• medical referrals
• surgical referrals
• workload
• general ophthalmic practice

Surgical advances have been spectacular during the past few decades and have radically changed the practice of ophthalmology.^1–3 Accordingly, most of the subspecialisation in ophthalmology is surgically oriented and the trainee in the 21st century rightly devotes much time honing skills in surgical manoeuvres. However, all ophthalmologists are aware that a large part of practice relates to medical—that is, non-surgical, problems. The severity and management of these “medical” conditions vary. While the treatment of some is relatively straightforward, the treatment of others is more complex such that it becomes a major responsibility for those providing care to ensure that care is properly delivered and monitored. Many of these conditions are related to broader general medical problems, such as rheumatology, neurology, endocrinology and diabetology, cardiovascular disease, and inflammatory/infectious disease. In these circumstances, ophthalmic surgeons commonly request assistance in the medical care of these patients from a general physician. However, this places a significant burden on the physician who may not feel sufficiently qualified to monitor the responses to medical treatment of the eye.

This is the argument for a new kind of ophthalmologist who is skilled in ophthalmic medical diagnosis, who can relate systemic medical disease to ophthalmological conditions, who can assess the general medical status of patients who have a primary ophthalmological disease, and who can prescribe and monitor the most appropriate drugs for treatment of medical sight threatening disease.⁴ It is on this basis that a limited training programme for consultant specialist medical ophthalmologists is already in place in the United Kingdom. However, recruitment in this programme has been slow, the result in part of the limited number of consultant positions currently funded. Nevertheless, before medical ophthalmology posts can be made …