Download Another amazing Congress - the Royal College of Ophthalmologists

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QUARTERLY BULLETIN
SUMMER 2015
Another amazing
Congress
This year’s Congress had a number
of exceptional highlights including
renowned speakers, educational
seminars and a chance to catch
up with colleagues from across the
ophthalmic world. All in a wonderful
location on the banks of the Mersey.
Focus
Museum Piece
Training
PAGE 5 Clinical
applications of Retinal
Auto Fluorescence
PAGE 11
Ophthalmo-phantoms
PAGE 12 John Ferris
discusses the benefits of
Simulated Ocular Surgery
college news
Dear fellow members,
Contents
2Introduction - Carrie
MacEwen, President
5Focus - Clinical applications of Retinal
Auto Fluorescence
haemorrhage
8The Annual Congress
2015
10Eye Journal - Editor’s
Choice
11Museum Piece
Ophthalmo-phantoms
12 S
imulated Ocular
Surgery
17 O
phthalmologists
in Training
19 B
OSU Surveillance
Study Bursary
23 Diary Dates
Don’t forget to
follow us on Twitter:
@rcophth
Articles and information to
be considered for publication
should be sent to:
Liz Price
Communications Manager
[email protected]
Copy deadlines:
Autumn: 18 September 2015
Winter: 4 December 2015
Spring: 18 March 2016
Summer: 17 June 2016
Editor of Focus:
Mr Faruque Ghanchi
Advertising queries should
be directed to:
Robert Sloan
020 8882 7199
[email protected]
Contact Details:
The Royal College of
Ophthalmologists
18 Stephenson Way
London, NW1 2HD
T. 020 7935 0702
2
Time never stands still and that is very
much the case for ophthalmology and
health care. A new UK government is in
power and although each of the four
devolved home nations has developed
their own health policies there are
common themes including improving
disease prevention, integrating health
and social care, developing IT and data
sharing, and enhancing community care.
These will all have an effect on the work
and direction of our specialty.
The College will certainly be continuing to work
hard to draw attention to the capacity issues that
face the ophthalmic sector. The current political
push for 7 day working seems highly aspirational
for our specialty as currently we do not have the
resource to safely provide elective care over 5 days.
Continuing care and emergency / urgent cover is
provided by ophthalmologists, all of whom have
been delivering care for 7 days a week since they
qualified and the vast majority continue to do so.
Safe care works within its limits. I will continue to
focus on strengthening relationships with those in
key influential roles to recognise the problems, but
in addition we must continue to work, as a specialty,
to identify solutions so that we are in a position to
direct improvements and new ways of working.
With this edition of College News you will find the
RCOphth post election Manifesto which can be
used in communications and meetings with your
Trusts and managers, CCG leaders, local MPs and
key decision makers. I will be sending out personal
copies of the Manifesto to those important
stakeholders that need to be made aware of the
issues facing patients and eye departments. If you
need more copies of the Manifesto, please contact
Liz Price, Communications Manager.
Moving to internal College policies - to ensure that
the RCOphth is run as efficiently and proactively
as possible, with particular emphasis on the legal,
financial and strategic aspects of the organisation
to secure a stable future for the College, we are
recommending updating the current governance
structures. I would encourage you all to review
the proposed changes to the Trustee board, which
would brings us in line with many other medical
royal colleges and protect the College’s assets and
interests.
As part of our general review The Strategic Plan
2015 – 2019 has brought focus to priorities that
have resulted in further changes. College roles are
now open to all members and will be advertised
via email and monthly newsletters. I hope that
members will take the new opportunities available
to involve themselves with the work of the College
and to share their knowledge and energy. The
move to new premises in Stephenson Way has
been highly successful and those who have
attended meetings, courses and seminars – or have
just popped in, have enjoyed the ambience and
functionality of the modern building.
There are a number of initiatives that I believe will
provide important information and support our
aims:
•‘The Way Forward’ is a College led project
looking at identifying the best models of care
for ophthalmology to ensure that the role of the
ophthalmologist remains central, interesting
and stimulating as the head of a team of
professionals.
• The HQIP study (NOD) will gather data on all
cataract surgery in England and Wales to identify
outcomes and risk factors which will help to
improve patient safety by driving up improved
quality of care (see page 19).
•The BOSU study on patients coming to harm
due to hospital initiated delayed follow up
appointments is important to help collect
data to demonstrate the impact of delayed
appointments on patient safety and outcomes
– please do report back as much as you can to
ensure the study is as comprehensive as possible
I know many of you attended Congress this year
in Liverpool which proved to be one of the best
conferences we have held. There was something
for everyone in every aspect and sub-speciality of
ophthalmology; educational or professional, clinical
or academic, service development or training, for
registrar or career grade. Alex Day has written a
good report of the three days and there’s a quick
A to Z guide of the highlights. The 5K run proved a
great addition to Congress and raised funds for the
John Lee Fellowship Award. The events team have
already started working on Congress 2016!
I hope you enjoy reading July’s College News.
Carrie MacEwen, President
[email protected]
THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | SUMMER 2015
The governance structure
of the RCOphth is changing,
find out why and how
The current governance structure of the RCOphth,
where Council members are also Trustees, was
introduced in 1988. The College has since become an
increasingly complex organisation and is subject to
greater regulatory burdens.
The pressures on NHS staff have grown; Trustees find it
increasingly difficult to find the time necessary to fulfil
their responsibilities and commit to being members of
Council.
How have proposed changes been identified?
Council set up a short-term Governance Working Party to identify
ways of improving the existing structure. Council has accepted
its recommendation that a Trustee Board should be created.
It noted that several other royal medical colleges have already
made a similar change, to good effect.
What is the role of the Trustee Board?
The Trustee Board would have the final responsibility for the
financial, business and legal aspects of the College. It would
bring in the expertise of lay members but medical members
would always be in the majority.
What is the role of Council?
Council would continue to manage the College’s medical,
professional and clinical obligations, with responsibility for
furthering and fulfilling the mission of the College and for setting
long-term goals and priorities.
Who approves the changes?
The proposed governance changes require the Charter and the
Ordinances to be redrafted. These have to approved, as a block,
by members voting at the 2016 AGM and then approved by the
Privy Council.
How will the membership be kept informed?
The College President, Carrie MacEwen, referred to this work in
her opening speech at the 2015 Annual Congress and explained
the rationale for change at the 2015 Annual General Meeting,
the AGM minutes are available in the members area on the
website.
A poster was also produced for the College stand that had a
prominent spot in the Congress exhibition hall. Further updates
will appear in future issues of College News and in Short Notes
from Council. If you wish to discuss the changes, please contact
Kathy Evans, Chief Executive
[email protected]
A view from the Education
and Training department
When asked to write an article for
College News about the department
my first thought was ‘what am I
going to write about that will be of
interest to the membership’. Help!
No research project to announce, no
new clinical guidelines to publish but
instead a brief look behind the scenes
on the third floor in Stephenson Way.
Phones constantly ringing, e-portfolio queries being
answered, ARCP season outcomes being returned, national
recruitment, CESR applicants training days being planned,
evaluations written up, processing CCT applications, skills
courses running, e-learning sessions being prepared, DSS
application being considered, committee meetings to
organise and TSCs to consider are just some of the work we
are involved with on a daily basis. The department is busy
and everyone strives to do their best to deal with all the issues
that come our way in a timely and professional manner.
For most of us no two days are exactly the same. Life in
the department is about juggling and prioritising as best
we can to make sure that we deal with all aspects of work
that covers both Education and Training. We work with
consultants, trainees, SAS doctors, outside bodies like the
Academy and the GMC to provide the best service. But none
of this would be possible without the hard work of all the
staff in the department, Vanna Fadda acting Deputy Head
and Daniah Ahmed, Doreen Agyeman and Carla Campbell
who have not long been with the College but have quickly
grasped the importance of the work that we do. Team work
is essential to make sure we provide the best we can to you
our members.
Our day to day work is sometimes rewarded in the means of
funding for more e-learning, a gold award for the materials
that Colleges have produced for e-learning, providing
successful courses for CESR applicants, streamlining
procedures for the appointment of College Tutors and
Regional Advisers to name but a few.
Things however never stay the same for long. The
challenges ahead for the department are: Shape of Training,
Credentialing, curriculum, e-portfolio and more. As always,
these workstreams have a wider impact across all areas of
College activity. If these topics are of interest to you and
you wish to contribute, then please contact us. This is your
College and your chance to be a part of supporting trainee
ophthalmologists of the future.
Alex Tytko, Head of Education and Training
[email protected]
3
college news
Join us for a fun-filled evening and raise funds for the John Lee Fellowship
Now in its third year, the John Lee Fellowship Quiz Night
annually raises funds for the fellowship in order for its crucial
research to continue. The fun will begin at The Royal College of
Obstetricians and Gynaecologists with a welcome drink and a
delicious meal will be served during the evening.
We are looking for teams of eight to compete and raise funds for
a fantastic cause, on Friday 4 September 2015 from 7pm.
Pre-organised teams and individuals alike are all welcome to
enter and tickets are £50 per person.
4
To book a place, email Kathy Evans,
[email protected]
Visit our website for more details:
www.rcophth.ac.uk/about/support-us/
To donate to the John Lee Fellowship, go to our Just Giving page:
www.justgiving.com/John-Lee-Fellowship-Appeal/
focus
THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | SUMMER 2015
Retinal Auto Fluorescence
(RAF): Clinical applications
of Confocal Blue laser RAF
Yit Yang, Wolverhampton Eye Infirmary
Faruque Ghanchi, Bradford teaching Hospitals
Email: [email protected]
Last decade has seen refinement in technology to
obtain fundus or Retinal Auto-Fluorescence (RAF)
images which has greatly facilitated the process of
capturing RAF images and also improved the quality
of the images, particularly the contrast and the
details of the RAF patterns of retinal lesions. These
technological advances such as confocal laser scanning
ophthalmoscopy and improved optical filters coupled
with the availability of descriptive normative data on
RAF have established this modality of imaging as a
useful everyday clinical tool which can be applied for
diagnosis and monitoring on a wide variety of retinal
conditions. Hence RAF is now commonly used by many
retinal clinicians routinely to aid diagnosis as well as help
in management of retinal conditions in judging response
to treatment and to predict outcome/ prognosis.
Interpretation of autofluorescent patterns is based on
understanding of normal distribution of lipofuscin based
on observing presence of normal or altered natural
autofluorescence in the retina.
Background:
Autofluorescence is the natural ability of a biological structure to
emit light of a longer, less energetic wavelength after absorbing
light of a shorter and higher energy wavelength. The human
retina has autofluorescent properties owing to the presence of
molecules, which contain parts called fluorophores that make them
autofluorescence after exposure to light of specific wavelengths.
The main source of retinal autofluorescence utilised in clinical
practice is from lipofuscin located in the retinal pigment epithelium
(RPE) cells1,2,3. Short (blue) and medium (green) wavelength light
can excite lipofuscin related autofluorecence that is captured by
commercially available SLO scanners. A confocal system provides
the ability to place the excitation light and capture of the emitted
light from the same plane giving high contrast images. Patterns of
autofluorescence from the retina captured in this way depends on
the health of the RPE and also any structures that would normally or
abnormally block the transmission of this emitted light through the
layers of fundus anterior to the RPE.
Capturing retinal autofluorescence is not new and has
conventionally been performed using commercial fluorescein
angiography cameras using the standard filters which allow passage
of fluorescent light to capture highly autofluorescent lesions such
as optic disc drusen without injection of the fluorescein dye.. The
fluorescence emitted in many other conditions however is usually
of low intensity and this standard, conventional method of capture
using non-confocal system is insufficient for capturing it. Instead of
using a light bulb and filters for conventional fluorescein angiograms,
the incorporation of laser devices to generate accurate excitation
wavelengths and specially developed filters in refined digital cameras
to capture the low intensity light that is emitted has helped to refine
images of high quality with good contrast and resolution. At present
RAF images can be obtained with some commercially available
camera systems in addition to standard fluorescein cameras. Of
the commonly available systems, Topcon utilises modified fundus
photography technique with Yellow – Green wavelength light, while
Optos utilises green wavelength (532nm). Of the Two commercial
systems using Blue light RAF, to our knowledge only Heidelberg
is currently in production and clinical used. Heidelberg and Optos
both are SLO systems though it needs to be recognised that
autofluorescent patterns are different with Blue light and Green
light; so comparisons cannot be made between these two systems.
The most commonly used confocal blue laser autofluorescence
system is the Heidelberg Spectralis Blue Peak Retinal Angiograph
or Spectralis OCT with Blue peak System (488nm). This article is
focussed on the wide spectrum of clinical applications of retinal
auto-fluorescence (RAF) using Heidelberg’s Blue peak technology
with particular emphasis on the principles behind the interpretation
of abnormal RAF patterns.
Technique:
Taking retinal images for autofluorescence require the same
technique as retinal photography, however one needs to be familiar
with the imaging kit to ensure autofluorescence mode is selected for
image capture. After positioning the patient on the camera and with
the eye aligned for uniform illumination of the retina, a standardised
protocol for RAF acquisition should be followed since the
autofluorescence pattern differs depending on adaptation of retina,
for example bright flash used of retinal photography bleaches retinal
pigments. Ideally autofluorescence images should be taken prior
to colour photography especially retinal angiography. In situations
where, an eye is exposed to bright light/ flash, sufficient interval
should be allowed for retina to recover from the bleaching effect.
The latter is prolonged in cases of retinal dystrophies especially. It
is recommended to defocus the camera by -1 D (from the infrared
focus) to get confocal plane of the RPE. The eye should be bleached
for 30 seconds with blue light (this takes out masking by rhodopsin).
Eye tracking should be used and a minimum of 10 frames of images
should be available for averaging to get best possible image. The
pre bleaching is useful to reduce masking impact of visual pigments
in vertically aligned photoreceptors and providing clearer picture of
lipofuscin related autofluorecence from the RPE.
Clinical Patterns of RAF:
Normal RAF
In a healthy eye the short wavelength blue light leads to
autofluorescence emitted from the lipofuscin in the RPE that is seen
as varying intensity of signal reflected from RPE, where brighter pixel
represents more autofluorescence.
Normal RAF pattern has an even glow of low hyperfluorescence from
the RPE. The optic disc, which does not have RPE, appears black, the
retinal vessels also appear dark as they block the emitted light from
the RPE. Around the fovea, there is normally least autofluorescence
due to the blockage of emitted light by the lutein pigment that is
normally concentrated in Muller cells in healthy foveal zone and
parafoveal zone (Figure 1a).
5
college news
FOCUS - THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | SUMMER 2015
Alterations in RAF patterns are described in various classifications
and harmonisation of these terms is needed. The descriptive terms
used include focal, diffuse, linear, banded, speckled/ granular,
reticular or homogenous4. The significance of different patterns of
altered (usually high) autofluorescence is emerging.
Table: Causes of altered retinal autofluorescence (RAF)
Decreased RAF
Increased RAF
RPE loss / atrophy
Excessive lipofuscin
Intraretinal fluid
Low visual pigments
Reduced RPE lipofuscin
Drusen
Fibrosis
Thin retina
Luteal pigment
AMD
Blood / exudates
where RAF provides a useful tool as increased RAF is seen MEWDS;
while PIC and MFC can start with increased RAF but this can be
hypofluorescent too. The latter is associated with poorer visual
outcome.
Conclusion:
RAF is a novel non-invasive imaging technique that provides
metabolic and functional information of retina (RPE). Availability of
RAF in commercial equipment has helped our understanding and
diagnosis of a number of retinal disorders. It is increasingly being
used in routine retina practice especially for retinal dystrophies,
AMD and white dot syndromes, and indications where it is useful are
getting broader. Further refinement in technology and introduction
of wide field lens will further enhance its use both in clinical research
and practice, especially with precision in phenotyping diseases and
potential linking with biomarkers of specific diseases.
*Quality of image may be affected by media opacity
It is expected that this summary will provide clinicians a practical
reference source for clinical practice.
Decreased RAF
Figures and legends:
The normal glow of RAF is reduced in conditions that result in
loss of RPE cells as seen in RPE rips (Figure 1b) and Geographic
Atrophy GA (Figure 1c). RAF images can clearly outline the area
of RPE atrophy/ loss. It is also observed in certain inflammatory
condition that has caused RPE damage, multifocal choroiditis,
puntcate inner choroidopathy and AZOOR for example. The normal
autofluorecence can be masked by any abnormality anterior to
the RPE, thus blocking the transmission of emitted light from the
underlying healthy RPE- e.g. retinal haemorrhages, lipid exudates,
subretinal fluid or fibrosis. Decreased RAF is also useful in identifying
specific conditions where there is absent RPE cells such as angioid
streaks.
Increased RAF
1a
1b
1c
Fig 1. Normal autofluorescence (a), hypo autofluorecence due to
no RPE in RPE rip (b) and geographic atrophy (c). Note speckled
hyperfluorescence around area of GA.
2a
2b
2c
Increased RAF was described in various retinal dystrophies initially.
Increased RAF is also commonly caused by an abnormally high
amount of lipofuscin seen in some macular dystrophies such as
vitelliform dystrophies and bestinopathies that are characterised
by lipofuscin collection (figure 2 a, b,). In RP a mixed pattern of
masking (from pigment) and window defect (from thinned retina)
can be seen.
Increased lipofuscin collection in the RPE is also recognised as an
important feature for AMD pathology. Increased RAF is seen due
to excessive accumulation of lipofuscin in RPE and drusen in early
AMD2,5. In wet AMD, a mixed pattern is seen with masking in area
of haemorrhage and fluid, focal loss of RAF with CNV and small area
of increased RAF around the CNV is not uncommon. Increased RAF
is also seen in areas with metabolically abnormal RPE cells as seen
around lesions of geographic atrophy and can evolve into complete
atrophy with time. Various patterns of increased RAF seen around
GA namely banded, diffuse and focal patterns are subject of further
research in progression and treatment of GA.
Increased RAF pattern is seen in conditions where there is reduced
blockade due to thinning of the retinal layers3 e.g. in chronic CSR
and AZOOR and especially in macular telangiectasia where there is
loss of the natural blockage from the lutein in the foveal area. RAF
is particularly useful cases of CSR without subretinal fluid on OCT,
where typical gravitational RAF tracks can help to establish the
diagnosis of previous CSR (figure 2c) and help the clinician to explain
the underlying cause of reduced vision.
White dot syndromes are rare inflammatory disorder that involve
choroid, RPE and retina, often presenting a challenge in diagnosis
6
Fig 2. Hyper autofluorescence: (a) Best’s vitelliform dystrophy with
characteristic hyperautofluorescence of lipofuscin deposition.
(b) Stargardt’s disease with hyperfluorescent flecks in macula.
(c) a case of CSR note diffuse hyper autofluorescence that tracks
inferiorly from the superior temporal arcade. The focal spots of
hypoautofluorescence in this case corresponded to IPCV.
References:
1. British Journal of Ophthalmology 1995; 79: 407-412
2. Retina. 2008 Mar;28(3):385-409.
3. JAMA Ophthalmol. 2013;131(12):1645-1649.
4. Br J Ophthalmol. 2005;89(7):874–878
5. Saudi J Ophthalmol. 2014 Apr;28(2):111-6.
college news
The Annual Congress 2015
This was the 27th Annual Congress of The
Royal College of Ophthalmologists, with
over 1,700 delegates and 200 speakers at
the Liverpool Arena and Convention Centre,
adjacent to the famous Albert Dock.
patients’ covered cataract research from risk models, to PROMs, to
how ‘big data’ can be used to improve patient care. After this, there
was the Ophthalmic trainees’ forum where, over drinks there was the
opportunity to discuss current training experiences and issues, and
future training changes with College representatives. This was swiftly
followed by the Congress 5k run in aid of the John Lee Fellowship.
Wednesday was also the Allied Professions Day with lectures covering
glaucoma to AMD and diabetic retinopathy, to education to VISION
2020 UK experiences.
Thursday, the final day, started with breakfast meetings on
training and simulation, survival strategies for new consultants,
commissioning, pensions and grand rounds in oculoplastics. These
were followed by sessions on giant cell arteritis, vitreoretinal advances,
dry eye disease and diabetic maculopathy in addition to special
sessions on glaucoma imaging and training the trainers. The Great
Debate was particularly entertaining with Bruce Allan and Milind
Pande discussing the arguments for and against multifocal IOLs.
For early Congress attendees there was the opportunity to attend
the Monday sub-specialty day with programmes for retina, glaucoma
and eye movements; or the separate UKISCRS Cornea and Cataract
sub-specialty day before the main Congress that ran Tuesday to
Thursday. The first day of the Congress opened with an introduction
by Carrie MacEwen and presentations from Clare Bailey on advances
in Medical Retina, George Spaeth on risk profiling for glaucoma and
Clare Gilbert discussing glaucoma research and treatment in Nigeria.
Following this, there were sessions on paediatric ophthalmology,
keratoconus, vitreoretinal surgery, neuro-imaging and orbital tumours
in addition to the retinal imaging course.
After lunch followed sessions on paediatric cornea, primary care,
refractive surgery, glaucoma and ocular surface disease and
inherited retinal disease before the first rapid fire session chaired
by Professor Andrew Dick. The Edridge Green Lecture was given by
David Crabb, Professor of Statistics and Vision Research from City
University London. His lecture, entitled ‘A view on glaucoma, are we
seeing it clearly?’ described how his research lead to be advances in
understanding the functional consequences of glaucomatous visual
field loss.
Wednesday started with early morning breakfast sessions on practical
statistics, NIHR collaborations and grand rounds in glaucoma and
uveitis. Followed by sessions on peri-ocular oncology, nystagmus,
service commissioning, the real world impact of eye research and
the RCOphth National Ophthalmology Database. The Keeler Lecture
was delivered by Professor Michael Marmor from Stanford University.
Entitled ‘Vision and Eye Disease in Art’ it was a fascinating tale of
how Ophthalmology helps you understand art and how art helps you
understand Ophthalmology. After coffee, the morning finished with
sessions on retinal stem cells, inflammatory retinal disease, an update
on AMD management and a glaucoma ‘meet the experts’ session.
The afternoon started with the second rapid fire session chaired
by Professor Miles Stanford. The biennial Duke Elder Lecture was
given by Professor John Sparrow. His presentation, ‘Learning from
8
Following the awards ceremony there was the Optic UK Lecture
delivered by Professor Anita Agarwal on structure function
relationships in macular dystrophies. After lunch the Congress
closed with sessions on emergency eye care, what makes a great
cataract surgeon and grand rounds in medical retina and neuroophthalmology.
Overall, it was a very successful meeting for keeping up to date with
the latest changes in practice across specialities, and catching up with
colleagues from all over the country (and world). Thanks should be
made to all involved in the organization and running of the Congress
with particular mention to Mike Burdon, Chairman of the Scientific
Committee and Mr Manoj Parulekar as Honorary Programme
Secretary to the Congress.
Alex Day, Academic Clinical Lecturer and Ophthalmologist,
UCL Institute of Ophthalmology and Moorfields Eye Hospital
Camera, Action
Thank you to everyone who contributed to the filming at
Congress. It was very much appreciated and we are delighted
to unveil the RCOphth Congress promotional video soon.
THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | SUMMER 2015
Congress Charity Run
Wednesday 20 May was a packed day at Congress 2015. There
were 14 parallel academic sessions plus the Keeler and Duke
Elder Lectures, SAS and OTG Forums, the AGM and a Rapid
Fire Session. Whilst most delegates, speakers and exhibitors
headed for the bars and restaurants at the end of the day,
around 60 people gathered for the inaugural Congress 5K run.
The run started at the ACC Liverpool and headed out and
back along the iconic River Mersey. After a week of rain and
cold weather, the sun finally came out for the race although
the strong wind was a challenge for the runners. The race
was aimed at runners of all abilities and people could enter
as individuals or in teams with prizes and medals as well as
bragging rights on offer. The winner of the men’s race was the
RCOphth’s BOSU Fellow Barny Foot with Yun Wong in second
and Huw Jenkins in third. The women’s race was won by Laura
Butler with Sophie Poore and Hannaa Bobat in second and
third respectively. The overall team prize was won by Team
BOSU Elite which included Mike Burdon, Chair of the Scientific
Committee.
The main aim of the run was to raise funds for the John Lee
Fellowship and with contributions from all of the runners
plus generous donations from Malosa Medical and Oraya
Therapeutics the total raised was in excess of £500. A special
mention should be given to Mike Dooling MBE from the local
Liverpool Harriers Athletics Club who set the course and
officiated on the day.
The Congress events team hope to make this an annual event
so start training now for Congress 2016.
George Hibdige, Events Manager
[email protected]
The A-Z of Congress:
A
is for the AMO Prize, won
in 2015 by Dr Albena
Dharzikova
B
is for Birmingham ICC,
where our 2016 congress
will be held on 24-25 May
C
is for Controversies in
Modern Vitreoretinal
Practice, delivered by Mr Tom
Williamson and Mr Edward Lee
D
is for Duke Elder Lecture
2015 given by The
RCOphth council member
Professor John Sparrow
E
is for Eldridge Green
Lecture, this year given by
Professor David Crabbe
F
is for The Foulds
Trophy this year won
by Andrew Tatham for the
paper: ‘Predicting risk of road
traffic accidents in drivers with
glaucoma’
G
is for the Great Debate,
this year chaired by Mr
Brian Little
H
is for Heidelberg
Engineering, winner of the
Desmond Wright Prize Shield for
best commercial exhibition
I
is for International: Our
highest number ever
of International speakers
and delegates attended the
RCOphth Congress in 2015
J
is for John Lee Poster Prize,
this year awarded to Dr
Jaya Chidambaram
K
is for The Keeler Lecture:
A fascinating lecture
discussing Vision and Eye
Disease in Art
L
is for Liverpool and the St
Paul’s Eye Unit who have
been awarded The Freedom of
the City, given in recognition
of the excellent services to eye
health over the last 143 years
M
is for Michael Marmor.
Michael is a Professor
of Ophthalmology at Stanford
University School of Medicine
and delivered our fantastic
Keeler Lecture
N
is for the Neuro-Imaging
Seminar, delivered by
Professor Paul Riordan-Eva
O
is for Optic UK Lecture,
this year delivered by
Professor Anita Agarwal from
the US
P
is for posters, over 250
accepted and displayed at
this year’s congress
Q
is for quick! 20 papers
presented in the rapid fire
paper sessions
R
is for running! The John
Lee Annual Fun Run 2015
raised over £500 for a fantastic
cause
S
is for the Societas
Ophthalmologica
Europaea Prize, this year
awarded to Dr Cecilia Lee
T
is for Trainees: Over 350
trainee ophthalmologists
visited the congress in 2015
U
is for Uevitis grand
round
V
is for video: This year
we were delighted to
capture some of our delegate’s
thoughts on our official
RCOphth video
W
is for Wet & Dry:
Plastics & Surface
Seminar delivered by Prof
Bernie Chang and Mr Sai Kolli
X
is for Xiaoxuan Liu and
Salman Mirza who
delivered the fascinating
seminar: Characteristics and
outcomes of intravitreal
Ocriplasmin injections for
Vitreomacular traction
Y
is for is for Mr David
Yorston, who looked
at when to refer patients
for macular surgery in our
Controversies in Modern
Vitreore Session
Z
is for Z card! Our first Z
card pocket timetable
made keeping on top of all the
fantastic seminars and lectures
as easy as possible.
9
college news
Eye Journal - Editor’s choice
1. Is spectral domain OCT as effective as fluorescein
angiography (FA) for diagnosing neovascular AMD (nAMD)?
Wilde et al in the May issue address this question (Eye (2015) 29,
602–610;) by reviewing the SD-OCT, colour fundus photographs
and fundus fluorescein angiograms of 411 consecutive patients
referred to a rapid access Macular Clinic over a 4-year period.
In comparison to FA they found a total of 47 false positives
with SD-OCT: a rate of 16.9%. The sensitivity and specificity of
SD-OCT alone for detecting choroidal neovascularization was
100 and 80.8%, respectively. They concluded that SD-OCT in
comparison to the reference standard of nonstereoscopic FA is
highly sensitive at detecting newly presenting nAMD but it does
not seem accurate enough to replace FFA in the diagnosis of
nAMD in current practice.
2. The Royal College of Ophthalmologists’ National
Ophthalmology Database study of cataract surgery:
report 1, visual outcomes and complications
Selected papers from second quarter 2015
concluded that visual outcomes, and the rate of posterior
capsule rupture or vitreous loss or both appear stable over the
past decade.
3. Neuropathic ocular pain: an important yet under
evaluated feature of dry eye
Patients suffering from dry eye symptoms are a common
problem seen in all ophthalmic departments. In Eye 29: 301312; Galor et al present evidence that chronicity is more likely
to occur in patients with dysfunction in their ocular sensory
apparatus (i.e., neuropathic ocular pain). Clinical evidence of
dysfunction includes the presence of spontaneous dysesthesias,
allodynia, hyperalgesia, and corneal nerve morphologic and
functional abnormalities. Importantly recognising neuropathic
ocular pain may affect the treatment of dry eye-associated
chronic pain.
Andrew Lotery, Editor in Chief, Eye
This seminal paper (Eye (2015) 29, 552–560 ;) studied the
outcomes of cataract surgery in the United Kingdom using
anonymised data on 180 114 eyes from 127 685 patients. Of
note 36.9% cases had ocular co-pathology and 41.0% patients
underwent cataract surgery on both eyes. Preoperative visual
acuity was 0.30 logMAR or better in 32.0% first eyes and
47.7% second eyes. Postoperative best-measured visual acuity
was 0.00 and 0.30 logMAR or better in 50.8 and 94.6% eyes
without ocular co-pathology, and 32.5 and 79.9% in eyes with
co-pathology. Posterior capsule rupture or vitreous loss or both
occurred in 1.95% cases, and was associated with a 42 times
higher risk of retinal detachment surgery within 3 months and
an eight times higher risk of endophthalmitis. The authors
Submit your article to Ophthalmopaedia
to win a prize
Ophthalmopaedia is an ambitious component of the Ophthalmology
e-Learning project. It is revolutionary as it is the world’s first online
encyclopaedia of ophthalmology, creating an authoritative resource that
can be used by any ophthalmologist wishing to look up a topic (trainers and
registrars alike). It is produced and maintained by the ophthalmic community
and any topic of relevance to the community may be included as the horizons
of this resource are not limited to a set curriculum.
Each month, a prize is awarded for the best article submitted by all grades
(consultants not included) and articles published are citable. Congratulations to
the following winners, who articles can be viewed in Ophthalmopaedia on the
e-LFH site. www.rcophth.ac.uk/professional-resources/ophthalmopaedia/
For April 2015 - Dr Pouya Alaghband, an Ophthalmology specialist registrars at
the Yorkshire and Humber Deanery for his article on Ocular Surface Stem Cell
Transplantation.
For May 2015 - Miss Laura Steeples, an Ophthalmology specialist registrar at
North Western Deanery for her article on Corneal Gluing.
10
2014 Impact Factors
for Eye
The Thomson Reuters journal citations
reports for 2014 have been released and The
College and NPG are delighted to announce
that the impact factor for Eye has increased
to 2.082. The journal now ranks at 22 out
of 57 journals in the subject category of
Ophthalmology. This is the first time the
impact factor has gone above 2 and is truly
a fantastic achievement. Congratulations to
everyone especially Andrew Lotery, Editor in
Chief of Eye.
We are pleased to announce that Eye Journal
is now on Twitter, @Eye_Journal. Follow for
the latest news, articles and special content.
THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | SUMMER 2015
Museum Piece
An ophthalmo-phantom is a face mask in
which pigs’ or artificial eyes can be held for the
ophthalmologist to practice eye surgery. It was
sometimes called a mannequin.
One of the earliest models (Fig 1) goes back to 1827 when Dr
Albert Sachs of Berlin constructed his mask. As can be seen his
phantom is mounted on top of a stand and could be angled
backwards.
Over the next two centuries there were many forms of phantom,
some had simple face masks with eye apertures others were
sophisticated with clever mechanisms for holding the eye. Not all
the faces were male.
The construction of these phantoms was made from a variety of
materials, cast iron, tin, copper, hard papier-mâché, ebonite, hard
rubber and plastic. Most were painted black and all replicate the
actual size and shape of the average human face although some
models used a half face. The phantom was fitted with two eyes in
order to practice ambidexterity.
All the early models were mounted in a vertical position on
a weighted base. Some could be tipped backwards others
were held on an articulated stem (Fig 2). The vertical or slight
backwards position imitated the sitting position of the patient
for eye operations until the supine operating position became
commonplace. The early models were used to practice cataract
extraction, iridectomy and discission.
Ophthalmo-phantoms
The Waldau phantom of 1869 (Fig 3) was fitted with a wire ‘orbit’
to which was attached a rod with screw thread. The purpose of this
was to adjust the hardness of the eye by tightening or loosening
the cage.
Adolf (Schuft) Waldau (1822-1895) was a friend and assistant to
Albrecht von Graefe. He gave a surgery course to students using his
phantom but had to use the waiting room because Graefe’s clinic
was so crowded.
One model of circa 1900 had the practice eye placed in a glass
orbit from which the air could be extracted using a rubber balloon
mounted behind it. The advantage of using glass was presumably
to make it easier to clean.
One early model for practicing eye surgery was Veasey’s homemade Cigar Box (Fig 4). The eye was fastened with tacks to a
rectangular piece of cork glued to the lid of the box. The lid could
be raised or lowered to the desired angle.
In the 20th century John Weiss produced two models for practicing
surgery. One was a simple wooden block with two tubes mounted
on top separated to replicate human eyes (Fig 5). Pigs’ eyes
were held in place with a push-on cap and a black cloth mask
representing the face was placed over the unit.
Weiss’s other model (Fig 6) was designed by N Bishop Harman and
was specifically used to practice strabismus operations.
Both these models appear crude compared to today’s phantom
from Simulated Ocular Surgery.
A pig’s eye was and is still the most commonly used animal’s eye as
it is closest in size and structure to the human eye.
Their mask is not unlike early 19th century models in appearance
but a range of silicon model eyes designed for specific operative
procedures makes this a very sophisticated system.
The mechanism for holding the pigs’ eyes in the eye apertures of
the phantom varied.
Richard Keeler, Honorary Curator
[email protected]
1.
2.
4.
3.
5.
6.
11
college news
Simulated Ocular Surgery
If you were a patient about to undergo eye surgery, what would
your expectations be of your surgeon’s technical abilities? To my
mind the following would not be unreasonable;
1.That the surgeon had practiced the steps of the surgery they
were about to perform and were deemed to be competent,
before operating on your eye
2.That the surgeon, or the supervising surgeon, could deal with
any unexpected complications that might occur during surgery
and that they had practiced dealing with these rare scenarios,
much as pilots do
Although surgical training in the UK is highly regarded, can we
honestly say that current surgical training always meets these
expectations? So how can we enhance the quality of our surgical
training, is it practical or even possible to meet these expectations?
In May 2014 the Simulated Ocular Surgery website www.
simulatedocularsurgery.com was launched at the RCOphth
Annual Congress. This website demonstrates how the model
eyes, designed by Phillips Studios, can be used to realistically
simulate a wide range of surgical procedures, not just cataract and
vitrectomy surgery. The eyes mimic the look and more importantly
the feel of the human eye, with life-like conjunctiva, sclera, and
extraocular muscles, lens of different densities in a capsular bag
and even epiretinal membranes.
Each of the five sections has a ‘talking head’ video featuring an
expert in their respective field, describing how the eye can be used
to realistically simulate cataract, glaucoma, vitrectomy, scleral
buckling and strabismus surgery, as well as intra-ocular injections.
In each section there is also an iPlayer-like carousel of instructional
videos. There is no need for a wet-lab as the eyes can be used in
your own operating theatre, or for some procedures practice can
be done at home.
The eyes can also be used to simulate surgical complications
such as posterior capsule rupture and vitreous loss, a slipped
muscle during strabismus surgery, or a button holed flap during
a trabeculectomy, to name a few. We are currently developing
Simulation in Training
The importance of surgical simulation is now widely recognised for
surgeons at all levels of experience and access to a broad range of
low and high technology is increasing all the time. The College now
expects trainees to undertake simulation on a regular basis and an
outline of the suggested curriculum for this is available at
www.rcophth.ac.uk/training/simulation/
In addition, you will be able source for purchase of a number of
simulated surgery products as well as details of how to access your
nearest EyeSi cataract or vitreoretinal simulator.
We will be collecting data on use of simulation by trainees for
presentation in our Annual Specialty Report and it is recommended
that trainees record their simulated surgery experience.
Mark Watts, Chair, Education Committee
Fiona Spencer, Chair, Curriculum Sub-committee
12
a corneal section, which will feature penetrating keratoplasty
simulation as well as models for practicing DSAEK and DMEK. A
new model for practicing non-penetrating glaucoma surgery is
also in the pipeline. This autumn a ‘Trainees and Trainers Gallery’
will be launched, which we hope will become a repository for great
surgical training videos, enabling surgeons to share their training
and simulation tips with colleagues around the world.
Although the Eyesi is a fabulous piece of equipment, there is
a misconception that all ophthalmic surgical simulation needs
to be high tech and expensive. The aim of the SOS website is
to demonstrate that simulation can be simple, that it is now
accessible to everyone and that simulation is not just for trainees!
As the College is incorporating both high and low tech simulation
into the OST curriculum, we will be able to go some way towards
meeting our patients’ expectations of their surgeons.
If you would like to be notified about new news and the latest
information, you can register for updates at
www.simulatedocularsurgery.com
John Ferris, Head of the School of Ophthalmology Severn
Deanery
Declaration of Interests: John Ferris designed and owns the
Simulated Ocular Surgery website
VISION 2020 UK Portfolio of
indicators for eye and healthcare
VISION 2020 UK’s Ophthalmic Public Health Group has
developed a collection of indicators to:
• Review and monitor population eye health and well being
• Embed eye health perspective in use and interpretation of
Outcome Frameworks
• Monitor/demonstrate UKVS outcomes
The aim is to provide an overall tool to primarily monitor
population eye health not individual patient experience and
outcomes. Find more information on the VISION 2020 UK
website www.vision2020uk.org.uk
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K series Slit Lamps
For further details please email Laura Haverley
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THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | SUMMER 2015
Perspex Fragments led to a surgical miracle
In August 1940 the Battle of Britain was raging. On
the afternoon of the 15th, Flying Officer Cleaver’s
601 Squadron, at RAF Tangmere, West Sussex, was
scrambled. His Hurricane would not start, so his Squadron
Leader told him on the radio telephone to jump out, run
to another warmed up Hurricane and catch them up. In his hurry he left his goggles in the first plane.
Neil Cleaver told me he
attacked a Dornier 17
bomber. The upper rear
gunner fired back, hitting
his Hurricane. This, he said,
surprised him because the
gunners, at the sight of
a machine-gun platform
coming at them at 300
1.
mph, were usually too
frozen with fear to shoot back. Worse was to follow. Cleaver was
blinded by engine oil and bilateral penetrating eye wounds caused
by fragments from the shattered Perspex windscreen. He had to
bail out by releasing the canopy and safety harness, turning the
plane upside down and falling free. (Figure 1).
Cleaver was taken to Salisbury Hospital. Unfortunately the sight
in his right eye was lost and in the left seriously reduced. He was
followed up at Moorfields Eye Hospital where it is likely that his
and other casualties’ Perspex intra-ocular foreign bodies, were
observed by the surgeon Harold Ridley, not to cause inflammation
(Figure 2).
Cleaver was awarded the DFC (Distinguished Flying Cross)
and released from RAF Administration in 1943, promoted to
Squadron Leader. Sometime in 1947, a medical student at St
Thomas’ Hospital, named Steve Perry, watched for the first time,
a cataract extraction by the intracapsular technique. The surgeon
was Harold Ridley. 2.
3.
Perry asked him if he planned to put a replacement lens into the
eye. This query stimulated and encouraged Ridley to design the
intraocular lens (IOL). He chose Perspex---polymethyl methacrylate
(PMMA)---recalling its biocompatibility in the eyes of wounded
aircrew and ICI Ltd made a pure form, Perspex CQ (clinical quality),
which remained the gold standard material for decades to come.
Ridley worked with John Pike, an optical scientist at Rayner &
Keeler Ltd, the company which made the first modern IOL. Ridley
inserted this lens in an extra capsular cataract extraction at St
Thomas’ on 29 November 1949. Because it appeared unstable
Ridley removed it, closed the eye and re-inserted the IOL 3 months
later. The result was optically poor because they had copied too
closely the human lens shape and guessed at the refractive power
of PMMA.
However the surgical principle had been established.
47 years later, Neil Cleaver developed a cataract in his only
eye, and in October 1987, Eric Arnott treated this using
phacoemulsification and a CILCO AR-4 posterior chamber IOL. His
vision was restored to normal. Like the bilateral, inert, intraocular
foreign bodies he still possessed, his new lens was made of PMMA.
Deservedly Sir Harold Ridley was knighted in 2000. (Figure 3) He
was, however, not the first ophthalmologist to insert an IOL. This
had been done and written up 150 years before him! That is
another story.
Hugh Williams, Honorary Consultant Surgeon, Moorfields
Eye Hospital
New Consultants
AppointeeHospital
Allaa Eldin Abumattar
North Manchester General Hospital, Manchester
Antonella Berry-Brincat
Leicester Royal Infirmary, Leicester
Laura Crawley
Western Eye Hospital, London
Simon Dulcu
Sutton Hospital, Sutton
Pedro Muel Gonzalez
Leighton Hospital, Cheshire
Anjana Haridas
University Hospital of Wales
Huw Jenkins
Glangwili Hospital, Carmarthenshire, Wales
Muhammad Irfan Khan
Lincoln County Hospital, Lincolnshire
Vasileios Konidaris
Leicester Royal Infirmary, Leicester
Krishnappa Chidambaraswamy Hull Royal Infirmary, Hull
Madhusudhana
Gopalakrishna Menon
Glangwili Hospital, Carmarthenshire, Wales
AppointeeHospital
Aashish Mokashi
Leicester Royal Infirmary, Leicester
Dimple Patel
Belfast City Hospital, Belfast
Lucia Pelosini
Maidstone Hospital, Maidstone
Farhan Ahmed Qureshi
North Manchester General Hospital, Manchester
Theresa Richardson
Western Eye Hospital, London
Rohit Saxena
King’s Mill Hospital, Nottinghamshire
Tejpal Shergill
Kettering General Hospital, Northamptonshire
Dawn Sim
Croydon University Hospital, Croydon
Rajen Tailor
Leicester Royal Infirmary, Leicester
Rajeev Tanawade
Blackpool Victoria Hospital, Blackpool
Reshma Thampy
Manchester Royal Eye Hospital, Manchester
15
THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | SUMMER 2015
Ophthalmologists in Training
Phakes and YAGgers . Play the game of training. You already do.
64
63
49
50
FINISH
Consultant:
(Supervising
Trainees)
Admin pile and
passwords
forgotten after
2 weeks of
leave
Parking ticket in
staff car park
despite permit
48
46
Go back
three spaces
32
31
You (finally)
understand
ocular motility
Dinner at
Consultant’s
house
Career
Temptation:
Pharma, The
City, Reality
TV, etc.
45
“Senior
trainee”:
poisoned
chalice
Patient
comments:
“you look far
too young..”
16
Fundus laser
lenses all
missing or
scratched
ARCP Outcome
5 (document
lost in mail)
Friction
between
Consultants:
You act
oblivious
13
First phaco
completed:
Primary
surgeon (PS)
2
Contentment
53 54
55
56
Tension
headache
and cataracts
referred as
GCA
3
You spot a cell
in the AC
Vasovagal
syncope in the
laser room
Eye Casualty:
Iritis, corneal
abrasions &
PVDs ONLY
43
Patient offers
a series of
sketches of
his floaters
Nursing
‘bake-off’ to
celebrate your
year
Patient letter
of complaint
(arbitrary)
Mandatory
training
violations
accumulate
First
unsupervised
phaco list: No
fatalities
4
Patient
demands
to see
Consultant
only
5
Guide dog
in clinic
First YAG
capsulotomy
PhD/MD thesis
submitted
39 40
Hug/Gift from
a patient
27
Introduction
of EPR: cue
chaos
Marvelling
at typing
howlers on
letter drafts
41
Premature
arthritis from
opening
Minims®
38
SHAPE OF
TRAINING:
[you scream in
silence]
Blepharitis
referral at 2am
from incoherent
A&E SHO
42
Patient letter
of thanks
(arbitrary)
You share
your skills at
a developing
world eye
clinic
26
Vitreous
happens
25
Your Consultant
is a role model
and an
inspiration
ESR
sample
“clotted”:
rejected
by lab
22
23
24
Critical
incident: Same
issue reported
6/12 ago
Horrific on call:
you instill saline
Minims® OU
at 8:30am
Assigned
the YAG
laser room
for clinic
12 11
“Bunching”
No suitable
trainee cases
on training list
10
MSF
incomplete:
culprits
untraceable
6
7
You contract
adenoviral
keratitis from
eye casualty
Floundering in
eye cas: Grab a
Life Jacket
9
Consultant
supports the
same football
club
8
Dropped
nucleus: you
hit rock bottom
too
Imran Yusuf, Editor
Trainee section
[email protected]
Median Trainee Emotion
Bliss
57
20 21
Post-op
patient:
monologue
of wonderful
outcome
14
Day 1: Feelings
of palpable
inadequacy
58
29 28
Realising that
eyes are cool,
and you love
your job
HCA brings
you a cup of
tea and cake
at 11 am
59
International
Fellowship:
Application
Successful
36 37
ZERO calls on
call: You call
switchboard to
exclude an
apocalypse
18 19
OCT images
not accessible
on your PC in
AMD clinic
60
44
First name
paper in
The Lancet
30
Endophthalmitis
following your
surgery
17
START
National
Training
Number
61
35
New
Consultant
oblivious to
your level of
training
1
Educational
Supervisor on
Leave until
ARCP
FRCOphth
Admissions
Ceremony
33
Relatives
convinced
you are an
optician
You are the
porter on your
own theatre list
51 52
Patient asks to
see YOU, rather
than the
Consultant!
47
Costa Coffee
(inevitably)
opens in your
DGH
62
Another
day at the
slit lamp
Blues
Dejection
Thanks to Dr Miranda Buckle & Mr Mandeep Bindra
for their creative tips.
17
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THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | SUMMER 2015
The BOSU Surveillance Study
Bursary for an ophthalmologist
in training 2015
With kind support from The Red Trust and the Ross Foundation, the
BOSU is once again offering three research bursaries of £6,000 to
support ophthalmologists in training to undertake an epidemiological
study of a rare eye condition through the British Ophthalmological
Surveillance Unit or the Scottish Ophthalmological Surveillance Unit.
1.
The RED Trust Surveillance Bursary for an ophthalmologist in
Training
2. The Ross Foundation BOSU bursary for an ophthalmologist in
Training in Scotland (Eligible ophthalmologists may submit the
same application for consideration for both awards)
3. The Ross Foundation SOSU study bursary for an
ophthalmologist in Training in Scotland
• Suitable conditions for BOSU studies are a predicted annual
incidence of less than five per million (300 cases per annum in the
UK), however we believe that topics with an expected incidence of
between 75 and 125 are best suited for this award
• Suitable conditions for SOSU studies are a predicted annual
incidence of less than 30 per million (150 cases per annum in
Scotland)
The objective for these awards is to:
• E
nable the successful ophthalmologist to develop their research
knowledge and skills
• Promote the role of the BOSU in the surveillance of rare eye diseases
• Add to the body of knowledge of rare eye diseases and conditions.
Closing date for applications for all bursaries is 9 October 2015.
Assistance with preparation of applications is available from the BOSU
and applicants are advised to initially contact Barny Foot,
[email protected] or 07808 581659 for an informal
discussion and to request application guidelines.
EIDO: Failure to warn
Failure to adequately inform patients prior to taking consent is a major cause
of litigation. Are you doing enough in your practice to limit this risk?
If you attended the College’s Annual Congress in May this year, you may
have seen EIDO Healthcare’s informed consent patient information leaflets
on display. EIDO’s leaflets have been developed in conjunction with the
RCOphth.
EIDO’s leaflets help you to achieve excellence in informed consent, and make
sure your patients really understand their procedure so that they can share in
the decision-making process. Each leaflet bears the Plain English Campaign’s
Crystal Mark for clarity. In addition, EIDO’s full library is updated regularly to
reflect advancements in technique and developments in medico-legal law.
Take an important step towards protection against litigation by enquiring
now about EIDO’s ophthalmology module. For further information, email
[email protected] or phone 0115 878 1000.
National Clinical Audit and
Patient Outcomes Programme National Ophthalmology Audit
The NCAPOP (National Clinical Audit and Patient
Outcomes Programme) is a set of national clinical
audits, registries1, Consultant Outcomes Programme2
and outcome review programmes3 which measure
healthcare practice on specific conditions against
accepted standards. These projects give individual
surgeons, healthcare providers and the public
benchmarked reports on performance, with the aim of
improving the care provided.
As reported last year, the RCOphth has been
commissioned by HQIP to run the first NCAPOP
National Ophthalmology Audit following a
competitive tender in 2013. The project officially
started on 1 September 2014 and consists of a
national cataract audit (England and Wales) and
feasibility studies for glaucoma, retinal detachment
and age-related macular degeneration. The project
will build on the existing National Ophthalmology
Database work but will be extended to cover all
providers of NHS funded cataract surgery in England
and Wales.
Where providers have an existing electronic patient
record (EPR) system, data will be extracted from the
system wherever feasible. For Trusts with paper based
records the project will need to provide an alternative
mechanism for data submission. The College has
contracted with Medisoft to provide a data collection
tool which will also allow for post-operative data to be
entered by optometrists.
The project set up is well underway and we are
entering into an exciting phase of the project; piloting
the data collection tool, specifying the website
for dissemination of the NOD results, and gaining
permissions for England and Wales’s wide data
extractions which will commence between September
2015 and September 2016. The permissions letters
will be sent to organisation Caldicott Guardians and
Clinical Leads for Ophthalmology.
The feasibility studies; Retinal Detachment, Glaucoma
and Age Related Macular Degeneration are in the
planning stages and further information will be
available in due course.
For more information contact [email protected]
or visit www.nodaudit.org.uk
John Sparrow, Clinical Lead for the National
Clinical Audit and Patient Outcomes Programme –
National Ophthalmology Audit
1. http://www.hqip.org.uk/national-joint-registry-njr/
2. http://www.hqip.org.uk/consultant-outcomespublication/
3. http://www.hqip.org.uk/clinical-outcome-reviewprogrammes-2/
19
college news
Deterioration of sight caused by delay Requests to survey our members is
in review or treatment: Study update now open again
“Sight loss or deterioration caused by delay in ophthalmic review
or treatment” has been on the BOSU yellow report card since
February 2015
In the first three months 57 cases have been reported and to date
30 questionnaires have been returned.
•Thirteen patients had Glaucoma, 6 Diabetic retinopathy, 2 AMD
and 9 with other diagnosis
•The median age is 63 years (range 7 mths – 92 years)
•The mean minimum delay beyond planned follow up was 33
weeks (range 3 – 203 weeks).
•20/25 reported the reason as delayed follow up/review, 3/25
delayed/lost referral, 1 delayed treatment, 1/25 indecision on
treatment funding and 5 provided no reason.
•18/30 patients reported to have permanent visual loss
•8/30 patients reported to have permanent visual field deterioration
•4/30 required further unplanned surgical procedures
Although this study is in its early days these data seem to point
towards this study providing important and valuable information
about the frequency of these cases and the extent of the visual loss.
We hope that the findings will highlight the extent of this problem,
which is not being taken seriously in many locations in the UK. They
will also help to inform resource planning and service provision to
clarify the support that ophthalmologists need in order to provide the
high quality care we all aspire to. We are very grateful to all those who
have reported cases and encourage all reporting ophthalmologists to
continue to return their yellow cards and study questionnaires.
Professor Carrie MacEwen, President
Barny Foot, British Ophthalmological Surveillance Unit
ECLO advisers – report highlights
their important role
A new RNIB (Royal National Institute of Blind People) report
was launched at RCOphth’s Congress in May. A number of senior
ophthalmologists shared their views about the positive benefits that
the ECLO advisers bring to both patients and eye clinics.
Sight loss advisers are trained non-clinical staff working within the eye
department providing patients and their families with vital emotional
and practical support, helping patients connect with key services.
The report highlights the difference that sight loss advisers can make,
freeing up clinician’s time and acting as a bridge between health
and social care. The report findings underline RNIB’s call for every
eye department in the UK to have access to a sight loss adviser, with
research suggesting that only 30 per cent of eye departments in the
UK currently have access to a qualified sight loss adviser. Year on
year ophthalmology continues to have the second highest number
of outpatient attendances of any specialty which places enormous
pressure on eye clinics.
Carrie MacEwen, who provided the foreword for the report commented,
‘We are calling upon ophthalmologists in all hospitals to explore the
need for a sight loss adviser service and to initiate discussions within
their eye department. Sight loss advisers provide a valuable service in
the running of any busy eye department and RNIB’s ambition for every
eye department in the UK to have access to an adviser will benefit
patients at a time when they are most vulnerable.’
20
As a College we are keen to help and support those who want
to carry out surveys of the membership to answer questions
that will ultimately be of benefit to our members or the broader
ophthalmology community.
We have in the past helped to distribute surveys, but we have become
aware that some have not generated reasonable response rates and
as such failed to provide any meaningful feedback.
We want to find a way to help those with an interest send out surveys
that produce information that will be of both relevance and benefit
to the our members or the broader ophthalmology community
and therefore to patients. Any individual or organisation wishing to
undertake a survey will now need to complete an application form
which can be downloaded from www.rcophth.ac.uk/requests-tosurvey-our-members/
This will request a brief summary, the aims and objectives, the
intended survey population, and the proposed analysis and
dissemination of results. Applications will be reviewed and assessed
to ensure that they request meaningful information and the aims
are achievable. Surveys will be supported if there is a clear benefit for
those providing the data and not just for those who are collecting it.
Additionally, where considered appropriate, we will limit the sample
size to minimise the burden placed upon members.
For approved surveys the College will administer the electronic
distribution of questionnaires but we will not share personal member
contact information, send out postal questionnaires or provide
address labels.
The College will charge a £100 + VAT administration fee for all
surveys carried out. Everyone carrying out a survey of College
members will be required to provide a report detailing response rates
and outcomes from the survey including how the information was
disseminated. A summary of all surveys accepted for distribution will
appear on the RCOphth website.
We hope that this change in approach will reduce the number but
improve the quality of surveys distributed to our membership. For
further information or to discuss a survey proposal please contact
Barny Foot, BOSU Fellow, [email protected]
Bayer Ophthalmology Honours – closing
date for entries is 21 August 2015
A new awards programme, the Bayer Ophthalmology Honours, was
launched at Congress this year. The programme aims to recognise and
celebrate the outstanding work being carried out by multi-disciplinary
teams in ophthalmology throughout the UK. Supported by the Macular
Society and the Royal National Institute of Blind People the awards
will identify exceptional initiatives that demonstrate clinical excellence
and innovation in ophthalmology. More information including entry
categories and process can be found at the Bayer Ophthalmology
Honours website, http://bayer-ophthalmology-awards.co.uk/
Obituaries
Dr Henri Sueke, Sydney Australia. His former colleagues at St Paul’s Eye
Unit have set up a fundraising website in his memory. To donate visit
www.gofundme.com/henrisueke
THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | SUMMER 2015
Notes on Uganda trip, April 2015
A VISION 2020 LINKS programme team lead by Chair
of the International Committee of the Royal College of
Ophthalmologists, Clare Davey recently returned from
Uganda where they helped to progress the diabetic
retinopathy screening service at the Mulago Referral
Hospital in Kampala.
Members of the team based
at the Royal Free Hospital were
trainee ophthalmologists Tina
Khanam and Robbie Walker as
well as orthoptist Clémentine
Casafina and retinal nurse,
Sofia Mendonça. Terry Cooper
of Volk Optical provided
technical support including
installation of the screening
equipment. Consultant
ophthalmologist, Geoffrey
Woodruff joined the team to
provide mentoring and training
to the pediatric ophthalmology team at Mulago. Our main
contacts in Mulago were ophthalmologists Moses Kasadhakawo
and Grace Ssali.
The visit, which took place in April, 2015 was carried out as
part of a VISION 2020 LINKS programme between the Royal
Free Hospital in London and the Mulago Referral Hospital in
Kampala. Launched in 2004 by The International Centre for
Eye Health in London, VISION 2020 LINKS programmes address
an important need for human resource development for eye
care in Africa. In such a link, an African eye department is
matched with a UK eye department in a long term partnership
with the objective of building capacity to deliver better quality
care to their patients. The link between the Royal Free Hospital
and Mulago has been in existence since 2010 and has seen
five annual visits to Uganda by the Royal Free team as well as
numerous reciprocal visits to the UK by Mulago staff.
The main objective of this visit was to help with the diabetic
retinal screening in Kampala as part of the Diabetic Retinopathy
Network (DR-NET.comm) programme. There are 17 such
programmes mostly in Africa and funded by The Queen
Elizabeth Diamond Jubilee Trust. An additional objective was to
continue to build children’s eye services in Kampala particularly
in the area of childhood cataract.
Prior to the visit, the team had acquired a bench top fundus
camera and OCT system as a result of generous charitable
donations as well as significantly reduced pricing from the
supplier, Topcon GB. Volk Optical also provided two portable
fundus cameras for the duration of the visit equipped with
Spectra Retineye Screening software donated by Health
Intelligence. Rayner was also generous in providing a supply of
viscoelastic and intra-ocular lenses.
On arrival in Kampala, the team was welcomed by Dr. Birabwa
Male Doreen, Deputy Executive Director of the hospital and
herself a pediatric surgeon. Dr. Birabwa Male thanked the
team for their visit and for the equipment donations which she
acknowledged as a major improvement in the capabilities of
the eye clinic. She also commented that the team was visiting
at an interesting time as the eye department is in the process of
renovation and was temporarily located in an older building that
was part of the X-ray department.
‘this visit was particularly successful because we had a
very defined remit, because we have already established
good working relationships with the team in Mulago’
During a two day period, 68 patients attending both a general
and diabetic eye clinic were screened by dilated fundus
photography either by a specialist retinal nurse or an orthoptist.
The images (both disc centred and macula centred for each
eye) were transferred to the Spectra Retineye software package
wirelessly over a local WiFi network and then assessed by an
ophthalmologist.
Those with abnormal retinal findings were also examined with
optical coherence tomography (OCT) and treated with laser as
appropriate. One patient in particular from JInja benefitted
from our visit. Fundus photography indicated significant
maculopathy which was confirmed by the first OCT examination
to be carried out in Uganda. Mr. Ndegeya was treated with laser
the same day.
The pediatric team carried out 14 intra-ocular operations on
children. Geoff Woodruff concentrated on training in the surgery
of paediatric cataract, to allow better provision by the team
there.
After the visit, team leader Clare Davey commented “this visit
was particularly successful because we had a very defined remit,
because we have already established good working relationships
with the team in Mulago, and because for the first time we had
a member from the optical industry (Terry Cooper) who set up
the equipment, optimised its use and helped train the local staff.
I recommend similar VISION 2020 UK visits to concentrate on
taking the most effective team”.
Terry Cooper, Regional Manager, Volk Optical
21
college news
Welcome to a number of new members of staff
The College has been through a busy few months and there have been changes afoot at 18 Stephenson Way.
We have seen some long term members of staff leave and have welcomed some new faces, here they tell you
a bit more about themselves and their role at the College.
Ms Amanda Sia: Examinations Co-ordinator
Doreen Agyeman: Education & Training Co-ordinator
After gaining valuable experience administering
postgraduate courses at a university, I began working in the
Examinations Department in February 2015. As Examinations
Coordinator, my primary role is to offer end-to-end delivery
of the Refraction Certificate Diploma, Fellowship Assessment
and Certificate in Laser Refractive Surgery examinations. I
thoroughly enjoy my role in the department and the excellent
support offered from the other members of the team.
I started at the College in May as the Education and Training
coordinator. My role involves running the skills courses and
providing administrative support. I am fully responsible for
the operation of the Skills Centre and the administration of
various courses. So far I am enjoying the role as no two days
are the same!
Bethan Landeg: Examinations Co-ordinator
In January I took up the position of Examinations
coordinator, after working in a similar role at The Royal
College of Surgeons. I’m really enjoying the friendly
atmosphere which comes with working in a smaller
organisation and through travelling for exams have got
to know our examiners well. I organise the Duke Elder
Award Examination, FRCOphth Part 1 Examination and the
Admission Ceremony so it’s great to support the candidates
from their very first contact with the College all the way
through to when they become members, Fellows and beyond.
Beverley Russell: Membership
Co-ordinator
I joined the College in January helping
out in finance and then took on the role of
membership co-ordinator in February. My
main duties are dealing with membership
subscriptions and processing affiliate,
membership and fellowship applications.
Carla Campbell: Education & Training
Co-ordinator
Before joining the College in June I worked at University
College London Hospitals within the Imaging and Research
department as a coordinator. So far I am enjoying my role at
the College within the Education and Training department,
I love working in a small setting and excited about learning
new aspects within the realm of Education and Development.
Daniah Ahmed: Education & Training
Administrator
I took up my post in the Education and
Training department in December 2014.
I look after the processing of the Dual
Sponsorship Scheme for International
Medical Graduates, CESR, Regional
Advisors and the Awards and Scholarships. I enjoy working
with my team, the trainees and all members and Fellows of
the College.
22
Imogen Armstrong: Examinations Assistant
I started working at the College from 1st June 2015. I work
within the Examination Department as the Examinations
Assistant, offering general support and assistance to my
colleagues as needed. I am also the front line for all queries
coming into the Department, whether it be by phone, email
or post. So far I am enjoying getting to know my new role and
the College as a whole; I hope it continues like this for the rest
of my time here.
Karla West: Professional Standards
Administrator
After nearly four years of working within
a Healthcare Trade Association, I joined
in February 2015 as a member of the
Professional Standards Department. I
look after processing applications for CPD
approval for meetings and provide general information
for the Department’s Committees. I enjoy working in my
team and I obtain a lot of support and knowledge from the
members of the College.
Lucey Barclay: PR & Website Assistant
I joined in a new role supporting the Communications
Manager in April of this year as the PR and Website
Assistant. It is a busy area of the College as it recognises the
importance of keeping our members and stakeholders as up
to date as possible with all the latest news and information.
I am enjoying my time working at the College and looking at
how to improve our communications with members.
Martina Olaitan: Project Support Officer – National
Ophthalmology Audit
I have eight years’ experience within the public and private
sectors including NHS Trusts, Nursing and Midwifery Council
& Capita Business Services, working in different roles. I also
have a BEng degree in Chemical & Process Engineering from
London South Bank University, where I originally got into
Project Management. I am excited to be part of the team at
the College and I hope to make positive contributions to the
organisation.
diary dates
RCOphth Seminars
Book your place by visiting www.rcophth.ac.uk/eventsand-courses/
All seminars and surgical skills courses are held at the RCOphth
premises unless otherwise specified.
Practical Neuro Ophthalmology
Friday 18 September 2015
Miss Margaret Dayan
Newcastle Civic Centre
Join us for the 6th National Eye Day
(SAS)
FRIDAY 16 OCTOBER 2015
The Royal College of Ophthalmologists
•Uveitis update – Miss Narciss Okhravi
•Staying Friends with the GMC
•Corneal Disease and Keratoconus update – Professor
Stephen Kaye
• The Patient Experience
•Clinical Pearls
Glaucoma Surgery: Balancing safety and success
FRIDAY 25 SEPTEMBER 2015
Mr Nicholas Strouthidis
Non-accidental Injury
Non-RCOphth Seminars
Wednesday 14 October 2015
45th Cambridge Ophthalmological Symposium
Mr William Newman
Wednesday 2 – Friday 4 September 2015
Venue: St John’s College Cambridge
2015 has been designated by the United Nations as the ‘Year of Light’.
Recent underlying advances of the physics and the effect of light on
the physiology of the eye will be discussed and the use of light in the
diagnosis and treatment of eye disease.
Registration Fee includes two night’s accommodation and all meals
Consultants: £585, Residents in Training: £465
A limited number of Bursaries are available. Application forms
available from: COS Secretariat, Cambridge Conferences.
T. 01223 847 464 E. [email protected]
www.cambridge-symposium.org
Seven Steps to Sustainable Eye Care
THURSDAY 15 October 2015
Mr Andrew Cassels-Brown
New Consultants
Wednesday 4 November 2015
Mr Mike Burdon and Professor Peter Shah
Ultrasound Course
Wednesday 4 November 2015
Mr Hatem Atta
Ophthalmologists and Optometrists
Working Together
Monday 9 November 2015
Ms Parul Desai and Mrs Melanie Hingorani
Primary Care Ophthalmology
Monday 23 November 2015
Miss Stella Hornby
Malmaison Hotel, Leeds
Clinical Leads Forum
Wednesday 25 November 2015
Mr Richard Harrad
Elizabeth Thomas Seminar for Macular Disease
FRIDAY 4 DECEMBER 2015
Mr Winfried Amoaku
East Midlands Conference Centre, Nottingham
Surgical Skills Courses
Please check the website or contact the Education and Training
Administrator on 020 3770 5341 or [email protected]
for availability as courses get fully booked quickly.
DSEK
FRIDAY 9 October 2015
Oculoplastics Course
Wednesday 18 November 2015
Paediatric Ophthalmology
THURSDAY 19 November 2015
Medical Students Taster Day
FRIDAY 27 November 2015
Clinical Health Informatics in Leadership
(CHIL Factor UK)
Friday 4 September 2015
Venue: The Royal Society of Medicine
This one day conference will look at E-innovations and Datasets as well
as Patient Experience. Featuring seminars and sessions with Mr Mike
Brace, Mr Nikhil Kaushik and Mrs Anna Tee. 7 CPD points awarded.
General tickets: £50, Trainee and Nurses: £25
T. 01970 636 222 E. [email protected]
www.chil2015.eventbrite.co.uk/
Coventry Ophthalmic Surgery Cadaver Course
Monday 14 – Tuesday 15 September 2015
Venue: West Midlands Surgical Training Centre
An opportunity to learn and practise the procedures using Fresh
Frozen Cadaver in a purpose built dissection facility. The course will
have minimal didactic lectures, a high trainer: trainee ratio and ample
opportunity to practise each of the surgical procedures. 7 CPD points
awarded per day.
Early bird Registration (until 27th July): £275/1 day, £ 450/2 days.
Late Registration (after 27th July): £300/1 day, £ 525/2 days
T. 024 7696 8792 E. [email protected]
www.mededcoventry.com/Courses/Ophthalmology/COSC
British Ophthalmic Anaesthesia Society,
16th Annual Scientific Meeting
Thursday 19 – Friday 20 November 2015
Venue: The Magic Circle, London
Two days of practical training in ophthalmic anaesthesia, how to
manage difficult cases, avoiding complications, clinical governance,
the future. £500 prize for best presentation by a trainee.
T. 01603 288 578 E. [email protected] www.boas.org.uk
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Katalyst USA have appointed Altomed as UK dealers
for an exciting range of VR instruments. The new DEX
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New IOL Cutter
New AlaHeavy
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Ala Heavy
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09/03/2015 09:10