Hi, my name is Linda and I’m a third year STP trainee in Ophthalmic and Vision Science (OVS) at Great Ormond Street Hospital for Children NHS Foundation Trust. While we may not be one of the larger specialisms out there, we have a vital role to play in patient care. After all, vision is one of the most fundamental ways we experience the world, and the eye is a window into the brain and body! For those considering starting their journey with clinical science, hopefully I can provide an eye-opening insight (see what I did there?) into the ‘What’, ‘Why’ and ‘How’ of OVS.
WHAT is Ophthalmic and Vision Science? Is it like going to the opticians?
When you look at something, the light reflected from the object travels through and is refracted by the front portion of your eye before reaching the retina (the thin layer at the back). The retina contains millions of photosensitive cells and support cells that convert this light stimulation into electrochemical signals, which are then transmitted along the optic nerve to the visual cortices of the brain for processing and interpretation. Signals from each eye partially cross over so each brain hemisphere receives information from both eyes.
While your local opticians or optometrist mainly help to diagnose and treat conditions that affect the front portions of your eye, some eye conditions might involve other parts of the visual system. These can include the eye muscles, the structures inside the eye, the retina, the optic nerves, the optic pathway through the head, or even the brain itself. These conditions may arise due to genetics, injury, autoimmunity, infection, diet, environmental factors, association with a syndrome or other illness, or have no clear underlying reason.
OVS scientists use a variety of sensitive technologies to investigate the different parts of this visual pathway. For example, electroretinography (ERG) can be used to check the functioning of different cells in the retina, while the visual evoked potential (VEP) records activity from the brain to assess the ‘wiring’ between the retina to the primary visual cortex. Using different imaging techniques such as ultrasound, optical coherence tomography and confocal laser scanning microscopy, we can also look for any structural changes of the posterior eye. Each different investigation adds another puzzle piece to the whole diagnostic picture, enabling the patient to receive the optimal management for their condition.
In a paediatric setting, the ERG and VEP as objective tests of visual function are particularly useful. For instance, if a baby shows early signs of vision concerns, you can’t really ask them to read down a letter chart or press buttons on a visual fields test to work out what’s going on! As well as aiding diagnosis we can also use data to monitor patients’ progress as they get older or recover on treatment. Common paediatric conditions like amblyopia or strabismus can have long-term effects on neural visual pathway development, so we often also work closely with orthoptists, who check eye movements and how both eyes are working together.
OVS scientists in adult settings may work with patients with later onset genetic conditions or eye issues secondary to medication, environment, injury or illness (e.g. macular degeneration, optic neuritis, glaucoma, chorioretinopathy etc.) so might tailor their testing in different ways. Nonetheless as healthcare scientists we need to ensure our investigations are evidence-based, accurate, and harmonised, so that data and patient care are comparable across sites and regions. We also play a part in research and innovation. For example, as well as our day-to-day roles, we may be also working to improve the quality, efficiency and patient-friendliness of processes; strengthening our understanding of structure-function relationships in disease; or researching how various conditions may manifest clinically in different people.
There are over 1.1 billion people living with sight loss worldwide, which in 90% of cases are preventable or treatable (IAPB, 2020). This makes vision science an important and powerful field. Current developments include genetic therapies for rare childhood-onset blindness, use of artificial intelligence in retinal scans, and new biomarkers for monitoring vision-related conditions. It’s a privilege to be training and working in a role that combines scientific problem-solving with making a direct difference to patient outcomes.
HOW did I get here?
I have a neuroscience/pharmacology background but have also had experience in the lab and in people-facing roles. After graduating from an MSc I worked in a company helping healthcare industry clients to run medical education events and commercialise their products – one of which included a lens implant for macular degeneration. While I enjoyed my time working there, it was entirely office-based and I missed being close to the science and making a tangible impact on people’s health. I had previously applied unsuccessfully to the STP as an undergraduate, so wanted to give it another try.
It is well known that the STP can be competitive and it is not uncommon for people to apply multiple times, though I also know several trainees who were succcessful straight from their undergraduate studies. For me, I feel the additional experiences I gained from hospital volunteering, insight from working in different sectors, and research skills built up during university all helped to consolidate my motivation for the programme and strengthen my application the second time around.
If you’re applying, don’t worry if you feel your experiences are not directly relevant – it will be more important to show how they have shaped your development, what you’ve learned, and how these skills could be transferable. There is a lot of emphasis on being a reflective practitioner. Before applying I also reached out to clinical physiologists to sit in on an evoked potentials clinic. If you’re interested, and especially if you’re a direct-entry applicant as I was, I would recommend visiting open days, speaking to current trainees/scientists (and reading blogs like this!) to get a truer feel for what the roles and responsibilities entail.
A day in the life of an OVS STP trainee
When working in a paediatric environment, no two days are the same! At the start of the day we power up all our necessary equipment and perform daily checks. This is important to make sure all components are working, electrically safe, and properly calibrated to ensure accuracy of our results. We look through the patients booked for the day to get an understanding of their medical history, reason for referral, and any special adjustments they might need. Our team sees children of all ages (from tiny babies to college-age teenagers), and with all levels of vision, abilities and backgrounds – so we need to tailor our investigations both to the individual patient and to the diagnostic question.
As you can imagine, getting an active toddler to cooperate with tests that require lots of staying still is not always easy! We work as a team with colleagues and parents/carers to help obtain the best data we can, as well as make the appointments enjoyable. Luckily we’re well-stocked with toys, stickers, cartoons and songs. The appointment might involve visual electrophysiology tests, ultrasound scanning, colour vision testing, eye-movement recordings, and/or retinal imaging. Procedures in adult centres may run slightly differently. We then analyse and interpret the data to produce a clinical report of our findings, which the referring clinician will use to guide discussion during the consultation with the patient/family.
As an STP trainee you will be trained in the clinical role of the OVS scientist as well as principles of Good Scientific Practice and professional practice, all of which go towards your final portfolio of competencies and assessments. I also had rotations with Neurophysiology and Audiology in other hospitals, which gave me valuable insights into how neurosensory services interact and complement one another, as well as how things work in adult settings. You will attend academic teaching on healthcare science and specialist modules, and carry out your own research project in years two and three. There may also be additional opportunities to partake in clinical research, audits and innovation in your department, and be involved with healthcare science outreach.
With so many responsibilities and deadlines to juggle, time management is undoubtedly a vital skill to hone as an STP trainee. However, it is just as important to look after your own mental wellbeing, maintain a good support network around you, and to take breaks and do the things you enjoy. Some centres have lots of trainees and others very few, so it might feel isolating if you’re in the latter, but you can look out for peer networks (pun unintended?) in your local area or region to meet trainees in the same boat as you.
Most trainees will agree that it’s certainly not always smooth sailing over the three years, especially now with the added uncertainties of Covid-19. The pandemic has definitely compelled me to become more adaptable and proactive with my own training and progression. Though the learning curve has at times been steep, I’ve found my journey so far through clinical science a fulfilling, fascinating and varied one. I am excited to see what the future holds for my field and for the healthcare science workforce. Best of luck if you’re applying!
Linda Shi, Great Ormond Street Hospital for Children NHS Foundation Trust