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My journey towards ophthalmology did not begin anywhere near the eye.
For most of my early surgical career, surgery was something I experienced on a large scale.
From foundation training, my time in general surgery, particularly hepatobiliary surgery, involved major abdominal operations, liver resections, biliary surgery and working around some of the largest and most unforgiving structures in the body. I was also exposed to emergency surgery, where the operating theatre could rapidly shift from controlled dissection to managing life-threatening pathology, including traumatic cardiac arrest and emergency thoracotomy in A&E.
My subsequent experience in trauma and orthopaedics continued that theme, albeit in a very different anatomical world. Instead of liver and major vessels, there were open fractures, fixation, arthroplasty and spinal surgery for scoliosis correction. The tissues changed, the instruments changed and the objectives changed, but surgery remained intensely physical.
Whether retracting during a major abdominal resection, manipulating a limb to achieve fracture reduction or assisting with exposure during orthopaedic surgery, operating often involved the whole body. Your fingers controlled the instruments, but so did your wrists, forearms, shoulders, posture and sometimes your body weight.
I loved that physicality. There is something immensely satisfying about handling anatomy directly: mobilising a large organ, achieving exposure around a major vessel, reducing a fracture or watching a joint reconstructed. Surgery felt tangible. Problems could sometimes be held in your hands.
Then I discovered ophthalmology.
My interest initially led me to undertake an ophthalmology taster week in Cardiff. I spent time in theatres and clinics and on the Eyesi simulator, and it quickly became apparent that I had entered a very different surgical world. Even a simple confrontation test of the visual fields at the bedside can reveal cranial nerve pathology that might otherwise be chased with a CT scan.
The anatomy had suddenly become smaller.
Much smaller.
The scale of the pathology, however, had not.
A change measured in millimetres could determine whether somebody could drive, read, work or live independently.
That was when the contrast with my previous surgical life became impossible to ignore.
I had gone from the IVC to the iris.
From liver to lens.
From spine to sclera.
From femur to phaco.
And, in an era where I had seen surgery embracing platforms such as the da Vinci robot, I was now sitting at an Eyesi simulator, looking through a microscope and learning that an entire operation could depend on movements smaller than those I would previously have considered significant.
It was almost a complete reversal of what I had come to associate with operating.
In abdominal and orthopaedic surgery, strength certainly does not replace technique, but physical control is undeniably part of the job. Retraction needs to be maintained. A limb may need to be manipulated. Large tissues have to be mobilised. Instruments can be substantial.
On the Eyesi, physical strength was almost irrelevant.
The challenge was restraint.
I quickly realised that moving more was often worse than moving less.
A movement of only a few millimetres could be excessive. Instead of using my arm to position an instrument, I was learning to isolate tiny movements within my fingers. Instead of thinking about how much force was required, I was thinking about how little movement I could use.
That fascinated me.
I became increasingly conscious of things I had rarely analysed so closely before. Was the movement coming from my fingers or my wrist? Was I unintentionally moving my entire hand? Could I keep one instrument completely still while making a tiny controlled movement with the other? Could I reproduce exactly the same manoeuvre, but more smoothly?
The operating field may have been microscopic, but the demand for control felt enormous.
I progressed from the basic Eyesi exercises to cataract surgery simulation, and repetition became strangely compelling. Each attempt revealed another small imperfection. A movement could be smoother. The instrument could be steadier. The trajectory could be shorter.
Instead of trying to make a bigger movement more effectively, I found myself trying to make a smaller movement more precisely.
Perhaps the most surprising part was how much I enjoyed becoming a beginner again.
My previous surgical experience certainly helped. Hepatobiliary surgery had taught me respect for complex anatomy and the importance of careful dissection around vital structures. Emergency surgery had taught me to remain composed when the situation changed rapidly. Orthopaedics had strengthened my three-dimensional understanding of anatomy and hand–eye coordination. Spinal surgery had already shown me how millimetres matter when operating beside structures that cannot tolerate error.
But microsurgery demanded another level of refinement.
It was not a rejection of everything I had learnt before. It felt more like distilling it.
The same respect for anatomy remained. The same need for planning remained. The same satisfaction of using your hands to solve a problem remained.
Only the scale had changed.
My taster week allowed me to see ophthalmology as a specialty. The Eyesi allowed me to feel what ophthalmic surgery might actually demand from me.
That distinction changed everything.
I had spent years becoming comfortable with operations involving large organs, major vessels, long bones and the spine. Now I found myself excited by the idea that my future operating field might be less than a centimetre across.
Yet the motivation underneath it is remarkably consistent and growing.
What ophthalmology has taught me is that surgery does not have to be physically large to be technically enormous.
Sometimes the greatest challenge is not learning how much force to use. It is learning how little movement you need. Thanks for reading.
Thinking about ophthalmology yourself? Start with our guide to getting into Ophthalmology ST1, the Ophthalmology ST1 Application Guide 2026, or browse ophthalmology courses and events on MedCourse.
