Download Prof. Colin Willoughby

APPOINTMENT OF CONSULTANT OPHTHALMIC SURGEON
ROYAL LIVERPOOL UNIVERSITY HOSPITAL TRUST
ST PAUL'S EYE UNIT
JOB DESCRIPTION
MEDICAL RETINA FELLOW
Introduction
This post is for a (senior) medical retina fellow, the proposed start date is September 2014.
This full time post is for 6 months in the first instance renewable subject to mutual
agreement for a further period up to a total of 12 months. The fellowship is aimed at
ophthalmologists nearing the end or having completed their SpR training (or equivalent) and
wishing to sub-specialise in Medical Retina. In addition the post will be suitable for seniors
or for ophthalmologists from outside the UK with experience in general ophthalmology
wishing to gain skills in medical retina.
The successful applicant will be attached to Mrs. J Sahni, Prof SP Harding, Mr MC Briggs,
Mr IA Pearce and Mr NAV Beare, Consultant Ophthalmologists, Dr. Amira Stylianides
Consultant Medical Ophthalmologist and Drs. Lenfestey, Criddle and Broadbent, Associate
Specialist Ophthalmologists.
There will also be the opportunity to
The timetable of the postholder will be flexible and arranged with discussion with the
Clinical Director and the Medical Retina Consultant team. Proposed activity includes the
following sessions:1 Uveitis clinic or retinal vascular clinic
2 or 2.5 AMD clinic
2 Medical retina/General clinic (includes inherited retinal disease)
1 or 0.5 Laser clinic
0.5 General Theatre session
1 Diabetic Retinopathy / Screening Assessment Clinic
1 or 2 Research/Audit/teaching/administration,
Research activity will be closely supervised and the successful applicant is expected to
progress his/her projects to presentation of scientific conferences and publication in peer
reviewed journals in a timely fashion. The academic unit of ophthalmology is the
Department of Eye and Vison Science which is led by Professor Simon Harding and sits
within the Institute of Aging and Chronic Disease at the University of Liverpool.
Post holders will be expected to achieve the following:
Experience and expertise in the diagnosis, management and follow-up of patients with
age-related macular degeneration, inherited retinal dystrophies, diabetic retinopathy and
maculopathy, uveitis and retinal vascular diseases.
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Attainment of the following practical skills:
Intravitreal therapy, sub-Tenon’s and peri-bulbar injections, cyclodiode laser, Argon Laser
and Verteporfin Photodynamic Therapy
The ability to accurately interpret a variety of imaging and diagnostic techniques including
electrophysiology, infra-red and autofluorescence imaging, Fluorescein / Indocyanine
Green Angiography and Optical Coherence Tomography including enhanced depth
imaging.
The timetable may include a theatre session (likely 0.5 per week) and if the post-holder has
the ability the perform cataract surgery independently it is very likely that he or she will
have the opportunity to maintain these skills but the fellowship is not intended to provide
training in cataract surgery.
St. Paul’s Eye Unit
St. Paul’s Eye Unit is situated in the Royal Liverpool University Hospital. The Unit
provides modern facilities for the treatment of general and specialist adult
ophthalmological diseases based around nine inpatient beds and a dedicated ophthalmic
day ward, together with a four theatre dedicated operating department. Three theatres are
equipped for posterior segment and vitreoretinal surgery with full video teaching aids.
Laser facilities include argon with green option and video teaching, indirect laser,
endolaser, YAG, Excimer on a monthly basis, diode and PDT.
The purpose built outpatient department has full departmental support including refracting
and dispensing optical services, contact lens service, orthoptics, digital photography,
electrodiagnosis, corneal topography, ultrasound, OCT, HRA, HRT, GDx and stereo disc
photography (Kowa). An Excimer laser service was set up in July 1994 and now offers a
comprehensive range of services including PRK, LASIK and LASEK. There is a 24 hour
ophthalmology Accident and Emergency service and a Primary Care Clinic. A two storey
Clinical Eye Research Centre opened in 2003.
There are 30 Specialist Registrars, Trainees and Academic Clinical Fellows in the Mersey
Deanery with 14 of these attached to St Paul’s Eye Unit plus a clinical lecturer. There are
also three associate specialists and one staff grade and a variety of pre- and postaccreditation fellowships. Each consultant is responsible for the training of at least one
Specialist Trainee attached to his / her firm and specialises in a particular aspect of
ophthalmology, running special tertiary referral clinics and treatment sessions and coordinating postgraduate teaching and research. In addition each consultant is responsible
for the delivery of their specialist service to the community including aspects of
prevention, screening and training of other professional groups. There is a high level of
cross-referral between teams within the unit allowing rapid accumulation of special
expertise and research cohorts.
The Royal Liverpool and Broadgreen University Hospitals NHS Trust is involved with a
major reconfiguration of health services on the north side of the river Mersey. There are
now firm plans for a new hospital, the building of which will commence within the next
nine months. A new model of care has been proposed for this hospital with an emphasis on
community services and closer cooperation between primary and secondary care.
Ophthalmology hopes to take advantage of these plans. There have recently been several
major re-organisations of healthcare in the region (Cheshire and Merseyside) the two most
prominent of which are the Major Trauma Centre which is a joint venture with Aintree
University Hospitals Trust and vascular services which are now centralised at the Royal
Liverpool University Hospital.
The current service profile at St. Paul’s Eye Unit is as follows:
A. General ophthalmic care including accident and emergency, out-patient clinics, day
case and in-patient surgery, laser surgery.
B. Supraregional specialist service

Ocular Oncology

Ophthalmic Pathology
C. Regional specialist clinics
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Medical Retina (including diabetic eye disease, uveitis, AMD, PDT and anti-VEGF)
Corneal and External Eye Disease
Excimer Laser Surgery
Vitreoretinal surgery
Glaucoma
Ocular motility
Neuro-ophthalmology
D. Other Special Services
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Community-based Diabetic Retinopathy Screening
Contact Lens
Electrodiagnostics
Visual Fields
Orthoptics
Low Vision, including on site liaison officer for the LVSB (ECLO)
Senior Medical Staff at St. Paul’s Eye Unit
Name
Mr. Sajjad Ahmad
Sub-specialty
Cornea and ocular surface
Mr. Mark Batterbury
Glaucoma/Cornea
Mr. Nick Beare
Medical Retina / Uveitis
Mr. Michael Briggs
Acute Ophthalmology /
Medical retina
Paediatric Ophthalmology
Mr. Arvind Chandna
Mrs. Anshoo
Choudhary
Prof. Sarah Coupland
Glaucoma
Mr. Jon Durnian
Prof. Heinrich
Heimann
Prof. Stephen Kaye
Motility / Neuroophthalmology
Vitreoretinal surgery, Ocular
Oncology
Medical Retina, Lead
Ophthalmologist for the
Diabetic Retinopathy
Screening Programme
Ocular Oncology, Vitreoretinal
surgery
Cornea
Mr. Bill Newman
Paediatric Ophthalmology
Mr. Ian Pearce
Medical & Surgical retina /
Uveitis
Medical Retina, Inherited
Retinal Disease
Vitreoretinal surgery
Mr Carl Groenewald
Prof. Simon Harding
Mrs. Jayashree Sahni
Mr. Theodor Stappler
Ocular Pathology
Role(s)
Senior Lecturer, Department of
Eye and Vision Science (UoL)
(Honorary Cons)
Directorate Lead for Education,
Director of Undergraduate
Studies (medical / orthoptic),
Lead for New Build
AMD lead, Co-ordinator of PG
Teaching
Clinical Director, director of the
Primary Care Clinic
Based whole time at Alder Hey
Children’s Hospital
Lead Clinician for Glaucoma
Lead for the Ocular Oncology
Research Group
College Tutor
Laser Safety Officer
Directorate Research lead, Head
of the Department of Eye and
Vision Science (UoL), Director
of CERC
Lead Clinician Ocular Oncology
Lead for Integrated Clinical
Academic Training (Mersey
Deanery), Chairman of
Division, Lead clinician for
Cornea
Based whole time at Alder Hey
Children’s Hospital
Regional Advisor (RCOphth)
Director, Liverpool Reading
Centre
Audit Lead, Deputy Clinical
Director, Lead clinician for V-R
Prof. Colin
Willoughby
Locum Consultants
Dr. Amira Stylianides
Mrs. Clare Rogers
Associate Specialists
Dr. Pauline Lenfestey
Dr. Ticiana Criddle
Dr. Deborah
Broadbent
Cornea, Glaucoma,
Ophthalmic Genetics
Professor, Department of Eye
and Vision Science (UoL)
(Honorary Cons)
Medical Ophthalmology
Glaucoma
AMD & Diabetic Eye Disease
Diabetic Eye Disease
Diabetic Eye Disease
The unit is supported by the following Consultant Anaesthetists: Drs A Jones, P Barclay,
M Goulden, C Parker, T Donnelly, L Fahy, J Beattie, A Leach, G. Sidaras
Paediatric ophthalmology services (age under 15) for Merseyside are provided at Alder
Hey Children’s Hospital with 3 consultants attending during the week (Messrs. Arvind
Chandna, Bill Newman, Harish Nayak).
Activity and Finance
St Paul’s has an income budget of £21m, provides more than 100,000 outpatient
appointments each year, including 16,000 new appointments, has 10,000 A&E attendances
and undertakes over 6,000 surgical episodes. Staff numbers are in the region of 200.
Emergency Ophthalmology / Primary Care
The “Primary Care” clinic (located in St. Paul’s and not in the community) was opened in
August 1994. It assesses and initiates the management of all ophthalmic A&E activity and
also sees returning emergency cases plus new GP and Optometrist referrals (by letter and
Choose and Book). A Consultant in Primary Care (Mr. M.C. Briggs) oversees the service.
Attendant medical staff include fellow consultants, trainees, a staff grade and an associate
specialist. The role of the Nurse Practitioner has been greatly expanded and has
significantly reduced waiting times for a range of common conditions affecting the anterior
segment. In addition there is one optometrist with a prescribing qualifiation who
undertakes independent assessment of emergency cases.
Out-of-hours
St. Paul’s provides a 24 hour emergency service. There is an Ophthalmic Specialist Trainee
in the hospital until 9pm. Thereafter new cases are seen and assessed by an Ophthalmic
Nurse Practitioner with support from a senior on-callophthalmic specialist trainee from
home. Consultant cover for St. Paul’s and Alder Hey Children’s Hospital eye emergencies is
provided by 10 of the consultants at St. Paul’s plus Messrs Newman and Chandna (one in
twelve rota). The five (four substantive plus one locum) vitreo-retinal consultants participate
in a separate rota providing vitreo-retinal emergency service.
Cornea, ocular surface and refractive surgery
The Corneal, External Eye and Refractive services are provided by Prof. Kaye, Mr
Batterbury and have recently been strengthened by the appointment of Professor Willoughby
and Mr. Ahmed, in addition Mr Tey currently makes a significant contribution to this
service. There is a highly skilled contact lens service, a corneal nurse practitioner and
orbscan elevation topography and corneal confocal microscopy. The Excimer Laser Service,
including a nurse practitioner, provides private and NHS treatment for refractive and other
conditions. The unit performs DSAEK, DALK and Intacs insertion plus corneal collagen
cross-linking in Keratoconus.
Cataract
All of the operating consultant ophthalmologists contribute to the cataract service. There is a
fast-track cataract assessment service provided by a combination of ophthalmic nurses and
optometrists including pre-operative assessment and biometry (IOL Master) on the day of
first assessment. Theatres are all equipped with Alcon Infiniti phaco machines. The unit is
currently developing techniques for improved refractive outcomes including toric lenses and
refractive keratotomy.
Glaucoma
Glaucoma specialist care is provided by Mr. Batterbury, Mrs. Choudhary and
Prof.Willoughby. Recent developments include the establishment of a community glaucoma
service at the South Liverpool Treatment Centre (SLTC). Two nurse practitioners and four
optometrists support the service at RLUH and at the South Liverpool Treatment Centre.
Glaucoma patients are also managed in general clinics also supported by th glaucoma
nurses. The fields service comprises two Humphrey visual field analysers. GDx, HRT,
corneal pachymetry, OCT and stereoscopic disc photography (Kowa Camera) are available.
Liverpool was established as a leading centre for non-penetrating glaucoma surgery by the
recently retired Mr Peter Wishart, many publications and presentations have emanated from
this pioneering surgery and he has left behind the knowledge and skills base for this work to
continue. Liverpool also has a strong pedigree in glaucoma basic science research, led by
Professor Grierson who has undertaken seminal work particularly around trabecular
meshwork, optic nerve and sub-conjunctival wound healing.
The Medical Retina Unit
The medical retina unit has grown consistently over the last ten years and now provides
regional services for uveitis, AMD, inherited retinal diseases and diabetic retinopathy. The
senior team comprises Mrs. J Sahni, Prof SP Harding, Mr MC Briggs, Mr IA Pearce, Mr
NAV Beare, Dr. T Criddle, Dr DM Broadbent and Dr PM Lenfestey. A wide range of
studies and therapeutic developments are underway within the team giving the successful
candidate an excellent opportunity to develop skills within the subspecialty and to engage in
research within the team and personally.
The Liverpool Diabetic Eye Screening Unit and Eye Study (LDES) have developed into
major national leaders in research and service delivery in diabetic eye disease. The
Liverpool model has been adopted to a large degree in the National Screening Programme
for detection of Sight-threatening Diabetic Eye Disease established throughout the UK in
2006.
The Medical Retina Team have been at the forefront of the research and development of
new treatments for age-related macular degeneration since 1997.
The Liverpool Ophthalmic Reading Centre is part of the UK Network of Ophthalmic
Reading Centres (NetwORC) and contracted to grade FA and OCT images for commercial
and non-commercial studies. It is at the forefront of image grading and interpretation in
retinal disease.
The successful applicant will have extensive opportunities to acquire skills in stereoscopic
FFA, stereoscopic ICG, classification of CNV in AMD, all aspects of anti-VEGF therapy
and also where appropriate PDT, all aspects of screening for diabetic eye disease and all
aspects of the management of uveitis and diabetic eye disease. Research opportunities will
be available in all of the above. There is a weekly fluorescein angiography review session
and other regular teaching and research meetings.
Neuro-ophthalmology
This service is provided by Mr Durnian who has established strong links with the Walton
Centre for Neurosciences at Fazakerley.
Ocular Oncology
This unit is led by Professor Heimann, supported by Mr. Groenwald and by two fellows.
This service receives supra-regional funding and is one of only three units in England. The
unit has an international reputation for patient care, audit and research. An expert team
including a specialist nurse, data manager and psychologist support the medical staff and
there is digital photography including wide field photography (Optos) and state-of-the art
ultrasonography. Therev are close links ith pathology at the university of Liverpool (see
below) and with local Oncology services (Clatterbridge Hospital) and with the Douglas
Cyclotron (proton beam radiotherapy) also at Clatterbridge.
Surgical Retina Unit
The surgical retina unit currently comprises four consultants (Prof. Heimann, Mr Pearce, Mr
Groenewald, Mr Stappler and currently one locum consultant), two fellowship posts and
junior staff rotating within the department. In addition two part-time research nurses and a
specialist vitreoretinal nurse assist in the busy clinical and research activities. The Unit is
actively involved in multi-centre UK and European research trials into various aspects of
surgical retina conditions.
First line vitreoretinal on-call is provided by the fellows with the consultant cover provided
on a (planned) 1 in 5 basis. Vitreo-retinal lists are available on all five weekdays and as a
result a minimum of out-of-hours surgery is performed.
Strabismus
The Strabismus service is provided by Mr Durnian and also byProf Kaye who also has an
interest in thyroid eye disease. It is supported by two orthoptists and has strong links with
the university department (see below). This service has established a strong research
pedigree.
Administration
St Paul’s Eye Unit is a Directorate of the Royal Liverpool & Broadgreen University
Hospitals NHS Trust. The Directorate has a Clinical Director (Mr M Briggs), a Directorate
Manager (Mrs Pauline Bradshaw), a Matron and a Directorate Accountant. The Directorate
is responsible to the Executive Board of the Trust. Weekly consultant meetings take place
on a Wednesday lunch-time and the Division of Ophthalmology meets monthly.
Consultant staff have administrative responsibility for their clinic management. The
Directorate has always performed well, achieving its financial, inpatient and outpatient
targets.
One of the senior specialist trainees is designated “Administrative Registrar” and attends
the Division of Ophthalmology to represent junior medical staff. A Junior Doctors Forum
takes place quarterly attended by all juniors and the Clinical Director.
Audit
Audit meetings take place six times per year. The audit lead is Mr T Stappler who oversees
the portfolio of activity and plans areas of audit need. All members of the unit of all
disciplines contribute to the audit portfolio and to the audit meetings.
Academic Ophthalmology
Ophthalmology at the University of Liverpool
The Department of Eye and Vision Science (DEVS) is a component of the Institute of
Ageing and Chronic Disease within the University of Liverpool. The clinical arm of the
academic unit is St Paul’s Eye Unit and bridging the two is the Clinical Eye Research
Centre (funded in part by a Wolfson Grant). The translational nature of the research being
carried out in this group is a consequence of the close working of the academic team and
the St Paul’s clinical teams in a range of specialist areas of eye research and service
provision. Academic Ophthalmology has developed and expanded exponentially because
of this close co-operation between clinical and laboratory-based research groupings.
This relationship has recently been strengthened by the appointment of two additional
clinical academics: Professor Colin Willoughby and Mr Sajjad Ahmed, they join Prof
Simon Harding, Head of the Department of Eye and Vision Science as honorary consultant
ophthamologists in St. Paul’s Eye Unit. There is also a clinical lecturer (honorary specialist
trainee) and three academic clinical fellows (ACFs). In addition Professor Stephen Kaye is
honorary professor, Mrs Jayashree Sahni, Mrs. Anshoo Choudhary, Messrs. Mark
Batterbury and Nick Beare are all honorary clinical senior lecturers within the Department
of Eye and Vision Science.
Prof. Rachel Williams, Prof. Ian Grierson, Dr. Luminita Paraoan, Dr. Paul Knox (both
Readers) and Dr. Carl Sheridan (Senior Lecturer) lead the laboratory arm of the
Department of Eye and Vision Science and co-ordinate basic science research within the
department.
The high research profile of the DEVS / St. Paul’s Eye Unit partnership is illustrated by
the annual research report. For 2011; peer reviewed publications meeting the likely REF
3*/4* category numbered 20 with another 36 publications appearing in medical journals or
textbooks; there were 37 abstracts published in peer reviewed journals, 60 presentations
and invited lectures to conferences were made and 7 conferences organised by members of
St. Paul’s Eye Unit. During 2011 there were active grants to the value of over £5million.
Particular strengths are as follows:


Cell biological glaucoma research; wound healing, optic nerve head and trabecular
meshwork.
The development of vitreous substitutes and tamponade agents.


Malarial retinopathy
Diabetic retinopathy in Sub-Saharan Africa
In addition there are very close links between the clinicians of the Liverpool Ocular
Oncology Centre at St. Paul’s Eye Unit (Prof. Heimann and Mr. Groenewald) and the
Ocular Oncology Research Group led by the George Holt Professor of Pathology (Prof.
Sarah Coupland) with sits within the Department of Molecular and Clinical Cancer
Medicine, Institute of Translational Medicine Centre, University of Liverpool. This group
have published extensively in many areas of eye cancer research but particularly in the
field of prognostication in Choroidal Melanoma
The Liverpool University Directorate of Orthoptics and Vision Science (headed by Dr.
Gail Stephenson) is one of only two units in the country offering a registerable
qualification in orthoptics and providing academic support to the orthoptic profession to
facilitate research. NHS funded undergraduate numbers are currently 40 per year.
Postgraduate students are also studying within the unit. Research interests include
quantitative assessment of eye movements (there is a purpose-built laboratory), visual
development, binocular vision and neuro-ophthalmology. This link offers a unique
opportunity for collaborative research.
Teaching
Clinical teaching of both Ophthalmology and Orthoptics is led by Mr. Mark Batterbury,
Director of Undergraduate Studies. In addition St. Paul’s Eye Unit is involved with the
teaching of a variety of postgraduates; nurses, optometrists, orthoptists and other
professional staff. Teaching of postgraduate doctors takes place each Wednesday afternoon
throughout the year. There is easy access to the programme by the staff at other hospitals
within the region and regular attendance by consultants from other units within the region.
There are regular guest speakers. Additional teaching takes place in the unit at other times
with the emphasis being didactic and includes training for FRCOphth examinations,
fluorescein angiography, glaucoma and cornea meetings, wet lab surgical training at
Warrington and informal teaching in clinics.
The Trust
The Royal Liverpool University Hospital opened in 1978 as the major teaching hospital in
the Mersey Region. It was granted NHS Trust status in 1991. The Royal Liverpool
University Hospital Trust & Broadgreen Hospital Trust merged on 1st April 1995, to form
a single Trust.
The combined Trust has 750 beds and provides a wide range of medical and surgical
specialities with special strengths in medical and surgical gastroenterology, breast disease,
renal transplantation, nephrology, hepatology, robotic urological surgery, haematology,
vascular surgery, major trauma and nuclear medicine. There are very close ties with the
University of Liverpool. The clinical academic departments of the university are situated
on the same site as the Hospital, including the Department of Eye and Vision Science. The
academic directorate of orthoptics is on the main campus of the university.
Broadgreen Hospital is situated within 2 miles at the end of the M62 motorway on the
major city ring road. This provides services for Care of the Elderly and elective general
surgery. There is no Accident & Emergency Department on the Broadgreen site.
Because of the strength of neighbouring stand alone units in paediatrics and women’s
services there is no provision of paediatrics or obstetrics/gynaecology at the Royal
Liverpool and Broadgreen University Hospitals NHS Trust. However, the Women’s
Services Hospital is situated approximately half a mile away from the Royal Liverpool
University Hospital campus and became operational in March 1995. Alder Hey Children’s
Hospital is close to Broadgreen Hospital, ophthalmic services for children are provided at
Alder Hey.
The Royal Liverpool and Broadgreen University Hospitals NHS Trust is involved with a
major reconfiguration of health services on the north side of the river Mersey. Plans for a
new hospital are well advanced, funding is secure and building will start in 2014. A new
model of care has been proposed, with an emphasis on community services and closer
cooperation between primary and secondary care. Ophthalmology hopes to take advantage
of these plans. Plans for building on the RLUH site include a Bio-campus which will be
built on the site of the current hospital, building will commence following completion of
the new hospital in 2017. A first phase of the Bio-campus is the BioInnovation centre
which will open in 2014.
Liverpool
Liverpool is a progressive and changing city, benefiting from multi-million pound
investment in inner city regeneration following its term as European Capital of Culture in
2008, the city celebrated its 800th birthday in 2007. An extensive road, rail and air network
provides excellent links with the rest of the country and four national parks are within
close proximity. The city is well known for its cultural and sporting diversions and
provides a very satisfactory quality of life for those living and working in it.
Criteria for Consideration
See person specification criteria below.
Terms and Conditions
This post is subject to the Trust Terms and Conditions of Employment. The successful
candidate must be a fully registered practitioner.
Applicants wishing to discuss the post may contact:
Mr Michael Briggs, Clinical Director 0151 706 2134 (PA)
Mrs. Jayashree Sahni, Consultant Ophthalmic Surgeon
Mr. Ian Pearce, Consultant Ophthalmic Surgeon
Mr. Nick Beare, Consultant Ophthalmic Surgeon
Personal Specification Criteria
Attributes
Attainments
Essential
 Comprehensive
experience in the
management of general
Ophthalmic problems
 Basic knowledge of
Medical Retina diseases
Qualifications
 MB ChB or equivalent
 Full registration and a
licence to practice with
the General Medical
Council
 Experience of Clinical
Audit
 Presentations to a
professional audience
Research /
Teaching /
Audit
Disposition
Other
Desirable
 Basic skills in interpretation
of Fluorescein angiography
and OCT
 Basic skills in administration
of intra-vitreal drugs
 Experience in retinal laser
treatments
Postgraduate qualification or
equivalent MRCOphth/FRCOphth/FEBO
 Evidence of Completion of
the “Audit Loop”
 Experience of teaching
Junior Medical Staff and
other health professionals
 presentations of original
clinical and/or laboratory
research in ophthalmology
 Publications in Ophthalmic
journals
 Research projects relative to
Medical Retina
 Experience and ability to  Experience of leading a
function as part of
multidisciplinary team
multidisciplinary team
 Organisation Skills
 Communication Skills
 Willingness to work
flexibly towards the
strategic aims of the
organisation.
 Managerial experience /
training
How judged
CV /
interview
CV
CV
CV,
interview,
references
CV
Interview
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