself was organised in a unique and structured manner. Patients waited seated outside the bay, while inside there were four slit-lamp tables for resident use and a central table connected to a screen where the consultant, referred to as Sensei, would sit. Residents first reviewed their own patients, typically around three each, before presenting them to the Sensei. The Sensei would then examine each patient using the slit lamp connected to the central screen and discuss findings with all residents waiting in line. This approach created a distinctive learning environment, as residents essentially learned from each other’s patients in addition to their own. After discussing the case with the Sensei, residents implemented the agreed management plan and spent the afternoon finalising detailed fundus drawings for each patient. This structure was quite unique for me to observe.

During my theatre days, I was invited to gown and observe a wide range of ophthalmic procedures. I spent time in vitreoretinal theatres, where I observed surgery for complex retinal detachments, including cases complicated by proliferative vitreoretinopathy, and was introduced to the principles of intraocular tamponade using either silicone oil or expansile gas. I was also taught the clinical relevance of the internal limiting membrane and epiretinal membranes, and how these are managed surgically during vitrectomy. In addition to multiple retinal detachment repairs, I observed scleral buckle procedures using silicone bands, which helped me understand how external indentation supports retinal reattachment. I also had the opportunity to watch a strabismus operation, after which a trainee explained the functional anatomy of the extraocular muscles and how altering their tension is used to correct ocular misalignment. This theatre exposure provided a valuable overview of both anterior and posterior segment surgery and immersed me in key surgical theory, at an undergraduate level.

I recall a session in which I was placed in a small group with other medical students and introduced to the pharmacology of commonly used ophthalmic drops, including agents that induce mydriasis and miosis. We were also taught the basic optics of diagnostic lenses used at the slit lamp. This included practical instruction on how to hold, position and manoeuvre lenses such as the 90-dioptre and three-mirror lenses to obtain a clear and stable view of the anterior segment and fundus. We were invited to instil dilating and constricting drops into our own eyes and then examine one another using the slit lamp. The microscope was linked to a video display, allowing us to describe what we were seeing in real time and receive guidance from the demonstrator. This approach was far more immersive than my undergraduate experience in the UK, which had largely been limited to model eyes and direct ophthalmoscopy.

We then spent time with the optometry team, where we were introduced to optical coherence tomography (OCT), widefield fundus imaging using Optos, and the principles of clinical refraction. Teaching started from first principles, including how visual acuity is measured, recorded and interpreted. We each underwent refraction and had OCT and widefield retinal images taken, which helped contextualise the investigations commonly performed before a patient is reviewed by an ophthalmologist. Observing how optometry and ophthalmology work together gave me a clearer understanding of the patient pathway in routine eye care.

A particular highlight was a wet-lab session in which we practised phacoemulsification on porcine eyes. After donning protective equipment, we were introduced to the phaco machine, including the function of the foot pedal and basic system set-up. A trainee first demonstrated the key steps of cataract surgery—capsulorhexis, hydrodissection, nucleus disassembly, phacoemulsification, and cortical aspiration—using a standard divide-and-conquer/phaco-chop technique under the supervision of a senior surgeon. The procedure was displayed on a large screen, with real-time commentary explaining instrument handling and fluidics control. We then took turns performing the surgical steps, with one student operating while the other assisted and observed through the second microscope eyepiece. We subsequently swapped roles, allowing each of us multiple opportunities to practise and receive immediate feedback from the supervising surgeon. This hands-on exposure was a valuable introduction to the surgical aspect of ophthalmology, which is rarely accessible at undergraduate level, and gave a tangible insight into the technical skills required in the specialty.

Discussion

A defining feature of this elective was how immersive and practical the teaching felt throughout. In contrast to many UK undergraduate placements, where ophthalmology is often limited to short attachments or lecture-based teaching with little hands-on experience, the Kyoto university programme placed strong emphasis on active participation and direct clinical engagement. Being encouraged to instil drops and examine fellow students under supervision, as well as reviewing our own OCT and widefield fundus images, made the learning personal and clinically meaningful rather than abstract.

The breadth of exposure was also striking. Teaching integrated optometric assessment, advanced imaging, subspecialty clinics and surgery, giving a much clearer sense of how patients move through the eye-care pathway. Seeing how optometry and ophthalmology work together in routine practice helped contextualise investigations and decision-making in a way that is rarely appreciated at undergraduate level.

Surgical exposure was a particular highlight. Practising phacoemulsification in a wet lab with real-time supervision and feedback provided insight into the technical and spatial demands of microsurgery that is rarely available to UK medical students outside of electives (6). This type of experience, if implemented in the UK, would allow students to make more informed decisions about whether the specialty suits their skills and interests ahead of the rigorous portfolio work needed for specialty applications.

The learning environment itself reinforced this. Clinics and theatres were set up so that multiple learners could view procedures and examinations on screens, creating a culture of shared learning. Group case discussions encouraged students to learn from each other as well as from their own patients, while the unhurried pace and supportive teaching allowed time for reflection and consolidation.

Together, these elements created a rich and engaging educational experience that demonstrated how undergraduate ophthalmology teaching can be both practical and intellectually stimulating, while giving students a realistic sense of what the specialty involves.

Final reflections and concluding

My elective at Kyoto University Hospital was an engaging and rewarding experience that provided a level of ophthalmology exposure that I did not have access to whilst studying in the UK. Participation in clinics, imaging, optometry and surgical teaching allowed theoretical knowledge to be reinforced through direct clinical experience, while observing patients move through diagnostic, outpatient and theatre settings gave a clear picture of how ophthalmic care is delivered in practice.

The placement also highlighted the importance of careful preparation. Organising the elective required navigating institutional processes, health checks and practical arrangements, all of which took time but were essential to ensuring a smooth and productive experience.

I am very grateful to the ophthalmology team at Kyoto University Hospital for their generosity and commitment to teaching. Residents and consultants were welcoming and supportive, actively involving me in clinical and surgical learning. I would strongly recommend an overseas ophthalmology elective to students interested in the specialty, as with proper planning it offers both excellent clinical exposure and valuable international perspective.

References

1. Hill SCL, Dennick R, Amoaku WMK. Present and future of the undergraduate ophthalmology curriculum: a survey of UK medical schools. Int J Med Educ. 2017;8:389–395. doi:10.5116/ijme.59f7.8b5d

2. Kyoto University Hospital. Hospital overview [Internet]. Kyoto: Kyoto University Hospital; c2026 [cited 2026 Jan 15]. Available from:

https://www.kuhp.kyoto-u.ac.jp/english

3. Kyoto University Hospital. Hospital statistics and staff [Internet]. Kyoto: Kyoto University Hospital; c2026 [cited 2026 Jan 15]. Available from:

https://www.kuhp.kyoto-u.ac.jp/outline/statistics-results.html

4. Kyoto University Hospital. Department of Ophthalmology – clinical services [Internet]. Kyoto: Kyoto University Hospital; c2026 [cited 2026 Jan 15]. Available from:

https://www.kuhp.kyoto-u.ac.jp/department/departments/ophthalmology.html

5. Kyoto University Hospital, Department of Ophthalmology and Visual Sciences. Student education and instruction [Internet]. Kyoto: Kyoto University Hospital; c2026 [cited 2026 Jan 15]. Available from:https://www.ophthalmol.kuhp.kyoto-u.ac.jp/page_instruction.html

6. Baylis O, Murray PI, Dayan M. Undergraduate ophthalmology education – a survey of UK medical schools. Med Teach. 2011;33(6):468–471. doi:10.3109/0142159X.2010.540594