By Dr. Jignesh M. Gala — Vitreoretinal & Cataract Surgeon, Crystal Clear Eye Clinic, Andheri West, Mumbai
Most patients have, at some point, heard the phrase “peer-reviewed medical journal.” Fewer know what that phrase actually means in practice — and even fewer know who the peer reviewers are. This post is, in some ways, my answer to that question for the part of medical publishing that I am personally involved in.
Since November 2019, I have served as a peer reviewer for BMJ Case Reports, the case-reports journal of the BMJ Publishing Group. Over the past six years I have reviewed several submitted manuscripts in ophthalmology, my contribution is acknowledged on the journal’s reviewer recognition list, and the role remains, quietly, one of the most intellectually formative parts of my professional life.
This post explains what BMJ Case Reports is, what peer reviewing actually involves, and why I think the work matters — both for medicine and for the patients who, ultimately, are the people any peer-reviewed paper exists to serve.
What BMJ Case Reports Is
BMJ Case Reports is the dedicated case-reports journal of the BMJ Publishing Group — the same publishing house that produces The BMJ (the British Medical Journal), one of the oldest and most influential general medical journals in the world, founded in 1840.
BMJ Case Reports itself is among the largest case-report journals globally, publishing thousands of peer-reviewed case reports across every major medical specialty each year. The journal’s editorial office is based at Tavistock Square in central London, and its mission is to share clinically valuable case reports — unusual presentations, rare diseases, novel investigative findings, and lessons learned from complications — with the international medical community.
Every case report submitted to the journal is sent to two or more independent peer reviewers — practising clinicians with relevant specialty expertise — who assess the manuscript before any decision to accept, revise, or reject is made.
I am one of those reviewers, on the ophthalmology specialty list.
How a Peer Review Begins
A peer review begins with an email invitation from the journal’s editorial office. The email contains the manuscript title, the lead and co-authors, and a brief summary of the case. The reviewer is given a defined deadline — typically two weeks — and can choose to accept, decline, or recommend an alternative reviewer if the topic falls outside their area of expertise.
Once an invitation is accepted, the reviewer is given access to the full submitted manuscript through the journal’s online review system. The work is strictly confidential — reviewers are required to treat the manuscript as a privileged document and may not share, discuss, or otherwise disclose its content outside the formal review process. This confidentiality is not optional; it is the foundation of how scientific peer review works.
The review itself involves reading the manuscript carefully — often multiple times — and answering structured questions covering:
- Novelty — is the case actually adding something to the published literature, or is it covering well-trodden ground?
- Clinical accuracy — are the investigations appropriate, the diagnoses justified, the management evidence-based?
- Methodology — has the imaging, investigation, and follow-up been carried out and reported correctly?
- Quality of communication — is the case clearly written, are the figures legible, would an international ophthalmologist reading this in another country understand the message?
- Ethical handling — appropriate patient consent, anonymisation of identifying details, adherence to the journal’s research ethics standards.
The reviewer then writes a structured assessment with specific recommendations and submits a final decision suggestion: accept, minor revision, major revision, or reject.
For complex manuscripts, the process can run across several rounds. A single case report may go through one or more major revisions, additional rounds of independent reviewer assessment, and a final re-evaluation before a decision is reached. Each round is a fresh, independent reading — even when the manuscript is one you have looked at before.
The Breadth of Ophthalmology Cases
Without disclosing anything case-specific (peer review is, as I have said, strictly confidential), I can say that my reviewing work over the past six years has spanned the breadth of clinical ophthalmology — including manuscripts in:
- Neuro-ophthalmology
- Medical retina
- Uveitis and ocular inflammation
- Cataract surgery and the assessment of post-operative complications
- Combined-pathology cases — for example, retinal disease in patients with co-existing glaucoma
The range of topics reflects something that is true of ophthalmology in general: the eye is rarely a single isolated system. A diabetic patient’s retina is also their kidneys and their cardiovascular health. A glaucoma patient’s optic nerve may be affected by a co-existing retinal vein occlusion. Peer review at this level constantly forces you to think about the whole patient — which is exactly the kind of thinking I try to bring to my own clinical practice every working day.
What Peer Reviewing Teaches You
There is a quiet truth about peer reviewing that I think is worth saying out loud: the reviewer learns at least as much as the author.
When you sit down with a manuscript that is being submitted to an international journal — whether you ultimately recommend accept, revise, or reject — you are forced to think harder about the underlying clinical question than routine practice usually demands of you. You re-read the relevant literature. You scrutinise the imaging. You check whether the dose of the medication was appropriate. You ask yourself whether you would have managed the patient the same way. If you wouldn’t, you ask why.
That discipline does not stay confined to the review. It comes back with you into clinic.
Six years of reviewing for BMJ Case Reports has had, for me, a cumulative effect that is difficult to describe but easy to feel. I am, I think, a more careful diagnostician than I would otherwise be. I am quicker to question my own initial impressions. I am more rigorous in the way I document clinical reasoning. And I read the medical literature with a more critical eye than I did before I started reviewing. Each of those things matters for the patients I look after.
Recognition on the Reviewer List
BMJ Case Reports formally acknowledges its peer reviewers through a published recognition list — a public record of clinicians who have contributed substantively to the journal’s review process. My name appears on that list, and that recognition is something I value not as an end in itself but as confirmation that work which has been done entirely in confidence, over six years, has met the journal’s standards.
For any clinician reading this who is considering becoming a peer reviewer: the work is unpaid, it is time-intensive, and it is largely invisible. But it is also, in my honest opinion, one of the most professionally enriching things a working clinician can do.
Why This Matters for the Patients I See
When a patient walks into Crystal Clear Eye Clinic in Andheri West today, they are not — of course — primarily interested in my peer review work. They want to know whether the diagnosis I have given them is correct, whether the treatment I am proposing is the right one, and whether their vision is going to be preserved.
But behind those answers, every single one, is the cumulative effect of years of disciplined engagement with the international medical literature. The clinical instinct I bring to a complex retinal case, the willingness to question a textbook diagnosis when the patient in front of me does not quite fit the textbook, the rigour of my note-taking and follow-up — all of these have been sharpened by the hundreds of hours I have spent, over the past six years, reading carefully and writing critically about other clinicians’ cases.
If you are reading this and you have an eye condition that has been difficult to diagnose, an unusual presentation that a previous doctor has been uncertain about, or a complex case that has not responded to standard treatment, I would be glad to offer you a careful second opinion at Crystal Clear Eye Clinic.
About the Author
Dr. Jignesh M. Gala is a vitreoretinal and cataract surgeon based at Crystal Clear Eye Clinic, Andheri West, Mumbai. He holds MRCS (Edinburgh) and FRCS (Glasgow) — dual Royal College surgical qualifications from the United Kingdom — along with FICO (London) from the International Council of Ophthalmology. He completed dual fellowships in Comprehensive Ophthalmology and Medical & Surgical Retina at L V Prasad Eye Institute, Hyderabad, and served as a Resident Physician with the Department of Ophthalmology, Woodlands Health (NHGEI), Singapore (2021). He has been a peer reviewer for BMJ Case Reports since November 2019.
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