How to Get Into Ophthalmology in the UK
- Virginija Vilkelyte
- Dec 8, 2025
- 5 min read
The interest in ophthalmology grows, as junior doctors all over the world are looking to get into the ophthalmology specialty. The UK is no exception. In the 2025 recruitment round, 2,197 applicants competed for just 102 ST1 posts.
This makes it a competition ratio of 22 to 1.
That number alone tells you two things:
You need to be very intentional about applying.
You have to start thinking about it early.
In this article, I’ll go through the basic pathway into ophthalmology in the UK, the application process, and how the portfolio works. I'd also share practical tips on what you can do in medical school and foundation training to give yourself the best possible chance.
1. The Basic Training Pathway
The route into ophthalmology in the UK is:
An accredited medical degree
Two years of Foundation Training (F1 and F2)
Application to Ophthalmology ST1 (OST) via Oriel
Some trainees are lucky enough to have a 4-month foundation rotation in ophthalmology. If you get this, use it well, it opens doors for:
Audit and QI projects
Teaching opportunities
Taster clinics and theatre lists
References and mentorship from ophthalmology consultants
2. Applying through Oriel
When you apply:
Roughly around November of your F2 year, you submit your application for ST1 Ophthalmology through the Oriel online system.
You’ll need to provide:
Basic demographic details
Current and previous job posts
Referees who can confirm your posts and performance
Declarations about your experience and eligibility
The application form itself is mostly admin. The real selection happens later through the MSRA, your portfolio, and the interview.
3. The MSRA
After you submit your Oriel application, you’ll be invited to sit the Multi-Specialty Recruitment Assessment (MSRA).
In short, the MSRA is:
A general medical and surgical knowledge exam
Mixed with a situational judgment component
Originally designed for GP recruitment, but now used across multiple specialties
It tests breadth rather than depth, so you’re not expected to know every last detail of all specialties. Instead, it looks at how safe and sensible you are as a doctor overall.
From everyone who applies to ophthalmology and sits the MSRA, only a proportion (roughly the top few hundred) are invited to go forward to the portfolio and interview stage.
In other words, a strong portfolio won’t help you if your MSRA score is too low to get through the door. It’s worth taking seriously.
4. The Interview
At the time of writing, interviews are conducted online and typically include elements such as:
Simulated patient consultations
Questions around communication, empathy, and management plans
Reflection on your experience and motivation for ophthalmology
Scores are awarded across different domains (e.g. professionalism, clinical reasoning, communication). Inevitably there is some subjectivity, and things like nerves or life events can affect how your interview goes on the day.
That’s exactly why I’m a big believer in the next bit being your anchor: the portfolio.
5. The Portfolio - The Part You Control Most
Compared to the MSRA and interview, the portfolio is the one major part of the process that you can shape over months and years, not just on a single day.
The guidance is set out in detail by the Severn Deanery / national recruitment team, but the main message is simple: Start early. The earlier the better.
Foundation training is busy. You’re adjusting to working life, nights, on-calls, and just learning how to function on the ward. Trying to build an entire portfolio from scratch during F1 and F2 is possible, but it’s hard work.
If you already know you’re interested in ophthalmology, it really helps to:
Use medical school to get some of the heavier lifts done (audits, projects, early teaching, maybe even a publication).
Plan ahead for key ophthalmology conferences – put dates in a calendar and see what fits around your rota.
Consider attempting FRCOphth Part 1 early. It’s an exam by the Royal College of Ophthalmologists that you’ll need later in training anyway, and it scores portfolio points simply for attempting it, with even more for a pass.
6. Portfolio Domains - A Quick Overview
Below is a very condensed summary of the current portfolio domains and how they’re scored. You don’t need to max out everything, but this gives you a sense of where to target your efforts.
Domain | Key Idea |
Previous Posts | List all posts (most recent first). Say if you’re not in a clinical job. Not scored – just context. |
Qualifications (max 5) | Extra non-intercalated degrees only. 1 pt each: MSc/BSc/PGCert ≥8 months full time (incl. Optometry). 3 pts: MD/MPhil with ≥2 years’ full-time research (not an automatic MD). 4 pts: PhD/DPhil with ≥3 years’ full-time research. MRCP/MRCS don’t score. |
Prizes / Awards (max 5) | Points for things like the Crombie Medal, strong performance in national exams (e.g. Duke-Elder), being 1st in year with evidence, lead author on successful grants, and “Best presentation/poster” prizes at national/international meetings (within limits). |
MSF (max 2) | Recent multi-source feedback (usually within 18 months), enough raters, signed or official TAB. 0 pts if missing/poor; 2 pts for satisfactory scores with good comments. |
Quality Improvement / Audit (max 5) | Your best audit or QI project in the last 3 years, with clear consultant letter. Marks increase as your role becomes more active (designing, writing up, implementing change). Top marks require closing the loop or supra-regional impact. If you weren’t clearly the lead, you’re capped at 1 point. |
Presentations (max 6) | Original work only. Regional, national and international presentations score differently; posters and videos get half points. Second author can sometimes score if you actually presented. Same piece of work can only be used once across domains. |
Publications (max 6) | Peer-reviewed original research or systematic reviews. More points for 1st/joint-1st author, fewer for 2nd–4th. Nothing if 5th or lower. Again, no double-counting with presentations or audits. |
Education & Teaching (max 5) | Helping with courses/mock OSCEs, e-learning, e-books, teaching qualifications, book chapters, or authoring a textbook can all score, but it’s the actual activities, not job titles, that matter. Formal teaching over time with feedback is important. |
Ophthalmology Specialty Links (max 13) | This is the big one for showing commitment: Refraction Certificate, FRCOphth Part 1 (attempt or pass), ophthal electives, student projects, taster weeks, extra clinics/theatre, EyeSi/simulation, meetings attended, and other relevant evidence. No double-counting with other sections. |
Overall Portfolio Layout (max 3) | How clear, logical and well-organised your portfolio is. You can gain up to 3 points just by making it easy to navigate. |
7. Final Thoughts
All in all, getting into ophthalmology in the UK is difficult, but absolutely possible.
You’re applying to a specialty where:
The competition ratio is brutal on paper.
The process is long and sometimes confusing.
Exams, courses and conferences are time-consuming and often expensive.
But you don’t need to have a “perfect” application. What you do need is:
A clear, consistent story of why you want to do ophthalmology.
A thoughtful, early approach to building your portfolio.
Enough breadth of general medicine knowledge to do well in the MSRA.
And a bit of resilience when things don’t go exactly to plan.
If you start early, use medical school and foundation training wisely, and are honest with yourself about your strengths and weaknesses, you give yourself a very real shot - even in a 22:1 world. You got this!
ABOUT THE AUTHOR
Virginija Vilkelyte is a Foundation Year 2 doctor currently working in Winchester, UK. Originally from Lithuania, she moved to Exeter, where she completed her medical degree. She is now pursuing her goal of training as an ophthalmologist.
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