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Ophthalmology Residency Interview Questions and Answers

Medical Residency Application & Interview Preparation Specialists

Interviews for an Ophthalmology Residency can require a breadth of knowledge and attributes. Here, we present 10 questions and answers suitable for candidates to an Ophthalmology Residency in the US. Further questions can be found in our Medical residency question bank

Career and General Knowledge

Tell me about the overview of training in ophthalmology. How long are you expecting to train?

I’m expecting to undertake a standard four year residency, of 1 transitional year, then the three years of ophthalmological residency. After this, I’m interested in taking a fellowship; I haven’t yet decided, but either paediatric ophthalmology or ophthalmic pathology would both be one year, for example – making a total training time of five years.

What subspecialty are you particularly interested in? How long will training take?

I’m most interested in paediatric ophthalmology, as I believe it will allow the chance to further my training in ophthalmology whilst still maintaining a relatively broad view of the specialty. I’ve always believed that working with young patients is especially rewarding, so being able to specialise, maintain some degree of generalisation with the specialty, and work with young patients is the perfect combination for me. Training would take four years for Residency, plus one year for the fellowship, so five years in total. 

Tell me about a classification system used to stage hypertensive retinopathy.

The Keith-Wagener-Barker classification is used for this purpose. Grade 1 is mild, generalised constriction of retinal arterioles. Grade 2 involves focal narrowing of retinal arterioles and AV nicking. Grade 3 is equivalent to grade 2, plus flame-shaped haemorrhages, hard exudates, and cotton wool spots. Grade 4 is equivalent to severe grade 3 retinopathy with papilloedema or signs of retinal oedema. 

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Knowledge of Disease

Tell me about the pathophysiology of acute-angle closure glaucoma.

AACG occurs in those with shorter eye lengths and a more shallow anterior chamber. Typically, those with this anatomy (i.e. those who are predisposed) will still not experience attacks. In AACG, reduced drainage of the aqueous humour is caused by narrowing of the anterior chamber angle. This is mediated through a pupillary block, in which there is contact between the iris and lens, with the iris mid-dilated. This in turn causes the peripheral iris to block the drainage angle, and in turn causes a rapid rise in intraocular pressure. 

Tell me about a classification system used to stage hypertensive retinopathy.

The Keith-Wagener-Barker classification is used for this purpose. Grade 1 is mild, generalised constriction of retinal arterioles. Grade 2 involves focal narrowing of retinal arterioles and AV nicking. Grade 3 is equivalent to grade 2, plus flame-shaped haemorrhages, hard exudates, and cotton wool spots. Grade 4 is equivalent to severe grade 3 retinopathy with papilloedema or signs of retinal oedema. 

How is amblyopia classified? What is it more commonly known as?

Amblyopia is classified according to the pathology underlying it. The most common form is strabismic amblyopia, which develops in children with ocular misalignment. Anisometric amblyopia develops due to an unequal refractive error in the two eyes, in turn meaning that one of the retina is defocused. Isometropic amblyopia is the result of equal and uncorrected refractive errors in both eyes, leading to a bilateral reduction in acuity. Deprivation amblyopia is typically caused by congenital media opacities like congenital cataracts or early-onset ptosis. This is both the least common and the most damaging amblyopia. 

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Diagnosis and Management

What are typical findings on exam of Herpes Zoster Virus?

Examination of patients with suspected HZO should cover visual acuity, colour vision, anterior segment examination, slit lamp exam, fundoscopy, and extraocular eye muscles. Typical findings will include eyelid erythema and oedema, skin lesions including macules, papules, vesicles, pustules and crusted lesions, conjunctival injection, punctate keratitis and pseudodendrites, signs of anterior uveitis, reduced corneal sensation, and cranial nerve palsy. Hutchinson’s sign is an important finding that predicts ocular involvement in HZO and refers to cutaneous lesions of the V1 nasal branch.

How would you manage Herpes Zoster Virus?

Antiviral therapy is the main treatment, and must be provided within 72 hours of the rash onset. Oral acyclovir 800 mg five times a day for 10 days would be a typical regimen. Oral steroids should be used concurrently, and may decrease pain and accelerate rash resolution. Supportive treatments include oral analgesics, lubricants and cold compresses. Severe many may require opioids, carbamazepine, gabapentin, tricyclics, cycloplegics or intraocular pressure lowering drops. 

How would you manage amblyopia?

Management should involve eliminating the obstacle to vision, correcting refractive error, and if needed forcing use of the poorer eye.

Optical correction is the first step, and is then followed by either spectacle correction or patching if needed. Patching of the good eye forces use of the weak eye. Duration of patching depends on the severity of the amblyopia and how it responds to treatment – for example, moderate amblyopia would require two hours per day, increased to six hours per day as improvement stops. Atropine penalisation is the purposeful degradation of the better eye with cycloplegic drops, forcing the use of the weaker eye. It is used if spectacles alone have no impact and patching compliance is poor. Atropine 1% can be used.

Tell me about the management of retinal detachment.

The first step is prevention – those with symptoms of acute posterior vitreous detachment or a retinal tear must be examined and treated with laser photocoagulation if a retinal tear is found. If a retinal detachment does occur, there are three surgical treatments used:
– Vitrectomy is the most common treatment, and uses cryotherapy or laser therapy to seal the retinal tear, with the eye then being filled with an absorptive agent (e.g. air or silicone oil) to hold it in place
– pneumatic retinopexy is a 2-step process for straightforward cases, and involves injecting an expansive gas into the vitreous, before using laser or cryotherapy retinopexy to create an adhesive scar that holds the retina in place.
– A scleral buckle is when cryotherapy or laser photocoagulation is used to create a scar, with a silicone band then sutured onto the sclera in order to close the retinal break. The buckle remains around the eye permanently in most cases.

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