Download Neuro-Ophthalmology in the United Kingdom

Worldwide Neuro-Opthalmology
Section Editor: Kathleen B. Digre, MD
Neuro-Ophthalmology in the United Kingdom
N
euro-ophthalmology in the United Kingdom has a rich
and longstanding history with a long list of luminaries
that include John Hughlings Jackson (1835–1911),
Douglas Argyll Robertson (1837–1909), Harry Moss
Traquair (1875–1954), Sir Gordon Morgan Holmes
(1876–1965), and William John Adie (1886–1935), to
name but a few. These historical figures set the foundation for modern neuro-ophthalmology with their seminal
work on fundamental concepts ranging from the topographical organization of the visual cortex to the physiological basis of the pupillary light reflex and to the island
of vision. More recent notable figures include William Ian
McDonald (1933–2006) for his pioneering work on optic
a distinct subspecialty in the United Kingdom owes a large
part to Michael Sanders who spent his fellowship year with
William Hot at University of California, San Francisco, CA
in 1967 before returning to practice at Queen Square in
London (Fig. 1). This important transatlantic link has since
flourished with a significant proportion of the current crop
of British neuro-ophthalmologists having trained directly
under Sanders’ wings.
Training Structure
The majority of neuro-ophthalmologists in the United Kingdom are Fellows of the Royal College of Ophthalmologists
FIG. 1. William Hoyt (center) with Michael Sanders (right) and Robert Daroff (left) during their fellowship year, 1967 (with
permission from Kline LB. An interview with William F. Hoyt, MD. J Neuroophthalmol 2002;22:40–50).
neuritis and multiple sclerosis and Anita Harding (1952–
1995) who in a short, but stellar, academic career published some of the defining articles on Leber hereditary
optic neuropathy and the inherited neuromuscular
diseases. The development of neuro-ophthalmology as
Wellcome Trust Centre for Mitochondrial Research, Institute of
Genetic Medicine, Newcastle University, Newcastle upon Tyne,
United Kingdom; Newcastle Eye Centre, Royal Victoria Infirmary,
Newcastle upon Tyne, United Kingdom; and NIHR Biomedical
Research Centre at Moorfields Eye Hospital and UCL Institute of
Ophthalmology, London, United Kingdom
Yu-Wai-Man: J Neuro-Ophthalmol 2014; 0: 1-3
(FRCOphth), having initially trained as general ophthalmologists before gaining additional subspecialty experience
in neuro-ophthalmology. The minimum period of
ophthalmology training is 7 years and, after being awarded
a Certificate of Completion of Training, a trainee is
eligible to apply for an attending position (known as
a Consultant in the United Kingdom). However, an
increasing number of neuro-ophthalmologists also come
from a neurology background, which further adds to the
diversity of skills and expertise. There are a number of
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Copyright Ó North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.
Worldwide Neuro-Opthalmology
well-regarded neuro-ophthalmology fellowships, for example, in Birmingham and in London, which attract both
local and overseas trainees. Prospective candidates should
keep an eye on the careers section of the British Medical
Journal where openings are regularly advertised (http://
careers.bmj.com/).
Neuro-Ophthalmology Services
The National Health Service (NHS) in the United
Kingdom is a publicly funded system of care that was
founded in 1948 at the end of the Second World War. It is
the world’s largest healthcare system and despite mounting
economic pressures, the NHS remains free at the point of
use for UK residents. Although neuro-ophthalmology
services are usually concentrated in larger ophthalmology departments based in major cities, many neuroophthalmologists will also provide outreach clinics,
especially in parts of the country with catchment populations spread over large geographical areas. Patients are
referred by a number of sources, but the majority of those
are from primary care physicians, casualty departments,
and secondary referrals from ophthalmology, and other
hospital specialties. Most neuro-ophthalmologists who
come from an ophthalmology background will also provide
a surgical service, for example, cataract and strabismus
surgery, depending on their fellowship training and
personal interests. Botulinum toxin injections also are
frequently provided by neuro-ophthalmologists for the
treatment of a wide range of neurological disorders, in
particular facial dystonias, and in the management of more
complex strabismus cases.
Clinical and Research Meetings
Neuro-ophthalmology is a relatively small subspecialty, but
our members are heavily involved in the training of junior
trainees at both local and national levels. Through the Royal
College of Ophthalmologists, a number of dedicated neuroophthalmology teaching days are organized each year, which
are always oversubscribed and highly valued by the
attendees (http://www.rcophth.ac.uk/). As a result of
popular demand, neuro-ophthalmology sessions have also
become a permanent fixture of the main ophthalmology
meetings in the United Kingdom such as the Annual
RCOphth Congress, the Oxford Ophthalmological Congress (http://www.oxford-ophthalmological-congress.org.uk/),
and the Annual Meeting of the Association of British Neurologists (ABN; http://www.theabn.org/). Gordon Plant laid
the foundation for a Special Interest Group allied to both the
ABN and to the Royal College of Ophthalmologists in 2006.
This effort culminated in the creation of the United
Kingdom Neuro-Ophthalmology Special Interest Group
(UKNOSIG), and the sixth annual meeting took place on
March 12, 2014 (Governors’ Hall, St Thomas’ Hospital,
London, United Kingdom) with Andrew Lee (Houston,
TX) as the keynote speaker (http://www.uknosig.com/).
Another important date in the calendar is the annual
TABLE 1. Some examples of neuro-ophthalmological research in the United Kingdom
Region
England
City
Birmingham
Research Interests
Idiopathic intracranial hypertension
Idiopathic intracranial hypertension and giant cell arteritis
Pediatric neuro-ophthalmology
Sheffield
Belfast
Mr Michael Burdon
Miss Susan Mollan
Miss Brinda
Muthusamy
Prof. Irene Gottlob
Mr James Acheson
Mr Nadeem Ali
Mr Fion Bremner
Dr Elizabeth Graham
Dr Gordon Plant
Mr Patrick Yu-Wai-Man
Mr John Elston
Prof. Christopher
Kennard
Dr Simon Hickman
Miss Jayne Best
Edinburgh
Bangor
Dr Stephen Madill
Dr Martyn Bracewell
Adult strabismus
Higher order visual dysfunction and visuomotor control
Cambridge
Leicester
London
Newcastle
Oxford
Northern
Ireland
Scotland
Wales
Investigator
Eye movement disorders, nystagmus, and ocular imaging
Rehabilitation of neuro-visual deficits and vigabatrin toxicity
Neuro-motility and functional disorders
Pupil abnormalities
Uveitis, inflammatory and infectious diseases
Optic neuropathies and demyelinating disorders
Mitochondrial disorders, neurogenetics, and clinical trials
Pediatric neuro-ophthalmology
Oculomotor control and neurodegenerative diseases
Optic neuritis, idiopathic intracranial hypertension, and clinical trials
Idiopathic intracranial hypertension
For those of you who are somewhat confused by the use of titles such as Mr and Miss in the above table, the explanation is relatively
simple. In the United Kingdom, historically, surgical trainees who have successfully completed their Royal College examinations are referred
to as Mr or Miss. This rather peculiar British tradition is a throwback to the early 18th century when surgeons (compared with physicians) did
not possess a university medical degree (MD) but instead belonged to the “Company of Barber-Surgeons.” However, to confuse matters even
further, surgeons in Scotland frequently use the title Dr, and not Mr or Miss, in their clinical practice.
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Yu-Wai-Man: J Neuro-Ophthalmol 2014; 0: 1-3
Copyright Ó North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.
Worldwide Neuro-Opthalmology
gathering of the British Isles Neuro-ophthalmology Club
(BINOC), which brings together a focused group of
consultants with a subspecialty interest in neuroophthalmology. The BINOC meeting takes place over
2 days, and it provides the ideal forum for colleagues to
discuss complex and unusual cases with a neuroradiologist
in attendance.
neuro-ophthalmology is certainly very bright in the United
Kingdom, but as a group, we are not resting on our laurels.
A central element of our mission statement is the need to
foster the next generation of neuro-ophthalmologists, not
only to deliver a first class clinical service, but also to lead
the way as the teachers, researchers, and leaders of
tomorrow.
Research Networks
Patrick Yu-Wai-Man, BMedSci (Hons), MBBS (Hons),
PhD, FRCOphth
Wellcome Trust Centre for Mitochondrial Research,
Institute of Genetic Medicine, Newcastle University,
Newcastle upon Tyne, United Kingdom
Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle
upon Tyne, United Kingdom
NIHR Biomedical Research Centre at Moorfields Eye
Hospital and UCL Institute of Ophthalmology, London,
United Kingdom
The close personal links between neuro-ophthalmologists
in the United Kingdom and the comprehensive clinical
network provided by the NHS are valuable assets that have
contributed to both the breadth and depth of neuroophthalmology research in this country. Our members
are heavily involved at the cutting edge of both basic
and translational research with active collaborations
across several specialties (Table 1). The UK neuroophthalmology community has also been well represented
within major international organizations over the years,
such the North-American Neuro-Ophthalmology Society
and the European Neuro-Ophthalmology Society
(EUNOS). Christopher Kennard is the current President
of EUNOS and the 11th EUNOS meeting (April 10–13,
2013) that took place in the beautiful and historic
setting of Oxford was a great success. The future of
Yu-Wai-Man: J Neuro-Ophthalmol 2014; 0: 1-3
ACKNOWLEDGMENTS
I am grateful to Simon Hickman (Sheffield) for his
very useful comments on the historical development of
neuro-ophthalmology in the United Kingdom.
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Copyright Ó North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.