8 Necessity's son: Moorfields Eye

Daithí Ó hAnluain Research priorities come from in an analysis of the 'knowledge cycle' – from observed IN 1805 Dr John Cunningham phenomena in patients, through Saunders opened the Dispensary basic science, research hypothesis for Curing Diseases of the Eye to and clinical trials and then back to combat the trachoma epidemic the patient in the form of that ripped through London in the improved clinical care. From this wake of the Egyptian campaigns of cycle researchers can quickly the Napoleonic War.That act, establish gaps in clinical born of necessity, ultimately led to understanding and focus research Moorfields Eye Hospital, which efforts there. celebrated its 200th birthday in For example, it was the March. 'knowledge cycle' that led to the Bill Aylward Necessity governs the hospital use of 5 Fluorouracil and low still as it continues to evolve. weight molecular heparin that might hide in a small sample Moorfields developed a network (LMWH) to prevent suddenly come to light in a large of clinics throughout London, for postoperative, proliferative sample.Also, any novel drugs, example, to provide ophthalmic vitreoretinopathy (PVR) in procedure or patient management care close to the patient.The patients undergoing a vitrectomy scheme can be quickly tested and Courtesy of Bill Aylward MD Courtesy of Bill Aylward and retinal reattachment for validated. hospital developed a large-scale Moorfields Hospital following a direct hit by “doodlebug” bomb during World War II. telemedicine program to offer its rhegmatogenous retinal "It is the tremendously exciting expertise to doctors in the created National Health Service The importance of relevance detachment (Asaria et al, research that the staff of developing world. (NHS), the UK's public heath remained an issue into the 1990s. (July 2001: 108; 7; Moorfields and the members of Necessity also governs system that was free of charge at "That's why we started 1179-1183)). the Institute of Ophthalmology Moorfields plan to open a the point of care. developing our network of clinics "Inspired by a child who lost his are conducting that places them 'hospital within a hospital', across London. Patients want to vision due to retinal scarring, we on the forefront of eye research dedicated to service, research and A strong team of sub- be treated locally, and we had a have carried out laboratory worldwide with their tremendous teaching in paediatric specialists patient focused service," says Mr research into why the retina scars clinical resources and experience of Moorfields and the profound ophthalmology, the International Even with this minimum of Aylward. and the use of drugs including 5- Children's Eye Hospital (ICEC). fluorouracil to prevent this scientific ingenuity and the newly security Moorfields had to combat available tools of genetic and Moorfields also plans to develop a questions over the efficiency of a Independent status scarring.This simple regimen was dedicated Clinical Trials Unit to developed, together with Bill biomolecular science. It is clear single speciality hospital. Recently, however, Moorfields that Moorfields will continue to meet the needs of increasing Presciently, in 1963, Dr Barrie became even more secure and Aylward and the Vitreo Retinal research outputs. team. It's very inexpensive, just make major contributions to the Jones encouraged all consultants independent when it achieved the prevention for blindness for many "We produce the largest to specialise within one of the status of a Foundation Hospital £4 per operation. The Moorfields volume of research literature in trial was the first trial in the years to come, said Professor major fields of ophthalmology. Trust. that demonstrate Hugh Taylor, director of the the world, with our partner If Moorfields were to be just a world-class clinical care and world to show that you can institution, the Institute of reduce scarring," said Professor Centre for Eye Research in single speciality hospital, then at hospital management can acquire Australia. Ophthalmology, which is based on least it would have the best Foundation status. It allows Khaw, head of the Ocular Repair the same site as us," said Bill specialists available.Again, hospitals to raise their own and Regeneration Biology lab at Aylward MD, consultant Moorfields and the Institute of Long history in medical developing a strong team of sub- finance and engage in new education ophthalmologist and Medical specialists ensured the best projects without the onerous Ophthalmology (IOO). Director at Moorfields. possible patient care was available. political oversight that typically If research spreads Moorfields kills initiative in the public health scientific expertise, teaching Current success masks system. spreads its clinical and medical turbulent history "We've got 12 "That's how we can do our new expertise worldwide. By 1810, five Adapting to necessity over 200 children's hospital.There's no years after it's founding, years made Moorfields one of the specialists in public money whatsoever going Moorfields already taught largest and most successful eye into that project. Most of it comes ophthalmic treatment to doctors. centres in the world, as well as glaucoma here at from private donations we've Some of these later became the most prolific. It has 270,000 raised mainly through an appeal. missionaries, and took their skills, outpatient appointments yearly, Moorfields. Many But we were able to start the and Moorfields reputation abroad. performs 22,000 surgeries and project a year early because we That tradition still exists with handles 48,000 A&E visits.This hospitals don't can underwrite any shortfall doctors from the UK and abroad requires a workforce of 67 ourselves," said Dr Aylward. trained in London. But the consultants, most of them leading have 12 It's an appeal made easier by tradition expanded, too, and now authorities in their field, 300 Moorfields strong links with its includes special instruction days nurses, and a support staff of 700. ophthalmologists former patients. Clinical expertise organised with other London But its vast size and venerable and respectful patient care means hospitals. Moorfields even teaches reputation now, masks a turbulent in total" many former patients become abroad with courses like the history fraught with incident.As a active allies, eager to promote Moorfields Macula and Moorfields voluntary hospital, it provided its This approach also took Moorfields and contribute to its Uveitis in Slovenia.Teaching also services to whoever required advantage of the vast number of work, either in time or money. expanded through Moorfields them, and relied on generous patients passing through The Friends of Moorfields is a Matron making rounds during World War II. telemedicine project, which helps donors for help. It was frequently Moorfields doors, which provided charity run by well-wishers and doctors in developing countries in debt and during WWII it a large caseload in all areas of former patients. The incidence of scarring with difficult cases. received a direct hit from a Nazi ophthalmology. In a smaller or dropped from 26.4% (placebo) to "We'd like to increase our 'V1 (a doodlebug'). general hospital it's difficult to get Knowledge cycle of research 12.6% (5 FU and LMWH; p, 0.02). partnerships with institutions An Ophthalmology editorial abroad, and we are examining In the face of these the patient load required to train Moorfields conducts research catastrophes the hospital sub-specialists. described the work as a landmark other outreach options in the UK, from 'bench to bedside'. Research study in the field. the Middle East and China," said persevered by focusing on its "We've got 12 specialists in ranges from short term, which primary goal: patient care through glaucoma here at Moorfields. Research like this benefits Mr Aylward. aims for results in three years or enormously from Moorfields large clinical excellence and the Many hospitals don't have 12 less, to 'blue skies’, an effort that Bill Aylward MD development of new treatments. ophthalmologists in total", says patient load. Consultants see requires more than 10 years more cases, and particularly [email protected] In 1948 Moorfields received a Professor Peng Tee Khaw, before the clinical relevance measure of security when it glaucoma specialist at Moorfields. unusual cases, so their experience Prof. Peng Tee Khaw, PhD FRCS FRCOphth becomes clear. [email protected] became absorbed into the newly develops. Fundamental problems

EuroTimes September 2005